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Gonçalves TODF, Rangel RMR, Marañón-Vásquez GA, Soares-Silva L, Agostini M, Abrahão AC, Romañach MJ, Maia LC. Management and recurrence of the odontogenic keratocyst: an overview of systematic reviews. Oral Maxillofac Surg 2024:10.1007/s10006-024-01277-4. [PMID: 38954313 DOI: 10.1007/s10006-024-01277-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 06/23/2024] [Indexed: 07/04/2024]
Abstract
MATERIALS AND METHODS An extensive literature search among six eletronic databases and Grey Literature was used to identify systematic reviews (S) that could respond if: in individuals diagnosed with OKC (P), is there any influence of the treatment method (I/C) on the recurrence rate of the lesion (O)? After evaluating all titles and abstracts and then applying the eligibility criteria, the included studies were read in full, and data were extracted based on a standardized sheet ordered in the PICO sequence. The assessment of the quality of the systematic reviews included, was determined by AMSTAR2, and final synthesis were descriptively made based on the results and quality of the systematic reviews. RESULTS From a total of 19 included systematic reviews, it was observed that the most used treatment for OKC was enucleation, followed by enucleation with adjuvant techniques and marsupialization. The mean percentage of recurrence was 16,2%, and the highest OKC recurrence rate was 43.2% after simple enucleation. The use of adjuvant techniques promoted reductions in OKC recurrence rates. The overall methodological quality of systematic reviews was critically low, and this parameter demonstrate the need for more studies to facilitate the choose of the treatment. CONCLUSION Despite being the most used treatment, simple enucleation is related to the highest rate of recurrence, except when performed after marsupialization/decompression. In addition, the use of adjuvant techniques has a strong impact on reducing the likelihood of recurrence. However, these findings are not conclusive because of the critically low quality of the systematic reviews.
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Affiliation(s)
- Thayanne Oliveira de Freitas Gonçalves
- Department of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal Do Rio de Janeiro (UFRJ), R. Prof. Rodolpho Paulo Rocco, 325, Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Renata Matuck Roque Rangel
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal Do Rio de Janeiro (UFRJ), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Guido Artemio Marañón-Vásquez
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal Do Rio de Janeiro (UFRJ), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Larissa Soares-Silva
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal Do Rio de Janeiro (UFRJ), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Michelle Agostini
- Department of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal Do Rio de Janeiro (UFRJ), R. Prof. Rodolpho Paulo Rocco, 325, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Aline Corrêa Abrahão
- Department of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal Do Rio de Janeiro (UFRJ), R. Prof. Rodolpho Paulo Rocco, 325, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mário José Romañach
- Department of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal Do Rio de Janeiro (UFRJ), R. Prof. Rodolpho Paulo Rocco, 325, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Lucianne Cople Maia
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal Do Rio de Janeiro (UFRJ), Rio de Janeiro, Rio de Janeiro, Brazil
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de Arruda JAA, de Lima KFA, de Oliveira Filho OV, Simonato LE, de Andrade BAB, Tomo S. Conservative management of multiple odontogenic keratocysts in a child with nevoid basal cell carcinoma syndrome: A case report. SPECIAL CARE IN DENTISTRY 2024. [PMID: 38685572 DOI: 10.1111/scd.13007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 04/16/2024] [Accepted: 04/17/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Nevoid basal cell carcinoma syndrome (NBCCS) is an autosomal dominant multisystemic disorder characterized by the presence of multiple odontogenic keratocysts (OKC), which are a hallmark feature of the syndrome. The treatment of these OKC poses challenges due to their high recurrence rates and the myriad of management options available. CASE REPORT We describe here a case of NBCCS diagnosed in an 11-year-old girl who presented with multiple OKC in the jaws. Chest and cranial radiographs showed no abnormalities in the ribs and the cerebral falx, respectively. Cephalometric analysis indicated mandibular retrusion, a skeletal class II relationship, and a convex profile. The treatment approach involved a personalized strategy tailored for each cyst, comprising marsupialization followed by enucleation. This approach aimed to minimize surgical trauma and to reduce the risk of recurrence. The patient underwent regular follow-up appointments, demonstrating successful outcomes with no signs of recurrence or de novo OKC observed over a 32-month period. CONCLUSION Clinicians should consider lesion characteristics and patient cooperation when determining treatment strategies for the optimization of outcomes for children and adolescents with NBCCS and multiple OKC.
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Affiliation(s)
- José Alcides Almeida de Arruda
- Department of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | | | | | - Saygo Tomo
- Department of Pathology, School of Dentistry, Universidade de São Paulo, São Paulo, Brazil
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Esonu OK, Burke AB, Dodson TB, Dillon JK. What Is the 5-year Incidence of Recurrent Disease of Odontogenic Keratocysts? J Oral Maxillofac Surg 2022; 81:499-503. [PMID: 36577505 DOI: 10.1016/j.joms.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 12/02/2022] [Accepted: 12/05/2022] [Indexed: 12/26/2022]
Abstract
PURPOSE There is no consensus on the ideal treatment of odontogenic keratocysts (OKCs). Certain risk factors may modify the disease recurrence rate. The purpose of this study was: 1) to estimate the incidence of OKC recurrence in a statistically rigorous manner; and 2) to identify risk factors associated with OKC recurrence. METHODS The investigators designed and implemented a retrospective cohort study and enrolled a sample derived from the population of patients presenting to the Department of Oral and Maxillofacial Surgery outpatient clinics at the University of Washington School of Dentistry and Harborview Medical Center for evaluation and management of OKCs between January 1, 2010, and December 31, 2020. Predictor variables included demographics (age, gender), radiographic characteristics (location of lesion, locularity, size, and cortical perforation), and type of operation performed (decompression + cystectomy, enucleation ± adjuvant therapy, or resection). The primary outcome variable was time to recurrent disease, defined as the time from treatment to radiographic or clinical evidence of a new lesion (recorded in months). Kaplan-Meier analysis was used to estimate median time to recurrence, and Cox proportional hazards models were used to identify covariates statistically associated with recurrent disease (P ≤ .05). RESULTS The sample was composed of 60 subjects with 63 previously untreated lesions. Eight subjects (13%) developed a recurrent lesion during the study interval with a median time to recurrence of 31 (interquartile range, 24 to 48) months. One of the 8 recurrences occurred within 12 months of treatment and 7 of the 8 recurrences occurred more than 21 months after treatment. Based on using Kaplan-Meier analysis, the 5-year incidence of disease recurrence was estimated to be 34%. Lesions with cortical perforation were 8.3 times more likely to recur (95% confidence interval [1.7, 41.3]; P-value = .01), and multilocular lesions were 10.6 times more likely to recur (95% confidence interval [1.3, 86.9]; P-value = .03). The sample size was the limiting factor to performing regression analyses. CONCLUSIONS Virtually every publication on OKCs to date reports frequencies of disease recurrence rather than applying appropriate survival analyses commonly used to estimate outcomes in cancer research. Failure to use the appropriate statistical analyses underestimates the risk of disease recurrence. Our study is no exception. The estimated frequency of disease recurrence during the study interval was 13% (8/60). When survival analyses are applied that account for varying months of follow-up, the incidence of disease recurrence is 34 per 100 per 5 years. We recommend the application of time-to-event analyses in the study of disease entities with the potential for recurrence.
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Affiliation(s)
- Onyi K Esonu
- Resident, Department of Oral and Maxillofacial Surgery, University of Washington School of Dentistry, Seattle, WA
| | - Andrea B Burke
- Assistant Professor, Department of Oral and Maxillofacial Surgery, University of Washington School of Dentistry, Seattle, WA
| | - Thomas B Dodson
- Professor and Chairman, Department of Oral and Maxillofacial Surgery, University of Washington School of Dentistry, Seattle, WA
| | - Jasjit K Dillon
- Professor, Program Director, Department of Oral and Maxillofacial Surgery, University of Washington School of Dentistry, Seattle, WA.
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Xiong X, Li C, Guo L, Wu Y, Wang Y, Song X. Effect of Intracapsular Pressure on Decompression Effectiveness. Int Dent J 2022; 72:839-846. [DOI: 10.1016/j.identj.2022.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/24/2022] [Accepted: 06/25/2022] [Indexed: 12/01/2022] Open
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An evidence-based surgical algorithm for management of odontogenic keratocyst. Oral Maxillofac Surg 2022:10.1007/s10006-022-01064-z. [PMID: 35476304 DOI: 10.1007/s10006-022-01064-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 04/08/2022] [Indexed: 02/04/2023]
Abstract
The effective management of odontogenic keratocyst (OKC) remains a subject of interest and confusion in the oral and maxillofacial surgery literature. Currently, there is a lack of consensus regarding the most appropriate treatment for patients with OKC. Of the various treatment options available, no modality to date has been shown to demonstrate a zero or near-zero recurrence rates except wide resection with clear margins. With the prevailing dearth of evidence based surgical protocols for the management of patients with OKC in the literature, this study aims to present a surgical algorithm, based on meta-analysis results, that hopefully will be beneficial in enhancing treatment of patients with this condition. Also, new meta-analysis was done to compare between modified Carnoy's solution (MCS) and 5-fluorouracil (5-FU) in respect of recurrence rate of OKC. Using parameters like size, lesion type (primary or secondary), syndromic or solitary nature of the lesion, presence of cortical perforations, and locularity; we present a decision tree, to aid treatment planning and help attain the least chance of recurrence in the management of the OKC. There was very low-quality evidence indicating that application of 5-FU, after enucleation and peripheral ostectomy of OKCs, significantly lowered recurrence rate when compared to MCS (RR = 0.087, CI: 0.017 to 0.436, P value = 0.003).
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6
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Stoelinga P. The odontogenic keratocyst revisited. Int J Oral Maxillofac Surg 2022; 51:1420-1423. [DOI: 10.1016/j.ijom.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/08/2022] [Indexed: 11/16/2022]
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Berretta LM, Melo G, Mello FW, Lizio G, Rivero ERC. Effectiveness of marsupialisation and decompression on the reduction of cystic jaw lesions: a systematic review. Br J Oral Maxillofac Surg 2021; 59:E17-E42. [PMID: 34749963 DOI: 10.1016/j.bjoms.2021.03.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 03/12/2021] [Indexed: 11/26/2022]
Abstract
In this study, we aimed to systematically review and critically appraise the available literature concerning the effectiveness of marsupialisation and decompression on the reduction of cystic jaw lesions. The 'Preferred Reporting Items for Systematic Reviews and Meta-Analysis' guidelines were followed and the study protocol was registered at the 'International Prospective Register of Systematic Reviews' (CRD42019116099). Six main databases were searched: Embase, LILACS, PubMed, Scopus, The Cochrane Library, and Web of Science. Searches were complemented with three grey literature sources: Google Scholar, ProQuest, and Open Grey. Any reduction measures, compared with preoperative status or other procedures, were considered. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Tool. Thirty-one studies were included, of which five were judged with low, 24 with moderate, and two with high risk of bias. Considering surgical approach, 20 studies assessed the decompression and 11 the marsupialisation technique. Most studies considered these techniques as preliminary treatments, followed by enucleation. From 1088 lesions found, most were odontogenic keratocysts (33.8%), followed by unicystic ameloblastomas (21.0%), dentigerous cysts (20.6%), and radicular cysts (8.4%). Large lesions and younger individuals frequently presented more favourable responses to treatment and anatomical location was not associated with lesion reduction overall. The intervention duration generally ranged between one to two years. In conclusion, marsupialisation and decompression were mostly considered as preliminary treatments, followed by enucleation. Lesion reduction was generally considered insufficient for these techniques to be used as definitive therapies, although benefits concerning the diminished invasiveness of the secondary surgery were often proposed.
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Affiliation(s)
- L M Berretta
- Dental School, Federal University of Santa Catarina - Florianópolis, Santa Catarina, Brazil.
| | - G Melo
- Postgraduate Programme in Dentistry, Federal University of Santa Catarina - Florianópolis, Santa Catarina, Brazil.
| | - F W Mello
- Postgraduate Programme in Dentistry, Federal University of Santa Catarina - Florianópolis, Santa Catarina, Brazil.
| | - G Lizio
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna - Bologna, Italy.
| | - E R C Rivero
- Department of Pathology, Health Sciences Centre, Federal University of Santa Catarina - Florianópolis, Santa Catarina, Brazil.
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Haas Jr. O, Betina Belloc. C, Agustín MF, André Xavier Padilha F, Neimar S, Rogério Belle DO. Multimodal Protocol for the Treatment of Odontogenic Keratocysts. Open Dent J 2021. [DOI: 10.2174/1874210602115010011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Purpose:
The aim of this study is to evaluate longitudinally the effectiveness of a multimodal protocol based on decompression followed by enucleation combined with the use of liquid nitrogen under local anesthesia for the treatment of odontogenic keratocysts.
Methods:
Seven patients with a diagnosis of odontogenic keratocyst were evaluated longitudinally to clinical and histological features, and pre- and postoperative radiographs were analyzed. Data were collected on the epidemiological profile of patients and on cysts, including the presence of recurrence, duration of drainage device use, lesion site, and presence of postoperative complications.
Results:
No recurrence was observed during follow-up. Mean follow-up was 59.57 months (range, 18-96 months). No pathological fracture was observed. None of the patients had persistent paresthesia of the inferior alveolar nerve. Substantial reduction in cyst size and epithelial differentiation were observed in all patients after multimodal treatment.
Conclusion:
Based on these results, the multimodal protocol proposed here was effective in the treatment of odontogenic keratocysts by reducing lesion size, avoiding possible damage to adjacent anatomical structures, and allowing a surgical procedure with less morbidity. The longitudinal follow-up of patients showed that this treatment modality is associated with a low recurrence rate compared with alternative therapies.
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9
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Carvalho FSR, Verde MML, Viana KF, Bezerra TMM, Fonseca SGDC, Pereira KMA, Ribeiro TR, Costa FWG. Pharmacological Characterization and Raman Spectroscopy Evaluation of Oral and Maxillofacial Surgery-Related Carnoy´S Solution Modified by Different Viscosity Agents. Asian Pac J Cancer Prev 2019; 20:3335-3339. [PMID: 31759357 PMCID: PMC7063025 DOI: 10.31557/apjcp.2019.20.11.3335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Indexed: 12/03/2022] Open
Abstract
Background: There are several lesions of odontogenic and non-odontogenic origin in the oral cavity, such as odontogenic keratocyst, as well as many treatment options for such lesions. In order to reduce recurrence due to conservative treatments and less aesthetic and functional impairment of the patient (radical therapies), Carnoy’s solution has been used as an adjuvant to surgery, showing satisfactory results. Its application is not standardized, presenting risks to adjacent tissues. Thus, we characterized the Carnoy’s solution with different viscosity agents to enhance its applicability. Material and Methods: All solutions prepared (Carnoy with and without chloroform) were added with viscosity agent: ethyl cellulose, propylene glycol, and glycerol totaling eight solutions. The pharmacological characterization of the solutions was performed by determining the mass density and relative density (using a clean and dry pycnometer), pH (using pH meter), and concentration of Fe3+ (using ultraviolet/visible spectroscopy). The analyses of the inorganic components were determined by Raman micro spectrometry. Data were analyzed with statistical program BIOESTAT 5.3. Results: Solutions with ethyl cellulose were discarded due to precipitate formation and suspension of the viscosity agent. In the other solutions, viscosity increase (propylene glycol solutions) and acidic pH were observed mainly in the glycerol group. The ferric chloride characterized as a hemostatic agent had its concentration increased with the use of thickening agents, theoretically favoring its action. Conclusion: The similarity of the propylene glycol and glycerol molecules justifies the Raman spectra of these substances to be similar and the difficulty in obtaining a “fingerprint”.
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Affiliation(s)
| | | | | | | | | | | | | | - Fábio Wildson Gurgel Costa
- Division of Oral Radiology, Walter Cantídio University Hospital, Federal University of Ceará, Fortaleza, Brazil
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Araújo S, Kindely Ramos De Oliveira L, Mombrini Pigatti F, Mayrink G. Queratocisto odontogênico em região anterior da maxila: relato de caso. HU REVISTA 2019. [DOI: 10.34019/1982-8047.2019.v45.16941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introdução: O queratocisto odontogênico é uma lesão cística intra-óssea que se origina do resto celular da lâmina dentária. Possui crescimento lento, assintomático e é comumente encontrado em radiografias de rotina. É mais prevalente no sexo masculino entre a 2ª e 3ª décadas de vida e acomete preferencialmente a mandíbula. Objetivo: relatar um caso de queratocisto em região anterior da maxila e realizar uma revisão dos tratamentos que estão disponíveis para essa lesão. Relato de caso: paciente do sexo feminino, 46 anos de idade, durante exame radiográfico de rotina, exibiu área radiolúcida unilocular com borda esclerótica definida que se estendia do dente 11 ao 24. No exame clínico não foi possível notar nenhuma expansão da cortical óssea. Foi realizada biópsia e instalado, no mesmo momento cirúrgico, dispositivo para descompressão da lesão. Após análise histopatológica e confirmação diagnóstica, a paciente foi submetida a enucleação cirúrgica. Conclusão: o paciente permanece em acompanhamento há 3 anos sem sinais clínicos ou radiográficos de recidiva da lesão.
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Fidele NB, Bing L, Sun Y, Wu T, Zheng Y, Zhao Y. Management of mandibular odontogenic keratocyst through radical resection: Report of 35 cases. Oncol Lett 2019; 18:733-741. [PMID: 31289548 PMCID: PMC6540166 DOI: 10.3892/ol.2019.10367] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 04/15/2019] [Indexed: 02/06/2023] Open
Abstract
The present study reported the clinical outcomes of 35 patients with mandibular odontogenic keratocysts (OKCs) following treatment by radical resection and immediate defect reconstruction. Amongst 565 patients with OKCs that were treated between April 2003 and May 2015, 35 patients underwent segmental or marginal mandibulectomy. The use of radical resection was based on clinical and/or radiographic evidence of size, cortical perforation and subsequent soft tissue involvement, and on the history of previous recurrence of the same lesion. Recurrence, justifications of the main major factor for resection, and functional and cosmetic results of the patients following mandibular reconstruction were systematically evaluated. There were 26 OKCs in the mandibular molar-ramus region, eight in the mandibular anterior-premolar region and one in the mandibular molar-ramus and anterior-molar regions. Among the 35 patients, 20 had primary OKCs and 15 had recurrent OKCs. A total of 31 patients underwent segmental mandibulectomy, of which 28 were immediately reconstructed with a vascularized flap, whereas four patients underwent marginal mandibulectomy. The functional and cosmetic outcomes of patients were evaluated as satisfactory. The length of the follow-up period ranged from 2 to 17 years following operation (average, 5.82 years). Recurrence was identified in one patient who had been treated with marginal mandibulectomy. In conclusion, the findings from the present study suggested that radical resection may be recommended for patients with OKCs and locally aggressive features. Immediate mandibular reconstruction with a vascularized flap may be a crucial part of this aggressive treatment method that may reduce OKCs-associated morbidity.
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Affiliation(s)
- Nyimi Bushabu Fidele
- Department of Oral Maxillofacial Head and Neck Oncology Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, Hubei 430079, P.R. China.,The 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, Hubei 430079, P.R. China
| | - Liu Bing
- Department of Oral Maxillofacial Head and Neck Oncology Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, Hubei 430079, P.R. China.,The 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, Hubei 430079, P.R. China
| | - Yanfang Sun
- Department of Oral Maxillofacial Head and Neck Oncology Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, Hubei 430079, P.R. China
| | - Tianfu Wu
- Department of Oral Maxillofacial Head and Neck Oncology Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, Hubei 430079, P.R. China
| | - Yueyu Zheng
- Department of Oral Maxillofacial Head and Neck Oncology Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, Hubei 430079, P.R. China
| | - Yifang Zhao
- Department of Oral Maxillofacial Head and Neck Oncology Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, Hubei 430079, P.R. China.,The 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, Hubei 430079, P.R. China
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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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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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Karaca C, Dere KA, Er N, Aktas A, Tosun E, Koseoglu OT, Usubutun A. Recurrence rate of odontogenic keratocyst treated by enucleation and peripheral ostectomy: Retrospective case series with up to 12 years of follow-up. Med Oral Patol Oral Cir Bucal 2018; 23:e443-e448. [PMID: 29924761 PMCID: PMC6051675 DOI: 10.4317/medoral.22366] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 06/20/2018] [Indexed: 11/23/2022] Open
Abstract
Background Odontogenic keratocysts have been reported with high recurrence rates in the literature so various treatment modalities from simple enucleation to resection have been performed to achieve the cure. The purpose of this retrospective study was to investigate the recurrence rate of odontogenic keratocysts (OKCs) treated by enucleation and peripheral ostectomy. Material and Methods An electronic search of the database of the Hacettepe University, Faculty of Medicine, Department of Pathology, was undertaken to identify patients histologically diagnosed with OKCs treated at Department of Oral and Maxillofacial Surgery between 2001 and 2015. Results In total, 81 patients were studied. The mean age at the time of diagnosis was 42 years, and the male:female ratio was 1:0.7. OKCs were located primarily in the posterior mandibular region (41%). Twenty-seven patients were re-examined to determine the recurrence rate. The mean follow-up period was 5 years (range, 1–12 years). The recurrence rate was 14.8%. The relationship between location of the lesion and recurrence was not statistically significant (p = 0.559). There was also no statistically significant relation between the recurrence rate and treatment option of teeth involved in the lesion (p = 0.579). Conclusions The authors conclude that treatment of OKCs by enucleation with peripheral ostectomy is associated with minimal morbidity and is preferred over other aggressive treatment modalities. Meticulous radiographic examination and careful surgical resection may decrease the recurrence rate of OKCs. Key words:Odontogenic keratocyst, recurrence rate, enucleation, enucleation plus peripheral ostectomy.
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Affiliation(s)
- C Karaca
- Hacettepe University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Ankara, Turkey,
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15
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Hwang DS, Kim YH, Kim UK, Ryu MH, Kim GC. Retrospective clinical study of multiple keratocystic odontogenic tumors in non-syndromic patients. J Korean Assoc Oral Maxillofac Surg 2018; 44:107-111. [PMID: 29963491 PMCID: PMC6024063 DOI: 10.5125/jkaoms.2018.44.3.107] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 02/07/2018] [Accepted: 02/12/2018] [Indexed: 11/07/2022] Open
Abstract
Objectives A keratocystic odontogenic tumor (KOT) is a type of odontogenic tumor that mainly occurs in the posterior mandible. Most KOTs appear as solitary lesions; however, they sometimes occur as multiple cysts. This study analyzed the clinical features of multiple KOTs. Materials and Methods The participants were diagnosed with KOT by biopsy with multiple surgical sites, and were patients at the Pusan National University Hospital and the Pusan National University Dental Hospital from January 1, 2005 to March 31, 2016. Charts, records, images and other findings were reviewed. Results A total of 31 operations were conducted in 17 patients. The mean patient age was 28.4±20.1 years. Multiple KOTs were found to occur at a young age (P<0.01). The predominant sites were in the posterior mandible (28.6%). Most cases of multiple lesions appeared in both the upper and lower jaw, and 40.3% of lesions were associated with unerupted and impacted teeth. The overall recurrence rate measured by operation site was 10.4% (8/77 sites). No patients were associated with nevoid basal cell carcinoma syndrome. Conclusion The pure recurrence rate was lower than estimated, but there was a higher possibility of secondary lesions regardless of the previous operation site; therefore, long-term follow-up is necessary.
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Affiliation(s)
- Dae-Seok Hwang
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University, Yangsan, Korea
| | - Yun-Ho Kim
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University, Yangsan, Korea
| | - Uk-Kyu Kim
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University, Yangsan, Korea
| | - Mi-Heon Ryu
- Institute of Translational Dental Sciences, Pusan National University, Yangsan, Korea
| | - Gyoo-Cheon Kim
- Institute of Translational Dental Sciences, Pusan National University, Yangsan, Korea
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16
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Radia S, Cash AC, Moar K. An Unusual Case of an Odontogenic Keratocyst Associated With an Ungrafted Alveolar Cleft: A Case Report and Review of the Literature. Cleft Palate Craniofac J 2018; 56:110-115. [PMID: 29672163 DOI: 10.1177/1055665618770053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We describe an unusual case of an odontogenic keratocyst (OKC) associated with an ungrafted left-sided alveolar cleft in a 10-year-old male patient. There is no previous report in the literature of OKC or other dental cysts associated with an alveolar cleft. We discuss the management of the OKC prior to secondary bone grafting and present this case to highlight the difficulty in the management of OKC concurrent with grafting of the alveolar cleft site, the proximity of unerupted permanent teeth, and possible treatment modalities.
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Affiliation(s)
- Sapna Radia
- 1 Queen Victoria Hospital, East Grinstead, United Kingdom
| | - Alexander C Cash
- 1 Queen Victoria Hospital, East Grinstead, United Kingdom.,2 South Thames Cleft Service, London, United Kingdom
| | - Kanwalraj Moar
- 3 Cleft Net East, Addenbrooke's Hospital, Cambridge, United Kingdom
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17
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Conservative surgical treatments for nonsyndromic odontogenic keratocysts: a systematic review and meta-analysis. Clin Oral Investig 2017; 22:2089-2101. [DOI: 10.1007/s00784-017-2315-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 12/12/2017] [Indexed: 10/18/2022]
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18
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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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19
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The bone lid technique in oral surgery: a case series study. Int J Oral Maxillofac Surg 2017; 46:1490-1496. [DOI: 10.1016/j.ijom.2017.06.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 05/16/2017] [Accepted: 06/29/2017] [Indexed: 11/20/2022]
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