Conservative Treatment Protocol of Odontogenic Keratocyst: A Preliminary Study

doi:10.1016/j.joms.2005.11.007

Journal of Oral and Maxillofacial Surgery

Volume 64, Issue 3, March 2006, Pages 379-383

https://doi.org/10.1016/j.joms.2005.11.007 Get rights and content

Purpose

The objective of this study was to report our experience with the treatment of 30 odontogenic keratocyst (OKC) patients with a conservative treatment protocol based on decompression with reference to the recurrence rate.

Patients and Methods

Twenty-eight patients (19 females, 9 males) with 30 OKCs attended the OMS Department of the Piracicaba Dental School of Campinas State University between 1995 and 2003. Age range was 13 to 69 years (mean, 30 years of age). Initial biopsy was carried out in all patients and the OKCs were diagnosed after histological examination by the Oral Pathology Department. The cases were treated according to the treatment employed in this department, consisting mainly of decompression and curettage of the remaining lesion. The average follow-up for the 28 cases was 24.89 months (±9.74).

Results

The majority of the lesions (16 patients, 53.3%) occurred in the angle of the mandible and mandibular ramus. The most common histological pattern of OKC was parakeratinized (66.6%) and 13 of 28 patients presented impacted teeth associated with the lesion. The mean time for decompression was 9.27 months. Recurrence occurred in 4 patients (14.3%) with 4 OKCs. These patients were treated initially with decompression and curettage (2 cases), or with decompression only (2 cases). All the cases were monitored continuously with panoramic radiographies and clinical evaluations.

Conclusions

The treatment protocol for OKC based on decompression offers a conservative and effective option with low morbidity and similar recurrence rates to those reported in the literature. The systematic and long-term post-surgical follow-up is considered to be a key element for successful results.

Section snippets

Patients and Methods

Twenty-eight patients (19 females, 9 males) with a total of 30 OKCs attended the OMS Department of Piracicaba Dental School at Campinas State University between 1995 and 2003. Basal cell nevus syndrome patients with multiple OKCs were not included in our trial. Two patients with 2 OKCs in different anatomic locations, without clinical features of Gorlin Syndrome, were included in the sample. In this study, the age range was 13 to 69 years (average, 30 years). All the OKCs were diagnosed by

Results

Of 28 patients, diagnoses of OKC were more prevalent in white (57.1%) young (20–29 years) females (19 patients, 67.9%). Most of the lesions (16 lesions, 53.3%) occurred in the angle of the mandible and mandibular ramus. The most common histologic pattern of OKC was parakeratinized (70%), and 13 of 28 patients presented impacted teeth associated with the lesion. Five OKCs presented satellite cysts and had the pattern parakeratinized. Twenty OKCs (68%) were treated by decompression and curettage

Discussion

Many authors have shown the successful treatment of large OKCs using the technique of decompression and irrigation.10, 11, 15, 16 This treatment does require a cooperative patient who will irrigate the cyst on a regular basis and will follow up regularly. For this reason, only a select group of patients may be suitable for this treatment.

The benefit of this treatment over more conventional approaches (enucleation, en bloc resection) lies in the minimal surgical morbidity. In addition,

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Long-term investigation of minimally invasive alcohol-based therapy as the treatment of odontogenic keratocyst:A retrospective cohort study
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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.
Which devices can be used to decompress odontogenic cystic lesions in the oral cavity? A systematic review
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Odontogenic cysts are bony lesions in the jaws that can reach large sizes. Decompression, a technique that helps in their surgical treatment, aims to reduce their size. We aimed to conduct a systematic review of the main types of device used for the decompression of odontogenic cysts and to analyse the indications, types, advantages, and disadvantages of the devices used. We searched PubMed, Science Direct, LILACS, EMBASE, and Web of Science until February 2023, with no time restriction. We considered studies with a minimum of 10 patients published only in English, those that reported cases and case series, randomised clinical trials of the decompression of odontogenic cysts, and the types of devices used during the decompression period. All reported odontogenic cysts had to have been confirmed by biopsy in their respective publications. We found 713 articles in the selected databases. After removing duplicates, 499 remained. After reading the titles and abstracts, we excluded 461 articles so 38 remained. Nine studies were selected for the review, totalling 244 patients. A total of 206 lesions were identified and confirmed by anatomopathological examination: 123 keratocysts, 40 dentigerous cysts, 34 radicular cysts, one cyst of epithelial origin but without specification, and eight unicystic ameloblastomas. Although we did not find out which device is best for the decompression of odontogenic cysts, our findings show that those that are most effective should be as comfortable as possible and should remain in place. They should have stability in the oral cavity and be easy for the patient to clean.
How reliable are follow-up studies on odontogenic keratocysts?
2023, International Journal of Oral and Maxillofacial Surgery
Follow-up studies on odontogenic keratocysts have reported widely varying recurrence rates. This raises the question of how reliable these studies are and how the results should be interpreted. The aim of this study was to critically assess the information from all follow-up studies published since 2004 against a set of criteria to determine how thorough the study was. These criteria include the exclusion of the orthokeratinized variant, exclusion of cysts associated with nevoid basal cell carcinoma syndrome, and appropriate reporting of dropouts. A search of four electronic databases covering the years 2004–2022 was performed. Only studies with a sufficient follow-up period (covering a range of 1–8 years) were included. Studies with fewer than 40 cases were excluded. Fourteen relevant studies were identified in the literature search. The vast majority of these studies had considerable shortcomings, giving rise to serious doubts about the validity of their recurrence rate results. Of note, these studies have often been included in meta-analyses that report on the best treatment options to reduce the tendency of recurrences. The results of this review strongly suggest that multicentre studies with strict protocols should be performed to advance knowledge of the presentation of recurrences, both the timing and frequency.
Management of the odontogenic keratocysts from diagnosis to treatment: an algorithm derived from the comparison of a single institution experience and literature review
2023, Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology
The aim of this study is to define an algorithm for the management of odontogenic keratocysts (OKCs) in order to reduce the recurrence rate (RR), morbidity and to analyse relapse risk factors.
This article is a 10-years retrospective study on 67 patients treated for odontogenic keratocysts with different surgical options established on clinical and radiological evaluations. Recurrence free survival (RFS) and relapse risk factors were analysed with Kaplan-Meier method and log-rank tests, with a confidence interval set at 95 %. A literature research was performed using PubMed to find the most relevant and recent papers about the argument.
Fifty-five subjects were included: 38 out of 55 patients presented the disease only once, while the others 17 patients presented at least one relapse. The total amount of histological examined lesions and relative surgical procedures was 75. More aggressive treatments showed lower recurrence rate but higher morbidity; more conservative ones had better functional and aesthetic outcomes but higher recurrence rate. Considering the literature, conservative treatments plus adjuvant procedures can reduce the RR. The recurrence rate was estimated to be 25.3 % with a median time to relapse of 24 months. Multilocularity resulted a negative prognostic factor significantly associated with recurrence free survival (p = 0.048).
According to our results and to the literature, we propose a management algorithm from diagnosis to treatment of the OKCs based on dimensions and internal arrangement of lesions, type (primary lesion or recurrence), presence of bony erosions, noble structure/teeth involvement. Multilocularity represented a statistically significant risk factor for relapse.
Volumetric change of bony cavity and shrinkage speed after marsupialization for odontogenic keratocyst and unicystic ameloblastoma
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The aim of this study was to evaluate the efficacy of marsupialization treatment for odontogenic keratocyst (OKC) and unicystic ameloblastoma (UA) based on the three-dimensional volumetric change over time, and to determine the difference between OKC and UA in terms of the absolute volume reduction (AVR) and absolute shrinkage speed (ASS), and whether they are correlated with the preoperative volume, time after marsupialization (time between marsupialization and second treatment), and patient age. This was a retrospective cohort study with a sample size of 60 patients: 29 with OKC and 31 with UA. Pre- and post-marsupialization cone beam computed tomography images were analysed using Mimics software. The volume reduction and shrinkage speed were analysed and correlated with the preoperative volume, time after marsupialization, and demographic data. Descriptive univariable and multivariable statistics were computed; significance was set at P ≤ 0.05. The mean percentage volume reduction after marsupialization was 67.6 ± 9.6% for OKC and 63.3 ± 20.1% for UA. There was no significant difference in AVR or ASS between the OKC and UA groups. For OKC and UA, the preoperative volume (both P < 0.001) and time after marsupialization (P = 0.024 and P < 0.001, respectively) were associated with AVR. Moreover, for OKC and UA, the preoperative volume and time after marsupialization were also significantly associated with the ASS (all P < 0.001). For both lesions, patient age was not significantly related to AVR or ASS. Marsupialization appears to be a viable option to decrease the volume of OKC and UA. Age was found not to be associated with the volume reduction of either UA or OKC.
Long-term bone remodeling after definitive decompression for jaw cysts based on a three-dimensional analysis
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Decompression is an effective treatment for jaw cysts. Many studies have reported its effectiveness as a preliminary treatment followed by secondary enucleation. This study aimed to explore long-term bone remodeling after definitive decompression for jaw cysts based on a three-dimensional (3D) analysis.
This was a retrospective study. The clinical and radiological data of patients with jaw cysts who underwent decompression and were followed up for two years or more at Peking Union Medical College Hospital between January 2015 and December 2020 were reviewed. The 3D radiological data before and after decompression were analyzed to study the long-term reduction in cysts, especially after one year of decompression.
A total of 17 patients with jaw cysts were included in this study. The radiological data showed a mean reduction rate of 78% one year after decompression. At the final examination, which was 36.1 months after decompression on average, the mean reduction rate was 86%. The unossified lesions could still ossify slowly after one year of decompression. The recurrence rate was 5.9% (1/17).
Bone remodeling continued for a long time after decompression. Definitive decompression could be an option for most patients with jaw cysts. Long-term follow-up is required.

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: Received from the Piracicaba Dental School of Campinas State University, Sao Paolo, Brazil.

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Basic and patient-oriented researchConservative Treatment Protocol of Odontogenic Keratocyst: A Preliminary Study

Purpose

Patients and Methods

Results

Conclusions

Section snippets

Patients and Methods

Results

Discussion

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Basic and patient-oriented research
Conservative Treatment Protocol of Odontogenic Keratocyst: A Preliminary Study