Marsupialization and peripheral ostectomy for the management of large odontogenic keratocyst: a case report (original) (raw)
Related papers
Contemporary Clinical Dentistry, 2015
Odontogenic cysts are considered as nonneoplasic benign lesions. Among the cysts, keratocyst odontogenic tumor (KCOT) is an intra-osseous tumor characterized by parakeratinized stratified squamous epithelium and a potential for aggressive, infiltrative behavior, and for the possibility to develop carcinomas in the lesion wall. Thus, the aim of this study was to describe a clinical case of KCOT in a young patient and discuss the treatment alternatives to solve this case. A 15-year-old male was referred for treatment of a giant lesion in his left side of the mandible. After the biopsy, a diagnostic of KCOT was made, and the following procedures were planned for KCOT treatment. Marsupialization was performed for lesion decompression and consequent lesion size reduction. Afterward, enucleation for complete KCOT removal was performed followed by third mandibular molar extraction. After 5 years, no signs of recurrence were observed. The treatment proposed was efficient in removing the KCOT with minimal surgical morbidity and optimal healing process, and the first and second mandibular molars were preserved with pulp vitality. In conclusion, this treatment protocol was an effective and conservative approach for the management of the KCOT, enabling the reduction of the initial lesion, the preservation of anatomical structures and teeth, allowing quicker return to function. No signs of recurrence after 5 years were observed.
Management of an extensive odontogenic keratocyst
Medicine, 2019
Introduction: The odontogenic keratocyst (OKC), previously known as keratocystic odontogenic tumor has been the most disputable pathologies of the maxillofacial region. Patients with OKC are often asymptomatic but may present with pain, swelling, or discharge. Despite the aggressive nature, previous literature as early as 1970s reported the fact that parakeratinized OKC can be treated by means of marsupialization alone. Patients concerns: The patient had reported with a complaint of pain and swelling in relation with a tooth in mandibular right quadrant. Diagnosis: This case report discusses features of a rare, extensive, panmandibular OKC that is only second of its kind mentioned in the literature. Intervention: As a usual treatment protocol, marsupialization was attempted first. Immunohistochemical analysis revealed reduced expression of Ki-67 and B cell lymphoma 2 (bcl-2) markers after marsupialization from 2 separate sites. However, due to incomplete resolution in the lower righ...
Marsupialization as a definitive treatment for the odontogenic keratocyst
Journal of Oral and Maxillofacial Surgery, 2004
Purpose: We sought to show that marsupialization can be a definitive treatment for the odontogenic keratocyst (OKC). Materials and Methods: Ten patients (10 males and 4 females) between the ages of 11 and 64 with biopsy-proven OKC (8 mandibular and 2 maxillary) measuring between 2 and 8 cm were treated by marsupialization consisting of excision of the overlying mucosa and the opening of a 1-cm window into the cystic cavity and, where possible, suturing of the cyst lining to the oral mucosa. Immunohistologic determination of bcl-2 was done for all samples of cyst lining. The cavities were kept open either by vigorous use of a home syringe by the patient or by suturing into place the flange and short length of a nasopharyngeal airway. Once the cyst had largely filled in, histologic material was taken from the base of the residual depression and studied by light microscopy and bcl-2 expression. Results: In the 10 patients, the OKCs completely resolved both clinically and radiographically. The time taken for resolution varied from 7 to 19 months. In all cases, the histologic material obtained after marsupialization showed normal epithelium only, with no signs of cystic remnants, daughter cysts, or budding of the basal layer of the epithelium. At initial biopsy, bcl-2 was expressed in the keratocyst lining, but not in the histologic material obtained after marsupialization. Follow-up time ranged from a minimum of 1.8 years to a maximum of 4.8 years. Teeth at the periphery of the cysts were observed to upright and erupt. Conclusions: All 10 OKCs resolved completely after marsupialization. Teeth within the cyst were found to be upright and erupt. Marsupialization requires a cooperative patient who will irrigate the cavity and keep it open. It appears that the cyst lining is replaced by normal epithelium during this treatment.
Journal of Oral and Maxillofacial Surgery, 2006
A 30-year-old man was referred to the Dental Department because of a hard, tender swelling of the left cheek. The patient reported that the swelling had gradually increased in size over a period of 2 months but denied any neurosensory deficit associated with the left inferior alveolar nerve. His past medical history and his general physical examination were unremarkable: in particular, the patient did not present any skin lesions suggestive of basal cell nevus syndrome. Laboratory data on admission were within the normal limits. Head and neck examination showed left facial swelling along with an expanded and indurate mandibular left buccal vestibule. There was a small discharge of purulent fluid from an opening in the oral mucosa just behind the mandibular left second molar. The teeth on the left side of the mandible presented some carious lesions and the second left molar was necrotic with grade II mobility.
The conservative management of large odontogenic keratocysts
British Journal of Oral and Maxillofacial Surgery, 1985
Odontogenic keratocysts, although well recognised to have a high recurrence rate are not invasive tumours and should not be treated by radical surgery with its attendant morbidity. Four cases of successful management by marsupialisation, and three examples of successful enucleation and packing are described. suggesting that conservative methods can be used in the treatment of large odontogenic keratocysts.
Morphometric evaluation of keratocystic odontogenic tumor before and after marsupialization
Brazilian Oral Research, 2013
The aim of the present study was the morphometric evaluation of the epithelial lining and fibrous capsule in histological specimens of keratocystic odontogenic tumors (KOTs) before and after marsupialization. Histological sections from six KOTs that had undergone marsupialization followed by enucleation were photographed. The thickness and features of the capsule and of the epithelial lining of the tumor were evaluated upon marsupialization and upon subsequent enucleation using Axion Vision software. The histological specimens taken upon marsupialization presented an epithelial lining that is typical of KOTs. After marsupialization, the enucleated specimens had a modified epithelial lining and a fibrous capsule that both presented a greater median thickness (p = 0.0277 and p = 0.0212, respectively), morphological changes, and significant enlargement. These modifications can facilitate full surgical treatment and may well be related to a low KOT recurrence rate.
Journal of Dentistry, 2021
Amongst odontogenic cysts, keratocystic odontogenic tumor (KOT) is a benign intra-osseous lesion, characterized by corrugated parakeratinized uniform stratified squamous epithelium, with potential for aggressive behavior and high tendency to recur. There are multiple treatment modalities for this cyst. Some surgeons prefer the conservative treatments such as marsupialization while the others prefer invasive treatments such as radical resection. The aim of this study was to present a case of KOT involving the right mandibular premolar area with an impacted tooth in a 9-year-old boy treated by marsupialization. The treatment resulted in eruption of the mandibular first premolar, and no signs of recurrence were observed after two years. Marsupialization was found to be an effective treatment in inducing the eruption of mandibular premolar associated with KOT in preadolescents and can be a reliable procedure to reduce recurrence tendency of KOT
The Odontogenic Keratocyst ; Evolution of Treatment Modalities and Recurrence Rates
2020
The odontogenic keratocyst (OKC) is considered one of the more aggressive cysts due to its high recurrence rate, expressed histopathologically by a delicate, friable wall containing small satellite cysts which is often difficult to enucleate from the bone in toto. First described by Philipsen in 1956, this particular entity has evoked much discussion and debate in terms of the treatment options and recurrence rates, in literature. Numerous surgical modalities have been practiced including decompression, marsupialization, enucleation with or without adjunct (such as Carnoy’s solution or cryotherapy) and resection. Having been classified as a cyst of odontogenic origin for over five decades, the designation changed from a cyst to an odontogenic tumour in 2005, and reversed back to a cyst in 2017. Approximately 11 % of all cysts of the maxillofacial region are comprised of odontogenic keratocysts and it is located most commonly in the mandibular posterior region. This paper aims to rev...
Journal of Islamabad Medical & Dental College
Odontogenic keratocysts are odontogenic cysts which have locally infiltrative behavior. They mostly occur in second and fourth decades but can occur at any age throughout life. In majority of cases, they are located in the posterior region of mandible, but can also be found in the maxilla especially in the canine region. In this article, we have discussed the diagnosis and management of a large odontogenic keratocyst cyst involving the maxillary sinus. A 22 years old male patient presented with pain and swelling on right side of the face since last one year. There was history of pus discharge and gradual increase in size of the swelling since last 3-4 months. Patient took antibiotics but there was no improvement. Odontogenic keratocyst is a developmental pathology which arises from additional remnants of dental lamina of oral epithelium. They present with swelling, pain and pus formation/discharge as signs of infection. Often, when the lesion is large there can be paresthesia of the...
The purpose of this study was to determine the Recurrence rate of odontogenic keratocysts (OKC), and association of recurrence with various surgical modalities. It was cohort analytical study. Eighty-two odontogenic keratocysts cases treated at Oral and Maxillofacial department Armed Forces Institute of Dentistry, Rawalpindi farmed the study subject, and were followed for a period of 9 years from 2004 to 2013. Recurrence of OKCs were evaluated from 1-9 years after surgical treatment by clinical and ra-diographic means and correlated with various treatment modalities. The most frequent site affected by OKCs was the posterior mandible including body, angle and ramus. Patients were followed for recurrence. 16 patients were lost to follow up and this journal was 14 cases of recurrence out of 66 were treated with varying modalities (21.2%). Patients treated conservatively with marsupialization or enucleation alone demonstrated higher recurrence rates (100% and 50% respectively). Odontogenic keratocyst is an aggressive cyst associated with high recurrence. Surgeons should decide on various modalities as per requirement of the case. Although resection carries least risk of recurrence, it should be limited to recurrent and aggressive OKCs. The outcomes of enucleation combined with peripheral ostectomy and chemical cauterization is reasonably acceptable.