Management of keratocystic odontogenic tumour with marsupialisation, enucleation and Carnoy's solution application: a case report (original) (raw)
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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.
Conservative Treatment Protocol for Keratocystic Odontogenic Tumour: a Follow-up Study of 3 Cases
Journal of Oral and Maxillofacial Research, 2010
The keratocystic odontogenic tumour is classified as a developmental cyst derived from the enamel organ or from the dental lamina. The treatment of keratocystic odontogenic tumour of the jaw remains controversial. The aim of this study was to report the outcome of our conservative treatment protocol for keratocystic odontogenic tumour. Methods: Three patients with different complaints referred to Oral and Maxillofacial Surgery Clinic, Faculty of Dentistry, Selçuk University. Initial biopsy was carried out in all patients and keratocystic odontogenic tumours were diagnosed subsequent to histopathological examination. The patients with keratocystic odontogenic tumours were treated by enucleation followed by open packing. This conservative treatment protocol was selected because of existing young aged patients. The average follow-up duration of the cases was 2 years. Results: Out of 3 cases, 2 lesions were present in mandible and 1 lesion in maxilla. There was no evidence of recurrence during follow-up. All the cases were monitored continuously with panoramic radiographs, computed tomography and clinical evaluations. Conclusions: This conservative treatment protocol for keratocystic odontogenic tumours, based on enucleation followed by open packing would be a possible choice with a view of offering low recurrence rate and low morbidity rate particularly in young patients.
Conservative Treatment of Keratocystic Odontogenic Tumour:-A Case Report
IOSR Journal of Dental and Medical Sciences, 2016
The treatment of keratocystic odontogenic tumour remains controversial. The aim of this article is to report the outcome of conservative treatment protocol for a large keratocystic odontogenic tumour crossing the midline treated with enucleation and open dressing. A 33 year old male patient with mandibular anterior swelling was referred to Department of Oral and Maxillofacial Surgery. CBCTreports revealed a large radiolucent lesion extending from 37 to 46 region and associated with bilateral mandibular impacted canines. Histopathological evaluation suggested akeratocystic odontogenic tumour. To minimize the possibility of pathologic fracture and complex surgical intervention the patientwas treated by enucleation followed by open packing. This conservative treatmentwas selected since the patient was young.Postoperative results are encouraging. This conservative treatment protocol for keratocystic odontogenic tumors, based on enucleation followed by open packing can be a possible choice in young patients.
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...
Conservative Management of Keratocystic Odontogenic Tumors of Jaws
The Scientific World Journal, 2012
Purpose. The aim of this study was to evaluate different surgical treatment methods for keratocystic odontogenic tumors (KCOTs) and the outcome of those treatments over a 9-year period.Patients and Methods. A retrospective review was performed on 43 KCOTs in 39 patients. In radiographic evaluations for diagnosis, follow ups and before and after treatment, panoramic, 3D CT and MR images were used. The three groups of different surgical treatment were (1) enucleation for small unilocular lesions without certainty of histology; (2) enucleation with Carnoy's solution, for small unilocular lesions after previous histological confirmation of KOCT; (3) marsupialization followed by enucleation with Carnoy's solution implemented for large often multilocular KCOTs with intact or destruction of cortical bone without infiltration of neighbouring tissue.Results. 43 KCOT cases were mostly localized in mandible (76.7%), radiologically unilocular (72%), and parakeratocysts (88.4%). Inflamma...
Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons, 2015
A variety of modalities has been suggested for treatment of keratocystic odontogenic tumor (KOT), including Carnoy's solution (CS) and modified Carnoy's (without chloroform) solution (MC). The purpose of the present study was to investigate the effect of CS versus MC as it relates to the KOT recurrence rates when used in conjunction with simple enucleation and curettage (E&C) for treatment of KOT. A retrospective cohort study of patients with a pathologic diagnosis of KOT treated with E&C and application of CS or MC by 3 surgeons at a single center from January 1996 to April 2014 was completed. The demographic, clinical, radiographic, and histologic data were collected for each patient. All disease recurrences were confirmed by biopsy. The primary outcome variable of the study was the interval to recurrence, with the predictor of CS versus MC. Other variables included in the analysis were gender, age, surgeon, and lesion location. Multivariate analysis, including the Wilcoxo...
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.
A Narrative Review on the Most Important Management of Keratocystic Odontogenic Tumor
2021
The term odontogenic keratocyst' (OKC) was first described by Philipsen in 1956 [1]. The World Health Organization (WHO) used the term keratocystic odontogenic tumor (KCOT) as benign but aggressive tumor of odontogenic origin in 2005. Histologically, KOT is characterized by a thin parakeratinized stratified epithelium. KCOT is a benign neoplasm with a keratinized epithelial outline with a high recurrence rate [2]. KOT is a relatively common developmental odontogenic cyst and represents approximately 10-14% of all jaw cysts [3]. The reason for the high recurrence rate in KCOT is due to its neoplastic characteristics including high proliferation rate, angiogenesis, presence of daughter cysts and epithelial islands [4, 5]. Incomplete resection of epithelial structure of KCOT due to the fragility of the tumor tissue is another reason for recurrence [4, 6]. In radiographic imaging, KCOT is seen as aunilocular or multilocular well-circumscribed radiolucent lesion with scalloped and co...