Treatment Of Keratocystic Odontogenic Tumor Research Articles

Enucleation with or without Adjuvant Therapy versus Marsupialization with or without Secondary Enucleation in the Treatment of Keratocystic Odontogenic Tumors

Objective: In order to assess enucleation with or without adjuvant therapy and marsupialization with or without secondary enucleation on patient outcomes regarding recurrence rates, complications and healing times in the context of KOT. Methodology: In this cohort study, a total of 150 participants diagnosed with Keratocystic Odontogenic Tumors. Patients were divided into four groups: enucleation with adjuvant therapy; enucleation without adjuvant therapy; marsupialization alone; and marsupialization then second surgery for enucleation. The outcomes of the study were recorded in terms of recurrence of the tumor and its complete regression Other outcomes like the recovery period of the patient, the occurrence of complications, and functional capacities were also noted for all the patients. Results: The recurrence rate in the enucleation with adjuvant therapy group was 8%, mean time to recurrence: 20±3.5 months while for enucleation without adjuvant therapy was 18% with mean time to recurrence of 21±4.0 months. Higher complications rate was noted in enucleation with adjuvant therapy at 10% and 15% in enucleation without adjuvant therapy. Marsupialization alone resulted in a recurrence rate of 13% (mean time to recurrence: 22±3.8 months, the complication rate was 7%. Marsupialization followed by secondary enucleation showed the lowest recurrence rate at 4% (mean time to recurrence: 25±4.1 months and the complication rate of 8%. Conclusion: Thus, adjuvant therapy and marsupialization with secondary enucleation proved to be less likely to result in the high recurrence rate that marsupialization alone causes and enucleation is less likely to result in high recurrence rate that leaving the mass in causes.

Decompression or Marsupialization; Which Conservative Treatment is Associated with Low Recurrence Rate in Keratocystic Odontogenic Tumors? A Systematic Review.

Various treatment modalities have been reported for keratocystic odontogenic tumors (KOT), with different recurrence rates. Marsupialization and decompression are two different conservative surgical techniques for the treatment of KOTs. This study aimed at comparing the recurrence rate between marsupialization and decompression in the treatment of KOTs with or without adjunctive treatments. This is a systematic review study. The research sources utilized were PubMed (MEDLINE), Google scholar, Ovid MEDLINE and Cochrane Library. The keywords which were selected based on Medical Subject Heading (MeSH) terms and PICOS criteria were odontogenic keratocyst, keratocyst odontogenic tumor AND marsupialization OR decompression OR cystectomy OR enucleation OR curettage. Statistical analyses were performed to compare the recurrence rate between marsupialization and decompression with or without adjunctive treatments, regarding various follow-up times. The number of subjects that underwent marsupialization was 182. There was a significant difference for the recurrence rate between the marsupialization and decompression groups without considering adjunctive treatments (p= 0.001). However, considering adjunctive treatments, there was no difference between marsupialization and the decompression groups (p= 0.18). It appears that decompression without any adjuvant treatment may have a lower recurrence rate than marsupialization. The recurrence rate was not different when enucleation or cystectomy was performed after decompression and marsupialization.

A Combination of Techniques in the Treatment of Keratocystic Odontogenic Tumor

A Combination of Techniques in the Treatment of Keratocystic Odontogenic Tumor

Using carnoy's solution in treatment of keratocystic odontogenic tumor

Aim:The aim of this study was to assess the treatment of keratocystic odontogenic tumor using enucleation and Carnoy's solution with peripheral ostectomy.Materials and Methods:Twenty-nine patients (14 females and 15 males) with age range from 12 to 62 years were included in this study and followed up for 7 years; all the patients were treated in the Department of Oral and Maxillofacial Surgery of the Specialized Surgeries Teaching Hospital (Al-Shaheed Ghazi Al-Hariri Hospital-Medical City, Baghdad, Iraq). Enucleation followed by peripheral ostectomy and the application of Carnoy's solution is the standardized method of treatment.Results:This study showed (32.7%) unilocular radiolucency for the lesions (19.9%) as multilocular radiolucency. Furthermore, it showed that the recurrence rate by this method was 0% with a minimum neurosensory disturbance.Conclusion:The complications and morbidity originating from the application of Carnoy's solution occurred less frequently and were less serious than those associated with resection while the recurrence rate is 0% which is equal to the recurrence rate of resection.

Enucleation with or without adjuvant therapy versus marsupialization with or without secondary enucleation in the treatment of keratocystic odontogenic tumors: A systematic review and meta-analysis.

The purpose of this study was to compare the recurrence rate (RR) of keratocystic odontogenic tumors (KOTs) in patients who underwent enucleation with or without adjuvant therapy, to patients who underwent decompression with or without residual cystectomy. An extensive search of major databases through PubMed, EMBASE, and Cochrane CENTRAL was conducted to identify all relevant articles published without date and language restrictions from inception to December 2015. Relevant articles were selected based on the specific inclusion criteria. A weighted RR and odds ratio (OR) using a Mantel-Haenszel (M-H) test and random effect model with 95% confidence interval (CI) were performed. Meta-regression analysis was conducted to further identify the influence of the duration of follow-up periods on the overall OR. A total of 997 KOTs enrolled in 14 studies were included in this analysis. There was a significant advantage for the enucleation±adjuvant therapy group in preventing recurrence for patients with KOTs (M-H, OR, 0.514; 95% CI, 0.302-0.875; p=0.014). The overall pooled weighted RR for enucleation±adjuvant therapy and decompression±secondary cystectomy were 18.2% and 27.1%, respectively. The meta-regression analysis showed that duration of follow-up time did not significantly influence the OR of KOT recurrence (Q=0.506, p=0.646). In conclusion, initialcystectomy ±adjuvant therapy was associated with fewer recurrences than decompression ±secondary cystectomy.

Results of the treatment of keratocystic odontogenic tumours using enucleation and treatment of the residual bony defect with Carnoy's solution

This retrospective study aimed to investigate the recurrence rate of keratocystic odontogenic tumours (KCOTs) treated by enucleation and the application of Carnoy's solution, and to assess the surgical morbidities associated with this treatment. KCOTs treated using a standard protocol of enucleation and the application of Carnoy's solution between 1990 and 2013 were evaluated. One hundred and five KCOTS in 105 patients (54 male, 51 female) were analysed. The mean follow-up period was 86.6 months (range 24–313 months). The recurrence rate was 11.4%. A postoperative inferior alveolar nerve neurosensory deficit occurred in 30.1% of the mandibular cases, with 16% of these being permanent. The postoperative infection and fracture rates were 1.9% and 0.9%, respectively. Younger age, multilocular KCOTs, larger tumour size, and longer antero-posterior lesion length on the radiograph were found to be risk factors for recurrence. It is concluded that enucleation and the application of Carnoy's solution to treat KCOTs results in a relatively low recurrence rate and a low rate of surgical morbidities.

Treatment of Keratocystic Odontogenic Tumours: A Prospective Study of 30 Cases

This prospective study aimed at presenting different treatment modalities and its association with the recurrence rate of KCOT. The study was conducted on 30 patients diagnosed with KCOT between March 2009 and 2012. The patients were followed up for a period of at least 1year. The clinical, radiographic and demographic data were recorded and four different treatment modalities were followed to assess the recurrence of the tumour. In the study, KCOT showed male predominance with a male: female ratio of 23:7. Of the total cases, 26 (86.67%) patients had parakeratinised KCOT and the rest 4 (13.3%) patients had orthokeratnised KCOT. Nine (30%) patients were reported with recurrence of the tumour within 1-2years of surgery-all these patients had parakeratinised cyst. Recurrence was observed in four (50%) out of eight cases of marsupialisation and four (44.44%) out of nine cases of treatment using the enucleation process. No recurrence was seen in patients treated with resection; however only one out of three patients treated with enucleation, followed by fixation with Carnoy's solution showed signs of recurrence. The histopathological examination determined the aggressive nature of KCOT and its association with the recurrence rate as well. The findings of our study indicate that more aggressive treatment can aid in reducing the chances of recurrence.

Role of Carnoy's solution in the treatment of keratocystic odontogenic tumor: A systematic review.

Introduction and ObjectiveThe keratocystic odontogenic tumor is a benign but aggressive neoplasm. As enucleation alone obtains high recurrence rates, some adjuvant treatments such as Carnoy’s solution have been proposed. The aim of this study is to evaluate the reduction of recurrences with the use of Carnoy’s solution as adjuvant in the treatment of keratocystic odontogenic tumors.Material and MethodsAn electronic search in Pubmed (MEDLINE), ScienceDirect and Cochrane databases was conducted with the key words “odontogenic keratocyst”, “keratocystic odontogenic tumor”, “carnoy’s solution”, “treatment” and “enucleation”. The inclusion criteria were clinical studies using Carnoy’s solution as adjuvant for the treatment of keratocystic odontogenic tumors, published in English, including at least 10 patients. Articles with an unclear reporting of the treatment applied, nonhuman studies, case reports and lesions associated to Gorlin-Goltz syndrome were excluded.ResultsAll the studies included were case series. The recurrence rate of enucleation ranged from 0% to 58.8%. With the only use of Carnoy’s solution as adjuvant treatment to the enucleation, recurrences varied from 0% to 100%. The use of ≥ 2 adjuvant treatments reduced the range between 0% and 7.9%.ConclusionsThe use of Carnoy’s solution as adjuvant therapy for the treatment of keratocystic odontogenic tumor has a grade C recommendation. Key words:Carnoy’s solution, keratocystic odontogenic tumor, treatment, recurrence.

Gorlin-Goltz Syndrome: Conservative Treatment of Keratocystic Odontogenic Tumors, Frequent First Clinical Manifestation in Pediatric Age

Objective: Gorlin-Goltz Syndrome, also known as Nevoid Basal Cell Carcinoma Syndrome, is a rare genetic condition resulting from mutations of the PTCH1 (9q22.3) gene. It involves multiple organs, such as the skin, skeleton and jaws. Aim of this study was to describe Keratocystic Odontogenic Tumors as frequent first clinical manifestation of NBCCS during pediatric age, and theirs conservative treatment, that is really important, especially among young patients. Methods: We report on 20 pediatric patients affected by Gorlin-Goltz Syndrome, presenting totally 60 Keratocystic Odontogenic Tumors. Patients underwent conservative lesion enucleation with maximal permanent teeth preservation. The ostectomy and osteoplasty were made with both conventional rotative instruments and piezoelectric tools, in order to remove damaged bone, epithelial remnants and satellite cysts, and to possibly minimize the recurrence risk. All surgical samples were subjected to histopathological examination and the patients were followed-up for a minimum of 18 months. Results: Overall, 60 Keratocystic Odontogenic Tumors were removed (8 patients with single and the remaining with multiple cysts) with healing of all the surgical wounds without complications. Nevertheless, recurrence of 5 lesions (8.3%) from 3 patients occurred: all of them were >5 cm in maximum diameter and associated with permanent teeth. Conclusion: Keratocystic Odontogenic Tumors in pediatric patients require conservative approaches for permanent teeth preservation. While conventional enucleation leads up to 60% recurrence rates, cavity ostectomy with piezoelectric tools significantly reduced the recurrence risk and allowed preservation of permanent teeth.

Interventions for the treatment of keratocystic odontogenic tumours.

The keratocystic odontogenic tumours (KCOTs) account for between about 2% and 11% of all jaw cysts and can occur at any age. They are more common in males than females with a male:female ratio of approximately 2:1. Although they are benign, KCOTs are locally very aggressive and have a tendency to recur after treatment. Reported recurrence rates range from 3% to 60%. The traditional method for the treatment of most KCOTs is surgical enucleation. However, due to the lining of the cyst being delicate and the fact that they frequently recur, this method alone is not sufficient. Adjunctive surgical treatment has been proposed in addition to the surgical enucleation, such as removal of the peripheral bone (ostectomy) or resection of the cyst with surrounding bone (en-bloc) resection. Other adjunctive treatments proposed are: cryotherapy (freezing) with liquid nitrogen and the use of the fixative Carnoy's solution placed in the cyst cavity after enucleation; both of which attempt to address residual tissue to prevent recurrence. To assess the available evidence comparing the effectiveness of interventions for the treatment of KCOTs. We searched the following electronic databases: the Cochrane Oral Health Group Trials Register (to 17 March 2015), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2015, Issue 2), MEDLINE via Ovid (1946 to 17 March 2015) and EMBASE via Ovid (1980 to 17 March 2015). We searched the US National Institutes of Health Trials Register (http://clinicaltrials.gov) and the WHO Clinical Trials Registry Platform for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. Randomised controlled trials comparing one modality of intervention with another with or without adjunctive treatment for the treatment of KCOTs. Adults, over the age of 18 with a validated diagnosis of solitary KCOTs arising in the jaw bones of the maxilla or mandible. Patients with known Gorlin syndrome were to be excluded. Review authors screened trials for inclusion. Full papers were obtained for relevant and potentially relevant trials. If data had been extracted, it would have been synthesised using the fixed-effect model, if substantial clinical diversity were identified between studies we planned to use the random-effects model with studies grouped by action provided there were four or more studies included in the meta-analysis, and we would have explored the heterogeneity between the included studies. No randomised controlled trials that met the inclusion criteria were identified. There are no published randomised controlled trials relevant to this review question, therefore no conclusions could be reached about the effectiveness or otherwise of the interventions considered in this review. There is a need for well designed and conducted randomised controlled trials to evaluate treatments for KCOTs.

Treatment of Keratocystic Odontogenic Tumours: A 10-Year Review of Cases

Treatment of Keratocystic Odontogenic Tumours: A 10-Year Review of Cases

Decompression as a Definitive Treatment for Keratocystic Odontogenic Tumor: A Case Report

Decompression as a Definitive Treatment for Keratocystic Odontogenic Tumor: A Case Report

Significantly Decreased Recurrence Rates in Keratocystic Odontogenic Tumor With Simple Enucleation and Curettage Using Carnoy's Versus Modified Carnoy's Solution

A variety of modalities has been suggested for treatment of keratocystic odontogenic tumor (KOT), including Carnoy's solution (CS) and modified Carnoy's (without chloroform) solution (MC). The purpose of the present study was to investigate the effect of CS versus MC as it relates to the KOT recurrence rates when used in conjunction with simple enucleation and curettage (E&C) for treatment of KOT. A retrospective cohort study of patients with a pathologic diagnosis of KOT treated with E&C and application of CS or MC by 3 surgeons at a single center from January 1996 to April 2014 was completed. The demographic, clinical, radiographic, and histologic data were collected for each patient. All disease recurrences were confirmed by biopsy. The primary outcome variable of the study was the interval to recurrence, with the predictor of CS versus MC. Other variables included in the analysis were gender, age, surgeon, and lesion location. Multivariate analysis, including the Wilcoxon test and χ(2) test of associations, was performed. A total of 210 patient medical records were reviewed, with 80 patients meeting the final study criteria. Of the 80 patients, 44 were in the CS arm and 36 in the MC arm. The median age was 47years (range 10 to 89) in the CS group and 50years (range 14 to 72) in the MC group (P= .70). Women accounted for 43% (19 of 44) and 44% (16 of 36) of the patients in the CS and MC treatment arms, respectively (P=.91). The lesions were found in the mandible in 26 of the 44 patients (59%) treated with CS and 22 of the 36 patients (61%) treated with MC (P= .85). Surgeon 1 treated 37 of the 44 patients (84%) and 21 of 36 patients (58%) in the CS and MC groups, respectively (P= .01). The recurrence rate was 10% for the CS arm and 35% for the MC arm (P= .027; hazard ratio 6.9). In the present retrospective study, the recurrence rate of KOTs treated by E&C with application of CS is significantly lower than that of MC. The data provided could be considered by the Food and Drug Administration for a clinical trial of CS in patients with KOT.

Keratocystic Odontogenic Tumor (KCOT/OKC)-Clinical Guidelines for Resection.

There is no clinical consensus for the treatment of Keratocystic Odontogenic Tumor (KCOT). KCOTs are regarded as benign aggressive tumors and resection is usually considered as a last option. We review the clinical indications for resection based on a case series. This is a retrospective study of patients with KCOT treated in a single unit over 17years. Eighty patients were identified, of which 12 (15%) underwent resection. The remaining 68 patients were managed by enucleation and curettage, enucleation with peripheral ostectomy, or decompression with secondary enucleation. Data extracted includes gender, age, race, location, previous treatment for the lesion, surgery and outcome/follow up. Twelve patients treated by resection were identified. The location in the ten benign resected KCOTs was either the mandibular ramus or the posterior maxilla. All mandibular KCOTs exhibited perforation of the lingual plate and involvement of the pterygoid musculature. Seven of the ten cases were recurrent KCOTs and three had no prior treatment. Two had malignant changes in the KCOT and were also resected. The primary reason for resection of KCOT was involvement of the pterygoid muscles. The presence of malignant change was a separate indication for resection.

Vismodegib hedgehog-signaling inhibition and treatment of basal cell carcinomas as well as keratocystic odontogenic tumors in Gorlin syndrome.

Vismodegib hedgehog signaling inhibition treatment has potential for reducing the burden of multiple skin basal cell carcinomas and jaw keratocystic odontogenic tumors. They are major criteria for the diagnosis of Gorlin syndrome, also called nevoid basal cell carcinoma syndrome. Clinical features of Gorlin syndrome are reported, and the relevance of hedgehog signaling pathway inhibition by oral vismodegib for maxillofacial surgeons is highlighted. In summary, progressed basal cell carcinoma lesions are virtually inoperable. Keratocystic odontogenic tumors have an aggressive behavior including rapid growth and extension into adjacent tissues. Interestingly, nearly complete regression of multiple Gorlin syndrome-associated keratocystic odontogenic tumors following treatment with vismodegib. Due to radio-hypersensitivity in Gorlin syndrome, avoidance of treatment by radiotherapy is strongly recommended for all affected individuals. Vismodegib can help in those instances where radiation is contra-indicated, or the lesions are inoperable. The effect of vismodegib on basal cell carcinomas was associated with a significant decrease in hedgehog-signaling and tumor proliferation. Vismodegib, a new and approved drug for the treatment of advanced basal cell carcinoma, is a specific oncogene inhibitor. It also seems to be effective for treatment of keratocystic odontogenic tumors and basal cell carcinomas in Gorlin syndrome, rendering the surgical resections less challenging.

Dredging Method-A Conservative Approach for the Treatment of Keratocystic Odontogenic Tumor -

Keratocystic odontogenic tumor (KCOT) was previously designated as odontogenic keratocyst, which stresses the benign behavior of this lesion. In 2005, WHO Working Group recommends the term KCOT as it better reflects its neoplastic nature.

Treatment of Keratocystic Odontogenic Tumors in Nevoid Basal Cell Carcinoma Syndrome

Nevoid basal cell carcinoma syndrome (NBCCS) is inherited as an autosomal dominant trait with variable conditions, including multiple basal cell carcinoma, numerous keratocystic odontogenic tumors (KOTs) in the jaws, ectopic calcification of the falx cerebri, bifid ribs, macrocephaly, kyphoscoliosis, cleft palate, frontal and temporal bossing, mild ocular hypertelorism, mild mandibular prognathism, vertebral fusion, and so on. A 16-year-old boy visited the Dong-A University Medical Center, requiring diagnosis and treatment of multiple cystic lesions. He presented with many conditions related to NBCCS, including multiple KOTs, bifid rib, cleft lip, frontal bossing, mild ocular hypertelorism, and mild mandibular prognathism. No characteristic cutaneous manifestations (nevoid basal cell carcinoma) were observed in this patient. We report on a case of multiple KOTs associated with NBCCS with a review of the literature.

Multiple Keratocysts of the Mandible in Association with Multiple Basal Epithelioma, Jaw Cysts and Bifid Rib Syndrome: A Rare Case Report

ABSTRACT Nevoid basal cell carcinoma syndrome is a syndrome with wide variety of manifestations ranging from oral lesions to skeletal deformities. It calls for due responsibility of maxillofacial surgeon to diagnose the syndrome because very often they are the first health professionals to see the patient for the treatment of keratocystic odontogenic tumor. Keratocystic odontogenic tumor (KCOT) has been the topic of numerous investigators and is known for its potentially aggressive behavior and significant rate of recurrences. Keratocystic odontogenic tumor often occurs as a solitary lesion, and in some instances multiple keratocysts may occur in association with a syndrome called Gorlin-Goltz syndrome (nevoid basal cell carcinoma, jaw cyst bifid rib basal cell nevus syndrome). Here, we present a case of multiple keratocysts in the mandible in association with skeletal, ocular and cutaneous anomalies in the given clinical scenario which has profound relevance in the clinical dental practice. How to cite this article Kulkarni GH, Khaji SI, Kulkarni HS, Metkari SB, Kulkarni R. Multiple Keratocysts of the Mandible in Association with Multiple Basal Epithelioma, Jaw Cysts and Bifid Rib Syndrome: A Rare Case Report. Int J Head Neck Surg 2014;5(1):39-41.

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.

Transnasal Marsupialization Using Endoscopic Sinus Surgery for Treatment of Keratocystic Odontogenic Tumor in Maxillary Sinus

Objective. We report the first utilisation of transnasal marsupialization to treat a keratocystic odontogenic tumor in the maxillary sinus of a 37-year-old man. Case Report. A 37-year-old man presented with a nasal discharge and right odontalgia. Computed tomography revealed an expanding cystic lesion with a calcificated wall containing an impacted tooth in the right maxillary sinus. The diagnosis was keratocystic odontogenic tumor. Transnasal marsupialization was performed using endoscopic sinus surgery to enlarge the maxillary ostium and remove a portion of the cystic wall. Pathological findings included lining squamous epithelium and inflammation. The remaining tumor shrank, becoming free of infection after surgery, without proliferation. Conclusion. Transnasal marsupialization using endoscopic sinus surgery is effective in treating keratocystic odontogenic tumors. It offers minimal surgical invasion and reductive change, making it advantageous for complete removal with fewer complications in the bones and surrounding tissue in the case of secondary surgery.