Dental and surgical controversial practices during the marsupialization procedure for the treatment of nasopalatine duct cysts

Background: Marsupialization procedure is a recognized treatment modality for larger nasopalatine duct cysts, before a secondary enucleation is performed. However, reported practices of tooth extraction, root canal therapy on vital teeth adjacent to the cyst, and the post-operative packing of the cystic cavity, appear to be questionable. Methods: This clinical study reviewed the chart of 20 patients following a standardized marsupialization procedure, for the treatment of large nasopalatine duct cyst. A large fenestration was created in the cystic wall. The vitality of all teeth adjacent to the cyst was preserved. Extraction of and/or root canal therapy of adjacent vital teeth were absolutely avoided. No postoperative packing of the cystic cavity was performed. Digital panoramic radiographs were used for pre and postoperative monitoring of the lesion. Results: All the cystic opening remained patent postoperatively for several months/years, without the use of any packing. The large cystic cavities steadily reduced in size.Primary and permanent teeth continued their normal eruption process in final positions in pediatric patients. All teeth adjacent to the cystic cavity remained vital after marsupialization. Clinical and radiological realignment of displaced teeth was observed. Conclusion: The preservation of vital teeth adjacent to the nasopalatine cyst remains a critical objective during marsupialization, irrespective of the lesion's size. Root canal therapy and extraction of vital teeth are unnecessary in the management of this non-odontogenic lesion. We found no rationale to support the postoperative packing of the cystic cavity. Keywords: Nasopalatine duct cyst, Marsupialization, Surgical controvers