Optimum time of enucleation following marsupialization as a treatment strategy for large odontogenic keratocyst. (Radiologic and histopathologic study) (original) (raw)
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An Experience with a Different Conservative Management of Keratocystic Odontogenic Tumor
The aim of our study is to share our experience with conservative management of odontogenic keratocyst, and also to study the role of carnoy's solution in prevention of recurrence of small keratocystic odontogenic tumour (KCOT). Methods: 29 consecutive patients with 30 KCOT treated in department of Oral & Maxillofacial Surgery in Teerthanker Mahaveer Dental college, Moradabad, UP. Initial biopsy was carried out in all patients and the OKCs were diagnosed after histological examination by the Oral Pathology Department. Out of 26 KCOT which were treated with enucleation alone, 14 patients were subjected to additional burning of cyst epithelium by carnoy's solution. 4 large OKC which might undergone pathological fracture were treated by two stage surgery marsupialization followed by enucleation. Results: The majority of the lesions (17 patients, 56.7%) occurred in the mandibular third molar region. Recurrence occurred in 4 patients, in which 3 of them were from enucleation group and one of marsuplization and enucleation group.All the caseswere monitored continuously with panoramic radiographies and clinical evaluations.curettage of the remaining lesion. The average follow-up was 15 months. Conclusion: Use of carnoy's solution with enucleation has definite advantage over the conventional enucleation. Further large KCOT can be conservatively treated with low morbidity with Marsupilization followed by enucleation successfully. The systematic and long-term post-surgical follow-up is considered to be a key element for successful results.
Journal of Oral and Maxillofacial Surgery, 2019
The literature does not present any consensus on a uniform treatment plan for odontogenic keratocysts and does not give adequate evidence for determining which modality is most effective in either lowering morbidity or preventing recurrence. The purpose of this study was to compare the effective of the surgical treatment based on one-step or two-step protocol. Methods: The investigators designed and implemented a retrospective cohort study and enroll a sample of subjects with diagnoses of odontogenic keratocyst between 1991 and 2018. The medical records of all cases were retrieved from the OMS Division of Piracicaba Dental School-Brazil files. The predictor variable was treatment group (one-step and two-step protocol). The statistical analysis was performed using The Kaplan-Meier, Mantel-Cox log-rank test and Proportional Hazard Regression Analysis. Results: The sample was composed of 72 subjects with a mean age of 40.72 and 38 were male. There were 14 subject in treatment one step and 58 subjects in treatment with two steps. The complex: body, angle and mandibular ramus, is the place most frequently affected. The regression model was significant (Chi-square=24.505, p=0.0108) and demonstrated evidences of age effect (p=0.0290), lesion type (uni-or multi-root, p=0.0130), presence of involved teeth (p=0.0260) on relapses and others factors associated with recurrence were lesion size and protocol used. Conclusion: One-step and two-step protocol of the OKCs is a safe and appropriate treatment as the first treatment option, offering a conservative and effective option with low morbidity. The treatment protocols associated with
Journal of Dentistry, 2019
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 marsu...
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.
Purpose: Among the different surgical treatments for keratocystic odontogenic tumors (KOTs), there is no single method associated with a zero recurrence rate (RR). Thus, this study aimed to seek the best surgical treatment with the least RR using a weighted event rated meta-analysis. Materials and methods: To address our study purpose, a systematic review and meta-analysis based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guideline was performed. An extensive search of major databases through PubMed, EMBASE, and Cochrane CENTRAL was conducted to identify all relevant articles published without language restrictions from inception to August 2016. Relevant articles were selected based on the following inclusion criteria: prospective, retrospective, and case series studies that assessed various treatments in non-syndromic KOTs in which RRs were included. The predictor variable was treatment groups, namely: enucleation alone, enucleation with peripheral ostectomy, enucleation with Carnoy's solution application, enucleation with cryotherapy, marsupialization alone, decompression followed by residual cystectomy, and resection. The outcome variable was RR. A weighted RR using a random effect model (because of variation in follow-up time) with a 95% confidence interval (CI) was performed. Data analysis was performed using a comprehensive meta-analysis software. Results: A total of 2287 KOTs in 35 studies were included in this analysis. The weighted RR for various treatment techniques was as follows: enucleation alone (23.1%), enucleation with curettage (17.4%), enucleation and Carnoy's solution (11.5%), enucleation plus liquid nitrogen cryotherapy (14.5%), marsu-pialization alone (32.3%), decompression followed by residual cystectomy (14.6%), and resection (8.4%). The pooled weighted overall RR of KOTs for all different treatments was 16.6%. Conclusion: Radical resection remains the certain option for obtaining the lowest recurrence with KOTs. However, low recurrence accompanies enucleation with application of Carnoy's solution or cryotherapy as the first-line treatment for primary KOTs. Marsupialization (where indicated) must be followed by secondary cystectomy to minimize recurrence. We believe that to achieve the least possible morbidity, resections should be reserved for multiple recurrent lesions and possibly syndromic cases.
How Well Do We Manage the Odontogenic Keratocyst? a Multicenter Study
Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, 2018
The recurrence rate for the odontogenic keratocyst is widely reported as a simple percent, which may under estimate the true recurrence rate. This is the largest study to date to analyze the recurrence rate using appropriate time-to-event survival analysis.
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, 2007
We discuss the outcome of 2 well-established and widely accepted methods used for the treatment of odontogenic keratocyst (OKC), enucleation with peripheral ostectomy or resection and decompression followed by enucleation and peripheral ostectomy. Patients and Methods: A retrospective chart review of all cases of OKC treated in the University of Maryland's Department of Oral and Maxillofacial Surgery between 1994 and 2004 was undertaken. A total of 31 patients with OKCs was identified. Three of these patients diagnosed with basal cell nevus syndrome and multiple OKCs and 6 patients who did not have adequate follow-up were excluded from this study; thus, 22 patients were evaluated. Of these 22 patients, 11 were treated with resection or enucleation with peripheral ostectomy (group I) and 11 were treated with decompression followed by enucleation when indicated (group II). Results: A total of 22 patients with biopsy-proven OKC ranging in age from 18 to 90 years were separated into 2 treatment arms. Group I comprised 6 females and 5 males, age 18 to 71 years, with 6 OKCs located in the mandible and 5 in the maxilla. Group II comprised 6 females and 5 males, age 24 to 90 years, with 10 OKCs in the mandible and 1 in the maxilla. The choice of treatment approach was based on the size of the cyst, recurrence status, and radiographic evidence of cortical perforation. The last follow-up revealed no recurrences in group I and 2 recurrences in group II. Both patients with recurrence in group II had undergone enucleation of the same lesion in the past, and both cysts recurred within 2 years after initial treatment. Conclusions: Our study results concur with the literature regarding recurrence rates of OKC. The aggressive nature of some OKCs necessitates equally aggressive treatment, whereas long-term follow up even for nonsyndromic patients with single lesions is of paramount importance. Age of the patient and the site and histological characteristics of the treated lesions were not significantly associated with the incidence of recurrence.
Does Surgical Fragmentation of Odontogenic Keratocystic Capsule Interfere With the Recurrence Rate?
Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons, 2017
We hypothesized that fragmentation of the cystic capsule during surgery would influence the recurrence rate of odontogenic keratocysts (OKCs) regardless of the treatment modality chosen. We reviewed, in a retrospective study, cases diagnosed as OKCs on histopathologic examination at the oral pathology department between 1991 and 2013. Fragmentation data were obtained from the records of the oral surgical department. Fragmentation of the capsules of OKCs during surgery did not affect recurrence, irrespective of the chosen treatment modality. The addition of techniques such as cryotherapy lowered the risk of recurrence of OKCs (P = .013) compared with after enucleation alone. Furthermore, patients with associated nevoid basal cell carcinoma syndrome had a greater recurrence rate than that of those with no associated syndrome (P = .033). Fragmentation of the cystic capsule does not play an important role in the rate of OKC recurrence. The rate of recurrence can be modified by using add...
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...