Odontogenic keratocyst: Review of 256 cases for recurrence and clinicopathologic parameters

Jaw cysts diagnosed in an Italian population over a 20-year period

BACKGROUND

Cysts of the jaws (JCs) are an important topic of oral pathology, but few epidemiological data are present in the literature, in particular about the potential of recurrence. The aim of this study was to describe a case series of JCs from a single institution, evaluating the frequency, the site, the age distribution, and the percentage of recurrence of all types of JCs.

METHODS

All JCs present in the histological records of the Section of Anatomic Pathology of the University of Bologna at Bellaria Hospital from 1992 to 2012 were retrieved.

RESULTS

A total of 1136 jaws cysts were obtained, of which 1117 (98.3%) were odontogenic and 19 (1.7%) were nonodontogenic. About odontogenic cysts (OCs), the most frequent was the radicular cyst (538 cases), followed by parakeratinized keratocystic odontogenic tumor (pKOT, 193 cases) and dentigerous cyst (120 cases). Among pKOT, 21 out of 193 cases (10.89%) showed a recurrence after a mean time of 4.5 years (range, 1-12 years). During follow-up (mean 11 years, range 1-19 years), all 3 cases of botrioid cysts, 12 out of 46 cases of unicystic ameloblastoma (26.09%), 2 out of 20 cases of calcifying OCs (10%) and 2 out of 538 cases of radicular cyst (0.37%) showed a recurrence.

CONCLUSION

Our study confirms that the distribution pattern of JCs in Italy is relatively similar to other studies worldwide and emphasizes the importance of recognizing the different histological types of JCs for their potential local aggressive behavior.

Clinical, radiological and therapeutic features of keratocystic odontogenic tumours: a study over a decade

Factors associated with the potential for recurrence of keratocystic odontogenic tumours (KCOT) still remain to be clearly determined and no consensus exists concerning the management of KCOT. The purpose of this study was to evaluate different clinical factors associated with KCOT and its treatment methods. A retrospective review was performed of 55 cases treated from 2001 to 2010. Of the 55 cases, 27% were associated with an impacted or semi-impacted tooth. The majority of the lesions (82%) were located in tooth-bearing areas, and the overall mandibular to maxilla ratio of tumour occurrence was 5:1. The treatment options included enucleation, marsupialisation, or peripheral ostectomy, with or without the use of Carnoy´s solution. Recurrence was found in 14 cases (25%). No significant association was seen between recurrence and age, symptomatic cases, location of the lesion, or unilocular or multilocular appearance. The recurrence rate was higher in the group with tooth involvement, more marked in cases with third molar involvement. Statistical analysis showed a significant relation between recurrence and the type of treatment, with higher rates in cases treated with enucleation associated with tooth extraction. In our series, those cases with a closer relation with dental tissues showed a higher risk of recurrence, suggesting the need for a distinct classification for peripheral variants of KCOT.

Key words:Keratocystic odontogenic tumour, Odontogenic keratocyst, Odontogenic cysts, Keratocyst, Carnoy’s solution.

Possible recurrence of keratocyst in nevoid basal cell carcinoma syndrome: A review of literature

This review will highlight some current areas of difficulty or controversy in diagnosis and treatment of nevoid basal cell carcinoma syndrome (NBCCS). The odontogenic keratocyst (OKC) has significant growth capacity and recurrence potential and is occasionally indicative of the NBCCS. The objective of this study is to clarify the causes of the recurrence of OKC in NBCCS. A literature search was conducted using Medline, accessed via the National Library of Medicine PubMed interface, searching for articles relating to the cause of recurrence of keratocyst in NBCCS written in English. This study has described the previous and the current outcomes of the treatment of OKC (recurrent cause). A protocol was then agreed to search for the possible causes of keratocyst recurrence in NBCCS. The general treatment of other manifestation of NBCCS has excluded from this study. Studies describing cohort, case series and miscellaneous clinical reports were retrieved and evaluated from 2010 to 2012.

Non-syndromic and syndromic keratocystic odontogenic tumors: systematic review and meta-analysis of recurrences

BACKGROUND

Keratocystic odontogenic tumors (KCOTs) are locally aggressive benign tumors which occur in the bones of both jaws with a high recurrence rate. The aim of the present study was to define and evaluate the post-treatment recurrence of KCOT lesions in non-syndromic and syndromic patients.

METHODS

A systematic review of the literature and meta-analysis was conducted according to the PRISMA statement. Seven electronic databases were searched from their start up to August 2013 for clinical studies on human patients without limitation to year, language or publication status.

RESULTS

A total of five case series studies with 323 treated KCOT lesions were included in the quantitative synthesis. The recurrence rate of KCOTs for three treatment forms ranged from 7% to 28%. Comparisons among the various treatments suggest that resection or marsupialization might be associated with fewer recurrences. However, high risk of bias and effect imprecision preclude the making of clinical recommendation. Existing evidence regarding nevoid basal cell carcinoma patients was likewise scarce.

CONCLUSIONS

The absence of studies with low risk of bias precludes the making of safe recommendations about the optimal management of KCOTs.

Gorlin-Goltz syndrome: A rare case report

Gorlin-Goltz syndrome is an uncommon autosomal dominant inherited disorder characterized by numerous basal cell carcinomas, odontogenic keratocysts (OKCs) and musculoskeletal malformations. A rare case of this syndrome observed in a 13-year-old male patient is presented in which multiple OKCs were causing disfigurement of the lower jaw as well as displacement and malocclusion of the teeth. Early diagnosis and treatment of this syndrome is important to reduce the severity of complications including cutaneous and cerebral malignancy and oromaxillofacial deformation and destruction due to jaw cysts.

Keratocystic odontogenic tumor with an ectopic tooth in maxilla

The term odontogenic keratocyst was first used by Philipsen in the year 1956. The lesion was renamed by him as keratocystic odontogenic tumor (KCOT) and reclassified as odontogenic neoplasm in the World Health Organization's 2005 edition that occurs commonly in the jaws having a predilection for the angle and ascending ramus of mandible. In contrast, KCOTs arising in the maxillary premolar region are relatively rare. Here, we discuss a rare case of keratocystic odontogenic tumor occurring in the maxilla with an ectopic tooth position.

Aggressive osseous commitment result by keratocyst odontogenic tumour: case report, radiographic and clinical standpoints

Keratocystic odontogenic tumour (KCOT) previously known as odontogenic keratocyst was recently classified as a benign lesion characterized by an infiltrating pattern, local aggressiveness with the propensity to recurrence. It is thought to arise from the dental lamina. Pain is usually not associated with KCOT until swelling occurs, and it commonly affects the posterior mandible. Multiple KCOT are associated with nevoid basal cell carcinoma syndrome. This study reports an aggressive case of KCOT with destruction of the osseous tissue of the mandible, accentuated face asymmetry, dysphagia and dysphonia. It was managed with a defined protocol which entailed diagnosis, treatment with enucleation along with peripheral ostectomy and rehabilitation. A long-term follow-up schedule was provided to the patient to observe the recurrence behaviour of this cyst. In postoperative phase, no complication was noticed regarding wound healing and recurrence.

The relationship between radiological features and clinical manifestation and dental expenses of keratocystic odontogenic tumor

Purpose

This study was performed to identify correlations between keratocystic odontogenic tumor (KCOT) data from CT sections, and data on the KCOT clinical manifestation and resulting dental expenses.

Materials and Methods

Following local Institutional Review Board (IRB) approval, a seven-years of retrospective study was performed regarding patients with KCOTs treated at the Seoul National University Dental Hospital. A total of 180 KCOT were included in this study. The following information was collected: age, gender, location and size of the lesion, radiological features, surgical treatment provided and dental expenses.

Results

There was no significant association between the size of the KCOT and age, gender, and presenting preoperative symptoms. In both jaws, it was unusual to find KCOTs under 10 mm. The correlation between the number of teeth removed and the size of the KCOT in the tooth bearing area was statistically significant in the mandible, whereas in the maxilla, no significant relationship was found. Dental expenses compared with the size of the KCOT were found to be significant in both jaws.

Conclusion

The size of KCOT was associated with a significant increase in dental expenses for both jaws and the number of teeth removed from the mandible. These findings emphasize the importance of routine examinations and early detection of lesions, which in turn helps preserving anatomical structures and reducing dental expenses.

Keratocystic odontogenic tumor: systematic review with analysis of 72 additional cases from Mumbai, India

OBJECTIVE

The aim of this systematic review was to assess the clinical and imaging findings of keratocystic odontogenic tumor (KOT). This article also attempts to determine the prevalence of KOTs and orthokeratinized odontogenic cyst (OOC) in the western Indian population and to compare demographic and radiographic findings of KOT of our cohort with that of the rest of the world.

STUDY DESIGN

Relevant publications on KOT were reviewed from the published literature from 1976 to March 2012. Data regarding the 72 additional cases from Mumbai also were analyzed.

RESULTS

Sixty-five reports were identified for this systematic review. The findings were divided into 4 global groups for analysis. The prevalence of KOT was 0.0173% and that of OOC 0.0012%. Male sex, mandible, and the unilocular variation were predominant for the additional cases.

CONCLUSIONS

The characterization of the KOT lesions was accomplished, taking into consideration the variations to the western Indian population.

How well do we manage the odontogenic keratocyst?

PURPOSE

To answer the clinical question: Among patients treated for odontogenic keratocysts (OKCs), what is the overall 5-year disease-free rate and what factors are associated with disease recurrence?

MATERIALS AND METHODS

The investigators implemented a retrospective cohort study and enrolled a sample composed of patients presenting for the evaluation and management of previously untreated OKCs. The predictor variables were grouped into demographic, medical, radiographic, and operative categories. The primary outcome variable was time to lesion recurrence. Data analyses were performed using univariate and bivariate or multivariate Cox proportional hazards models.

RESULTS

The study sample was composed of 31 patients (31 OKCs) with a mean age of 41.0 years. Of the 31 OKCs treated, 19 (61.3%) were treated with decompression with or without residual cystectomy and 12 (38.7%) were treated with enucleation with or without adjunctive therapy. There were 8 recurrences in 8 patients, with a median time to recurrence of 17.8 months (interquartile range, 13.4 to 26.4 months). The 5-year disease-free estimate was 51.2% (95% confidence interval, 37.2%-65.2%). Multiloculated lesions were 33.6 times more likely to recur than unilocular lesions.

CONCLUSION

This may be the first study looking at disease recurrence after treatment of OKCs using appropriate statistical analyses for a time-dependent outcome (disease recurrence). The risk for recurrent disease is higher in this report than in many other studies and raises the issue that other reports may have underestimated the risk for recurrent disease owing to inappropriate statistical methods for assessing time-dependent outcomes.

Recurrent keratocystic odontogenic tumor in the masseter muscle overlying the boney perforations: a case report

Keratocystic odontogenic tumor (KCOT) is a benign intraosseous neoplasm of odontogenic origin with high recurrence rates and tendency to invade adjacent tissue. Most recurrences occur in the first 5 years after surgery and are usually located at the site of the primary tumor in the jaws. We report a rare case of KCOT which recurred in the masseter muscle 14 years after segmental mandibulectomy and autogenous frozen lesional mandible reimplantation. The patient had undergone enucleation of KCOT in the right mandible 20 years before segmental mandibulectomy. This case could further demonstrate the aggressive behavior of KCOT.

Radiographic assessment of a keratocystic odontogenic tumour using cone-beam computed tomography

BACKGROUND

The keratocystic odontogenic tumour (KCOT), formerly known as the odontogenic keratocyst, is a benign intra-osseous odontogenic tumour. The KCOT is characterised by a potential for locally destructive behaviour and a relatively high recurrence rate. Most KCOT are incidentally discovered as well-defined unilocular or multilocular radiolucencies on routine panoramic radiographs.

CASE REPORT

A 15-year-old boy was referred to dental care with a non-syndromic KCOT in the right angle of the mandible. Using cone-beam computed tomography (CBCT) as a diagnostic instrument for precise assessment of the KCOT, the exact location of the lesion was determined.

TREATMENT

The cystic formation was enucleated without peripheral ostectomy.

FOLLOW-UP

At post-operative follow-up after 3 and 6 months, the boy reported no pain and there was no residual swelling or fracture. Imaging was planned after 1 year to decide whether further surgical treatment is indicated.

CONCLUSION

The CBCT is considered beneficial in cases of cystic formations to determine the localisation and borders of the lesion in all three dimensions.

Multiple non-syndromic odontogenic keratocysts in three siblings

Occurrence of multiple cysts (MC) involving the jaw is rare. When multiple, it is usually associated with a syndrome. Occurrence of MC without syndromic association is extremely rare. Multiple odontogenic cysts mostly could be odontogenic keratocysts or dentigerous cysts. Odontogenic keratocyst shows involvement of mandible over maxilla, with peak incidence in second and third decade and it is exceedingly rare before 10 years of age. However multiple odontogenic keratocysts found in children are often reflective of nevoid basal cell carcinoma syndrome. Here is a case report which documents multiple jaw cysts involving both the jaws, in three siblings of ages 10, 13 and 17 years with negative parental history. All three reported cases were free of any systemic involvement. As odontogenic keratocyst spreads through bone marrow, destruction is more before any clinical manifestation. Therefore, early detection and intervention are essential in preventing extensive destruction.

The syndromic multiple odontogenic keratocyst in siblings: A familial study

Purpose:

Our aim is to demonstrate the importance of postoperative assessment and highlight the need for a lifetime follow-up of the patient and the siblings in cases of Nevoid Basal Cell Carcinoma Syndrome (NBCCS).

Materials and Methods:

Three siblings out of which two were of syndromic multiple odontogenic keratocysts, with multiple basal cell nevae were followed-up for manifestations of NBCCS from year 2001 till date. Two of the patients were treated for multiple bilateral odontogenic keratocysts (OKCs). Familial occurrence of the syndromic multiple odontogenic keratocysts was studied.

Result:

Although NBCCS is associated with multiple OKCs, it does not imply that a patient should have more than one cyst at a given point in time, rather it refers to the lifetime history of the patient. Early diagnosis will often make it possible to use conservative therapies rather than complex treatments.

Conclusion:

Recognition of the syndrome permits early treatment in other but possibly asymptomatic relatives. Close attention of the family and past medical history and physical examination will alert the clinician to its presence, allowing for appropriate genetic counseling and serial screening for the development of malignancies and other complications besides OKCs.

Keratocystic odontogenic tumours of the jaws and associated pathologies: a 10-year clinicopathologic audit in a referral teaching hospital in Kenya

AIM

To establish the pattern of occurrence and the clinicopathological features of keratocystic odontogenic tumour (KCOT) over a 10-year period.

MATERIALS AND METHOD

Patients from the University of Nairobi Dental Hospital treated for KCOT were included in the study over a 10-year period. The study highlights the demographic, clinico-radiological and histological features of these tumours.

RESULTS

A total of 22 confirmed cases of KCOTs were recorded with equal gender prevalence; (M:F = 1.44:1). The age range of the patients was from 10 to 69 years with a peak in the second decade of life (mean = 27.5 yrs). Of the 22 cases, 15 (68.2%) occurred in the mandible of which eight (53.3%) involved the body, five (33.4%) the angle and ramus. Six (27.3%) occurred in the maxilla, and one (4.5%) was in both jaws and was associated with Gorlin-Goltz Syndrome. The most common presenting complaint in most patients was swelling 54.6%, and in 18.2% was incidental finding. Eight (36.4%) cases showed satellite cysts upon pathologic evaluation. Thirteen (59.1%) cases were managed by surgical excision, while nine (40.9%) were managed by enucleation.

CONCLUSION

Based on the outcome of this study, KCOT present mostly in body, angle and ramus of the mandible and its peak is in the second decade of life.

Incidental discovery of odontogenic keratocyst in an edentulous patient: importance of routine pre-prosthetic radiographic evaluation

The most common modality of treatment for completely edentulous patients are conventional removable complete dentures. The protocol for fabrication of complete denture would involve a thorough clinical examination and radiographic investigation. As a routine, unless clinical findings suggest presence of remnant tooth structures, or the patient presents himself with symptoms, the radiographic investigations are overlooked. This case report presents one such situation wherein routine radiographic evaluation of a clinically asymptomatic edentulous individual prior to prosthetic rehabilitation revealed the presence of an odontogenic keratocyst of anterior maxilla substantiating the importance of such routine pre-prosthetic radiographic investigations.

Survivin gene promoter polymorphism -31G/C as a risk factor for keratocystic odontogenic tumor development

Several single nucleotide polymorphisms in survivin gene promoters, notably -31G/C, have been shown to modulate the expression and activity of the survivin protein. Consequently, the -31G/C polymorphism has been identified as a risk factor for the development of several types of tumors. The aim of this study was to investigate a possible association between the -31G/C polymorphism and the risk for keratocystic odontogenic tumor (KCOT) development. DNA from 52 biopsy specimens of KCOTs and from 82 buccal swabs of healthy individuals was subjected to PCR restriction fragment length polymorphism analysis to identify individual genotypes. The distribution of genotypes in KCOT and control groups, respectively, was: GG: 30 (57.7%) vs. 26 (31.7%); CG: 17 (32.7%) vs. 45 (54.9%); and CC: 5 (9.6%) vs. 11 (13.4%), respectively. These differences were statistically significant. The G allele was more common in the KCOT group than in the control group: 76 (74%) vs. 96 (59%), respectively. Logistic regression analysis showed that GC heterozygotes had a considerably decreased susceptibility for KCOTs compared with GG homozygotes. The same was true for GC+CC vs. GG. The GG genotype of the -31G/C polymorphism might be a risk factor for KCOT development.

[Pediatric keratocystic odontogenic tumor and nevoid basal cell carcinoma syndrome. Predictive factors for recurrence and aggressiveness]

INTRODUCTION

Keratocystic odontogenic tumors (KOT), as complications in Nevoid Basal Cell Carcinoma Syndrome (NBCCS), occur early (before 20 years of age) and are usually more aggressive. The aim of this retrospective study was to determine the clinical, histological, and genetic phenotype, of these lesions and to define predictive features of aggressiveness.

PATIENTS AND METHODS

We retrospectively studied five patients presenting with one or several KOT with NBCCS. We collected their clinical, radiological, and therapeutic data, rate of recurrence or new localization. Anatomopathological examinations were reviewed systematically. Somatic PTCH, SMO and SMAD 4 sequencing were completed.

RESULTS

The average age at diagnosis was 11.2 years. The average number of KOT was 3.2 most often located in the molar region. All the cysts were enucleated. Anatomopathological examination revealed the presence of satellite cysts and daughter cysts and epithelial expansion in more than 80% of cases. No somatic mutation was observed among KOT.

DISCUSSION

KOT develop in the first 10 years, in patients presenting with NBCCS, and recurrence is observed in the second and third decade. KOT are typically aggressive and have a tendency to recur, especially in patients with NBCCS. Anatomopathological examination may be predictive of the lesion's aggressiveness. Understanding the genetic and immunological mechanisms should open the way for new medical treatment.

Recurrent keratocystic odontogenic tumours: report of 19 cases

OBJECTIVES

The aim of this study was to analyse 19 recurrent keratocystic odontogenic tumours (KCOTs).

METHODS

19 patients with recurrent KCOTs were retrospectively analysed. These patients had been treated by either enucleation or a combination of enucleation and Carnoy's solution. The analyses covered major aspects of primary KCOT and/or recurrent KCOT identities, including patient profile, clinical features, histopathology, radiology, treatment and prognosis.

RESULTS

19 (7.4%) out of 257 primary KCOT cases recurred, with an average patient age of 30.5 years (age range 18-45 years). 15 lesions were in the mandible and the remaining 4 were in the maxilla. There were more unilocular than multilocular occurrences for the primary tumours, with a ratio of 2.2:1. These KCOTs were initially treated by simple enucleation (12 cases) or enucleation with Carnoy's solution (7 cases). After the initial surgery, 15 out of 19 (78.9%) recurred within 6 years, while 4 (21.1%) recurred after 6 years. Evidently, the recurrent lesion was involved with the roots of the teeth in three out of six cases whose teeth were preserved. In addition, the recurrent KCOTs had a tendency to be more multilocular or multifocal than the primary cases, with a unilocular-to-multilocular ratio of 1.1:1.

CONCLUSIONS

7.4% of primary KCOTs recurred within 6 years after initial treatment with either enucleation or a combination of enucleation and Carnoy's solution. The recurrent KCOTs were more likely to be multilocular or multifocal than the primary cases and often involved the teeth. The method of operation for these recurrent lesions would be considered as a more aggressive approach.

Conservative management of keratocystic odontogenic tumors of jaws

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%). Inflammation and satellite cysts (daughter cysts) were detected histopathologically in 14 (32.5%) and 7 (16.3%), respectively. Among the 43 cysts, 20 (46.5%) were associated with the impacted third molar and of 21 (48.8%) was in tooth bearing area, and 5 (11, 6%) located on edentulous areas. It was located mostly in the anterior region of maxilla (90%) and in mandibular molar and ramus (62.8%). The treatments of KCOTs were 18 (41.9%) for group 1, and 10 (23.3%) group 2, and 15 (34.8%) group 3. A statistically significant relationship was found between the radiographic appearance and treatment methods (P = 0.00). No recurrence was found on 40.54 ± 23.02 months follow up.

CONCLUSION

We concluded that successful treatment methods were enucleation and Carnoy's solution in small lesions and marsupialization in lesions that have reached a very large size, but because KCOT was observed in second decade mostly, long-term follows up are suggested.

Nevoid basal cell carcinoma syndrome in Indian patients: a clinical and radiological study of 6 cases and review of literature

OBJECTIVE

Nevoid basal cell carcinoma syndrome (NBCCS) is rarely reported in the Indian population. We present the clinical and radiological features of 6 cases of NBCCS in Indian patients.

STUDY DESIGN

The clinical and radiological features of 6 cases of NBCCS were characterized into major and minor criteria and compared with features reported in Indian patients and in patients from other parts of the world.

RESULTS

The most common features seen were presence of multiple keratocystic odontogenic tumors, rib abnormalities, and calcification of falx cerebri. Talons cusp and supernumerary teeth are features not previously reported in association with NBCCS. Basal cell carcinoma was not seen in any patient.

CONCLUSIONS

Combining the current series with 17 additional cases reported in Indian patients, it is evident that the frequency of clinical and radiological features in NBCCS in Indian patients differs from other ethnic groups.

Keratocystic odontogenic tumors: predictive factors of recurrence by Ki-67 and AgNOR labelling

PURPOSE

The purpose of the present study was to investigate the possible role of Ki-67 and argyrophilic nucleolar organizing regions (AgNOR) between the recurrent and nonrecurrent keratocystic odontogenic tumors (KCOTs). Another aim was to compare the correlation between these two markers.

MATERIALS AND METHODS

22 KCOTs were evaluated retrospectively. The actual proliferative activity of the KCOT was measured by Ki-67 labelling index and argyrophilic nucleolar organizing regions AgNOR count per nucleus.

RESULTS

Recurrence occurred in 3 patients (13.6%) during the follow-up period (mean follow-up, 37.8 months) The Ki-67 and AgNOR counts were significantly higher in the recurrent lesions comparing to the non-recurrent lesions. (p=0,045; p=0,049) The correlation between Ki-67 and AgNOR counts was found to be positive (r=0,853 p=0,0001).

CONCLUSION

Within the limit of the present study, it is thought that Ki-67 and AgNOR might be helpful as a prognostic marker for the recurrences of KCOTs. These markers reinforced the meaning of the new classification of the lesion as an odontogenic tumor. Enucleation with curettage or decompression following enucleation with curettage is a simple and appropriate surgical model for the treatment of KCOT despite the relative high recurrence rate. On the other hand, the conservative treatment can be chosen only if there is no coronoid invasion, no interruptive cortical lysis and no tissular invasion.

Two-stage treatment protocol of keratocystic odontogenic tumour in young patients with Gorlin-Goltz syndrome: marsupialization and later enucleation with peripheral ostectomy. A 5-year-follow-up experience

OBJECTIVE

Keratocystic odontogenic tumour (KCOT) is a benign uni- or multicystic intraosseous odontogenic tumour with potential for local destruction and tendency for multiplicity, especially when associated with Gorlin-Goltz syndrome. We suggest a conservative surgical treatment based on marsupialization and later enucleation with peripheral ostectomy in order to preserve jaw's integrity in young patients.

METHODS

Three young patients affected of nevoid basal cell carcinoma syndrome (NBCCS or Gorlin-Goltz syndrome) presented large and multiple KCOTs, which have been treated following a two-stage surgical strategy. Initially marsupialization was performed and after a mean period of 10 months, contextually to evident reduction in radiological size image, enucleation with peripheral ostectomy was carried out.

RESULTS

All the patients showed high collaboration in daily self-irrigation of the stomia with chlorhexidine 0.2% during the period of marsupialization. Definitive surgical intervention led to complete healing and no signs of recurrence have been observed during a 5-year-follow-up.

CONCLUSIONS

The main advantage of this modality is the preservation of important anatomical structures involved in the lesion and jaw's continuity. Therefore in a selected group of cooperative patients, especially those affected of Gorlin-Goltz syndrome, the surgical protocol exposed allows for a less invasive approach with excellent results avoiding extensive disfiguring procedures.

Gorlin-Goltz syndrome

Gorlin-Goltz syndrome is an autosomal dominant inherited disorder characterized by the presence of multiple odontogenic keratocysts along with various cutaneous, dental, osseous, ophthalmic, neurological, and sex organ abnormalities. Early diagnosis is essential as it may progress to aggressive basal cell carcinomas and neoplasias. Gorlin-Goltz syndrome has rarely been reported from India. We report here one such patient, diagnosed at a rural hospital.

[Therapy-resistant aggressive cystic lesion of the mandible]

Several extensive surgical interventions of a cystic lesion in the left mandible were followed by recurrences. The lesion extended from the primary mandibular region into the area of pterygopalatine fossa finally infiltrating the orbital region and the skull base. Histological results could never demonstrate a malignancy with certainty. Due to the patient's poor general condition, the refusal for further surgical inventions and due to the malignoma-like growth pattern radiation treatment was performed. However, this had no effect on tumor progression.

A cumulative analysis of odontogenic cysts from major dental institutions of Bangalore city: A study of 252 cases

Background:

The objective of this study was to perform a cumulative analysis of odontogenic cysts obtained from the data of major dental institutions of Bangalore city, as well as to evaluate their distribution during a 5-year period and compare the results with other international studies.

Materials and Methods:

Data for the study were obtained from the reports of patients diagnosed with odontogenic cysts between 2005 and 2010 from different dental institutions of Bangalore. Case records of patients that fit the histological classification of the World Health Organization (WHO) (2005) were included in the study and the following variables were analyzed: age, gender, anatomic location, and histological type.

Results:

In a total of 252 cyst specimens diagnosed, 79.76% were odontogenic cysts and 20.24% were nonodontogenic cysts. Among the odontogenic cysts most frequent lesions were radicular cysts (50.25%), followed by keratocysts (27.36%) and dentigerous cysts (22.39%).

Conclusions:

Our study provides a cumulative data of odontogenic cysts in the population of Bangalore city. The results of our study showed a similar frequency of odontogenic cysts as compared to other populations of the world, with radicular cyst being identified as the most frequent odontogenic cyst. Keratocyst was the second most common cyst followed by dentigerous cyst.

Maxillary reconstruction for a huge odontogenic keratocyst

A range of different entities may be responsible for cystic lesions in the maxillary region. However, sometimes an accurate diagnosis cannot be made based on clinical or radiologic presentation. In this case, the surgeon should evaluate the clinical situation so that a comprehensive surgical plan that addresses the patient's complaints can be made. We present a 25-year-old female patient with a huge maxillary cyst causing obvious cheek protrusion. For cosmetic concern, she received surgical excision of the cystic lesion and reconstruction of anterior maxillary defect. No recurrence was seen at 18 months' follow-up, and the patient was quite satisfied with the aesthetic result. We reported the case to provide an effective procedure for benign maxillary cysts that result in cosmetic concerns with simple excision and reconstruction.

Range and demographics of radiolucent jaw lesions in a New Zealand population

AIM

To determine the range and demographic features of radiolucent jaw lesions in a New Zealand population.

METHODS

Histopathology reports from the University of Otago School of Dentistry over a 20-year period were reviewed to identify radiolucent jaw lesions. Reporting characteristics where standardised over the time period. There were no clinical exclusive criteria and the samples represented a wide range of clinical presentation and treatment history from multiple providers. Data were analysed using SPSS.

RESULTS

A total of 17, 038 specimens were submitted to the oral pathology diagnostic service of which there were 4983 radiolucent lesions that fulfilled the criteria to be included in the study. The full range of pathology was detected over the twenty-year period and the study showed that the five most common radiolucent jaw lesions were the periapical granuloma, radicular cyst, dentigerous cyst, hyperplastic dental follicle and odontogenic keratocyst, which they accounted for 79.6% of all radiolucent jaw lesions.

CONCLUSION

The range and demographic features of radiolucent jaw lesions in a New Zealand population was similar to international trends.

Keratocystic odontogenic tumour: systematic review

OBJECTIVES

The aim of this review is to evaluate the principal clinical and conventional radiographic features of non-syndromic keratocystic odontogenic tumour (KCOT) by systematic review (SR), and to compare the frequencies between four global groups.

METHODS

The databases searched were the PubMed interface of Medline and LILACS. Only those reports of KCOTs that occurred in a series of consecutive cases, in the reporting authors' caseload, were considered.

RESULTS

51 reports, of 49 series of cases, were included in the SR. 11 SR-included series were in languages other than English. KCOTs affected males more frequently and were three times more prevalent in the mandible. Although the mean age at first presentation was 37 years, the largest proportion of cases first presented in the third decade. The main symptom was swelling. Over a third were found incidentally. Nearly two-thirds displayed buccolingual expansion. Over a quarter of cases recurred. Only a quarter of all SR-included reported series of cases included details of at least one radiological feature. The East Asian global group presented significantly as well-defined, even corticated, multilocular radiolucencies with buccolingual expansion. The KCOTs affecting the Western global group significantly displayed an association with unerupted teeth.

CONCLUSIONS

Long-term follow-up of large series that would have revealed detailed radiographic description and long-term outcomes of non-syndromic KCOT was lacking.

Orthokeratinized odontogenic cyst: a systematic review

OBJECTIVES

The aims of the review were to evaluate the principal clinical and conventional radiographic features of orthokeratinized odontogenic cyst (OOC) by systematic review (SR), and to compare the frequency of OOC between four global groups.

METHODS

The databases searched were the PubMed interface of MEDLINE and LILACS. Only those reports of OOCs that occurred in a consecutive series of OOCs in the reporting authors' caseload were considered.

RESULTS

37 reports on 36 case series were included in the SR. OOC affected males twice as frequently and the mandible almost 2.5 times as frequently. Although the mean age at first presentation was 35 years, the largest proportion of cases first presented in the third decade for the Western, East Asian and Latin American global groups. Seven reports included details of at least one clinical finding. 11 reported case series included at least 1 radiological feature. All OOCs were radiolucent, 93% were unilocular and 68% were associated with unerupted teeth. 28% of the reported case series included follow up. 4% of OCC recurred and all of these were in the Western global group.

CONCLUSIONS

Although one feature of OOCs is that they are unlikely to recur, some do. Not only is there a lack of long-term follow up of large series with long-term outcomes of OOC, but there is a paucity of clinical and radiological details of OOC at initial presentation.

Keratocystic odontogenic tumour: An experience in the northeast of Brazil

Introduction. Keratocystic odontogenic tumours raise particular interest, because of their high recurrence rate and association with nevoid basal cell carcinoma syndrome. Objective. To analyze the clinical and histopathological features of all cases diagnosed as keratocystic odontogenic tumour in a Brazilian population. Methods. A total of 64 keratocystic odontogenic tumours, arising in forty-six patients, were evaluated using the following parameters: association with nevoid basal cell carcinoma syndrome, gender, age at first diagnosis, race, anatomical location, symptoms, radiographic features, history of recurrence, association with teeth, and treatment. Results. Keratocystic odontogenic tumours were more frequent among women than men (1:0.84). The mean patient age was 31.5 years (SD: ?16.6). Ten tumours (16.4%) involved the maxilla and 51 (83.6%) the mandible. Swelling (n=12; 46.1%), followed by pain and swelling (n=4; 15.3%), were most common clinical manifestations. A unilocular radiotransparency with well-defined margins was the main radiographic finding (n=29; 87.8%). A significant association was observed between the multilocular radiographic pattern and recurrence (p<0.05, Fisher?s Test). Sixty-one (95.3%) tumours were treated by surgical enucleation followed by bone curettage, and the recurrence rate was 13% (n=6). This study showed that the keratocystic odontogenic tumours relapsed within a mean period of 25-36 months. Conclusion. Despite the results of this study being similar to previous reports found in the literature, it provides an important insight about keratocystic odontogenic tumours in a Brazilian population.

Lateral periodontal cyst: a case report and literature review

Background

The lateral periodontal cyst is considered a developmental odontogenic cyst with unusual occurrence. In most cases it is preliminary diagnosed as a radiographic finding, presenting as well circumscribed or as a round or teardrop-shaped radiolucent area. Due to its location it can easily be misdiagnosed as a lesion of endodontic origin. Final diagnosis should be based on histopatological examination. The purpose of this paper is to report a classic case of lateral periodontal cyst located in the anterior region of mandible and to review the relevant literature which describes the clinical, radiological and histopathological features of lateral periodontal cysts.

Methods

A 50 years female patient complained of an asymptomatic gingival swelling in the region between the left mandibular lateral incisor and canine. Radiographic examination revealed a well circumscribed radiolucency with approximately 0.5 cm diameter with a radiopaque margin between the roots of the left mandibular lateral incisor and canine. The adjacent teeth had vital pulp.

Results

A total enucleation of the lesion was performed, and intraoperative examination showed a single lesion with no communication between the cyst's cavity and the oral environment. Histological examination revealed that the lesion was "lateral periodontal cyst of developmental origin". There was no recurrence or complications for 24 months follow-up.

Conclusions

The lateral periodontal cyst can be considered in the differential diagnosis when a radioloucent lesion appears adjacent to the roots of vital teeth. The treatment of choice is surgical removal and subsequent histological evaluation to confirm the diagnosis. Relapses are infrequent.