Treatment of a large odontogenic keratocyst using the Brosch procedure

Recurrence of nonsyndromic odontogenic keratocyst after marsupialization and delayed enucleation vs. enucleation alone: a systematic review and meta-analysis

PURPOSE

This study was conducted in order to determine whether marsupialization before definitive enucleation of nonsyndromic odontogenic keratocysts (OKCs) is capable of decreasing the recurrence rate more effectively than just enucleation.

METHODS

We searched MEDLINE, Web of Science, Scopus, and Cochrane Library, until August 5th of 2017 for original studies reporting on the treatment of OKCs with and without previous marsupialization and the related recurrence rate. All records and data were independently assessed, meta-analysis was performed, and the odds ratio of recurrence was the effect measure; P value for the summary effect of < 0.05 was considered statistically significant.

RESULTS

The 748 records retrieved were reduced to 6 studies to be qualitatively assessed and 5 studies were included in the meta-analysis. The overall odds ratio of 0.57 [0.25-1.28] of the pooled values pointed that marsupialization reduced the recurrence rate in comparison to just enucleation; however, the P value showed that there is no strong evidence to support this statement.

CONCLUSIONS

Marsupialization followed by enucleation after 12 to 18 months reduces the recurrence rate, but more studies are necessary to support this statement.

Conservative Treatment of Multiple Keratocystic Odontogenic Tumors in a Young Patient with Nevoid Basal Cell Carcinoma Syndrome by Decompression: A 7-year Follow-up Study

Multiple keratocystic odontogenic tumors (KCOT) occurred in a young child is challenging problem in the field of pediatric dentistry, and might have been related to nevoid basal cell carcinoma syndrome (NBCCS). Because of high recurrence rate of KCOTs, complete surgical resection is generally accepted as definitive treatment. However, complete surgical resection could induce negative effect on the development of permanent teeth and growth of jaw. Herein, we reported successful treatment case of young KCOT patient with NBCCS. Although multiple KCOTs occurred continually, the majority of the lesions healed well by decompression and important anatomical structures and permanent teeth were successfully preserved. The purpose of this paper is to report more conservative treatment of multiple keratocystic odontogenic tumors (KCOTs) by repeated decompressions with later peripheral ostectomy during a 7-year follow-up.

Application of osteomucoperiosteal flap in large unicystic ameloblastoma to promote early bone healing: An alternative to primary bone grafting

Background:

The unicystic variety of ameloblastoma is reported to be significantly less prone to recurrence in young patients than its conventional counterpart, and therefore can be treated conservatively. This paper describes a technique of using an osteoperiosteal flap to allow complete enucleation of a unicystic ameloblastoma. The technique maintains the continuity of the mandible and restores full thickness as well as strength of the mandible to promote early healing. It also maintains blood supply and proper facial contour so that esthetics is unimpaired.

Materials and Methods:

We describe two cases of unicystic ameloblastoma in which we used an osteoperiosteal flap. This flap was then infractured at the lower border to obliterate the dead space.

Results:

The sequential radiographs demonstrate early incorporation of the graft and complete filling of the defect by 3 months. At 5 years of follow-up in our first case, complete healing of bone was observed.

Conclusions:

We believe that these procedures can be the treatment of choice in such cases, especially with larger lesions, as these rapidly restore the patient's facial contour to normal as well as reduce the healing time.

Effects of mandibular odontogenic keratocyst surgery and removable partial prostheses on masticatory performance

STATEMENT OF PROBLEM

Surgical treatment of odontogenic keratocysts often results in tooth loss. However, information about the effects of different surgical methods and postoperative prosthetic therapy on masticatory performance is lacking.

PURPOSE

The purpose of this study was to compare tooth loss following odontogenic keratocyst treatment by enucleation, segmental mandibulectomy with reconstruction, or marsupialization, and the resultant effect on masticatory performance with and without removable partial dentures (RPDs).

MATERIAL AND METHODS

Patients with odontogenic keratocysts of the mandible were treated with either enucleation (n=33), segmental mandibulectomy and immediate autogenous bone reconstruction (n=18), or marsupialization in combination with secondary enucleation (n=9). Clinical and radiographic examinations were used to assess the number of teeth with cyst involvement preoperatively and the number of teeth lost following cyst treatment. Masticatory performance with peanuts was measured after cyst treatment both with and without an RPD. The differences in the number of the teeth involved preoperatively and lost postoperatively were compared among the 3 groups with a chi square test for trend. The absorbance value (reflecting masticatory performance) difference among the 3 groups preprosthesis and postprosthesis was analyzed using a 1-way analysis of variance (ANOVA), respectively. The pre- and postprosthetic comparison was made within each group, and a paired t test was used. Age was compared using 1-way ANOVA among 3 groups. Gender was compared using the chi square test (alpha=.05).

RESULTS

Although the average number of teeth involved preoperatively with the cyst was similar among the 3 treatment groups, the number of teeth lost following marsupialization was significantly less than the number lost following enucleation or segmental mandibulectomy. Prior to provision of an RPD, mean masticatory performance (mean absorbance value of 0.36+/-0.08) in subjects receiving segmental mandibulectomy was significantly lower than for subjects receiving enucleation (0.52+/-0.15) or marsupialization (0.89+/-0.12) (P<.01). Provision of an RPD significantly increased masticatory performance in subjects who were treated by enucleation or segmental mandibulectomy (P<.01).

CONCLUSION

Masticatory performance following odontogenic keratocyst surgery is related to the number of lost teeth, which is a function of the operative method used. Restoration with an RPD postoperatively may improve masticatory function when multiple teeth are lost following enucleation or segmental mandibulectomy.

Glandular odontogenic cyst: Treatment and recurrence

PURPOSE

To investigate the correlation between clinical characteristics, radiologic features, treatment modalities, and treatment outcome of glandular odontogenic cyst, and to suggest a treatment protocol based on these results.

PATIENTS AND METHODS

The study included a total of 56 cases, 49 from the literature and 7 new cases. Demographic data, locularity and radiographic extension, cortical plate integrity, treatment modalities, follow-up, and recurrence were analyzed.

RESULTS

There were 34 male and 22 female patients aged 14 to 74 years (mean, 48 years). The mandible was involved in 41 cases (73.2%) and the maxilla in 15 (26.8%), predominantly in the anterior region; 53.6% of the lesions were unilocular and 46.4% multilocular. Large lesions were found in 78.5% of cases. Cortical integrity was compromised in 53.6% (cortical perforation in 39.3% and thinning or erosion of the cortical plate in 14.3%). Recurrence occurred at a rate of 29.2%, within 0.5 to 7 years (mean, 2.9 years). Mean follow-up was also 2.9 years. Two patients had 3 recurrences each. Recurrence was associated with minor surgery such as enucleation or curettage; none of the patients treated by peripheral ostectomy, marginal resection, or partial jaw resection had a recurrence. Compared with the patients without recurrence, the recurrence group had a higher frequency of multilocularity than the nonrecurrent group (64.3% vs 41.2%) and of compromised cortical integrity (71.4% vs 47.1%).

CONCLUSION

Glandular odontogenic cyst is an aggressive lesion. Treatment by enucleation or curettage alone is associated with a high recurrence rate. Small unilocular lesions can be treated by enucleation. In large uni- or multilocular lesions, an initial biopsy is recommended. Surgical treatment of large lesions should include enucleation with peripheral ostectomy for unilocular cases and marginal resection or partial jaw resection in multilocular cases. Marsupialization followed by second phase surgery is an option for lesions approaching vital structures. Follow-up should continue for at least 3 years (up to 7 years in cases with features associated with increased risk).

Treatment of odontogenic keratocysts: a follow-up of 255 Chinese patients

OBJECTIVE

The purpose of this study was to report our experience in the surgical treatment of 484 Chinese patients with follow-up in 255 cases.

METHODS

A retrospective analysis was conducted of all odontogenic keratocysts that were surgically treated and histopathologically diagnosed between 1962 and 1998. The odontogenic keratocysts were surgically treated with enucleation, marsupialization followed by secondary enucleation, and resection with or without continuity defects. The recurrence rate was evaluated for the patients followed more than 3 years.

RESULTS

Of a total of 489 odontogenic keratocysts, 327 (66.87%) were found in the mandible and 162 (33.13%) in the maxilla. Follow-up data were obtained in 255 patients. Recurrence was found in 31 cases (15.27%) in 203 patients treated with enucleation after an observation period of 3 to 29 years. Twenty-nine recurrences (17.79%) were found in 163 patients treated with enucleation alone, two recurrences (6.70%) were seen in 29 patients who received Carnoy's solution fixation of the cyst wall before enucleation, and no recurrence was found in 11 cases treated with marsupialization in combination with secondary enucleation. No recurrence was seen in 52 patients treated with resection.

CONCLUSION

Odontogenic keratocysts treated with enucleation alone have a higher recurrence rate. Enucleation with adjunctive treatment can decrease recurrence rate. Radical excision has no recurrence but does have the highest morbidity rate and should be reserved for multiple recurrent cysts after conservative means.

The use of enucleation and liquid nitrogen cryotherapy in the management of odontogenic keratocysts

PURPOSE

This study evaluated the use of enucleation and cryosurgery in the management of odontogenic keratocysts.

PATIENTS AND METHODS

This study involved a retrospective review of 26 patients. All of the patients received a combination of enucleation and cryosurgery. Postoperative follow-up consisted of clinical and radiographic examinations.

RESULTS

Before enucleation and cryotherapy, 22 of the 26 patients had received previous treatment consisting of enucleation alone. The average time from initial treatment to recurrence was 6.2 years. Twenty-three cases occurred in the mandible, 22 in the posterior (proximal to the canine), and 1 in the anterior mandible. Three cases involved the maxilla. Three of the 26 patients (11.5%) developed a recurrence after treatment. The average time from treatment to recurrence in these 3 patients was 1.6 years (range, 1.2 to 1.9 years). The remaining 23 patients (88.5%) had no evidence of clinical or radiographic recurrence. The average time of follow-up was 3.5 years (range, 2.0 to 10.0 years).

CONCLUSIONS

Based on these results, the combination of enucleation and liquid nitrogen cryotherapy may offer patients improved therapy in the management of odontogenic keratocysts.

Long-term follow-up on keratocysts treated according to a defined protocol

A prospective study was conducted on 82 odontogenic keratocysts (OKCs) diagnosed in 80 patients over a 25 year period. The clinical and radiographic data were correlated, which resulted in an accurate picture of the clinical presentation, relationship with teeth and incidence of lingual perforations in mandibular OKCs. In 40% of the cysts no suspicion had arisen before surgery, in 60% the diagnosis was secured before surgery. This last group of patients was treated according to a defined protocol, with the exception of the maxillary OKCs, which entailed excision of the attached, overlying mucosa and enucleation of the cyst after which the defect was treated with Carnoy's solution. The other patients underwent just enucleation of the cysts. For the first 5 years the patients were seen every year, thereafter every 2 years if possible. Recurrences (9/82) were mainly found in the patients in which the cyst had just been enucleated. Only three cysts recurred in the group treated according to the above mentioned protocol. Most recurrences presented within 5 years, but late recurrences did occur even after 25 years. The aetiology and pathogenesis of OKCs is briefly discussed in the light of the present findings. It is concluded that the suggested treatment protocol and follow-up schedule provides a safe means to manage a lesion that is known to recur and may even give rise to life threatening situations.

Treatment of mandibular odontogenic keratocysts

OBJECTIVE

The purpose of this study was to report our experience with surgical treatment of 31 mandibular odontogenic keratocysts, with special reference to their recurrence, and to review the literature on this subject.

STUDY DESIGN

A retrospective analysis was conducted of all odontogenic cysts treated in the Department of Oral Surgery and Oral Medicine at Jordan University of Science and Technology between 1989 and 1995. Of a total of 227 odontogenic cysts, 31 odontogenic keratocysts were histopathologically diagnosed preoperatively. They were surgically treated through an intraoral approach by resection without continuity defects. The lower border of the mandible and/or the posterior border of the ramus was left intact. In cases where teeth were in continuity with the lesion, they were extracted. In cases where cortical perforation occurred, any associated overlying mucoperiosteum was excised. All patients were reviewed annually for a follow-up period of 2 to 8 years.

RESULTS

All odontogenic keratocysts were found in the mandible. Of these, 23 were in the ramus and angular region (74.2%) and 8 were located in the body of the mandible. No recurrences of the operated odontogenic keratocysts were observed during the follow-up period.

CONCLUSION

Our findings indicate that removal of odontogenic keratocysts by resection without continuity defects is a satisfactory method of treatment.

Extensive Odontogenic Keratocysts of the Maxilla: Review of the Literature and Report of Six Cases

The clinical, radiological and histological features of six large maxillary odontogenic keratocysts are reviewed. Special treatment considerations for extensive maxillary lesions are discussed. Patient follow-up, including imaging studies, is important to allow the early detection and treatment of recurrent lesions when they are small and well localized.

Treatment of large odontogenic keratocysts by decompression and later cystectomy: a long-term follow-up and a histologic study of 23 cases

OBJECTIVE

The purpose of this study was to determine the course of healing, the frequency of recurrence, and the changes in the epithelium of keratocysts after decompression treatment.

STUDY DESIGN

The treatment of 23 keratocysts, which had been divided into two groups (12 and 11 patients, respectively), was carried out in two phases: (1) insertion of a polyethylene drain and removal of a biopsy specimen from the cyst wall, and (2) cystectomy and removal of the drain approximately 1 year later. Histologic examination of the biopsy material from the two phases was carried out, and the material classified according to Forssell.

RESULTS

Reduction in cyst volume together with bone healing occurred in all cases, although there was recurrence in two patients. Decompression resulted in substantial histologic changes in the epithelium in 19 cases (83%).

CONCLUSIONS

(1) Decompression results in new bone formation and thickening of the cyst wall. (2) This treatment conserves bone and anatomic structures. (3) The frequency of recurrence is low. (4) The keratocyst epithelium is modulated histologically to nonkeratocyst after decompression.