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A, Orthopantomogram shows multilocular odontogenic keratocyst in mandible from right first molar to left first molar with scalloped margins. B, Radiograph 3 years postoperatively shows extensive bone repair and remodefing.
Source publication
The purpose of this study was to report our experience with surgical treatment of 31 mandibular odontogenic keratocysts, with special reference to their recurrence, and to review the literature on this subject.
A retrospective analysis was conducted of all odontogenic cysts treated in the Department of Oral Surgery and Oral Medicine at Jordan Unive...
Citations
... Multilocular cysts with specific bony trabeculae are as difficult as removing the epithelium in unilocular. (39) Enucleation by cutting the soft tissue covering OKCs in an attempt to reduce the incidence of its recurrence has been suggested by a number of authors using Carney's solution (absolute alcohol, chloroform, glacial acetic acid, and iron chloride) are suggested before draining the cysts by removing the covering 0% 20% 40% 60% 80% marsupializaion marsupializaion + peripheral ostectomy percent of recurrence of OKC OKC treatment with surgery approach mucosa in continuity with the lesion. 39) The results of research and investigation showed that the complementary treatment includes marsupialization along with the removal of the surrounding bone. ...
Aim: Odontogenic keratocyte tumor is a developmental cyst with proliferative and invasive nature. which is often observed in the posterior region of the mandible and is commonly seen in the third decade of life. The highest age of prevalence is in the 3rd to 6th decades and the male to female ratio is 2 to 1. Normally, if there is no infection, it is not manifested and it is discovered accidentally in rayograph, but if the size increases, it manifests as an extension in the form of pain, swelling and infection in the dental and bone area if the tooth is hidden. In radiographs, it appears as a radiolucent lesion with distinct ionic or multilocular boundaries and sometimes with a scallop border in the dental area or even extending to the ascending ramus and condylar area. Research shows that the origin of this cyst is the remaining odontogenic epithelium of Ceres in the alveolar region. And it can be syndromic (Gorlin syndrome) or non-syndromic. This cyst has a thin epithelium and has multiple daughter cysts, which causes the risk of recurrence due to incomplete removal of the lesion. Enucleation, marsupialization, Carney’s solution and resection are treatment methods. What is investigated in this project is the comparison of the prevalence of the two therapeutic methods of marsupialization alone and the combination of marsupialization and peripheral sect my in patients with odontogenic keratocytes regardless of whether they are syndromic or sporadic. Method and Materials: In this study, which is conducted on 10 patients referred to Behoney Hospital in Kerman. First, the patient is selected with clinical examinations and then with the preparation of panoramic radiographs. If there is visible swelling, aspiration is performed with a 10-cc syringe, and then the patient is operated on for a biopsy to definitively diagnose the odontogenic keratocyte of the tumor. In this study, there is no difference between the age and sex of the patient, and whether KOT is syndromic or sporadic; Both are included in the review. The patient is subjected to marsupialization, then the patient undergoes follow-up and periodic x-rays are used to ensure that the lesion shrinks. In the lesions where there is involvement of the surrounding bone in the form of a saucerization, after the lesion is reduced, the patients are treated with peripheral sect my or removal of the bone around the lesion in the form of a curt shape, and in small lesions, the treatment is completed with marsupialization. arrives. Then the patients are followed up and the recovery process and the rate of recurrence are checked by preparing periodical x-rays. Results: In this study, out of ten patients, 4 patients (40%) had recurrence, and among these 4 patients, 3 patients (75%) were in the first group who were treated with marsupialization. The follow-up of the patients was one year, and after the preparation of OPG, the reduction of cyst dimensions was compared to the size before the operation. The criterion for the recurrence of keratocyte odontogenic lesion is the increase in the size of the lesion according to the qualitative scale and the comparison of the graph prepared before and after marsupialization. Out of 4 patients with recurrence, one case in the second group (25%) is treated with marsupialization and peripheral sitcom, a ten-year-old boy has multiple jaw cysts in the front of the mandible, behind the maxilla on both sides, and behind the mandible on both sides. The maxillary sinus is left. According to the obtained results, the treatment of marsupialization with peripheral sect my has more effectiveness and the results had a significant difference. p value=0.043 Conclusion: According to the obtained results, the treatment of marsupialization with peripheral sitcom has more effectiveness and less recurrence.
... While we detected a relatively smaller percentage (20.19%) of OKs associated with impacted teeth than what reported in the literature [19], our data confirm that multiple OKs were mostly detected within NBCCS patients, who also experienced higher recurrence rates and larger sizes of the lesions. Quite interestingly, the recurrence rate of OKs in non-syndromic patients included in the current series was lower than the one reported in the literature, with analogous treatment modalities [19][20][21][22]. ...
(1) Background: The aim of this study was to compare the histopathological features of syndromic and non-syndromic odontogenic keratocysts (OKs) using conventional and Confocal Laser Scanning Microscopy (CLSM) with their biological behaviour. (2) Methods: Data from the medical records of 113 patients with histological diagnosis of (single and/or multiple) OKs were collected. Globally, 213 OKs (120 syndromic and 93 sporadic) were retrieved, and their histological slides were re-evaluated with conventional H&E staining and with autofluorescence on the same slides using CLSM (Nikon Eclipse E600 microscope). (3) Results: Syndromic OKs showed more satellite cysts than sporadic cases, as well as a basophilic layer in the basement membrane, which was absent in sporadic OKs; both were highlighted with CLSM. The basement membrane in syndromic OKs appeared amorphous and fragile, thus possibly being responsible for the epithelial detachment and collapse, with scalloped features. Furthermore, the basal epithelial layers in such cases also showed increased cellularity and proliferative activity. All these histological features may possibly justify their higher tendency to recur. (4) Conclusions: CLSM is useful advanced technology that could help to quickly and easily discriminate between syndromic and non-syndromic OKs and to more accurately predict their biological behaviour in order to set fitter clinico-radiological follow-ups for individual patients.
... The OKC shows aggressive clinical behavior with a high and extremely varied recurrence rate [3][4][5]. The recurrence rate is reported to be 25-60%, varying according to the treatment method [1]. ...
Decompression followed by enucleation, which is one of the treatments used for odontogenic keratocysts (OKCs), is frequently used in OKC lesions of large sizes. This method offers the advantage of minimizing the possibility of sensory impairment without creating a wide-range bone defect; moreover, the recurrence rate can be significantly lower than following simple enucleation. This study aimed to assess the changes in histology and expression of proliferation markers in OKCs before and after decompression treatment. A total of 38 OKC tissue samples from 19 patients who had undergone decompression therapy were examined morphologically and immunohistochemically to observe changes in proliferative activity before and after decompression. The markers used for immunohistochemistry (IHC) staining were Bcl-2, epidermal growth factor receptor (EGFR), Ki-67, P53, PCNA, and SMO. The immunohistochemistry positivity of the 6 markers was scored by using software ImageJ, version 1.49, by quantifying the intensity and internal density of IHC-stained epithelium. The values of Bcl-2, Ki-67, P53, proliferating cell nuclear antigen (PCNA), and SMO in OKCs before and after decompression showed no significant change. No correlation between clinical shrinkage and morphologic changes or expression of proliferation and growth markers could be found. There was no statistical evidence that decompression treatment reduces potentially aggressive behavior of OKC within the epithelial cyst lining itself. This might indicate that decompression does not change the biological behavior of the epithelial cyst lining or the recurrence rate.
... were females [3]. Surgical management involves enucleation of the cystic lesion with excision of the underlying softand hard tissues involvedto reduce the incidence of recurrence [4]. Prosthetic rehabilitation after enucleation of the cystic lesion can become challenging at times. ...
... All 94 studies (Ahlfors et al., 1984;Anand et al., 1995;Anniko et al., 1981;August et al., 2003;Balercia et al., 1983;Bataineh and al Qudah, 1998;Berge et al., 2016;Berrone et al., 1994;Blondeau et al., 1986;Bolbaran et al., 2000;Borg et al., 1974;Brannon, 1976;Zhao et al., 2002Zhao et al., , 2012Zhou et al., 2012) were retrospective. Detailed data of the included studies are listed in Table 1 in Supplementary Material. ...
Purpose:
To investigate and compare the probability of recurrence of keratocystic odontogenic tumors (KCOTs) for different variables and treatment protocols.
Materials and methods:
An electronic search was undertaken in April 2016 that included clinical series of KCOTs reporting recurrences. Untransformed proportions and meta-analyses were performed to estimate the probability/risk of recurrence, according to several variables.
Results:
A total of 94 publications were included (6427 KCOTs, 1464 recurrences). Probability of recurrence: all lesions, 21.1%; nevoid basal cell carcinoma syndrome, 35.4%; males, 20.3%; females, 19.3%; maxilla, 15.3%; mandible, 21.5%; unilocular, 14.7%; multilocular, 24.4%; marsupialization/decompression, 28.7%; decompression + enucleation ± additional therapy, 18.6%; enucleation/curettage, 22.5%; enucleation + peripheral ostectomy, 18.6%; enucleation + Carnoy's solution, 5.3%; enucleation + cryotherapy, 20.9%; marginal/segmental resection, 2.2%. The recurrence was not statistically significantly affected by lesion location (maxilla vs. mandible, risk ratio [RR] 0.92, P = 0.32) or patient's sex (male vs. female, RR 0.94, P = 0.44), but by locularity (unilocular vs. multilocular, RR 0.67, P = 0.007). Recurrence risk for surgical managements: marsupialization vs. enucleation (RR 1.65, P = 0.0006), marsupialization vs. resection (RR 3.17, P = 0.009), enucleation alone vs. enucleation + peripheral ostectomy (RR 1.66, P = 0.05), enucleation alone vs. enucleation + Carnoy's solution (RR 1.94, P = 0.03), enucleation alone vs. enucleation + cryotherapy (RR 0.88, P = 0.56).
Conclusions:
KCOTs have a considerable rate of recurrence, which varies significantly according to some clinical, radiographic, and histopathological features, as well as surgical management.
... Treatment of KCOT is surgical. It consists in complete removal of the tumour (Dammer et al., 1997; Bataineh and al Quadah, 1998; Stoelinga, 2001; Ghali and Connor, 2003; Marx and Stern, 2003; Morgan et al., 2005; Maurette et al., 2006). ...
Keratocystic odontogenic tumour is relatively rare benign tumour. It is characterized by its fast aggressive growth and high risk of recurrence. Treatment is always surgical: conservative (enucleation, marsupialization) or aggressive (enucleation followed by application of Carnoy's solution, cryotherapy; peripheral ostectomy or en block resection of the jaw). Authors analysed retrospectively 22 patients who fulfilled inclusion criteria, i.e. had odontogenic keratocystic tumour of mandible, wherein antero-posterior dimension was at least 30 mm, and the tumour penetrated into the surrounding soft tissues. All patients underwent tumour enucleation, in 11 patients Carnoy's solution was given into the bone cavity after enucleation. The recurrence rate in the evaluation at least 36 months after surgery was both patient groups the same: 45.4%.
... The recurrence rate with total resection var-ies among reports. Bataineh and al Qudah (1998) reported 0% of recurrence rate in their own 31 cases of mandibular KCOT but review of the literature has indicated that recurrence rates may vary from 0 to 62%. The high recurrence rate then led surgeons to believe that that complete removal of the KCOT with meticulous curettage of surrounding tissues was necessary in order to address the problem of high recurrence. ...
Keratocystic odontogenic tumor (KCOT) is one of the benign developmental odontogenic cystic lesions arising from impacted teeth. In comparison to other odontogenic cysts, such as radicular cysts and dentigerous cysts, KCOT is known to be more aggressive and is associated with a relatively high recurrence rate. Traditionally, KCOT has been treated with total resection through sublabial incision. Marsupialization is advocated to reduce surgical invasion. However in all the cases, marsupialization was performed in the oral cavity. With the recent development of appropriate instruments and the endoscopic modified medial maxillectomy (EMMM) technique, which allows preservation of the inferior turbinate and nasolacrimal duct, an exclusive endoscopic approach to KCOT becomes possible. However, when the KCOT invades the hard palate, total resection of the tumor requires subtotal maxillectomy including hard palate. Consequently, as the maxillary sinus connects to the oral cavity, life-long use of a prosthesis becomes mandatory. Here we report a case of a seventeen-year-old female with a hard palate-invading KCOT who was successfully treated with the EMMM approach. The KCOT was fenestrated to the nasal cavity, leading to preservation of the hard palate. The lesion invading the hard palate was found to remain unchanged over one year upon follow-up. The trans-nasal approach with EMMM is a direct, minimally invasive method providing a direct field of view for the treatment of maxillary odontogenic cysts. Marsupialization of the KCOT with the EMMM technique might be a viable treatment option if the maxillary KCOT invades surrounding structures.
... The incidence of daughter cysts is reported to range between 7% and 30.1 (22,28). Some clinicians believed that the histopathological presence of daughter cysts wall may result in a report by Myoung et al. (21) where the presence of one or more daughter cysts showed a statistically significant higher recurrence rate. ...
... Recurrence rates of KCOT are reported from 0% (28) to 62.5% (2,4,28). Different studies show different recurrence rates (2,4,33). ...
... Recurrence rates of KCOT are reported from 0% (28) to 62.5% (2,4,28). Different studies show different recurrence rates (2,4,33). ...
... Resection is reported to have a 0% recurrence rate, but at an increased morbidity for the patient. 2,12,[17][18][19]33 Higher recurrence rates for decompression with or without residual cystectomy and enucleation with or without adjuvant therapy (Carnoy solution, cryotherapy, or peripheral ostectomy) are often tolerated for the benefit of less morbidity for the patient. 3,5,7,9,10,[20][21][22][23][24] The authors recently published findings showing comparable recurrence rates for decompression with or without residual cystectomy and enucleation with or without adjuvant therapy. ...
To determine whether the clinical management of odontogenic keratocysts (OKCs) is more complex in patients who undergo enucleation with or without adjuvant therapy than in patients who undergo decompression with or without residual cystectomy.
The authors implemented a retrospective cohort study and enrolled a sample composed of patients presenting for the evaluation and management of OKCs. The predictor variable was treatment group, classified as decompression with or without residual cystectomy versus enucleation with or without adjuvant therapy (Carnoy solution, cryotherapy, or peripheral ostectomy). The outcome variables were measurements of complexity of management, including total number of procedures, venue of procedure (operating room vs office), type of anesthesia, hospital admissions, and total number of follow-up visits. Data analyses were performed using univariate and bivariate statistics and a multiple linear regression model.
The study sample was composed of 45 patients (66 OKC lesions) with a mean age of 43.3 years. Of the 66 OKCs treated, 34 (51.5%) were treated with decompression with or without residual cystectomy and 32 (48.5%) were treated with enucleation with or without adjunctive therapy. Larger lesions and lesions with radiographic evidence of cortical perforation were treated more often with decompression with or without residual cystectomy. Based on the multiple linear regression model, patients who underwent enucleation with or without adjuvant therapy compared with those who underwent decompression with or without residual cystectomy had on average 1) 1.1 fewer total procedures (P < .01), 2) 0.8 fewer total office procedures (P < .01), 3) 0.6 fewer local anesthesia procedures (P < .01), and 4) 4.8 fewer postoperative visits (P < .01). There was no difference in the number of general anesthesia procedures, office sedation procedures, or hospital admissions.
Given comparable recurrence rates, the increased complexity of managing OKCs with decompression with or without residual cystectomy might not be warranted. Enucleation with or without adjunctive therapy could be the more efficient treatment option.
Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.
... The incidence of daughter cysts is reported to range between 7% and 30.1 (22,29). Some clinicians believed that the histopathological presence of daughter cysts wall may result in a report by Myoung et al. (22) where the presence of one or more daughter cysts showed a statistically significant higher recurrence rate. ...
... Recurrence rates of KCOT are reported from 0% (29) to 62.5% (2,4,29). Different studies show different recurrence rates (2,4,34). ...
... Conservative treatment mostly includes simple enucleation, with or without curettage, or marsupialization. Aggressive treatment generally includes peripheral ostectomy (36), chemical curettage with Carnoy's solution (37), cryotherapy with liquid nitrogen (38), or electrocautery and segmental resection (12,29,39,40). In the current literatures, aggressive treatments have generally been recommended for mandibular KCOTs and recurrent lesions (39). ...
Summary
Aim: The purpose of this retrospective study was to evaluate the clinicopathological features of 64 patients with keratocystic odontogenic tumor (KCOT). Material and Methods: The patients ranged in age at the time of diagnosis from 8 to 74 years (mean: 38.20 ± 16.71). Postoperative follow up period was 3-8 years ( mean time 4.76 ± 1.10). This research was carried out on panoramic radiographs and histopathological samples. Data such as gender, age, treatment methods, location of the tumor, presence of impacted teeth and its histological features were subjected to descriptive statistical analyses with the statistical software program. Results: Of the 64 analyzed cases of KCOT, 68.8% occured in men, and 31.2% in females (male to female ratio was 2.2:1.). KCOT had a peak of occurance in the third and fifth decade of life (23.4% - 20.3%). The incidence of KCOT was higher in the mandible than in the maxilla (76.6%-23.4%). KCOTs in nine out of 64 subjects (14.1%) recurred early follow up period. Recurrence of the KCOT was more often occured in posterior mandible. It is noteworthy that from the total of 9 recurrences, 4 lesions were associated with daughter cysts, and 7 lesions were parakeratotic KCOTs in our study. Conclusion: Although there are several studies about KCOT in literature, the most effective treatment modality remains controversial. The method of operation for these recurrent lesions should be considered as a more aggressive approach. Periodic controls and aggressive treatment aproachs may be effective for the prevention of these recurrences.
Key Words: Keratocystic odontogenic tumor, daughter cysts, parakeratinization, recurrence.
