Treatment Of Odontogenic Keratocyst Research Articles

Treatment of odontogenic keratocyst and 7-year follow-up

Treatment of odontogenic keratocyst and 7-year follow-up

Role of decompression in the treatment of odontogenic keratocyst

Role of decompression in the treatment of odontogenic keratocyst

Large Keratocyst Extending to Mandibular Ramus and Coronoid Process: A Case Report

Odontogenic keratocysts are odontogenic epithelial-originated developmental cysts characterized by minimal expansion, high recurrence rate, and aggressive nature. They are usually asymptomatic and detected in routine dental examinations so can be overlooked until the lesions reach large sizes. The treatment of odontogenic keratocyst is controversial, and there are various surgical approaches ranging from conservative approaches to more invasive procedures. In this case report, a 16-year-old female patient with an enlarged odontogenic keratocyst associated with an impacted third molar and extending through the mandibular angle, ramus, and coronoid process regions is presented with the clinical, radiological, and histopathological findings and the surgical treatment plan.

Maxillary Odontogenic Keratocyst Superimposed by Infection: Case Report

Odontogenic Keratocysts (OKCs) are rare cystic lesions known for their aggressive behavior and tendency to recur after excision. These benign tumors usually occur in the mandible or maxilla and are believed to arise from the dental lamina. The medical community is still debating whether these lesions are developmental or neoplastic [1]. However, most experts agree that they are locally aggressive and require prompt treatment to avoid complications. On imaging, they typically appear as a solitary unilocular lesion that extends longitudinally in the posterior portions of the mandible. Although most are solitary, multiple odontogenic keratocysts can also be present in some cases, and an associated condition such as basal cell nevus syndrome should be considered. It’s worth noting that involvement of the maxillary sinus by OKC is rare, but it can happen [2]. The maxillary sinus is part of the paranasal sinuses, which are in proximity to developing tooth and root apices of premolar and molars. The overlapping of various structures makes it challenging to diagnose such lesions via maxillary radiographs. Therefore, prompt diagnosis and treatment of OKCs is essential to prevent further complications [3].

Long-term investigation of minimally invasive alcohol-based therapy as the treatment of odontogenic keratocyst:A retrospective cohort study

The aim of this study was to evaluate the clinical efficacy of alcohol-based therapy for patients with large odontogenic keratocysts (OKCs).The study was implemented as a retrospective, single-center study. Patients treated with ethanol-based therapy for odontogenic keratocyst were retrospectively evaluated for baseline and postoperative data. The pre- and postoperative clinical situation and the extent of radiographic shrinkage were compared. The event is defined as the achievement of >50% reduction in cyst volume.The cyst reduction rate calculated on panoramic radiographs ranged from 7.4% to 99.9% (mean [standard deviation] 55.3% [27.9%]) and was statistically significant (P < 0.05). Specifically, it has been found that, radiographically, 47.6% of patients achieved >50% reduction in cyst volume within 12 months. The continuous cortical bone was rebuilt, and the cyst cavity was filled with regenerated trabecular bone. The 22 included patients presented with nonclinical problems, had no need for further intervention, and exhibited persistent impaction of the teeth.The results of this study demonstrated that ethanol-based therapy triggered marked radiographic reductions of large OKC, indicating that using this technique is efficient.

The Role of Adjunctive Chemical Solutions in the Treatment of Odontogenic Keratocysts: A Scoping Review.

Odontogenic keratocysts (OKC) are aggressive cysts with a high recurrence potential. Treating them with surgical enucleation procedures alone is associated with high recurrence rates; therefore, additional or supportive treatment approaches, such as peripheral osteotomy, cryotherapy, and chemical solutions, are warranted.The objective of the present review was to evaluate the existing literature on the efficacy of chemical approaches, such as Carnoy's solution (CS), in preventing recurrence after the enucleation of OKC.An electronic search was conducted on PubMed, Scopus, and Google Scholar databasesto find articles published from January 2010 to December 2022 by using the Medical Subject Headings (MeSH) terms "Odontogenic Keratocyst" "Carnoy's Solution," "Treatment," and "Enucleation." Articles published in the English language were selected for the study. The PICOS criteria (population: patients with non-syndromic OKC with histopathological diagnosis and a minimum follow-up of six months; intervention and comparison: enucleation followed by adjunctive chemical therapy and standard procedure; outcome: recurrence rates; study design: retrospective and prospective studies, randomized controlled trials, and case series involving at least 10 cases of OKC) were employed. Studies involving syndromic (nevoid basal cell carcinoma) cases were excluded from the search.Seventeen studies fulfilled the inclusion criteria and the majority of them were retrospective studies, with a few case series. OKC was found more frequently in the mandible, with a recurrence rate of 11%, when treated with CS following enucleation after four years of follow-up. Modified Carnoy's solution (MC) was used in two studies. The mean follow-up period was 44 months. Based on our findings, adjuvant therapy using a chemical approach following enucleation is a more effective and beneficial modality for the treatment of OKC.

Investigation of the effects of marsupialization on histomorphological and immunohistochemical markers of odontogenic keratocysts.

Despite its extensive bone resorption and high recurrence rate, marsupialization is the preferred option in the treatment of odontogenic keratocysts (OKCs). We aimed to assess the effect of marsupialization on histomorphological and biochemical markers of OKCs. The study is conducted on 48 paraffin blocks of 24 OKC cases between the years 2012 to 2018. The main clinical, radiographic, and histomorphometric measurements were recorded. Immunohistochemical staining with E-cadherin, Ki67, IL1α, TNFα, Slug, and Snail were performed and compared for pre-marsupialization and post-marsupialization values. OKCs mostly located in the mandibular posterior region. The mean marsupialization period was 8.8 ± 6.5 (3-25) months. The mean radiographic size of OKC (57.1 ± 53.5 mm) was significantly reduced after marsupialization (22.6 ± 19.9 mm, P = 0.002). Histologically, significantly increased thickness of the OKC epithelium (p = 0.002) and collagen production (p = 0.034) was detected after marsupialization. The post-marsupialization group showed positive correlation of inflammation score to both TNFα (r: 0.69, P < 0.001) and IL-1α (r: 0.58, P = 0.008) expressions in connective tissue. Among immunohistochemical parameters, only Slug expression was significantly higher after marsupialization (p = 0.019). Our study suggests that increased Slug expression may enable the second surgery by increasing fibrosis in the cyst wall.

Mast Cells Released Inflammatory Markers Play a Vital Role in Mandibular Remodeling of Odontogenic Keratocyst Patients

Background: Odontogenic Keratocyst (OKC) falls among the distinctive and rare odontogenic developmental cyst which is derivative of the dental lamina and contains clear fluid along with a cheesy material which resembles keratin debris. Treatment strategies for OKC are for the most part classified as conservative or aggressive. Mast Cells play an important role in the pathogenesis of inflammatory conditions. Objective: The goal of our study was to observe the participation of inflammatory mediators (RANKL, TNF-α, TGF-β and MMP-9) in the pathogenesis as well as the recovery process of OKC. Methods: Enrolled patients were divided into three groups while a fourth group was formed of the control individuals. Sampling of all groups was done once after required data collection. Blood samples were taken, mRNA extraction and cDNA was then subjected to qRT-PCR. IHC for mast cells was done on patient samples. Results: qRT-PCR showed higher expressions of inflammatory markers in patients undergoing treatment as compared to individuals with completed treatment procedure. Levels of RANKL were high in patients that were currently undergoing bone development as compared to other patients. The levels of TNF-α were comparatively higher in patients who showed visible signs of inflammation like swelling and pain. TGF-β and MMP-9 expression levels showed correlation with each other in all three groups. Both these cytokines were also found to be in association with mast cells. The results of histochemical staining of mast cells suggested the involvement of these cells in the pathogenesis of the cystic lesion via inflammation. Conclusions: The findings of the study suggest that the expressions of inflammatory mediators correlate with the presence of mast cells, therefore, application of mast cells stabilizers in addition to marsupialization in the treatment of OKC can be a prospective treatment strategy in future clinical settings.

The odontogenic keratocyst revisited

The treatment of odontogenic keratocysts is reviewed in light of the aetiology and pathogenesis of these lesions. The role of the dental lamina and submucosal hamartias, as frequently seen in nevoid basal cell carcinoma syndrome, is discussed, and the implications for treatment are emphasized.

Is enucleation followed by peripheral ostectomy and Carnoy s solution application an adequate treatment for Odontogenic keratocyst? A case series with up to five years of follow up

Objective: To evaluate the treatment outcome of enucleation and peripheral ostectomy with the use of Carnoy’ssolution for management of Odontogenic keratocyst. Material and Methods: 17 patients with OKC who reportedfrom 2011 to 2015 were included. All the cases were treated by enucleation and peripheral ostectomy of 0.5mmfollowed by Carnoy’s solution cauterization for 4 minutes. All patients were followed up for 4-5 years. Results:All the cases were followed-up by using serial panoramic radiography and clinical evaluation at regular intervals.No recurrence was reported in any of the cases. Conclusion: Treatment of Odontogenic keratocyst by enucleationand 0.5mm of peripheral ostectomy, followed by Carnoy’s solution cauterization for 4 minutes is an effectivetreatment with zero recurrence rates for five years of follow-up.KEYWORDSOdontogenic keratocyst; Enucleation; Carnoy’s solution; Recurrence.

The epidemiology and management of odontogenic keratocysts (OKCs): A European multicenter study

The objective of the present study was to assess the epidemiology including demographic variables, diagnostic features, and the management of odontogenic keratocyst (OKCs) at several European departments of maxillofacial and oral surgery.This study is based on a systematic computer-assisted database that allowed the recording of data from treated OKCs. The following data were recorded for each patient: gender, age, voluptuary habits, comorbidities, site, size, radiographic features, treatment of OKCs, length of hospital stay, complications, recurrence, management and complications of eventual recurrence.A total of 405 patients, 249 male and 156 female, with 415 OKCs (407 sporadic and 8 syndromic lesions) were included in the study: 320 lesions were found in the mandible, whereas 95 were found in the maxilla. In the mandible, the most frequently involved subsite was the angle, whereas in the maxilla it was the molar region. The most frequently performed treatment option was enucleation plus curettage/peripheral ostectomy in 204 OKCs (recurrence rate, 9%). Decompression without residual cystectomy (recurrence rate, 66%), marsupialization with residual enucleation with the use of Carnoy's solution (recurrence rate, 50%), decompression with residual cystectomy (recurrence rate, 43%), and simple enucleation (recurrence rate, 24%) were the treatment options with the highest recurrence rates.An appropriate management of odontogenic keratocysts should be individualized, taking into consideration clinical and radiological findings, as well as patients’ age and comorbidities.

Cisto odontogênico ceratinizado: diagnóstico e tratamento

An analyses of the literature about the diagnosis and treatment of Odontogenic Keratocyst and the obtained results in the available causuistry is presented. A sample group of sixteen (16) pacients were studied and evaluated at the Service of Oral and Maxillofacial Surge and Traumatology of The Pontifícia Universidad Catolica do Rio Grande do Sul and Independencia Hospital, collected during the period of time between january 1982 to june 1983. After the discussion of the obtained results and evaluation of the opinions from many authors, we recomend the histopatological study to get the correct diagnosis. The treatment must be conservatory surgical with a followup of five (5) years, at least.

Modified Carnoy's Compared to Carnoy's Solution Is Equally Effective in Preventing Recurrence of Odontogenic Keratocysts

Carnoy's solution (CS), the gold standard for adjunctive chemical cautery in treatment of odontogenic keratocysts (OKCs), has been banned for 7 years, leading to substitution with the non-chloroform containing modified Carnoy's solution (MC) without data to support its effectiveness. We performed this study to compare the earlier data with CS to the more current outcomes with MC. A retrospective cohort study was conducted on patients diagnosed with OKC and treated by a single surgeon (GHB) with enucleation and curettage (EC), peripheral ostectomy, and application of CS or MC. The primary predictor variables were use of CS or MC. The primary outcome variables were recurrence (yes vs. no) and time to recurrence. Secondary variables included demographics, anatomic location, and whether teeth adjacent to the lesion were extracted. Statistical analyses included chi-squared test/Fisher's exact test, Wilcoxon rank sum test, and Kaplan-Meier curves. 77 patients, 36 patients in the CS group and 41 in the MC group, met inclusion criteria, including at least 1 year of follow-up time. Characteristics of the groups were similar: median age 41.5 and 46, 61% and 71% male gender, 81% and 90% posterior, and 64% and 50% mandibular lesions, respectively. Overall recurrence was similar, 14.29%, with 5 (13.9%) recurrences in the CS group and 6 (14.6%) in the MC group (P = 0.92). Median time to recurrence was 24 months for both groups. Preserving adjacent teeth was associated with a significant increase in recurrence (P = 0.0036). Based on this comparison of retrospective outcome data, we found no significant difference in recurrence rate or distribution of time to recurrence between OKCs treated with CS or MC. Aggressiveness of surgical technique is likely a predictive factor in recurrence rate. Future studies should focus on prospective studies and continuing follow-up of the MC group.

Multimodal Protocol for the Treatment of Odontogenic Keratocysts

Purpose: The aim of this study is to evaluate longitudinally the effectiveness of a multimodal protocol based on decompression followed by enucleation combined with the use of liquid nitrogen under local anesthesia for the treatment of odontogenic keratocysts. Methods: Seven patients with a diagnosis of odontogenic keratocyst were evaluated longitudinally to clinical and histological features, and pre- and postoperative radiographs were analyzed. Data were collected on the epidemiological profile of patients and on cysts, including the presence of recurrence, duration of drainage device use, lesion site, and presence of postoperative complications. Results: No recurrence was observed during follow-up. Mean follow-up was 59.57 months (range, 18-96 months). No pathological fracture was observed. None of the patients had persistent paresthesia of the inferior alveolar nerve. Substantial reduction in cyst size and epithelial differentiation were observed in all patients after multimodal treatment. Conclusion: Based on these results, the multimodal protocol proposed here was effective in the treatment of odontogenic keratocysts by reducing lesion size, avoiding possible damage to adjacent anatomical structures, and allowing a surgical procedure with less morbidity. The longitudinal follow-up of patients showed that this treatment modality is associated with a low recurrence rate compared with alternative therapies.

DECOMPRESSION TREATMENT OF ODONTOGENIC KERATOCYST IN ANTERIOR MANDIBLE

Odontogenic keratocyst (OK) accounts for 3% to 11% of all odontogenic cysts. Most occur between the first and fourth decade of life, with a slight prevalence for men, and the posterior mandible is more affected. This study aims to report a case of OK in the region of ment with 2-year follow-up without relapses. A female patient with leukoderma and edentulism complained of swelling in the mental protuberance region, which avoided the use of prosthesis, and in the symphyseal region with integrity of the underlying mucosa. Decompression is an approach that reduces cystic fluid pressure, which allows the volume of the cavity to reduce and, thus, allows for bone apposition around the walls of the lesion, avoiding more invasive treatments. The treatment of OK with decompression and subsequent enucleation and curettage allowed the preservation of the cortical bone and mucous membranes and was considered a successful approach.

Tratamento conservador de queratocisto mandibular: relato de caso de 1 ano de acompanhamento

O queratocisto é um cisto de desenvolvimento raro de alto poder de destruição podendo atingir grandes dimensões e de alto índice de recidiva. Em sua grande maioria essa lesão acomete homens na faixa de 20 a 40 anos acometendo a região posterior de mandíbula. Pode ser assintomático quando em pequenas dimensões mesmo apresentando um crescimento lento, muitas vezes, o diagnóstico pode ser amplamente observado em exames radiográficos de controle que são usados em nosso dia a dia clínico. O objetivo deste relato de caso foi demonstrar o tratamento conservador do Queratocisto Odontogênico (QO) em uma criança de seis anos de idade. O paciente foi submetido ao exame de imagem (radiografia panorâmica) e ao procedimento cirúrgico com resultado de anátomo patológico. É importante informar que o objetivo foi alcançado com a manobra cirúrgica, porém vale ressaltar que o desconforto pelo dispositivo e a dificuldade de higienização do paciente se fez presente. Nota-se que o acompanhamento deste estudo foi de um ano e é recomendado que o paciente deva permanecer indo as consultas preventivas, devido ao alto poder de recorrência desta patologia. Concluímos que a descompressão foi um método utilizado como um tratamento conservador e esta opção de tratamento continua sendo considerado de sucesso e muito menos invasivo dentre as possibilidades apresentadas para esse tipo de patologia.

How well do we manage the odontogenic keratocyst? A multicenter study

The aim of this study was to answer the following clinical questions: Among patients treated for odontogenic keratocysts (OKCs), what is the overall 5-year disease-free rate, and what factors are associated with disease recurrence? We implemented a multicenter retrospective cohort study composed of patients presenting for the evaluation and management of previously untreated OKCs. The predictor variables were grouped into demographic, medical, radiographic, and operative categories. The primary outcome variable was time to lesion recurrence. Data analyses were performed by using bivariate analysis and univariate or multivariate Cox proportional hazards models. The study sample was composed of 231 OKCs. Of these, 57 (24.7%) were treated with decompression with residual cystectomy, 86 (37.2%) with enucleation without adjuvant therapy, and 78 (33.8%) with enucleation with peripheral ostectomy. There were 44 recurrences (19%), with a median time to recurrence of 26.7 months (range 15.8-49.8). This multicenter study is the largest study analyzing disease recurrence after treatment of OKCs by using appropriate statistical analysis for a time-to-event outcome (disease recurrence). The 5-year disease-free estimate was 29%. Mandibular lesions, multilocular lesions, and lesions treated with decompression and residual cystectomy were associated with recurrence.

Clinical and histomorphometric evaluation of decompression followed by enucleation in the treatment of odontogenic keratocyst

Background/purposeThe classification and treatment of odontogenic keratocyst (OKC) are controversial. The objective of this study was to present the efficiency of decompression followed by enucleation by clinical and histomorphometric evaluation for the treatment of OKC. Materials and methodsThirty four OKCs of 27 patients who underwent decompression followed by enucleation were included in this study. Clinical and histomorphometric analysis were performed. ResultsThe average decreasing rate was 59% in maximum diameter, 66% in the amount of the volume for the average of period of the decompression was 9.8 months. The mean of increasing rate of the thickness of the epithelial lining was 921.16%. There were no recurrences for a mean follow-up period of 5.8 years. The thin and friable cyst wall of the OKC was changed to thickened, hard type. ConclusionThe decompression was found to be effective and reliable as a treatment of the OKC to decrease the recurrence tendency, even for Gorlin-Goltz syndrome.

Recurrence rate of odontogenic keratocyst treated by enucleation and peripheral ostectomy: Retrospective case series with up to 12 years of follow-up.

BackgroundOdontogenic keratocysts have been reported with high recurrence rates in the literature so various treatment modalities from simple enucleation to resection have been performed to achieve the cure. The purpose of this retrospective study was to investigate the recurrence rate of odontogenic keratocysts (OKCs) treated by enucleation and peripheral ostectomy.Material and MethodsAn electronic search of the database of the Hacettepe University, Faculty of Medicine, Department of Pathology, was undertaken to identify patients histologically diagnosed with OKCs treated at Department of Oral and Maxillofacial Surgery between 2001 and 2015.ResultsIn total, 81 patients were studied. The mean age at the time of diagnosis was 42 years, and the male:female ratio was 1:0.7. OKCs were located primarily in the posterior mandibular region (41%). Twenty-seven patients were re-examined to determine the recurrence rate. The mean follow-up period was 5 years (range, 1–12 years). The recurrence rate was 14.8%. The relationship between location of the lesion and recurrence was not statistically significant (p = 0.559). There was also no statistically significant relation between the recurrence rate and treatment option of teeth involved in the lesion (p = 0.579).ConclusionsThe authors conclude that treatment of OKCs by enucleation with peripheral ostectomy is associated with minimal morbidity and is preferred over other aggressive treatment modalities. Meticulous radiographic examination and careful surgical resection may decrease the recurrence rate of OKCs. Key words:Odontogenic keratocyst, recurrence rate, enucleation, enucleation plus peripheral ostectomy.

Reclassification and treatment of odontogenic keratocysts: A cohort study.

The odontogenic keratocyst (OKC) is a recurrent cyst that has been recently reclassified from an odontogenic tumor to an odontogenic cyst. The aim of the present study was to investigate its treatment and address issues related to its association with nevoid basal cell carcinoma syndrome (NBCCS). Lesions from the cohort of patients included in the present study consisted of 40 OKCs, of which 27 lesions were treated by enucleation (GE) and 13 underwent decompression (GD). Complementary treatment occurred in 38 (95%) lesions, of which 10 underwent isolated peripheral ostectomy (GO) and 28 underwent peripheral ostectomy combined with Carnoy's solution (GC). Thirteen lesions were associated with NBCCS (GS), while the others (n=27) were non-syndromic lesions (GnS). The recurrence-free periods (RFP) in the sample groups were compared using the Kaplan-Meier function and log-rank test at a significance level of 5% (p < 0.05) and were used to calculate the cumulative risk of recurrence (CRR) in each postoperative year. During the follow-up period, which had a mean of 43.5 months (range: 12-102 months), six (15%) recurrences were diagnosed. There was no significant difference among the RFP for the compared groups (p > 0.05) or increased CRR for the decompression (15.4%) over five years. Application of Carnoy's solution did not increase the efficacy of the peripheral ostectomy, but was related to a CRR of 0% for the syndromic lesions over five years. Therefore, 1) decompression did not increase the recurrence risk; 2) peripheral ostectomy demonstrated a similar efficacy as the combination with Carnoy's solution; 3) the association of NBCCS did not seem to significantly influence OKC recurrence; and 4) syndromic lesions seem to behave in the same manner as non-syndromic lesions when submitted to complementary treatments.