Dual-stent decompression of an extensive orthokeratinized odontogenic cyst: a case report and technical innovation

Orthokeratinized odontogenic cyst (OOC) is a rare developmental entity with a low recurrence rate in pediatric patients, voluminous cysts can compromise mandibular integrity and displace teeth, necessitating conservative management to preserve vital structures. We report an extensive mandibular OOC in a 12-year-old female managed via a dual-stent decompression strategy. A 12-year-old female presented with an 8-cm midline-crossing OOC involving both mental foramina. To minimize risks of nerve damage and pathologic fracture, a two-stage protocol was initiated. Initial decompression was performed with a single stent; however, to optimize the drainage gradient across the midline, a dual-stent modification was implemented. This dynamic adjustment appeared to facilitate significant centripetal bone apposition over 8 months. The resulting volume reduction allowed for definitive enucleation under local anesthesia, completed within a 30-minute operative window to ensure pediatric cooperation. Histopathology confirmed OOC. Serial radiographic monitoring over 32 months demonstrated complete bone regeneration, spontaneous repositioning of incisors, and no recurrence. To our knowledge, this represents one of the first reported cases of dual-stent decompression in pediatric oral surgery. This technique may facilitate conservative intervention for extensive odontogenic cysts in children, supporting optimal healing, preservation of neurovascular integrity, and minimal morbidity while respecting pediatric behavioral management constraints.