Multimodal Protocol for the Treatment of Odontogenic Keratocysts

Orion Haas Jr.1, 2, *, Crescente Betina Belloc.1, 2, #, Machado-Fernández Agustín1, 2, Favoreto André Xavier Padilha1, 2, Scolari Neimar3, de Oliveira Rogério Belle1, 2
1 Department of Oral and Maxillofacial Surgery, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
2 Department of Oral and Maxillofacial Surgery, Hospital São Lucas, Porto Alegre, Brazil
3 Department of Oral and Maxillofacial Surgery, Universidade Franciscana , Santa Maria, Brazil

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© 2021 Haas Junior et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Oraland Maxillofacial Surgery, Pontifícia Universidade Católica do Rio Grande do Sul, Avenida Ipiranga, 6681, Building 6, 90619-900 - Porto Alegre, Brazil; Tel: +55 51 999679116 E-mail:
#Both authors contributed equally



The aim of this study is to evaluate longitudinally the effectiveness of a multimodal protocol based on decompression followed by enucleation combined with the use of liquid nitrogen under local anesthesia for the treatment of odontogenic keratocysts.


Seven patients with a diagnosis of odontogenic keratocyst were evaluated longitudinally to clinical and histological features, and pre- and postoperative radiographs were analyzed. Data were collected on the epidemiological profile of patients and on cysts, including the presence of recurrence, duration of drainage device use, lesion site, and presence of postoperative complications.


No recurrence was observed during follow-up. Mean follow-up was 59.57 months (range, 18-96 months). No pathological fracture was observed. None of the patients had persistent paresthesia of the inferior alveolar nerve. Substantial reduction in cyst size and epithelial differentiation were observed in all patients after multimodal treatment.


Based on these results, the multimodal protocol proposed here was effective in the treatment of odontogenic keratocysts by reducing lesion size, avoiding possible damage to adjacent anatomical structures, and allowing a surgical procedure with less morbidity. The longitudinal follow-up of patients showed that this treatment modality is associated with a low recurrence rate compared with alternative therapies.

Keywords: Odontogenic keratocysts, Cryotherapy, Decompression, Multimodal protocol, Surgical complications, Recurrence.