Clinical Paper
Clinical Pathology
Surgical removal of keratocystic odontogenic tumours via a Le Fort I osteotomy approach: a retrospective study of the recurrence rate

https://doi.org/10.1016/j.ijom.2017.01.006Get rights and content

Abstract

The keratocystic odontogenic tumour (KCOT) is one of the most aggressive odontogenic cysts and has a high recurrence rate. The treatment of these tumours is the subject of debate. A KCOT in the posterior maxilla with sinus involvement is rare. Few reports have been published in the literature. The purpose of this study was to evaluate the recurrence rate after surgical removal of maxillary KCOTs via a Le Fort I osteotomy. A search was performed to identify patients with a follow-up time of at least 5 years. Nine patients were included in the study. The following clinical variables were analyzed: age at surgery, sex, symptoms, site and size of the tumour, surgical approach, and recurrence rate. The surgical approaches were curettage (n = 6) and enucleation (n = 3). Recurrence was seen in three patients (33%); all had multilocular tumours. No recurrence was seen in patients with unilocular tumours. The Le Fort I osteotomy approach allows direct visualization and ensures wide excision, minimizing the risk of recurrence. In this series, cases with a multilocular KCOT showed a higher risk of recurrence due to the difficulty of removing the tumour in total. All recurrences took place within 2 years of the intervention; a 5-year follow-up is recommended.

Section snippets

Identification of the study population

A database search was done to find patients who had undergone Le Fort I osteotomy surgery and the surgical removal of cystic lesions over a 20-year period (1995–2015). The International Classification of Diseases, 10th revision (ICD-10) codes EEC.5 and EFA50 were used to identify subjects in the database. A review of the medical records was then performed to confirm the diagnosis. The inclusion criteria were (1) full documentation including surgical notes, (2) confirmed histopathological

Demographic data and clinical manifestations

Fifteen patients were identified in the records. Six patients were excluded from the study because they were followed up for too short a time. Thus, data were collected for nine patients: four female and five male, with a mean age of 37 years (range 16–64 years). Four of the KCOTs were located in the right maxillary sinus and five were located in the left maxillary sinus. The most common symptoms were intraoral discharge (n = 5) and pain (n = 3) (Table 1).

KCOT and treatment strategies

All patients underwent biopsy

Discussion

To achieve the total excision of a KCOT in the maxillary sinus and complete haemostasis, an extensive approach such as the Le Fort I osteotomy is necessary. In the present study, the KCOTs were located in the posterior maxilla and the maxillary sinus. A Le Fort I osteotomy was performed in all cases in order to gain good access to these lesions. This surgical approach was found to be beneficial, with a low recurrence rate in patients with unilocular tumours. A high recurrence rate was seen in

Funding

Linköping University Hospital. This study was supported by the Department of Oral and Maxillofacial Surgery, Linköping, Sweden.

Competing interests

No conflict of interest.

Ethical approval

The study was approved by the Regional Committee for Ethics in Linköping, Sweden (2015/82-31).

References (45)

  • J. Jensen et al.

    A comparative study of treatment of keratocysts by enucleation or enucleation combined with cryotherapy

    J Craniomaxillofac Surg

    (1988)
  • A.B. Bataineh et al.

    Treatment of mandibular odontogenic keratocysts

    Oral Surg Oral Med Oral Pathol Oral Radiol Endod

    (1998)
  • M. Shear

    The aggressive nature of the odontogenic keratocyst: is it a benign cystic neoplasm? Part 1. Clinical and early experimental evidence of aggressive behavior

    Oral Oncol

    (2002)
  • N. Blanas et al.

    Systematic review of the treatment and prognosis of the odontogenic keratocyst

    Oral Surg Oral Med Oral Pathol Oral Radiol Endod

    (2000)
  • J.W. Sikes et al.

    Expansile intraosseous lesion of the maxilla

    J Oral Maxillofac Surg

    (2000)
  • C.R. Albright et al.

    Large dentigerous cyst of the maxilla near the maxillary sinus: report of case

    J Am Dent Assoc

    (1971)
  • P. Scolozzi et al.

    Le Fort I type osteotomy and mandibular sagittal osteotomy as a surgical approach for removal of jaw cysts

    J Oral Maxillofac Surg

    (2007)
  • L. Gold et al.

    Standardized surgical terminology for the excision of lesions in bone: an argument for accuracy in reporting

    J Oral Maxillofac Surg

    (1991)
  • R.B. Brannon

    The odontogenic keratocyst. A clinicopathologic study of 312 cases. Part II. Histologic features

    Oral Surg Oral Med Oral Pathol

    (1977)
  • L. Barnes et al.

    World Health Organization classification of tumours: pathology and genetics of head and neck tumours

    (2005)
  • L. Thompson

    Head and neck pathology

    (2006)
  • R.E. Marx et al.

    Oral and maxillofacial pathology. A rationale for diagnosis and treatment

    (2012)
  • Cited by (0)

    View full text