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Palem SR, Devarakonda V, Navakoti P, Pendyala KS. A rare case of Odontogenic Keratocyst in the Maxillary Sinus: diagnosis and management. Malawi Med J 2023; 35:228-230. [PMID: 38362567 PMCID: PMC10865051 DOI: 10.4314/mmj.v35i4.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
Odontogenic keratocyst is a benign intraosseous lesion of odontogenic origin which is characterized by its aggressive nature. It is usually present in the mandibular posterior area, although it can also be found in the maxilla, particularly in the canine region. We discuss a unique example of OKC in the maxillary sinus involving the 27&28 region. Due to comparable clinical signs, this lesion is more prone to be mistaken for other lesions of the maxillary sinus, such as sinusitis or polyps. On the other side, this benign disease has the potential to develop into Ameloblastoma or squamous cell carcinoma. A favorable prognosis thus depends on early identification, precise diagnosis, appropriate treatment, and follow-ups.
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Alwakeel A, Arakkal Vettath M, Eltanany MA, Waznah R, Aloufi A. Odontogenic Keratocyst Presented as Multi-Locular Radiolucency in Mandibular Canine and Premolar Region: A Case Report. Cureus 2023; 15:e39291. [PMID: 37346195 PMCID: PMC10281079 DOI: 10.7759/cureus.39291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2023] [Indexed: 06/23/2023] Open
Abstract
An odontogenic keratocyst (OKC) was first described by Philipsen in 1956. They are benign cysts of odontogenic origin that behave aggressively and have a high recurrence rate. The present case report describes an unusual presentation of OKC as a multi-locular lesion in the anterior mandible. A 14-year-old male patient was referred to the oral maxillofacial surgery clinic in Tabuk Specialist Dental Centre by his orthodontist to evaluate a radiolucent lesion that had been identified in his lower anterior teeth during an OPG examination. The patient was medically fit and had multiple previous dental restorations. An intraoral examination revealed a small bony expansion in the cystic lesion on the buccal side. The panoramic radiograph showed well-defined multi-locular radiolucencies in the lower left canine area, despite there being no tooth resorption; however, there was a slight divergence noted between the teeth. An excisional biopsy was performed, and the subsequent histopathological examination revealed a cystic lesion diagnosed as an odontogenic keratocyst. The six-month follow-up OPG showed that the site had completely healed without any lesions recurring. OKCs can present at any age, irrespective of gender. The differential diagnosis included a lateral periodontal cyst or a radicular cyst when the tooth was not vital. In this case, the six-month follow-up OPG following surgery revealed no recurrence, although a close follow-up is recommended because of the high recurrence rate.
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Affiliation(s)
| | - Mohamed Arakkal Vettath
- Pediatric Dentistry, Tabuk Specialist Dental Center, Ministry of Health in Tabuk City, Tabuk, SAU
| | | | - Rayyan Waznah
- Restorative Dentistry, Tabuk Dental Center, Tabuk, SAU
| | - Abdullah Aloufi
- Restorative Dentistry, Special Needs Dentistry, Tabuk Specialist Dental Center, Ministry of Health in Tabuk City, Tabuk, SAU
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Is modified Carnoy’s solution as effective as Carnoy’s solution in terms of amount of bone necrosis and depth of penetration? Br J Oral Maxillofac Surg 2023; 61:233-239. [PMID: 36990880 DOI: 10.1016/j.bjoms.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 02/17/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023]
Abstract
Carnoy's solution, a chemical cauterisation agent, has been indicated as one of the adjuvant treatment modalities for odontogenic keratocyst. In 2000, after the ban of chloroform many surgeons adopted the use of Modified Carnoy's solution. The purpose of this study is to compare the depth of penetration and amount of bone necrosis of Carnoy's versus Modified Carnoy's solution on the mandible of Wistar rats at different time intervals. Twenty-six male Wistar rats of six to eight weeks old, weighing approximately 150-200 grams, were allocated for this study. The predictor variables were type of solution and application time. The outcome variable was depth of penetration and amount of bone necrosis. Carnoy's solution was applied on the defect on the right side of the mandible and Modified Carnoy's solution on the left side for five minutes on eight rats, eight minutes on eight rats, and 10 minutes on eight rats. All specimens were subjected to histomorphometric analysis done using Mia image AR software. Univariate ANOVA test, and paired sample t test was done to compare the results. The depth of penetration for Carnoy's solution was more than Modified Carnoy's solution in the three different exposure times. Statistically significant results were observed at five minutes and eight minutes. The amount of bone necrosis was more in Modified Carnoy's solution. The results were not statistically significant at the three different exposure times. To conclude, when one wants to use Modified Carnoy's solution, the minimum exposure time should be 10 minutes to achieve similar results as those of Carnoy's solution.
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Miyamoto S, Goto T, Shirakawa J, Kawano T, Murahashi M, Ide K, Maruyama N, Matayoshi A, Nishihara K, Nakamura H. Odontogenic keratocyst in the mandibular condyle base region: A case report. Exp Ther Med 2023; 25:141. [PMID: 36845954 PMCID: PMC9947583 DOI: 10.3892/etm.2023.11840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 12/30/2022] [Indexed: 02/16/2023] Open
Abstract
Odontogenic keratocysts (OKCs) often occur in the molars in the mandibular ramus; they often progress asymptomatically and are discovered only after widespread development. Some cases of OKC progress to the mandibular condyle; however, very few cases exist only in the condyle. To the best of our knowledge, in all of the previously reported cases, OKCs occurred in the mandibular ramus, which underwent resection. The present study reports the case of a 31-year-old man in whom an OKC (13x12x6 mm) occurred discretely in the base of the condyle, in which the condylar head was successfully preserved. The tumor was removed under general anesthesia using the approach of shaving the anterior surface of the mandible. The extraction cavity was managed using the packed open technique and with an obturator. Approximately 20 months post-operation, the patient remained recurrence-free. This report presents a rare case of an OKC in the mandibular condyle base region. Resection was performed under general anesthesia and the condylar process was successfully preserved.
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Affiliation(s)
- Sho Miyamoto
- Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of The Ryukyus, Nishihara, Okinawa 903-0215, Japan,Correspondence to: Dr Sho Miyamoto, Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of The Ryukyus, 207 Uehara, Nakagami, Nishihara, Okinawa 903-0215, Japan
| | - Takahiro Goto
- Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of The Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Jumpei Shirakawa
- Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of The Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Toshihiro Kawano
- Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of The Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Makoto Murahashi
- Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of The Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Kentaro Ide
- Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of The Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Nobuyuki Maruyama
- Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of The Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Akira Matayoshi
- Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of The Ryukyus, Nishihara, Okinawa 903-0215, Japan,Department of Oral Surgery, Nanbu Tokushukai Hospital, Shimajiri, Okinawa 901-0417, Japan
| | - Kazuhide Nishihara
- Department of Oral and Maxillofacial Surgery, Okinawa Red Cross Hospital, Naha, Okinawa 902-8588, Japan
| | - Hiroyuki Nakamura
- Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of The Ryukyus, Nishihara, Okinawa 903-0215, Japan
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Al-Moraissi EA, Kaur A, Gomez RS, Ellis E. Effectiveness of different treatments for odontogenic keratocyst: a network meta-analysis. Int J Oral Maxillofac Surg 2022; 52:32-43. [PMID: 36150944 DOI: 10.1016/j.ijom.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 09/08/2022] [Accepted: 09/09/2022] [Indexed: 11/30/2022]
Abstract
Odontogenic keratocysts (OKC) are benign but aggressive lesions. As there is a lack of well randomized clinical studies assessing the effectiveness of the different treatment options for OKC, a network meta-analysis (NMA) was performed to identify the best treatment option with the lowest recurrence rate. An electronic search was performed following the PRISMA guidelines to identify all clinical studies comparing treatment options against enucleation alone. The outcome variable was recurrence. The predictor variables were treatments. The eight included treatments were: enucleation with peripheral ostectomy/curettage (E + PO/curettage); enucleation with cryotherapy (E + CRYO); enucleation with/without PO followed by modified Carnoy's solution (E ± PO+MCS); enucleation with PO and with topical 5-fluorouracil (E + PO+5FU); enucleation with/without PO followed by original Carnoy's solution (E ± PO+CS); marsupialization alone (MARS); marsupialization followed by secondary enucleation with/without PO (MARS+2°E ± PO); and resection. The odds ratio was used to estimate the recurrence rate. A frequentist NMA was performed using Stata software. A total of 2989 patients in 40 studies were included. Both direct pairwise meta-analysis and NMA showed that E + 5FU+PO was significantly superior to E ± PO+MCS. However, no statistically significant difference was found between E ± PO+CS vs E + 5FU+PO, E ± PO+MCS, and resection, respectively (all very low quality evidence). The three most effective treatments in reducing the recurrence rate were E + PO+ 5FU (98.1%; very low quality evidence), resection (83.5%; very low quality evidence), and E ± PO+CS (63.8%; moderate quality evidence). The findings from this study suggest that CS remains the most effective fixative agent after enucleation and PO until proven otherwise. Additionally, 5FU appears to be an effective method with promising results that needs further research. Finally, the efficacy of MCS remains controversial; further in vivo and in vitro studies are required to determine new protocols. As this NMA included retrospective studies, the results should be interpreted with great caution (level of evidence: type III).
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Affiliation(s)
- E A Al-Moraissi
- Department of Oral and Maxillofacial Surgery, Thamar University, Thamar, Yemen.
| | - A Kaur
- All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - R S Gomez
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - E Ellis
- Department of Oral and Maxillofacial Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
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Sarfi D, Bouya M, Ben Yahya I. Conservative management of a large Odontogenic Keratocyst: A case report. ADVANCES IN ORAL AND MAXILLOFACIAL SURGERY 2022. [DOI: 10.1016/j.adoms.2021.100238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Chitta S, Patel J, Renapurkar S, Loschiavo C, Rhodes J, King K, Salkey K, Couser N. Nevoid basal cell carcinoma syndrome: a case report and literature review. Ophthalmic Genet 2021; 43:27-35. [PMID: 34608840 DOI: 10.1080/13816810.2021.1983847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Nevoid basal cell carcinoma syndrome (NBCCS) is a rare genetic disorder associated with basal cell carcinomas (BCC), skeletal anomalies, and jaw cysts, and a number of ocular abnormalities. We describe a case of a 12-year-old boy diagnosed with NBCCS found to have several ophthalmic manifestations including a myelinated retinal nerve fiber. We conducted a literature review targeting the ocular and systemic manifestations of NBCCS, with a focus on the ophthalmic findings that have not been well characterized. MATERIALS AND METHODS We conducted a literature search from 1960 to 2021 utilizing specific keywords and criteria and excluded non-clinical articles. A total of 46 articles were ultimately used for the literature review. RESULTS In NBCCS, BCCs typically present before the age of 30 and gradually become numerous. Certain ocular features, less common in the general population, are much more common with NBCCS. Depending on the study, prevalence of these features in patients with NBCCS ranges from 26-80% for hypertelorism and 7-36% for myelinated retinal nerve fiber layer. Prevalence of nystagmus in patients with NBCCS was found to be approximately 6%. Systemic findings such as bilamellar calcification of the falx cerebri, palmar pits, and odontogenic keratocysts (OKCs) are also prevalent. CONCLUSION NBCCS may affect numerous organ systems, and thus requires a multidisciplinary team to manage. BCCs and jaw cysts are commonly occurring clinical features that have various surgical excisional options. The ocular anomalies of NBCCS are individually rare, and certain anomalies may present in the amblyogenic period of development and contribute to visual impairment.
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Affiliation(s)
- Shripadh Chitta
- Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Jineet Patel
- Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Shravan Renapurkar
- Department of Oral and Maxillofacial Surgery, Virginia Commonwealth University School of Dentistry, Richmond, VA, USA
| | - Christopher Loschiavo
- Department of Oral and Maxillofacial Surgery, Virginia Commonwealth University School of Dentistry, Richmond, VA, USA
| | - Jennifer Rhodes
- Craniofacial and Pediatric Plastic Surgery, Children's Hospital of Richmond at VCU, Richmond, VA, USA
| | - Kayla King
- Department of Human and Molecular Genetics, Virginia Commonwealth University Health System, Richmond, VA, USA
| | | | - Natario Couser
- Department of Human and Molecular Genetics, Virginia Commonwealth University Health System, Richmond, VA, USA.,Department of Ophthalmology, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.,Department of Pediatrics, Virginia Commonwealth University School of Medicine, Children's Hospital of Richmond at VCU, Richmond, Richmond, VA, USA
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The immunohistochemical profile of basal cell nevus syndrome-associated and sporadic odontogenic keratocysts: a systematic review and meta-analysis. Clin Oral Investig 2021; 25:3351-3367. [PMID: 33730212 DOI: 10.1007/s00784-021-03877-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 03/08/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To provide a systematic review of the literature on studies comparing the immunoprofile of nevoid basal cell carcinoma syndrome (BCNS)-associated and sporadic odontogenic keratocysts (OKCs), in order to identify markers that could accurately distinguish the two OKC subtypes. MATERIALS AND METHODS We searched MEDLINE/Pubmed, Web of Science, EMBASE via OVID, and grey literature for publications until December 28th, 2019, that compared the immunohistochemical expression of the two OKC subtypes. The studies were qualitatively assessed using the Critical Appraisal Tool for Case Series (Joana Briggs Institute). Sensitivity and specificity, positive and negative likelihood ratio, diagnostic odds ratio and area under the curve, and pooled estimates were calculated, using a random-effects model. RESULTS Seventy-one studies were qualitatively analyzed; 61 markers were evaluated in one study and 32 in ≥ 2 studies. Twenty-five studies reported differential expression of 29 markers in the form of higher number of positive cells or greater staining intensity usually in BCNS-associated OKCs. Meta-analysis for bcl-2, Cyclin D1, CD56, CK18, p53, and PCNA showed that none of those markers is distinguishable between BCNS-associated and sporadic OKCs, in a 95% confidence interval. The risk of bias was high in 34 studies, moderate in 22, and low in 15. CONCLUSIONS The present systematic review and meta-analysis uncovered that, although several immunohistochemical markers might characterize the OKC phenotype, they cannot discriminate between the BCNS-associated and sporadic OKCs. CLINICAL RELEVANCE This study highlighted the requirement for additional screening for markers by immunohistochemistry, preferentially coupled to alternative diagnostic applications such as genomics technologies.
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Al-Juhni A, Al-Omar A, Muaadi H, Al-Anazi A. Conservative management of odontogenic keratocyst by marsupialization. SAUDI JOURNAL OF ORAL SCIENCES 2021. [DOI: 10.4103/sjoralsci.sjoralsci_43_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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10
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Omami G. Multilocular Radiolucency of the Mandibular Ramus and Body. EAR, NOSE & THROAT JOURNAL 2020; 101:292-293. [PMID: 32921174 DOI: 10.1177/0145561320955130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Galal Omami
- Division of Oral Medicine, Diagnosis and Radiology, Department of Oral Health Practice, University of Kentucky College of Dentistry, Lexington, KY, USA
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Kadashetti V, Patil N, Datkhile K, Kanetakar S, Shivakumar KM. Analysis of expression of p53, p63 and proliferating cell nuclear antigen proteins in odontogenic keratocyst: An immunohistochemical study. J Oral Maxillofac Pathol 2020; 24:273-278. [PMID: 33456236 PMCID: PMC7802852 DOI: 10.4103/jomfp.jomfp_203_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 03/04/2020] [Accepted: 03/23/2020] [Indexed: 11/25/2022] Open
Abstract
Background: Odontogenic keratocyst (OKC) is a benign intraosseous lesions (within the jaw bone) of odontogenic origin that account for about 10% of jaw cysts. They are characterized by an aggressive behavior with a relatively high recurrence rate. Early diagnosis and follow-up of the patient with OKC is important because the possibility of such patient there is develop to other features of Nevoid basal cell carcinoma syndrome in future. Considering the roles and effects of p53, p63 and proliferating cell nuclear antigen (PCNA) in cells proliferation, this study was designed. Objectives: To understand the behavior of epithelial cells in pathogenesis and biological aspects of OKC in diagnosis. Materials and Methods: Immunohistochemical (IHC)technique was performed in 21 cases of OKCs. Results: Immunological stained p53 cells were mainly located in the suprabasal layers. p63 and PCNA-positive cells were found throughout the lining epithelium including basal and suprabasal cell layers. The intensity of staining was more in p63 and PCNA than the p53 expression of the cystic epithelial lining. Conclusions: It is possible that the biological behavior of OKCs may be related to the suprabasal proliferative compartment in the cystic epithelium as observed. These proteins may participate in the regulation of epithelial cell differentiation. Taken together, these data may favor tumerigenesis on OKCs.
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Affiliation(s)
- Vidya Kadashetti
- Department of Oral Pathology and Microbiology, Forensic Odontology, School of Dental Sciences, Krishna Institute of Medical Sciences Deemed University, Malkapur, Maharashtra, India
| | - Nanda Patil
- Department of Pathology, Krishna Institute of Medical Sciences, Krishna Institute of Medical Sciences Deemed to be University, Malkapur, Maharashtra, India
| | - Kailas Datkhile
- Department of Molecular Biology and Genetics, Krishna Institute of Medical Sciences Deemed University, Malkapur, Maharashtra, India
| | - Sujata Kanetakar
- Department of Pathology, Krishna Institute of Medical Sciences, Krishna Institute of Medical Sciences Deemed to be University, Malkapur, Maharashtra, India
| | - K M Shivakumar
- Public Health Dentistry, School of Dental Sciences, Krishna Institute of Medical Sciences Deemed University, Malkapur, Maharashtra, India
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Consolo U, Tognacci S, Barausse C, Carlo Salgarelli A, Bellini P. Enucleation of a multilocular odontogenic keratocyst using sagittal osteotomy: A case report. ORAL AND MAXILLOFACIAL SURGERY CASES 2020. [DOI: 10.1016/j.omsc.2020.100154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Firth N, Alsarraf A, Vujcich N, Kujan O. Synchronous occurrence of odontogenic keratocyst and ameloblastoma: A case report and review of the literature. Clin Pract 2020; 10:1205. [PMID: 32637055 PMCID: PMC7322632 DOI: 10.4081/cp.2020.1205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 06/17/2020] [Indexed: 11/22/2022] Open
Abstract
Odontogenic keratocyst (OKC) and ameloblastomas are distinct histopathologically diagnosed odontogenic lesions of the oral cavity. Both are primarily located in the posterior regions of the mandible, however, they can involve the maxilla as well. The occurrence of both an OKC and ameloblastoma in a patient is very uncommon. This case demonstrated such a lesion in the mandible of a 57 years old female. The diagnostic work-up and features of both lesions are illustrated with special focus on histopathological variances distinguishing OKC from ameloblastoma with the support of immunohistochemistry. This case highlights the importance of identifying accurate diagnoses for such lesions which may prompt clinical implications. Clinico-pathologic understanding of both lesions signifies the need for careful management plan and prevention of recurrence. Previously reported simultaneous occurrences of odontogenic cysts and/or tumors in the oral cavity are also reviewed.
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Affiliation(s)
- Norman Firth
- School of Dentistry, University of Queensland, Herston QLD, Australia
| | | | - Nathan Vujcich
- Department of Oral and Maxillofacial Surgery, Royal Perth Hospital, Perth WA, Australia
| | - Omar Kujan
- UWA Dental School, University of Western Australia, Nedlands WA, Australia
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Giovacchini F, Bensi C, Paradiso D, Belli S, Mitro V, Tullio A. Factors influencing the recurrence of keratocysts: monocentric study. JOURNAL OF ORAL MEDICINE AND ORAL SURGERY 2019. [DOI: 10.1051/mbcb/2019031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Introduction: The purpose of the study was to retrospectively analyse the recurrence rate of odontogenic keratocysts and to identify eventual features of the lesions that may influence recurrence. Material and methods: This was a retrospective study carried out for a period of 3 years. The medical records of patients treated in our institution were analysed to identify all the cases of odontogenic keratocysts. Results: A total of 16 odontogenic keratocysts were recorded. These lesions were treated with simple enucleation with or without adjuvant Carnoy's solution. The relapse occurred in 4 patients treated with simple enucleation and in none of the patients that underwent enucleation and Carnoy's solution application. The kind of treatment appeared not to influence recurrence rate at statistical analysis. Conclusions: Odontogenic keratocyst is a lesion with a locally aggressive behavior and a high tendency to relapse. This tendency of recurrence may be greater with syndromic presentation of odontogenic keratocyst, with soft tissue involvement, and with teeth proximity to the lesion. The application of Carnoy's solution may be useful to minimize recurrence rate in those odontogenic keratocysts with an aggressive clinical behavior and secondly may be used for all the other lesions treated with simple enucleation that experienced relapse.
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Kammer PV, Mello FW, Rivero ERC. Comparative analysis between developmental and inflammatory odontogenic cysts: retrospective study and literature review. Oral Maxillofac Surg 2019; 24:73-84. [PMID: 31858303 DOI: 10.1007/s10006-019-00816-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 11/12/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE To assess epidemiological, clinical, and radiographic characteristics of odontogenic cysts (OCs) in a South Brazilian sample and to compare the results with international literature. METHODS For the main study purposes, biopsy and histopathological records were retrospectively analyzed from December 2006 to December 2018, OC cases were selected, and data about clinical characteristics were evaluated. Further, a literature review was performed for similar studies. RESULTS In the main study, the prevalence of OCs was 11.26% (n = 406), the majority of patients was male (56.73%), and the mean age was 39 ± 17.33 years. Radicular cyst was the most common OC (46.06%), followed by the odontogenic keratocyst (15.02%), dentigerous cyst (14.04%), and paradental cyst (13.55%). Inflammatory OCs were more prevalent in the maxilla (54.84%) and developmental cysts in the mandible (69.92%) (p < 0.05). Individuals with inflammatory OCs were usually older (41.0 ± 15.34 years) than the ones with developmental OC (28.0 ± 19.68 years) (p < 0.05). Regarding the literature review, 22 articles were included. Analysis of pooled data showed that global prevalence of OCs was 11.62% (95%CI = 9.97-13.37), from which radicular cyst was the most common (54.26%; 95%CI = 49.30-59.18), followed by dentigerous cyst (22.94%; 95%CI = 19.22-26.89) and odontogenic keratocyst (11.99%; 95%CI = 8.88-15.49). Furthermore, studies from Asia (72.40%; 95%CI = 70.30-74.40) and South America (68.48%; 95%CI = 64.07-72.72) presented the highest frequencies of inflammatory OCs. CONCLUSION The main study showed that the prevalence of OCs was 11.26%, which corroborates with international literature. Considering geographic variability of OC distribution, public health authorities and researchers could use these data for the development of focused prevention interventions, especially with regard to inflammatory OCs.
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Affiliation(s)
- Pedro Vitali Kammer
- Dental School, Federal University of Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil
| | - Fernanda Weber Mello
- Postgraduate program in Dentistry, Federal University of Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil
| | - Elena Riet Correa Rivero
- Department of Pathology, Health Sciences Center, Federal University of Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil.
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Conservative management of odontogenic keratocyst with long-term 5-year follow-up: Case report and literature review. Int J Surg Case Rep 2019; 66:8-15. [PMID: 31785568 PMCID: PMC6889737 DOI: 10.1016/j.ijscr.2019.11.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 11/13/2019] [Accepted: 11/14/2019] [Indexed: 11/26/2022] Open
Abstract
The World Health Organization, in the last classification of the Head and Neck tumours defined Odontogenic Keratocyst as a cyst instead of a tumor. There are plenty of approaches in order to reduce the high recurrence of this lesion consisted in surgical, non-surgical and combined treatment. Surgical treatment is considered, for several years as the gold standard treatment, but currently a combined therapy has become as a first choice.
Introduction Odontogenic Keratocyst (OKC) is a benign lesion recently considered an odontogenic cyst in the present World Health Organization (WHO) classification of Head and Neck tumors (2017) mainly based on its clinical and histopathological features. Several studies, systematic reviews and meta-analyses have shown a multimodal approach to reducing the high recurrence rates inherently exhibited by this pathological condition after long-term periods of follow-up. Presentation of case The patient, a 67-years-old woman, was submitted to conservative surgical management of an odontogenic keratocyst. Initially this consisted of decompression and subsequent enucleation, with a long-term period of follow-up to ensure that there was no recurrence. Discussion Conservative surgical management is the first choice and might be considered the gold standard, but combined therapy such as marsupialization, application of Carnoy’s solution, enucleation of the remnant lesion and an extensive follow-up period would considerably reduce recurrence rates. Conclusion Therefore, an appropriate long-term follow-up must be done after the treatment performed in order to ensure clinical success, which in this case was described as an absence of signs of recurrent disease.
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Hakeem A, Fitzpatrick SG, Gonsalves CA, Isom J, Islam MN, Bhattacharyya I, Cohen DM, Drew PA. p16INK4a as a proliferation marker unrelated to HPV expression in odontogenic cysts and tumors. J Oral Pathol Med 2019; 49:72-81. [PMID: 31680334 DOI: 10.1111/jop.12972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/24/2019] [Accepted: 10/27/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION p16INK4a is a tumor suppressor protein that retards cell cycle progression from G1 to S phase. Prior studies have evaluated p16INK4a expression in odontogenic keratocyst and ameloblastoma, but data regarding other odontogenic cysts and tumors have been sparse. METHODS With IRB approval, cases from the following entities were identified from archives of the UF Oral Pathology Biopsy Service (2005-2015): benign incidental odontogenic rest, dentigerous cyst, lateral periodontal cyst, calcifying odontogenic cyst, glandular odontogenic cyst, odontogenic keratocyst, orthokeratinized odontogenic cyst, adenomatoid odontogenic tumor, calcifying epithelial odontogenic tumor, and ameloblastoma. All cases were submitted for p16INK4a immunohistochemical testing. RESULTS Results were scored as follows: nuclear and cytoplasmic staining of <5% cells (score 0), 5%-25% (score 1), 25%-50% (score 2), >50% (score 3). No significant difference in p16INK4a staining was noted between odontogenic cysts and the listed odontogenic tumors (chi-square, P = .540). When comparing lesions with higher recurrence rates (over 25% as reported in the literature) versus lesions with low recurrence rates (under 25%), higher recurrence correlated to significantly higher p16INK4a positivity (chi-square, P = .001). Follow-up testing was performed on 18 cases with "2" or "3" p16INK4a expression scores for high-risk HPV strains through HPV in situ hybridization (ISH) messenger RNA testing with no cases exhibiting a positive result. CONCLUSION This study exhibits an association between increased p16INK4a positivity and odontogenic lesions with higher recurrence rates and highlights the role of p16INK4a as a progression marker unrelated to HPV expression in this group of pathologic entities.
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Affiliation(s)
- Abdulaziz Hakeem
- Department of Oral and Maxillofacial Diagnostic Sciences, College of Dentistry, University of Florida, Gainesville, FL, USA
| | - Sarah G Fitzpatrick
- Department of Oral and Maxillofacial Diagnostic Sciences, College of Dentistry, University of Florida, Gainesville, FL, USA
| | - Catherine A Gonsalves
- Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - James Isom
- Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Mohammed N Islam
- Department of Oral and Maxillofacial Diagnostic Sciences, College of Dentistry, University of Florida, Gainesville, FL, USA
| | - Indraneel Bhattacharyya
- Department of Oral and Maxillofacial Diagnostic Sciences, College of Dentistry, University of Florida, Gainesville, FL, USA
| | - Donald M Cohen
- Department of Oral and Maxillofacial Diagnostic Sciences, College of Dentistry, University of Florida, Gainesville, FL, USA
| | - Peter A Drew
- Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
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Fidele NB, Zhao Y, Tianfu W, Sun Y, Man Q, Liu B. Treatment of Multiple Odontogenic Keratocysts Involving Chinese Patients. J Oral Maxillofac Surg 2019; 77:2044-2054. [PMID: 31276655 DOI: 10.1016/j.joms.2019.05.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/30/2019] [Accepted: 05/30/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE The optimal treatment of odontogenic keratocysts (OKCs) remains a matter of debate in reported studies. The present study aimed to estimate the postoperative recurrence rates of multiple OKCs (MOKCs) in Chinese patients. MATERIALS AND METHODS A retrospective cohort study of histologically confirmed MOKCs treated from 2003 to 2017 using enucleation, marsupialization alone, enucleation and peripheral ostectomy, or marsupialization followed by secondary enucleation was performed. Patients with MOKCs who had undergone follow-up for 12 or more months with panoramic radiographs and radiographs of the chest and skull available from the first visit and had been treated by the same team using the same treatment protocol were included in the study. Patients were excluded if the lesion had been treated previously, they had a solitary OKC, or their medical records were not available for review. The treatment methods, recurrence rate, and interval to recurrence were evaluated. The Kaplan-Meier method was used to estimate the survival rate and median time to recurrence. Univariate analysis was used to identify the risk factors associated with recurrence. Significant differences were determined at an α level of 5%. RESULTS The sample included 81 patients with MOKCs; 21 (25.6%) were male and 60 (74.07%) were female. The age range was 7 to 63 years (mean ± standard deviation, 18.4 ± 4). The overall recurrence rate was 26.63%, with an overall recurrence-free interval of 26.85 months. The average length of follow-up was 55.68 months. No association was found between the treatment method used and the risk of recurrence (P = .178). Although the interval to recurrence was not affected by any of the study variables, the average interval to the recurrence of MOKCs involving the maxilla was short compared with that of MOKCs involving the mandible. CONCLUSIONS The surgical treatment method did not influence the risk of recurrence in patients with MOKCs, and the interval to recurrence was not associated with any of the study variables.
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Affiliation(s)
- Nyimi Bushabu Fidele
- Resident, Department of Oral Maxillofacial Head and Neck Oncology Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Yifang Zhao
- Professor, Department of Oral Maxillofacial Head and Neck Oncology Surgery; and State Key Laboratory Breeding Base of Basic Science of Stomatology and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Wu Tianfu
- Resident, Department of Oral Maxillofacial Head and Neck Oncology Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Yanfang Sun
- Resident, Department of Oral Maxillofacial Head and Neck Oncology Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Qiwen Man
- Resident, Department of Oral Maxillofacial Head and Neck Oncology Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Bing Liu
- Associate Professor, Department of Oral Maxillofacial Head and Neck Oncology Surgery; and State Key Laboratory Breeding Base of Basic Science of Stomatology and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China.
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Dokova AF, Anamali S, Ismail R, Lindhout JA, Benavides E, Salzmann LB, Danciu TE. A pediatric patient with multiple radiolucencies impeding normal tooth eruption. J Am Dent Assoc 2019; 150:70-75. [DOI: 10.1016/j.adaj.2018.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 05/09/2018] [Accepted: 05/15/2018] [Indexed: 11/16/2022]
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Slusarenko da Silva Y, Stoelinga PJW, Naclério-Homem MDG. Recurrence of nonsyndromic odontogenic keratocyst after marsupialization and delayed enucleation vs. enucleation alone: a systematic review and meta-analysis. Oral Maxillofac Surg 2018; 23:1-11. [PMID: 30498866 DOI: 10.1007/s10006-018-0737-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 11/16/2018] [Indexed: 12/24/2022]
Abstract
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.
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Affiliation(s)
- Yuri Slusarenko da Silva
- Department of Oral and Maxillofacial Surgery, Traumatology and Prosthesis, Faculty of Dentistry of the University of São Paulo, Av Prof. Lineu Prestes 2227 Butantã, São Paulo, 05508-000, Brazil.
| | - Paul J W Stoelinga
- Department of Oral and Maxillofacial Surgery, Radboud University, Nijmegen, the Netherlands
| | - Maria da Graça Naclério-Homem
- Department of Oral and Maxillofacial Surgery, Traumatology and Prosthesis, Faculty of Dentistry of the University of São Paulo, Av Prof. Lineu Prestes 2227 Butantã, São Paulo, 05508-000, Brazil
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Yuhan BT, Svider PF, Mutchnick S, Sheyn A. Benign and Malignant Oral Lesions in Children and Adolescents: An Organized Approach to Diagnosis and Management. Pediatr Clin North Am 2018; 65:1033-1050. [PMID: 30213347 DOI: 10.1016/j.pcl.2018.05.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Oral lesions in children encompass a wide range of etiologies, including idiopathic entities as well as those related to an underlying systemic illness. In addition, oral masses include benign entities harboring locally destructive behavior and even malignancies in rare cases. Thorough patient history and detailed and efficient physical examination are critical for determining which lesions can be closely observed versus those require further diagnostic work-up. Understanding normal oral cavity anatomy is crucial for performing appropriate evaluation. This review describes the appropriate diagnostic and therapeutic strategies for oral cavity lesions and reviews the broad differential diagnosis of oral cavity masses.
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Affiliation(s)
- Brian T Yuhan
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, 4201 Street Antoine, Detroit, MI 48201, USA
| | - Peter F Svider
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, 4201 Street Antoine, Detroit, MI 48201, USA.
| | - Sean Mutchnick
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, 4201 Street Antoine, Detroit, MI 48201, USA
| | - Anthony Sheyn
- Department of Otolaryngology, University of Tennessee Health Science Center, 910 Madison Avenue, Suite 420, Memphis, TN 38163, USA; Department of Pediatric Otolaryngology, LeBonheur Children's Hospital, 848 Adams Avenue, Memphis, TN 38103, USA; Department of Otolaryngology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
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Odontogenic keratocyst: imaging features of a benign lesion with an aggressive behaviour. Insights Imaging 2018; 9:883-897. [PMID: 30066143 PMCID: PMC6206371 DOI: 10.1007/s13244-018-0644-z] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 06/07/2018] [Accepted: 06/28/2018] [Indexed: 12/22/2022] Open
Abstract
Abstract The latest (4th) edition of the World Health Organization (WHO) Classification of Head and Neck Tumours, published in January 2017, has reclassified keratocystic odontogenic tumour as odontogenic keratocyst. Therefore, odontogenic keratocysts (OKCs) are now considered benign cysts of odontogenic origin that account for about 10% of all odontogenic cysts. OKCs arise from the dental lamina and are characterised by a cystic space containing desquamated keratin with a uniform lining of parakeratinised squamous epithelium. The reported age distribution of OKCs is considerably wide, with a peak of incidence in the third decade of life and a slight male predominance. OKCs originate in tooth-bearing regions and the mandible is more often affected than the maxilla. In the mandible, the most common location is the posterior sextant, the angle or the ramus. Conversely, the anterior sextant and the third molar region are the most common sites of origin in the maxilla. OKCs are characterised by an aggressive behaviour with a relatively high recurrence rate, particularly when OKCs are associated with syndromes. Multiple OKCs are typically associated with the nevoid basal cell carcinoma syndrome (NBCCS), an autosomal dominant multisystemic disease. Radiological imaging, mainly computed tomography (CT) and, in selected cases, magnetic resonance imaging (MRI), plays an important role in the diagnosis and management of OKCs. Therefore, the main purpose of this pictorial review is to present the imaging appearance of OKCs underlining the specific findings of different imaging modalities and to provide key radiologic features helping the differential diagnoses from other cystic and neoplastic lesions of odontogenic origin. Key Points • Panoramic radiography is helpful in the preliminary assessment of OKCs. • CT is considered the tool of choice in the evaluation of OKCs. • MRI with DWI or DKI can help differentiate OKCs from other odontogenic lesions. • Ameloblastoma, dentigerous and radicular cysts should be considered in the differential diagnosis. • The presence of multiple OKCs is one of the major criteria for the diagnosis of NBCCS.
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Kaczmarzyk T, Kisielowski K, Koszowski R, Rynkiewicz M, Gawełek E, Babiuch K, Bednarczyk A, Drozdzowska B. Investigation of clinicopathological parameters and expression of COX-2, bcl-2, PCNA, and p53 in primary and recurrent sporadic odontogenic keratocysts. Clin Oral Investig 2018; 22:3097-3106. [PMID: 29508125 PMCID: PMC6224022 DOI: 10.1007/s00784-018-2400-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 02/22/2018] [Indexed: 11/15/2022]
Abstract
Objectives Odontogenic keratocyst (OKC) presents considerable variation in aggressiveness and propensity for recurrence, yet hitherto, no explicit clinicopathological features have been determined to clearly demonstrate the potential for relapse. This retrospective study aims to investigate the prognostic relevance of various clinicopathological features as well as immunoexpression of COX-2, bcl-2, PCNA, and p53 in sporadic OKC. Materials and methods Among 41 patients with OKC treated by enucleation, the frequency of recurrence for various clinicopathological features as well as immunoexpression for COX-2, bcl-2, PCNA, and p53 was evaluated. Results The mean follow-up was 8.49 years, and recurrences were ascertained in 29.27% of cases. We found significant differences between recurrent and non-recurrent cysts in terms of multilocularity (P = 0.029), cortical perforation (P = 0.001), and lesion size (P < 0.001). Hazard risk for the recurrence was 3.362 (95% CI 1.066–10.598) for multilocular cysts, 7.801 (95% CI 2.1–28.985) for evidence of cortical perforation, and 1.004 (1.002–1.006) for 1 mm2 of lesion size on panoramic radiographs. We also found that immunoexpression of PCNA significantly correlates with the radiographic evidence of cortical perforation (P = 0.048) and that there is significant positive correlation between expression of COX-2 and bcl-2 (P = 0.001) as well as significant negative correlation between immunoexpression of COX-2 and age (P = 0.002). None of the other analyzed factors were associated with the recurrence. Conclusions Larger size, multilocularity, and cortical perforation in sporadic OKC may be correlated with the relapse. Clinical relevance Immunohistochemical analyses of COX-2, bcl-2, PCNA, and p53 lack prognostic utility in sporadic OKC.
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Affiliation(s)
- Tomasz Kaczmarzyk
- Department of Oral Surgery, Institute of Dentistry, Medical College, Jagiellonian University, ul. Montelupich 4, 31-155, Kraków, Poland. .,Chair of Periodontology and Clinical Pathology of the Oral Cavity, Institute of Dentistry, Medical College, Jagiellonian University, ul. Montelupich 4, 31-155, Kraków, Poland.
| | - Konrad Kisielowski
- Department of Oral Surgery, Institute of Dentistry, Medical College, Jagiellonian University, ul. Montelupich 4, 31-155, Kraków, Poland
| | - Rafał Koszowski
- Academic Center of Dentistry and Specialized Medicine, Plac Akademicki 17, 41-902, Bytom, Poland
| | - Magdalena Rynkiewicz
- Department of Pathomorphology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, ul. 3 Maja 13/15, 41-800, Zabrze, Poland
| | - Ewa Gawełek
- Department of Pathomorphology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, ul. 3 Maja 13/15, 41-800, Zabrze, Poland
| | - Karolina Babiuch
- Chair of Periodontology and Clinical Pathology of the Oral Cavity, Institute of Dentistry, Medical College, Jagiellonian University, ul. Montelupich 4, 31-155, Kraków, Poland
| | - Anna Bednarczyk
- Department of Oral Surgery, Institute of Dentistry, Medical College, Jagiellonian University, ul. Montelupich 4, 31-155, Kraków, Poland
| | - Bogna Drozdzowska
- Department of Pathomorphology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, ul. 3 Maja 13/15, 41-800, Zabrze, Poland
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Akbari M, Chen H, Guo G, Legan Z, Ghali G. Basal cell nevus syndrome (Gorlin syndrome): genetic insights, diagnostic challenges, and unmet milestones. ACTA ACUST UNITED AC 2018; 25:77-82. [PMID: 29454489 DOI: 10.1016/j.pathophys.2017.12.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Accepted: 12/28/2017] [Indexed: 12/18/2022]
Abstract
In this article, we present three clinical case reports on Basal Cell Nevus Syndrome (Gorlin Syndrome). Gorlin syndrome is an inherited medical condition with challenges that manifest in multiple body systems and complicate early diagnosis. We examine the epidemiology of the disease and benefits of genetic testing, molecular pathophysiology, and advancement in the molecular-based therapy of Basal Cell Nevus syndrome. The goal of this paper is to shed light on both unmet challenges and advancements in the management of Gorlin syndrome and to provide a new clinical perspective and guidance for future research. Furthermore, the FDA approved Hedgehog pathway inhibitors Vismodegib and Sonidegib designed for advanced basal cell carcinoma have opened a new door for treatment that may ultimately decrease the number of surgeries for a patient with Gorlin syndrome. The role of these agents in syndromic odontogenic keratocyst has not been studied extensively, but one study found that hedgehog pathway inhibitors decrease the size of syndromic odontogenic keratocyst. Ideal surgical treatment that balances low recurrence rates with low impact on one's quality of life for syndromic odontogenic keratocyst is another unanswered question for oral and maxillofacial surgeons. Per survey studies, treatment options practiced for syndromic odontogenic keratocyst range from marsupialization to segmental osteotomy. Future studies performed should take a comprehensive long-term approach with at least three years of follow-up in order to determine the most appropriate treatment.
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Affiliation(s)
- Maryam Akbari
- Resident, Department of Oral and Maxillofacial surgery, Mount Sinai Medical Center, New York, NY.
| | - Harold Chen
- Louisiana State University at Shreveport, LA
| | - Grace Guo
- Sidney Kimmel Medical college of Thomas Jefferson University, Philadelphia, PA
| | - Zachary Legan
- Former Resident, Department of Oral and Maxillofacial/Head and Neck Surgery, Louisiana State University Health Sciences Center, Shreveport, LA
| | - Ghali Ghali
- Department of Oral and Maxillofacial/Head and Neck Surgery, Louisiana State University Health Sciences Center, Shreveport, LA, United States; Chancellor and Dean, Louisiana State University Health Sciences Center, Shreveport, LA, United States
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Ribeiro-Júnior O, Borba AM, Alves CAF, Gouveia MMD, Deboni MCZ, Naclério-Homem MDG. Reclassification and treatment of odontogenic keratocysts: A cohort study. Braz Oral Res 2017; 31:e98. [PMID: 29267660 DOI: 10.1590/1807-3107bor-2017.vol31.0098] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 10/19/2017] [Indexed: 11/21/2022] Open
Abstract
The odontogenic keratocyst (OKC) is a recurrent cyst that has been recently reclassified from an odontogenic tumor to an odontogenic cyst. The aim of the present study was to investigate its treatment and address issues related to its association with nevoid basal cell carcinoma syndrome (NBCCS). Lesions from the cohort of patients included in the present study consisted of 40 OKCs, of which 27 lesions were treated by enucleation (GE) and 13 underwent decompression (GD). Complementary treatment occurred in 38 (95%) lesions, of which 10 underwent isolated peripheral ostectomy (GO) and 28 underwent peripheral ostectomy combined with Carnoy's solution (GC). Thirteen lesions were associated with NBCCS (GS), while the others (n=27) were non-syndromic lesions (GnS). The recurrence-free periods (RFP) in the sample groups were compared using the Kaplan-Meier function and log-rank test at a significance level of 5% (p < 0.05) and were used to calculate the cumulative risk of recurrence (CRR) in each postoperative year. During the follow-up period, which had a mean of 43.5 months (range: 12-102 months), six (15%) recurrences were diagnosed. There was no significant difference among the RFP for the compared groups (p > 0.05) or increased CRR for the decompression (15.4%) over five years. Application of Carnoy's solution did not increase the efficacy of the peripheral ostectomy, but was related to a CRR of 0% for the syndromic lesions over five years. Therefore, 1) decompression did not increase the recurrence risk; 2) peripheral ostectomy demonstrated a similar efficacy as the combination with Carnoy's solution; 3) the association of NBCCS did not seem to significantly influence OKC recurrence; and 4) syndromic lesions seem to behave in the same manner as non-syndromic lesions when submitted to complementary treatments.
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Affiliation(s)
- Ophir Ribeiro-Júnior
- Universidade de São Paulo - USP, School of Dentistry, Department of Oral & Maxillofacial Surgery, Traumatology and Prosthesis, São Paulo, SP, Brazil
| | - Alexandre Meireles Borba
- Universidade de São Paulo - USP, School of Dentistry, Department of Oral & Maxillofacial Surgery, Traumatology and Prosthesis, São Paulo, SP, Brazil
| | - Carlos Augusto Ferreira Alves
- Universidade de São Paulo - USP, University Hospital, Department of Oral & Maxillofacial Surgery, São Paulo, SP, Brazil
| | - Marcia Maria de Gouveia
- Universidade de São Paulo - USP, University Hospital, Department of Oral & Maxillofacial Surgery, São Paulo, SP, Brazil
| | - Maria Cristina Zindel Deboni
- Universidade de São Paulo - USP, School of Dentistry, Department of Oral & Maxillofacial Surgery, Traumatology and Prosthesis, São Paulo, SP, Brazil
| | - Maria da Graça Naclério-Homem
- Universidade de São Paulo - USP, School of Dentistry, Department of Oral & Maxillofacial Surgery, Traumatology and Prosthesis, São Paulo, SP, Brazil
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Daroit NB, da Rocha Vieira R, Visioli F, Maito FDM, de Oliveira MG, Rados PV. Does Surgical Fragmentation of Odontogenic Keratocystic Capsule Interfere With the Recurrence Rate? J Oral Maxillofac Surg 2017; 76:770-774. [PMID: 29100832 DOI: 10.1016/j.joms.2017.09.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 09/29/2017] [Accepted: 09/29/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE 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. MATERIALS AND METHODS 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. RESULTS 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). CONCLUSIONS 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 additional strategies such as cryotherapy.
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Affiliation(s)
- Natália Batista Daroit
- PhD Student, Department of Oral Pathology, School of Dentistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Rúbia da Rocha Vieira
- PhD Student, Department of Oral Pathology, School of Dentistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Fernanda Visioli
- Professor, Department of Oral Pathology, School of Dentistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Fabio Del Moro Maito
- Professor, Department of Oral Pathology, School of Dentistry, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Márcia Gaiger de Oliveira
- Professor, Department of Oral Pathology, School of Dentistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Pantelis Varvaki Rados
- Professor, Department of Oral Pathology, School of Dentistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
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Noy D, Rachmiel A, Zar K, Emodi O, Nagler RM. Sporadic versus syndromic keratocysts-Can we predict treatment outcome? A review of 102 cysts. Oral Dis 2017; 23:1058-1065. [DOI: 10.1111/odi.12687] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 03/09/2017] [Accepted: 04/07/2017] [Indexed: 11/29/2022]
Affiliation(s)
- D Noy
- Department of Oral and Maxillofacial Surgery; the Clinical Research Institute and the Rappaport Faculty of Medicine; Technion-Israel Institute of Technology; Haifa Israel
| | - A Rachmiel
- Department of Oral and Maxillofacial Surgery; the Clinical Research Institute and the Rappaport Faculty of Medicine; Technion-Israel Institute of Technology; Haifa Israel
| | - K Zar
- Department of Oral and Maxillofacial Surgery; the Clinical Research Institute and the Rappaport Faculty of Medicine; Technion-Israel Institute of Technology; Haifa Israel
| | - O Emodi
- Department of Oral and Maxillofacial Surgery; the Clinical Research Institute and the Rappaport Faculty of Medicine; Technion-Israel Institute of Technology; Haifa Israel
| | - RM Nagler
- Department of Oral and Maxillofacial Surgery; the Clinical Research Institute and the Rappaport Faculty of Medicine; Technion-Israel Institute of Technology; Haifa Israel
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What surgical treatment has the lowest recurrence rate following the management of keratocystic odontogenic tumor?: A large systematic review and meta-analysis. J Craniomaxillofac Surg 2017; 45:131-144. [DOI: 10.1016/j.jcms.2016.10.013] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 09/26/2016] [Accepted: 10/21/2016] [Indexed: 01/19/2023] Open
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Díaz-Belenguer Á, Sánchez-Torres A, Gay-Escoda C. Role of Carnoy's solution in the treatment of keratocystic odontogenic tumor: A systematic review. Med Oral Patol Oral Cir Bucal 2016; 21:e689-e695. [PMID: 27475699 PMCID: PMC5116110 DOI: 10.4317/medoral.21250] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Accepted: 03/24/2016] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION AND OBJECTIVE The keratocystic odontogenic tumor is a benign but aggressive neoplasm. As enucleation alone obtains high recurrence rates, some adjuvant treatments such as Carnoy's solution have been proposed. The aim of this study is to evaluate the reduction of recurrences with the use of Carnoy's solution as adjuvant in the treatment of keratocystic odontogenic tumors. MATERIAL AND METHODS An electronic search in Pubmed (MEDLINE), ScienceDirect and Cochrane databases was conducted with the key words "odontogenic keratocyst", "keratocystic odontogenic tumor", "carnoy's solution", "treatment" and "enucleation". The inclusion criteria were clinical studies using Carnoy's solution as adjuvant for the treatment of keratocystic odontogenic tumors, published in English, including at least 10 patients. Articles with an unclear reporting of the treatment applied, nonhuman studies, case reports and lesions associated to Gorlin-Goltz syndrome were excluded. RESULTS All the studies included were case series. The recurrence rate of enucleation ranged from 0% to 58.8%. With the only use of Carnoy's solution as adjuvant treatment to the enucleation, recurrences varied from 0% to 100%. The use of ≥ 2 adjuvant treatments reduced the range between 0% and 7.9%. CONCLUSIONS The use of Carnoy's solution as adjuvant therapy for the treatment of keratocystic odontogenic tumor has a grade C recommendation.
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Al-Moraissi EA, Pogrel MA, Ellis E. Enucleation with or without adjuvant therapy versus marsupialization with or without secondary enucleation in the treatment of keratocystic odontogenic tumors: A systematic review and meta-analysis. J Craniomaxillofac Surg 2016; 44:1395-403. [PMID: 27452613 DOI: 10.1016/j.jcms.2016.05.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 04/17/2016] [Accepted: 05/24/2016] [Indexed: 11/29/2022] Open
Affiliation(s)
- Essam Ahmed Al-Moraissi
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Thamar University, Thamar, Yemen.
| | - M Anthony Pogrel
- Department of Oral and Maxillofacial Surgery, University of California, San Francisco, USA
| | - Edward Ellis
- Department of Oral and Maxillofacial Surgery, University of Texas Health Science Center, San Antonio, TX, USA
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Pereira T, Shetty S, Date A. Multiple cysts of the maxilla and mandible in an 82-year-old edentulous male: A case report. Eur Geriatr Med 2016. [DOI: 10.1016/j.eurger.2016.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Silva ER, Neto ECM, Silva FLD, Carvalho FKD, Xavier SP. Marsupialisation of kerastocystic odontogenic tumours in a patient with Simpson-Golabi-Behmel syndrome. Br J Oral Maxillofac Surg 2016; 55:215. [PMID: 27449335 DOI: 10.1016/j.bjoms.2016.06.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 06/29/2016] [Indexed: 11/18/2022]
Affiliation(s)
- Erick Ricardo Silva
- Department of Oral and Maxillofacial and Periodontology, Ribeirão Preto Dental School, University of São Paulo, Brazil.
| | - Evandro Carneiro Martins Neto
- Department of Oral and Maxillofacial and Periodontology, Ribeirão Preto Dental School, University of São Paulo, Brazil.
| | | | | | - Samuel Porfirio Xavier
- Department of Oral and Maxillofacial and Periodontology, Ribeirão Preto Dental School, University of São Paulo, Brazil.
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Abstract
Keratocystic odontogenic tumor (KCOT) has potential aggressive and infiltrative behavior. Decompression has been widely preferred for large KCOTs due to safety and lower recurrence rates. However, KCOT is still likely to recur even after effective decompression. Here, we present a rare and interesting case of recurrent KCOT after effective decompression with adjunctive enucleation. Redecompression was then performed again, and the effect was still satisfactory on long-term follow-up.
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Brajić I, Škodrić S, Milenković S, Tepavčević Z, Soldatović I, Čolić S, Milašin J, Andrić M. Survivin, cyclin D1, and p21hras in keratocystic odontogenic tumors before and after decompression. Oral Dis 2016; 22:220-5. [DOI: 10.1111/odi.12414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 11/17/2015] [Accepted: 11/26/2015] [Indexed: 11/29/2022]
Affiliation(s)
- I Brajić
- Department of Oral Surgery; School of Dental Medicine; University of Belgrade; Belgrade Serbia
| | - S Škodrić
- Department of Pathology; School of Medicine; University of Belgrade; Belgrade Serbia
| | - S Milenković
- Department of Pathology; Clinical Hospital Center; Zemun Serbia
| | - Z Tepavčević
- Department of Pathology; School of Dental Medicine; University of Belgrade; Belgrade Serbia
| | - I Soldatović
- School of Medicine; University of Belgrade; Belgrade Serbia
| | - S Čolić
- Department of Oral Surgery; School of Dental Medicine; University of Belgrade; Belgrade Serbia
| | - J Milašin
- Department of Molecular Genetics; School of Dental Medicine; University of Belgrade; Belgrade Serbia
| | - M Andrić
- Department of Oral Surgery; School of Dental Medicine; University of Belgrade; Belgrade Serbia
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Gamoh S, Akiyama H, Tominaga K, Nakajima M, Kakudo K, Tanaka A, Shimizutani K. Simultaneous occurrence of keratocystic odontogenic tumor and ameloblastoma in the mandible: A case report. Oncol Lett 2015; 10:785-789. [PMID: 26622570 DOI: 10.3892/ol.2015.3323] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 05/08/2015] [Indexed: 11/05/2022] Open
Abstract
Keratocystic odontogenic tumors (KCOTs) and ameloblastomas are benign odontogenic tumors that primarily occur in the molar region of the mandible. However, it is uncommon for these tumors to arise simultaneously in a patient's jaw. The present study reported the diagnostic process and features of a rare case of the simultaneous occurrence of KCOT and ameloblastoma in the mandible of a 45-year-old male. Image-based diagnosis was challenging due to several conditions, including the intactness of the teeth and bone cortex as well as the sizes and locations of the lesions. Based on radiographic evidence, the patient was initially misdiagnosed and underwent a biopsy for a radicular cyst and a simple bone cyst prior to the correct diagnoses of KCOT and ameloblastoma, respectively. In addition, the present study discussed the diagnostic process of the present case and reviewed previous literature regarding the simultaneous occurrence of benign tumors of the jaw.
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Affiliation(s)
- Shoko Gamoh
- Department of Oral Radiology, Osaka Dental University, Osaka 540-0008, Japan
| | - Hironori Akiyama
- Department of Oral Radiology, Osaka Dental University, Osaka 540-0008, Japan
| | - Kazuya Tominaga
- Department of Oral Pathology, Osaka Dental University, Osaka 540-0008, Japan
| | - Masahiro Nakajima
- Department of Dentistry for Disability and Oral Health, Osaka Dental University, Osaka 540-0008, Japan ; Department of Oral and Maxillofacial Surgery, Osaka Dental University, Osaka 540-0008, Japan
| | - Kenji Kakudo
- Department of Oral and Maxillofacial Surgery, Osaka Dental University, Osaka 540-0008, Japan
| | - Akio Tanaka
- Department of Oral Pathology, Osaka Dental University, Osaka 540-0008, Japan
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de Santana Santos T, Vajgel A, Martins-Filho PRS, de Albuquerque Maranhao Filho AW, De Holanda Vasconcellos RJ, Frota R, Filho JRL. Nevoid Basal Cell Carcinoma Syndrome: A Long-Term Study in a Family. Craniomaxillofac Trauma Reconstr 2015; 9:94-104. [PMID: 26889355 DOI: 10.1055/s-0035-1558454] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Accepted: 02/22/2015] [Indexed: 12/11/2022] Open
Abstract
We present a family case series with 10 individuals having nevoid basal cell carcinoma syndrome (NBCCS) with a 10-year follow-up. All articles published in the literature between 1967 and 2011 on familial Gorlin-Goltz syndrome in any language were surveyed to determine the mapping of cases per country of occurrence of this disease. All patients in the present series were presented with calcification of the falx cerebri, mild hypertelorism, and frontal bossing. Odontogenic keratocystic tumors, palmar and plantar pits, and multiple basal cell carcinomas occurred in 90, 40, and 20%, respectively, of the patients. One of the patients died of skin cancer. Diagnosis of odontogenic keratocyst tumors was confirmed by histopathological examination. NBCCS is a rare autosomal dominant cancer predisposition syndrome; it is important to recognize it when a patient has multiple odontogenic keratocyst tumors because life-long monitoring is essential for patient management.
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Affiliation(s)
- Thiago de Santana Santos
- Hospital Universitário, Universidade Federal de Sergipe, Rua Claudio Batista, Aracaju, Sergipe, Brazil
| | - André Vajgel
- Department of Oral and Maxillofacial Surgery, Pernambuco School of Dentistry, Camaragibe, Pernambuco, Brazil
| | | | | | | | - Riedel Frota
- Department of Oral and Maxillofacial Surgery, Pernambuco School of Dentistry, Camaragibe, Pernambuco, Brazil
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