Management Of Keratocystic Odontogenic Tumor Research Articles

Management of keratocystic odontogenic tumor in the maxillary sinus of 12-year-old children: A case report

Objective: Keratocystic odontogenic tumor (KCOT) is a benign intraosseous tumor of odontogenic origin, making up the third most common odontogenic cyst. KCOTs arise from the remnants of dental lamina or the basal cells of the overlying oral epithelium. KCOTs are characterized by an aggressive behaviour with a relatively high recurrence rate, especially if they are associated with syndromes. Treatment of KCOTs include marsupialization, saucerization, 
 Methods: A 12-year-old child patient was referred to the Specialist Clinic of Oral and Maxillofacial Surgery, Cipto Mangkusumo Hospital. On physical examination, facial asymmetry, a fixated swelling and lump in right maxilla from the second molar to canine with tenderness were observed. A complete history was taken and clinical examination followed by complete enucleation with sulcular flap from 12 region until 18 regions was performed. The diagnosis was maxillary dentigerous cyst based on histopathological result after the operation. 
 Results: The medical history was not significant and patient was in a generally good condition with no fever, nausea, pain, or difficulty in breathing. Extra oral examination showed facial asymmetry and visible lump in the right region of the maxilla.
 Conclusion: The diagnosis of maxillary KCOT expanding to maxillary sinus can be achieved with adequate datas; history, clinical, and histopathological examinations. Careful surgical approach and proper treatment decision is crucial to avoid complications according to individual case of each patient, especially in children.

A review on the most important management of keratocystic odontogenic tumor.

Keratocystic odontogenic tumor (KCOT) is a recurrent benign tumor with a keratinized epithelial shape. The treatment methods in KCOT are still debated. The aim of all treatment methods is to eradicate the cyst and to reduce recurrence and surgical complications. This review article was conducted to assess the findings of studies on the dia-gnosis, management and recurrence of KCOT. Information were gathered by searching keywords such as management, treatment, pharmacology, surgery and keratocystic odontogenic tumor in international databases such as Web of Science, PubMed and Scopus. The search period was between 2010-2020. Techniques used for the treatment include decompression, marsupialization, enucleation with or without adjunct, Caldwell-Luc surgery and resection. Of the 40 studies, recurrence was observed in 13 studies and the recurrence ranged from 0 to 48% in different treatment methods. Due to the high recurrence of this disease, it is suggested that long term follow-up be considered after treatment to reduce recurrence. Decision on the treatment should be made considering age, tumor size, and the site of involvement in order to reduce the economic and psychological burden of the disease.

What surgical treatment has the lowest recurrence rate following the management of keratocystic odontogenic tumor?: A large systematic review and meta-analysis.

Among the different surgical treatments for keratocystic odontogenic tumors (KOTs), there is no single method associated with a zero recurrence rate (RR). Thus, this study aimed to seek the best surgical treatment with the least RR using a weighted event rated meta-analysis. To address our study purpose, a systematic review and meta-analysis based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guideline was performed. An extensive search of major databases through PubMed, EMBASE, and Cochrane CENTRAL was conducted to identify all relevant articles published without language restrictions from inception to August 2016. Relevant articles were selected based on the following inclusion criteria: prospective, retrospective, and case series studies that assessed various treatments in non-syndromic KOTs in which RRs were included. The predictor variable was treatment groups, namely: enucleation alone, enucleation with peripheral ostectomy, enucleation with Carnoy's solution application, enucleation with cryotherapy, marsupialization alone, decompression followed by residual cystectomy, and resection. The outcome variable was RR. A weighted RR using a random effect model (because of variation in follow-up time) with a 95% confidence interval (CI) was performed. Data analysis was performed using a comprehensive meta-analysis software. A total of 2287 KOTs in 35 studies were included in this analysis. The weighted RR for various treatment techniques was as follows: enucleation alone (23.1%), enucleation with curettage (17.4%), enucleation and Carnoy's solution (11.5%), enucleation plus liquid nitrogen cryotherapy (14.5%), marsupialization alone (32.3%), decompression followed by residual cystectomy (14.6%), and resection (8.4%). The pooled weighted overall RR of KOTs for all different treatments was 16.6%. Radical resection remains the certain option for obtaining the lowest recurrence with KOTs. However, low recurrence accompanies enucleation with application of Carnoy's solution or cryotherapy as the first-line treatment for primary KOTs. Marsupialization (where indicated) must be followed by secondary cystectomy to minimize recurrence. We believe that to achieve the least possible morbidity, resections should be reserved for multiple recurrent lesions and possibly syndromic cases.

Abordagem conservadora no tratamento do tumor ceratocístico odontogênico

Abordagem conservadora no tratamento do tumor ceratocístico odontogênico

Expression of human papillomavirus is correlated with Ki-67 and COX-2 expressions in keratocystic odontogenic tumor.

The aim of the current study was to investigate the presence of human papillomavirus (HPV) and evaluate its association with Ki-67 and cyclooxygenase-2 (COX-2) expressions in keratocystic odontogenic tumor (KCOT). Nineteen cases were included in the present study. Conventional PCR method and immunohistochemical analysis were performed for the detection of HPV-DNA and HPV-L1 capsid protein. Moreover, the expressions of Ki-67 and COX-2 proteins were analyzed immunohistochemically. HPV-DNA was detected in 36.8% (7/19) of tumor samples, whilst HPV-L1 protein was identified in 68.4% (13/19) of them. The Kappa coefficient statistical test showed a moderate agreement (κ 0.424) between PCR and IHC assays for HPV detection. Expression of HPV-DNA was positively correlated with Ki-67 and COX-2 expressions (p < 0.05), whereas HPV-L1 positive staining was positively correlated with COX-2 (p < 0.05) and highly associated with those of Ki-67 (p < 0.01). There was no significant correlation between the presence of HPV and the recurrence of the studied lesions. The results of the current study showed that active HPV infection was present in the odontogenic epithelium of KCOT, and it was associated with increased proliferation rate and COX-2 expression. These findings suggest that HPV may have a role in the pathogenesis and aggressiveness of KCOT. Based on these conclusions, we recommend further investigations of HPV vaccine or antiviral therapy and COX-2 inhibitors as nonsurgical options in the prevention and management of KCOT.

Response to the critique of “Keratocystic odontogenic tumor: systematic review with analysis of 72 additional cases from Mumbai, India”

Response to the critique of “Keratocystic odontogenic tumor: systematic review with analysis of 72 additional cases from Mumbai, India”

Importance of Different Modalities of Treatment For the Management of Keratocystic Odontogenic Tumour with Five year follow-up.

The keratocystic odontogenic tumors is a benign but one of most aggressive developmental cyst with many distinguishing clinical and histologic features and high recurrence rate. In the given study, authors have studied and presented their experience of managing Keratocystic odontogenic tumour. The aim of the study was to define an appropriate treatment protocol for the management of KCOT. Total 8 patients, whose histopathological reports confirmed Gorlin - Goltz syndrome and KCOT, with age between 10 - 50 years, were selected from cases being treated at Sree Balaji Dental College, Chennai, India. Enucleation and resection were the surgical techniques employed. Modality of treatment was based on parameters like age , size, aggressiveness and extent of the lesion. All the patients were operated under general anaesthesia. Cases were studied, reviewed and followed up for five years between 2007-2012. The study included 8 cases in which three cases were opted for resection and five cases for enucleation followed by application of Carnoy's solution. Treatment modality should be decided on age, extent, aggressiveness and nature of the tumour.

Keratocystic Odontogenic Tumor Surgical Management: Retrospective Analysis on 77 Patients

In 2005 the WHO introduced the former odontogenic keratocyst to the category of benign odontogenic tumours. The change in terminology was based on the observation that the odontogenic keratocyst behaves as a neoplasm and not like a benign cystic lesion. The present paper is a retrospective analysis on the management of keratocystic odontogenic tumor over a period of 11 years (2001–2012) in the Department of Maxillo-Facial Surgery at the University of Rome “Sapienza”, with particular focus on the surgical choices and the relative rates of relapse. The patient population consisted of 34 females and 43 males. Administered treatment modalities consisted of enucleation in 55 cases and radical resection in 22 cases. Nineteen percent of patients who underwent enucleation suffered KCOT relapse. No relapse was observed in the radical resection group with follow-up of 3–7 years. The goals of the treatment include elimination of the pathology and decrease of potential recurrence while minimizing harm to the patient. In the Authors' experience, conservative treatment still encompasses a high rate of recurrence; otherwise, resection provides the lowest recurrence rate, yet causes the most suffering to the patient. The issue surgeons encounter is whether to choose a conservative approach, reducing the morbidity to the patient, knowing that several operations may be required to eliminate recurrence; or being more aggressive and potentially more destructive, at the same time ensuring the best condition to avoid recurrence. Other studies are needed in order to find definitive guidelines for this challenging pathology.

Management of keratocystic odontogenic tumour with marsupialisation: a case report

Management of keratocystic odontogenic tumour with marsupialisation: a case report

Nonsurgical Management of Keratocystic Odontogenic Tumor: Report of a Clinical Case

Because of its intrinsic characteristics consistent with neoplasms, the odontogenic keratocyst has joined the group of benign odontogenic tumors in 2005 and renamed keratocystic odontogenic tumor (KOT). The main characteristics of this pathology include: aggressive behavior, autonomous growth, high recurrence rate and, sometimes, silent clinical manifestation of lesions to large size. These peculiarities, combined with their frequency, delay diagnosis, prognosis and limited treatment difficult. This study aims to present a case of atypical KOT emphasizing its solvability without surgical intervention or invasive procedures, and comparing its clinical, radiological and histopathological characteristics and therapeutic alternatives to those described in the literature. The most common treatment for KOT is enucleation followed by curettage, but its friable nature, associated with a fibrous connective tissue with thin, hinders its complete removal. In large lesions, it has been chosen by marsupialization followed by enucleation. The advantages of this technique are the thickness of the capsule, the reduction in lesion size and, therefore, easy and complete removal lower recurrence rate. Due to the characteristics of this injury, it deserves special attention, since successful treatment depends on accurate diagnosis, an appropriate surgical procedure and an appropriate and periodic radiographic preservation, in order to prevent the appearance of new lesions in the area.

Decompression for Management of Keratocystic Odontogenic Tumor in the Mandible

Keratocystic odontogenic tumor (KCOT) is a benign intraosseous neoplasm of odontogenic origin with high recurrence rate. To date, various conservative or aggressive management strategies have been suggested as a method of treatment. Decompression is a conservative method that has been used in the treatment of large odontogenic cysts. The present paper reports a case of KCOT located in the mandible and discusses the importance of its management using conservative methods. The authors present a case of a 38-year-old patient with a KCOT located in the right mandibular angle and ascending ramus, which was treated by decompression followed by enucleation and curettage. The lesion did not recur during a follow-up period of 3 years after surgery. Preserving important structures of the bone and soft tissue decompression is a method with low morbidity. In addition, according to the literature, decompression has a success rate at least as high as the one of most aggressive treatments.