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Eid MK, Alqhtani NR, Atef AM, Sakka S. Application of topical 5-Fluorouracil to reduce the recurrence of odontogenic keratocyst: A prospective study with 2-year follow-up. Curr Probl Surg 2024; 61:101558. [PMID: 39168535 DOI: 10.1016/j.cpsurg.2024.101558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 06/27/2024] [Accepted: 07/01/2024] [Indexed: 08/23/2024]
Affiliation(s)
- Mohamed Kamal Eid
- Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Prince Sattam bin Abdulaziz University, Al Kharj, Saudi Arabia; Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Tanta University, Tanta, Egypt.
| | - Nasser Raqe Alqhtani
- Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Prince Sattam bin Abdulaziz University, Al Kharj, Saudi Arabia
| | - Asmaa Mohamed Atef
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Tanta University, Tanta, Egypt
| | - Salah Sakka
- Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Prince Sattam bin Abdulaziz University, Al Kharj, Saudi Arabia
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2
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Colnot N, Savoldelli C, Afota F, Latreche S, Lupi L, Lerhe B, Fricain M. Treatment of benign maxillomandibular osteolytic lesions larger than 4 cm: A systematic review. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024; 125:101933. [PMID: 38823480 DOI: 10.1016/j.jormas.2024.101933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 05/21/2024] [Accepted: 05/29/2024] [Indexed: 06/03/2024]
Abstract
OBJECTIVE This systematic review aimed to assess the different treatments of benign maxillo-mandibular radiolucent bone lesions over 4 cm to propose a management algorithm. STUDY DESIGN A literature search was conducted using MEDLINE/PubMed, Scopus, Google Scholar, Virtual Health Library databases, and gray literature. Randomized or non-randomized clinical trials and case series with 10 or more patients with a minimum follow up of 1 year, published in French or English until August 2023, were included. The risk of bias was assessed for all papers included. RESULTS Of 1433 records identified, 22 were included in this review, reporting data from 1364 lesions. Ameloblastoma was the most common lesion (51.22%) and mandible was the most common site (81.21%). Initial conservative treatment was prevalent (71.04%). Recurrence was higher after conservative (13.8%) than after radical treatments (6.5%). Multilocularity, cortical perforation, dental element preservation were linked to a higher recurrence risk. CONCLUSION This study has shown importance of understanding specific characteristics and recurrence risk in benign maxillomandibular osteolytic lesions. Multidisciplinary team approval, personalized approach based on lesion type and patient are crucial. The presence of at least one risk factor could lead to therapeutic decision. Despite limitations, the study informed lesion management and provided precise recommendations.
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Affiliation(s)
- Nathan Colnot
- Department of Oral and Maxillo Facial Surgery, Head and Neck Institute, University of Côte d'Azur, Nice 06100, France.
| | - Charles Savoldelli
- Department of Oral and Maxillo Facial Surgery, Head and Neck Institute, University of Côte d'Azur, Nice 06100, France
| | - Franck Afota
- Department of Oral and Maxillo Facial Surgery, Head and Neck Institute, University of Côte d'Azur, Nice 06100, France
| | - Sarah Latreche
- Department of Oral and Maxillo Facial Surgery, Head and Neck Institute, University of Côte d'Azur, Nice 06100, France
| | - Laurence Lupi
- Department of Oral Surgery, Oral and Dental Medicine Institute, University of Côte d'Azur, Nice 06300, France
| | - Barbara Lerhe
- Department of Oral and Maxillo Facial Surgery, Head and Neck Institute, University of Côte d'Azur, Nice 06100, France; Paediatric Maxillofacial Surgery and ENT Department, Lenval Hospital, University of Côte d'Azur, Nice 06200, France
| | - Margaux Fricain
- Department of Oral and Maxillo Facial Surgery, Head and Neck Institute, University of Côte d'Azur, Nice 06100, France
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3
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Polyetheretherketone/
Nano‐Ag‐TiO
2
composite with mechanical properties and antibacterial activity. J Appl Polym Sci 2022. [DOI: 10.1002/app.53377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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4
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Watanabe T. Recurrence of odontogenic keratocyst in the buccal space. BMJ Case Rep 2022; 15:e246735. [PMID: 35210225 PMCID: PMC8883213 DOI: 10.1136/bcr-2021-246735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Odontogenic keratocyst (OKC) rarely appears in the buccal space. It is aggressive and infiltrative, and simple enucleation results in high recurrence. This case report describes an OKC located in the buccal space recurring twice in a 62-year-old man with a 25 mm diameter cystic lesion in the right pterygomandibular space. The multicystic lesion was enucleated. Subsequently, a recurrence was observed, and the gourd-shaped recurrent lesion was also enucleated. The difficulty in detaching the mass from the scar tissue resulted in the perforation of the cystic wall. Thereafter, a second recurrence was observed, and the tissue surrounding the unicystic recurrent lesion was excised. The histopathological features were consistent with those of OKC. The present case is the 11th reported case of OKC in the buccal space and the first with apparent recurrence. Since complete enucleation in the pterygomandibular space is difficult, excision along with the surrounding tissues could prevent recurrence.
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Affiliation(s)
- Takuma Watanabe
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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5
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Chemical adjuncts and cryotherapy in the management Of odontogenic keratocysts: A systematic review. ADVANCES IN ORAL AND MAXILLOFACIAL SURGERY 2021. [DOI: 10.1016/j.adoms.2021.100116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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6
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Consolo U, Setti G, Tognacci S, Cavatorta C, Cassi D, Bellini P. Histological changes in odontogenic parakeratinized keratocysts treated with marsupialization followed by enucleation. Med Oral Patol Oral Cir Bucal 2020; 25:e827-e833. [PMID: 33037805 PMCID: PMC7648911 DOI: 10.4317/medoral.23898] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 09/03/2020] [Indexed: 01/18/2023] Open
Abstract
Background The purpose of this study was to evaluate whether marsupialization treatment induces changes in the histology of odontogenic keratocyst epithelium and to compare our experience with the literature.
Material and Methods A retrospective revision of histological samples was performed. 5 patients with odontogenic keratocyst treated with marsupialization follow by enucleation were selected. Histologic evaluation analyzed the changes in the keratocyst epithelium after marsupialization in terms of type of keratinization, thickness of the epithelium and connective tissue, the presence of acanthosis, the presence and grade of fibrosis, the type and grade of inflammation and the presence and number of mitotic figures and daughter cysts.
Results In our case series, a variation of para-keratinized into ortho-keratinized keratocyst was found in one case, and no significant increases were observed in the epithelium and capsule thickness, or even in the level of inflammation. However, we observed an increase in fibrosis and qualitative changes in inflammation type.
Conclusions Minor and major histological changes were associated with reduction in cyst volume, which resulted in a simpler and less invasive cystic enucleation after marsupialization. Key words:Keratocyst, marsupialization, enucleation, histology, histological changes.
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Affiliation(s)
- U Consolo
- University of Modena and Reggio Emilia Modena, Italy
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7
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Borrás-Ferreres J, Sánchez-Torres A, Alberdi-Navarro J, Aguirre-Urizar JM, Mosqueda-Taylor A, Gay-Escoda C. Therapeutic management of the odontogenic keratocyst. An energetic approach with a conservative perspective and review of the current therapeutic options. J Clin Exp Dent 2020; 12:e794-e799. [PMID: 32913578 PMCID: PMC7474939 DOI: 10.4317/jced.56722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 01/27/2020] [Indexed: 11/06/2022] Open
Abstract
Background Odontogenic keratocysts (OKC) are cystic lesions appearing in the jaws, usually asymptomatic with a progressive growth into the bone. Many of them are diagnosed by a routine radiological examination.
Material and Methods This study reports a 12-year-old girl that presented an asymptomatic large radiolucent unilocular lesion associated to the crown of 3.8 that caused displacement of the molar and the inferior alveolar canal. Differential diagnosis included OKC, unicystic ameloblastoma, ameloblastic fibroma, dentigerous cyst and orthokeratinized odontogenic cyst. Two surgical interventions were performed; first, a marsupialization, and 10 months after, the third molar extraction plus cyst enucleation, mucosa excision and the application of Carnoy’s solution.
Results The anatomopathological exam confirmed diagnosis of OKC. There was no evidence of recurrence after 2 years of follow-up.
Conclusions Marsupialization followed by surgical enucleation with mucosa excision and Carnoy’s solution can help manage treatment of OKC, a lesion characterized by an aggressive behavior. Key words:Odontogenic keratocyst, mucosa excision, carnoy solution, third molar, tooth extraction.
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Affiliation(s)
- Jordi Borrás-Ferreres
- DDS. MS. Master's Degree Program in Oral Surgery and Orofacial Implantology (EFHRE International University/FUCSO)
| | - Alba Sánchez-Torres
- DDS, MS. Master of Oral Surgery and Orofacial Implantology. Associate Professor of the Oral Surgery Department, School of Dentistry, University of Barcelona, Spain
| | - Javier Alberdi-Navarro
- DDS, MS, PhD, Assistant Professor of the Oral Medicine and Oral and Maxillofacial Pathology Unit, Dental Clinic Service, Department of Stomatology II, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - José-Manuel Aguirre-Urizar
- MD, DDS, PhD. Chairman and Professor of the Oral Medicine and Oral and Maxillofacial Pathology Unit, Dental Clinic Service, Department of Stomatology II, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Adalberto Mosqueda-Taylor
- MD, DDS, MSc. Health Care Department, Universidad Autónoma Metropolitana Xochimilco, Mexico City, Mexico
| | - Cosme Gay-Escoda
- MD, DDS, MS, PhD, EBOS, OMFS. Chairman and Professor of the Oral and Maxillofacial Surgery Department, School of Dentistry, University of Barcelona. Director of Master's Degree Program in Oral Surgery and Implantology (EFHRE International University/ FUCSO). Coordinator/Researcher of the IDIBELL Institute. Head of Oral and Maxillofacial Surgery and Implantology Department of the Teknon Medical Centre, Barcelona, Spain
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Consolo U, Bellini P, Melini GM, Ferri A, Lizio G. Analysis of Marsupialization of Mandibular Cysts in Improving the Healing of Related Bone Defects. J Oral Maxillofac Surg 2020; 78:1355.e1-1355.e11. [PMID: 32482564 DOI: 10.1016/j.joms.2020.02.034] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 02/19/2020] [Accepted: 02/19/2020] [Indexed: 01/09/2023]
Abstract
PURPOSE Marsupialization, designed to reduce the mandibular cyst volume, has continued to debated regarding its influence on the healing of the related bone cavity. The aim of the present study was to evaluate the 3-dimensional radiographic variation over time in mandibular odontogenic cystic lesions after marsupialization and assess the correlations between these variations and variables that can affect the procedure. MATERIALS AND METHODS We planned a retrospective cohort study. The predictor variables were the treatment duration, preoperative volume, patient age, histologic type, and number of preoperative residual bony walls. The outcomes variables were the postoperative volume reduction and the daily reduction rate calculated using computed tomography (CT) from before to after marsupialization using software designed for volumetric reconstruction and measurement of cyst-related bone defects. The descriptive and bivariate statistics were computerized, and the significance level was set at P = .05. RESULTS The sample included 15 patients (12 men and 3 women; mean age, 51.6; range, 27 to 85 years) affected by keratocysts (n = 6), dentigerous cysts (n = 6), and radicular cysts (n = 3) who had undergone marsupialization. The median duration of marsupialization was 406 days (25th to 75th percentile, 276 to 519). The mean ± standard deviation (SD) pre- and postdecompression volumes were 6,908.27 ± 2,669.058 and 2,468.13 ± 1,343.517 mm3, respectively (P < 0.001), and the mean ± SD percentage of reduction was 63.90 ± 13.12%. The volume decrease in the bone defects correlated positively with the treatment duration (P = .009) and preoperative volume (P < .001). However, no correlation was found with the other variables (P > .05) nor between the daily reduction rate and other variables (P > .05). CONCLUSIONS Marsupialization appears useful in improving the healing of cyst-related bone defects in mandibles, especially larger defects. Further studies with a wider sample size would add more knowledge to this topic.
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Affiliation(s)
- Ugo Consolo
- Professor, Division of Maxillofacial Surgery, Department of Surgery, Medicine, Dentistry, and Morphological Sciences with Transplant Surgery, Oncology, and Regenerative Medicine Relevance, School of Dentistry, University of Modena and Reggio Emilia, Modena, Italy
| | - Pierantonio Bellini
- Researcher, Department of Surgery, Medicine, Dentistry, and Morphological Sciences with Transplant Surgery, Oncology, and Regenerative Medicine Relevance, School of Dentistry, University of Modena and Reggio Emilia, Modena, Italy
| | - Gian Marco Melini
- Postgraduate Student, Department of Surgery, Medicine, Dentistry, and Morphological Sciences with Transplant Surgery, Oncology, and Regenerative Medicine Relevance, School of Dentistry, University of Modena and Reggio Emilia, Modena, Italy
| | - Agnese Ferri
- Scholar, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Giuseppe Lizio
- Resident, Unit of Dentistry and Maxillofacial Surgery, Policlinico di Modena Hospital, Modena, Italy; Research Assistant, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
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9
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Wang Y, Chang S, Lin Z, Chen R, Huang Z. Endoscopic-assisted enucleation of large mandibular odontogenic cysts. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 129:115-119. [PMID: 31786170 DOI: 10.1016/j.oooo.2019.05.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 04/15/2019] [Accepted: 05/27/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Traditional enucleation of large mandibular odontogenic cysts is an invasive method, which might be associated with several complications. The purpose of this study was to evaluate the clinical outcome of endoscope-assisted enucleation of large mandibular cysts. STUDY DESIGN Fifty-seven patients with large mandibular odontogenic cysts were enrolled in this study. Patients were divided into 2 groups as follows: (1) 25 patients who were treated with traditional enucleation and (2) 32 who underwent endoscope-assisted enucleation. Allogeneic bone grafting was applied in all cases. RESULTS All patients successfully underwent the operation. The follow-up period ranged from 16 to 28 months. Recurrence was found in 2 patients (8%) in the traditional enucleation group; no recurrence was observed in patients in the endoscope-assisted enucleation group. Permanent mandibular nerve palsy was found in 2 patients in the traditional enucleation group; only 2 cases of temporary mandibular nerve palsy were observed in the endoscope-assisted enucleation group. CONCLUSIONS Endoscope-assisted enucleation of large mandibular odontogenic cysts proved to be an effective treatment method, providing complete enucleation of the cystic lesion while preserving surrounding tissue.
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Affiliation(s)
- Yan Wang
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Shaohai Chang
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Zhaoyu Lin
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Rui Chen
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Zhiquan Huang
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China, 510120.
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10
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Abstract
Odontogenic cysts are epithelial-lined pathologic cavities and surrounded by fibrous connective tissue that originate from odontogenic tissues that occur in tooth-bearing regions of maxilla and mandible. Cystic conditions of the jaw cause bony destruction and may cause resorption or displacement of adjacent teeth. Odontogenic cysts have developmental or inflammatory origins. More cases have been published in the adult age group than the pediatric population. Periapical cyst and dentigerous cysts are frequently reported conditions in dental practice. Histopathologic examination remains the gold standard investigation. Odontogenic cysts are managed with enucleation or marsupialization procedures. Early recognition and referral to oral surgery minimize the extent of jaw bone destruction.
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Affiliation(s)
- Arvind Babu Rajendra Santosh
- School of Dentistry, Faculty of Medical Sciences, The University of the West Indies, Mona campus, Kingston 7, Jamaica, West Indies.
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11
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Nonsyndromic Examples of Odontogenic Keratocysts: Presentation of Interesting Cases with a Literature Review. Case Rep Dent 2019; 2019:9498202. [PMID: 31511794 PMCID: PMC6714379 DOI: 10.1155/2019/9498202] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 03/18/2019] [Accepted: 07/02/2019] [Indexed: 01/31/2023] Open
Abstract
The odontogenic keratocyst (OKC) may occur at any age. However, it mostly occurs during the second and third decades of life. Compared to other odontogenic cysts, this type occurs with a frequency of 5-15%. It is more common in the mandible region and in the male sex. Histologically, odontogenic keratocysts are characterized by the presence of an external connective tissue capsule, with keratinizing lining of the epithelium consisting of 5-8 cell layers with marked palisadisation of polarized basal cells and a corrugated parakeratin layer. The objective of this study is to present cases of odontogenic keratocysts, with reference to the latest classification and dilemmas in therapeutic doctrine. This project was realized in the form of descriptive studies, specifically in a series of cases. A collection of four individual cases was found at the Department of Oral Surgery. Due to the proper approach towards diagnosis, adequate and detailed histopathological analysis, and suitable therapeutic procedures, all cases of odontogenic keratocysts were successfully treated without complications. Enucleation of OKC, with a regular follow-up, proved to be the effective therapeutic choice for the patients described in this paper. Only in the case of recurrence would we consider other therapeutic options, primarily enucleation in combination with Carnoy's solution.
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12
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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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Kshirsagar RA, Bhende RC, Raut PH, Mahajan V, Tapadiya VJ, Singh V. Odontogenic Keratocyst: Developing a Protocol for Surgical Intervention. Ann Maxillofac Surg 2019; 9:152-157. [PMID: 31293945 PMCID: PMC6585208 DOI: 10.4103/ams.ams_137_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The aim of this study was to report the outcome of a conservative treatment protocol – “enucleation and packing open” for odontogenic keratocyst (OKC). Ten patients with OKC were treated at our institute by peripheral ostectomy, enucleation followed by open packing. This conservative treatment protocol was selected because of relatively young age of the patients and relatively large size of the lesions. All the cases were monitored at regular predetermined intervals using clinical evaluation and panoramic radiographs. There was no evidence of recurrence during follow-up. The conservative treatment protocol for OKC, based on enucleation followed by open packing would be a possible choice in view of the simplicity of surgical procedure and low morbidity. This treatment modality has a low recurrence rate and may be particularly useful in young patients and patients with advanced systemic disease not amenable to major surgical intervention.
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Affiliation(s)
- Rajesh Ashok Kshirsagar
- Department of Oral and Maxillofacial Surgery, Bharati Vidyapeeth Dental College and Hospital, Pune, Maharashtra, India
| | - Rajat Chandrashekhar Bhende
- Department of Oral and Maxillofacial Surgery, Bharati Vidyapeeth Dental College and Hospital, Pune, Maharashtra, India
| | - Pratik Hemantkumar Raut
- Department of Oral and Maxillofacial Surgery, Bharati Vidyapeeth Dental College and Hospital, Pune, Maharashtra, India
| | - Vrushika Mahajan
- Department of Oral and Maxillofacial Surgery, Bharati Vidyapeeth Dental College and Hospital, Pune, Maharashtra, India
| | - Vishal Jugalkishor Tapadiya
- Department of Oral and Maxillofacial Surgery, Bharati Vidyapeeth Dental College and Hospital, Pune, Maharashtra, India
| | - Vikram Singh
- Department of Oral and Maxillofacial Surgery, Bharati Vidyapeeth Dental College and Hospital, Pune, Maharashtra, India
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Lizio G, Ferraioli L, Melini M, Marchetti C. Long-term investigation of decompression as a definitive treatment for mandibular cysts associated with impacted third molars. J Am Dent Assoc 2018; 149:953-959. [PMID: 30173817 DOI: 10.1016/j.adaj.2018.07.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 06/29/2018] [Accepted: 07/03/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Clinicians sometimes use decompression for secondary, low-risk cyst enucleation. The authors explored whether the decompression of dentigerous cysts associated with third molars is a reliable, long-term, definitive treatment option. METHODS The authors monitored 25 mandibular cysts associated with impacted third molars in adults after surgical decompression without the extraction of the related tooth for a mean (standard deviation) time of 37 (15) months (range, 12-71 months). The authors carefully evaluated the postoperative clinical situation and the extent of radiographic shrinkage. RESULTS A minimal epithelial slit remained patent in all patients. All lacked clinical problems, had no need for further intervention, and exhibited persistent impaction of the teeth. The cyst reduction rate calculated on panoramic radiographs ranged from 63.4% to 98.8% (mean [standard deviation] 87.5% [10.6%]) and was statistically significant (P < .05). In 13 patients, the reduction rate was greater than 90%. CONCLUSIONS Decompression triggered marked radiographic reductions of cysts when epithelial communication persisted. The situation stabilized after the first 6 through 8 months, and no further intervention was required. PRACTICAL IMPLICATIONS It is risky to enucleate cysts associated with impacted third molars and extract the molars. Clinicians can solve the problem in dental practice by using surgical decompression.
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Dias G, Marques T, Coelho P. Treatment options for keratocyst odontogenic tumour (KCOT): a systematic review. ACTA ACUST UNITED AC 2016. [DOI: 10.1111/ors.12250] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- G. Dias
- Oral Surgery Department; School of Dentistry; University of Lisbon; Lisbon Portugal
| | - T. Marques
- Improvement in Teaching Methods in Conservative Dentistry; School of Dentistry; University of Lisbon; Lisbon Portugal
| | - P. Coelho
- Oral Surgery Department; School of Dentistry; University of Lisbon; Lisbon Portugal
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16
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Kamil AH, Tarakji B. Odontogenic Keratocyst in Children: A Review. Open Dent J 2016; 10:117-23. [PMID: 27335612 PMCID: PMC4891985 DOI: 10.2174/1874210601610010117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 10/06/2015] [Accepted: 10/08/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Is to highlight the characteristics and management of odontogenic keratocyst in children only. MATERIAL AND METHOD Computerized search in pubmed between (2005-2015) using specific words such as odontogenic keratocyst in children, odontogenic keratocyst association with Gorlin-Goltz syndrome with abstract written in English only. RESULT During computerized literature search 77 articles in the years (2005-2015) were found. All these publications were miscellaneous studies including case series and case reports. Only 35 papers were selected which conform to our criteria. Most of the papers indicate that the histological type of keratocyst prevalent in children was parakeratinized variant, and most of the cases occurred in maxilla rather than mandible. CONCLUSION We recommend that the surgeons who treat keratocysts in children take into consideration the late presentation in addition to the destructive nature and high recurrence rate. General practitioners face difficulty in early detection and referral of children with keratocysts or Gorlin syndrome. Treatment by multidiscplinary team is important if associated with Gorlin's syndrome Postoperative follow up is advised every 6 months.
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Affiliation(s)
- Ahmed H Kamil
- Department of Oral Maxillofacial Sciences, Alfarabi College of Dentistry and Nursing, Riyadh, Saudi Arabia
| | - Bassel Tarakji
- Department of Oral Medicine and Diagnostic Sciences, Alfarabi College of Dentistry and Nursing, Riyadh, Saudi Arabia
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Ecker J, Horst RT, Koslovsky D. Current Role of Carnoy's Solution in Treating Keratocystic Odontogenic Tumors. J Oral Maxillofac Surg 2016; 74:278-82. [DOI: 10.1016/j.joms.2015.07.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 07/20/2015] [Accepted: 07/21/2015] [Indexed: 10/23/2022]
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Nomura K, Arakawa K, Fujishima F, Yamazaki Y, Ozawa D, Nomura Y, Hidaka H, Yoshida N, Katori Y. Minimally Invasive Treatment for Hard Palate-Invading Maxillary Keratocystic Odontogenic Tumor. TOHOKU J EXP MED 2015; 237:267-72. [PMID: 26567556 DOI: 10.1620/tjem.237.267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Keratocystic odontogenic tumor (KCOT) is one of the benign developmental odontogenic cystic lesions arising from impacted teeth. In comparison to other odontogenic cysts, such as radicular cysts and dentigerous cysts, KCOT is known to be more aggressive and is associated with a relatively high recurrence rate. Traditionally, KCOT has been treated with total resection through sublabial incision. Marsupialization is advocated to reduce surgical invasion. However in all the cases, marsupialization was performed in the oral cavity. With the recent development of appropriate instruments and the endoscopic modified medial maxillectomy (EMMM) technique, which allows preservation of the inferior turbinate and nasolacrimal duct, an exclusive endoscopic approach to KCOT becomes possible. However, when the KCOT invades the hard palate, total resection of the tumor requires subtotal maxillectomy including hard palate. Consequently, as the maxillary sinus connects to the oral cavity, life-long use of a prosthesis becomes mandatory. Here we report a case of a seventeen-year-old female with a hard palate-invading KCOT who was successfully treated with the EMMM approach. The KCOT was fenestrated to the nasal cavity, leading to preservation of the hard palate. The lesion invading the hard palate was found to remain unchanged over one year upon follow-up. The trans-nasal approach with EMMM is a direct, minimally invasive method providing a direct field of view for the treatment of maxillary odontogenic cysts. Marsupialization of the KCOT with the EMMM technique might be a viable treatment option if the maxillary KCOT invades surrounding structures.
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Affiliation(s)
- Kazuhiro Nomura
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine
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Klein IP, da Silva AD, Martins MAT, Rados PV, Mengatto CM, Martins MD, Carrard VC. Slow-growing mass and expansive swelling in the maxilla. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 120:284-90. [PMID: 26159086 DOI: 10.1016/j.oooo.2015.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 04/20/2015] [Accepted: 05/17/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Isadora Peres Klein
- Department of Conservative Dentistry, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Alessandra Dutra da Silva
- Department of Conservative Dentistry, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Pantelis Varvaki Rados
- Department of Conservative Dentistry, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Cristiane Machado Mengatto
- Department of Conservative Dentistry, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Manoela Domingues Martins
- Department of Conservative Dentistry, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Vinicius Coelho Carrard
- Department of Conservative Dentistry, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
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Complete Eruption of a Deeply Impacted Tooth in a Recurrent Keratocystic Odontogenic Tumor With Orthodontic Occlusal Alignment. J Craniofac Surg 2015; 26:944-5. [DOI: 10.1097/scs.0000000000001356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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21
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Conservative Management of Keratocystic Odontogenic Tumour with Enucleation, Excision of the Overlying Mucosa and Electrocauterization - A Case Report. W INDIAN MED J 2015; 63:775-8. [PMID: 25867564 DOI: 10.7727/wimj.2014.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 02/27/2014] [Indexed: 11/18/2022]
Abstract
Odontogenic keratocyst remains an enigma for clinicians and researchers, although gains in knowledge in recent years have improved the understanding of this interesting lesion. The diagnostic problems are mainly related to the relative lack of specific clinical and radiographic features that unequivocally point to a proper diagnosis. Of particular interest to clinicians is the biologic behaviour of keratocysts which includes high rates of recurrence and potential existence as a benign odontogenic neoplasm, keratocystic odontogenic tumour. Various surgical modalities have evolved in an attempt to reduce the recurrence rate, including curettage, peripheral ostectomy, removal of overlying mucosa in cases of cortical perforation and osseous resection in the form of marginal or segmental osteotomies. The present case report describes the conservative surgical management of a large keratocystic odontogenic tumour in a young patient with no evidence of recurrence at two years follow-up.
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Kumar V. Conservative surgical approach to aggressive benign odontogenic neoplasm: a report of three cases. J Korean Assoc Oral Maxillofac Surg 2015; 41:37-42. [PMID: 25741467 PMCID: PMC4347036 DOI: 10.5125/jkaoms.2015.41.1.37] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Revised: 08/22/2014] [Accepted: 09/03/2014] [Indexed: 11/15/2022] Open
Abstract
Aggressive benign odontogenic neoplasms have substantial potential to grow to an enormous size with resulting bone deformities, and they often invade adjacent tissues and spread beyond their normal clinical and radiographic margins; as such, they have a high rate of recurrence. Historically, management (conservative versus aggressive) on the basis of clinical, radiographic and/or histopathologic characteristics has been controversial. However, recent advances in the understanding of the biological features of these lesions may provide greater evidence of the benefits of conservative management. Three patients with different complaints and final histopathologic diagnoses were enrolled in the study. All three cases were treated by a single operator with similar conservative surgical procedures. During follow-up, the patients had uneventful secondary healing and bone regeneration, less packing time than previously reported, no clinical or radiographic evidence of recurrence and no apparent deformity. The aggressive behavior of these lesions requires long clinical and radiographic follow-up. Conservative surgical management may be an option to reduce recurrence and morbidity and increase the probability of uneventful secondary healing and bone regeneration.
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Affiliation(s)
- Vijay Kumar
- Department of Oral and Maxillofacial Surgery, R. D. Dental Hospital & Research Center, Patna, India
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Abstract
PURPOSE There is no clinical consensus for the treatment of Keratocystic Odontogenic Tumor (KCOT). KCOTs are regarded as benign aggressive tumors and resection is usually considered as a last option. We review the clinical indications for resection based on a case series. METHODS This is a retrospective study of patients with KCOT treated in a single unit over 17 years. Eighty patients were identified, of which 12 (15 %) underwent resection. The remaining 68 patients were managed by enucleation and curettage, enucleation with peripheral ostectomy, or decompression with secondary enucleation. Data extracted includes gender, age, race, location, previous treatment for the lesion, surgery and outcome/follow up. RESULTS Twelve patients treated by resection were identified. The location in the ten benign resected KCOTs was either the mandibular ramus or the posterior maxilla. All mandibular KCOTs exhibited perforation of the lingual plate and involvement of the pterygoid musculature. Seven of the ten cases were recurrent KCOTs and three had no prior treatment. Two had malignant changes in the KCOT and were also resected. CONCLUSION The primary reason for resection of KCOT was involvement of the pterygoid muscles. The presence of malignant change was a separate indication for resection.
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Robles P, Roa I. Keratocystic odontogenic tumor: Clinicopathological aspects and treatment. JOURNAL OF ORAL RESEARCH 2014. [DOI: 10.17126/joralres.2014.056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Sánchez-Burgos R, González-Martín-Moro J, Pérez-Fernández E, Burgueño-García M. Clinical, radiological and therapeutic features of keratocystic odontogenic tumours: a study over a decade. J Clin Exp Dent 2014; 6:e259-64. [PMID: 25136427 PMCID: PMC4134855 DOI: 10.4317/jced.51408] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 01/19/2014] [Indexed: 11/25/2022] Open
Abstract
Factors associated with the potential for recurrence of keratocystic odontogenic tumours (KCOT) still remain to be clearly determined and no consensus exists concerning the management of KCOT. The purpose of this study was to evaluate different clinical factors associated with KCOT and its treatment methods. A retrospective review was performed of 55 cases treated from 2001 to 2010. Of the 55 cases, 27% were associated with an impacted or semi-impacted tooth. The majority of the lesions (82%) were located in tooth-bearing areas, and the overall mandibular to maxilla ratio of tumour occurrence was 5:1. The treatment options included enucleation, marsupialisation, or peripheral ostectomy, with or without the use of Carnoy´s solution. Recurrence was found in 14 cases (25%). No significant association was seen between recurrence and age, symptomatic cases, location of the lesion, or unilocular or multilocular appearance. The recurrence rate was higher in the group with tooth involvement, more marked in cases with third molar involvement. Statistical analysis showed a significant relation between recurrence and the type of treatment, with higher rates in cases treated with enucleation associated with tooth extraction. In our series, those cases with a closer relation with dental tissues showed a higher risk of recurrence, suggesting the need for a distinct classification for peripheral variants of KCOT.
Key words:Keratocystic odontogenic tumour, Odontogenic keratocyst, Odontogenic cysts, Keratocyst, Carnoy’s solution.
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Affiliation(s)
- Rocío Sánchez-Burgos
- Oral and Maxillofacial Department, Hospital Universitario de Canarias, Tenerife, Spain
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Bimaxillary keratocystic odontogenic tumour: a case of diagnostic and therapeutic difficulty. Case Rep Med 2014; 2014:194810. [PMID: 24790606 PMCID: PMC3984809 DOI: 10.1155/2014/194810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 02/24/2014] [Indexed: 11/17/2022] Open
Abstract
Keratocystic odontogenic tumour (KCOT) is a benign cystic intraosseous tumour of odontogenic origin that is usually solitary except when syndromic. It rarely occurs in the maxilla; therefore a rapidly progressive, nonsyndromic bimaxillary KCOT with locoregional extension poses significant diagnostic and management challenges. To the best of the authors' knowledge, documentation of a nonsyndromic bimaxillary KCOT is nonexistent in the English literature. We therefore present the case of an extensive bimaxillary KCOT in a 38-year-old Nigerian male.
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Arcieri Mastromattei D, Falco A, Berardini M, Pistilli R. Trattamento chirurgico di una cisti odontogena gigante associata a terzo molare inferiore incluso, follow-up a 2 anni. DENTAL CADMOS 2014. [DOI: 10.1016/s0011-8524(14)70180-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ebenezer V, Ramalingam B. Importance of Different Modalities of Treatment For the Management of Keratocystic Odontogenic Tumour with Five year follow-up. J Clin Diagn Res 2014; 8:225-8. [PMID: 24783143 DOI: 10.7860/jcdr/2014/7486.4168] [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: 08/27/2013] [Accepted: 01/30/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND The keratocystic odontogenic tumors is a benign but one of most aggressive developmental cyst with many distinguishing clinical and histologic features and high recurrence rate. In the given study, authors have studied and presented their experience of managing Keratocystic odontogenic tumour. The aim of the study was to define an appropriate treatment protocol for the management of KCOT. MATERIALS AND METHODS Total 8 patients, whose histopathological reports confirmed Gorlin - Goltz syndrome and KCOT, with age between 10 - 50 years, were selected from cases being treated at Sree Balaji Dental College, Chennai, India. Enucleation and resection were the surgical techniques employed. Modality of treatment was based on parameters like age , size, aggressiveness and extent of the lesion. All the patients were operated under general anaesthesia. Cases were studied, reviewed and followed up for five years between 2007-2012. RESULTS The study included 8 cases in which three cases were opted for resection and five cases for enucleation followed by application of Carnoy's solution. CONCLUSION Treatment modality should be decided on age, extent, aggressiveness and nature of the tumour.
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Affiliation(s)
- Vijay Ebenezer
- Professor and HOD, Department of OMFS, Sree Balaji Dental College and Hospital , Chennai, India
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Liu B, Cai Y, Wang SP, Zhao YF. Recurrent keratocystic odontogenic tumor in the masseter muscle overlying the boney perforations: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 113:e1-5. [PMID: 22668437 DOI: 10.1016/j.tripleo.2011.07.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2011] [Revised: 06/25/2011] [Accepted: 07/04/2011] [Indexed: 11/18/2022]
Abstract
Keratocystic odontogenic tumor (KCOT) is a benign intraosseous neoplasm of odontogenic origin with high recurrence rates and tendency to invade adjacent tissue. Most recurrences occur in the first 5 years after surgery and are usually located at the site of the primary tumor in the jaws. We report a rare case of KCOT which recurred in the masseter muscle 14 years after segmental mandibulectomy and autogenous frozen lesional mandible reimplantation. The patient had undergone enucleation of KCOT in the right mandible 20 years before segmental mandibulectomy. This case could further demonstrate the aggressive behavior of KCOT.
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Affiliation(s)
- Bing Liu
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, China
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Volume reduction of cystic lesions after surgical decompression: a computerised three-dimensional computed tomographic evaluation. Clin Oral Investig 2012; 17:1701-8. [DOI: 10.1007/s00784-012-0869-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 10/17/2012] [Indexed: 10/27/2022]
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Johnson NR, Batstone MD, Savage NW. Management and recurrence of keratocystic odontogenic tumor: a systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 116:e271-6. [PMID: 22771402 DOI: 10.1016/j.oooo.2011.12.028] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Accepted: 12/19/2011] [Indexed: 01/31/2023]
Abstract
OBJECTIVES The objective of this study was to evaluate the most up-to-date treatment modalities and respective recurrence rates for keratocystic odontogenic tumor (KCOT). STUDY DESIGN A systematic review of the literature from 1999 to 2010 was undertaken examining treatment and recurrence rates for KCOT. Four inclusion criteria were defined for articles to then be analyzed against 8 standards. RESULTS Of the 2736 published articles, 8 met the inclusion criteria. When merging the data, enucleation and enucleation with adjunctive measures (other than Carnoy's solution) had recurrence rates of 25.6% and 30.3%, respectively. Marsupialization with adjunctive measures produced a recurrence rate of 15.8%, whereas enucleation with Carnoy's solution presented a recurrence rate of 7.9%. Only one resection case had recurrence (6.3%). CONCLUSIONS The enucleation technique with the use of adjunctive procedures (other than Carnoy's solution) provides a higher recurrence rate than any other treatment modality.
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Affiliation(s)
- Nigel R Johnson
- Principal Researcher, Maxillofacial Department, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
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Kaczmarzyk T, Mojsa I, Stypulkowska J. A systematic review of the recurrence rate for keratocystic odontogenic tumour in relation to treatment modalities. Int J Oral Maxillofac Surg 2012; 41:756-67. [DOI: 10.1016/j.ijom.2012.02.008] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Revised: 12/20/2011] [Accepted: 02/15/2012] [Indexed: 10/28/2022]
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Marsupialisation for keratocystic odontogenic tumours in the mandible: longitudinal image analysis of tumour size using 3D visualised CT scans. Int J Oral Maxillofac Surg 2012; 41:290-6. [DOI: 10.1016/j.ijom.2011.10.015] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2010] [Revised: 10/11/2011] [Accepted: 10/18/2011] [Indexed: 11/21/2022]
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Ribeiro Junior O, Borba AM, Alves CAF, de Gouveia MM, Coracin FL, Guimarães Júnior J. Keratocystic odontogenic tumors and Carnoy’s solution: results and complications assessment. Oral Dis 2012; 18:548-57. [DOI: 10.1111/j.1601-0825.2012.01907.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Güler N, Sençift K, Demirkol O. Conservative management of keratocystic odontogenic tumors of jaws. ScientificWorldJournal 2012; 2012:680397. [PMID: 22454609 PMCID: PMC3289950 DOI: 10.1100/2012/680397] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Accepted: 11/15/2011] [Indexed: 01/10/2023] Open
Abstract
PURPOSE The aim of this study was to evaluate different surgical treatment methods for keratocystic odontogenic tumors (KCOTs) and the outcome of those treatments over a 9-year period. PATIENTS AND METHODS A retrospective review was performed on 43 KCOTs in 39 patients. In radiographic evaluations for diagnosis, follow ups and before and after treatment, panoramic, 3D CT and MR images were used. The three groups of different surgical treatment were (1) enucleation for small unilocular lesions without certainty of histology; (2) enucleation with Carnoy's solution, for small unilocular lesions after previous histological confirmation of KOCT; (3) marsupialization followed by enucleation with Carnoy's solution implemented for large often multilocular KCOTs with intact or destruction of cortical bone without infiltration of neighbouring tissue. RESULTS 43 KCOT cases were mostly localized in mandible (76.7%), radiologically unilocular (72%), and parakeratocysts (88.4%). Inflammation and satellite cysts (daughter cysts) were detected histopathologically in 14 (32.5%) and 7 (16.3%), respectively. Among the 43 cysts, 20 (46.5%) were associated with the impacted third molar and of 21 (48.8%) was in tooth bearing area, and 5 (11, 6%) located on edentulous areas. It was located mostly in the anterior region of maxilla (90%) and in mandibular molar and ramus (62.8%). The treatments of KCOTs were 18 (41.9%) for group 1, and 10 (23.3%) group 2, and 15 (34.8%) group 3. A statistically significant relationship was found between the radiographic appearance and treatment methods (P = 0.00). No recurrence was found on 40.54 ± 23.02 months follow up. CONCLUSION We concluded that successful treatment methods were enucleation and Carnoy's solution in small lesions and marsupialization in lesions that have reached a very large size, but because KCOT was observed in second decade mostly, long-term follows up are suggested.
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Affiliation(s)
- Nurhan Güler
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Yeditepe University, Bagdat Cad. No: 238 Goztepe, Istanbul, Turkey.
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Zhou H, Hou R, Ma Q, Wu K, Ding Y, Qin R, Hu K. Secondary healing after removal of large keratocystic odontogenic tumor in the mandible: enucleation followed by open packing of iodoform gauze. J Oral Maxillofac Surg 2012; 70:1523-30. [PMID: 22330329 DOI: 10.1016/j.joms.2011.12.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Revised: 12/02/2011] [Accepted: 12/03/2011] [Indexed: 11/18/2022]
Abstract
PURPOSE The aim of this retrospective study was to present the findings of an open packing method after enucleation of large keratocystic odontogenic tumors (KCOTs) in the mandible. PATIENTS AND METHODS We performed a retrospective case series study of 27 patients with KCOTs larger than 5 cm treated at our institution between September 2003 and September 2008. A conservative surgical treatment was applied, which involved enucleation of the primary lesion and open packing of the residual osseous defect with iodoform gauze for secondary healing. Bone regeneration, tumor recurrence, and surgical complications were observed and analyzed. We used the χ(2) test and Pearson correlation coefficient for statistical analysis. RESULTS The postoperative follow-up time was 52.3 months on average (range, 24 to 84 months). The packing gauze was changed every 2 weeks after enucleation, and the total duration for packing was 10.2 months on average (range, 7-15 months). Bone regeneration and satisfactory secondary healing were observed clinically and radiographically after treatment. Only 1 case had a recurrence 6 months after initial treatment, which was attributed to insufficient bony unroofing during enucleation. The recurrent lesion was re-treated by the same method, and no recurrence occurred in the following 6 years. No serious complications from this method of treatment were observed. No significant variables were found to be related to the recurrence. CONCLUSIONS Enucleation with subsequent open packing was shown to be a conservative and comfortable treatment for patients and appears to be an effective choice for the management of large KCOTs in the mandible.
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Affiliation(s)
- Hongzhi Zhou
- Department of Oral and Maxillofacial Surgery, School of Stomatology, Fourth Military Medical University, Xi'an, China.
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Multilocularity as a Radiographic Marker of the Keratocystic Odontogenic Tumor. J Oral Maxillofac Surg 2012; 70:320-4. [DOI: 10.1016/j.joms.2011.03.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Revised: 03/09/2011] [Accepted: 03/10/2011] [Indexed: 11/21/2022]
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Taguchi T, Morita KI, Shimada Y, Omura K. A clinical study on the recurrence of keratocystic odontogenic tumor. ACTA ACUST UNITED AC 2012. [DOI: 10.5843/jsot.24.9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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[Therapy-resistant aggressive cystic lesion of the mandible]. Radiologe 2011; 51:876-9. [PMID: 21845481 DOI: 10.1007/s00117-011-2221-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Several extensive surgical interventions of a cystic lesion in the left mandible were followed by recurrences. The lesion extended from the primary mandibular region into the area of pterygopalatine fossa finally infiltrating the orbital region and the skull base. Histological results could never demonstrate a malignancy with certainty. Due to the patient's poor general condition, the refusal for further surgical inventions and due to the malignoma-like growth pattern radiation treatment was performed. However, this had no effect on tumor progression.
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Yang SI, Park YI, Choi SY, Kim JW, Kim CS. A retrospective study of 220 cases of keratocystic odontogenic tumor (KCOT) in 181 patients. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.ajoms.2011.03.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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41
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Abdullah WA. Surgical treatment of keratocystic odontogenic tumour: A review article. Saudi Dent J 2011; 23:61-5. [PMID: 24151416 PMCID: PMC3770236 DOI: 10.1016/j.sdentj.2011.01.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2009] [Accepted: 12/23/2009] [Indexed: 11/18/2022] Open
Abstract
KCOT is one of the most aggressive odontogenic cysts with a high recurrence rate, this was explained histopathologically as it typically shows a thin, friable wall, which is often difficult to enucleate from the bone in one piece, and have small satellite cysts within the fibrous wall. Multiple surgical approaches were introduced including decompression, marsupilization, enucleation with or without adjunct (Carnoy's solution, enucleation) and resection. Depending on other studies KCOT can be conservatively treated with enucleation and application of Carnoy's solution or cryotherapy. This can be used specially in the large lesions that when treated with resection, the continuity of the jaw will be interrupted. This technique shows comparable results to other more aggressive techniques.
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Apajalahti S, Hagström J, Lindqvist C, Suomalainen A. Computerized tomography findings and recurrence of keratocystic odontogenic tumor of the mandible and maxillofacial region in a series of 46 patients. ACTA ACUST UNITED AC 2011; 111:e29-37. [DOI: 10.1016/j.tripleo.2010.10.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Revised: 10/03/2010] [Accepted: 10/04/2010] [Indexed: 10/18/2022]
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Lee IH, Choi SY, Park JH, Kim CS. Expression of Bcl-2 in the epithelial lining and clinical findings of keratocystic odotogenic tumor. J Korean Assoc Oral Maxillofac Surg 2011. [DOI: 10.5125/jkaoms.2011.37.3.161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- In-Hyuk Lee
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University, Daegu, Korea
| | - So-Young Choi
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University, Daegu, Korea
| | - Ji-Hoon Park
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University, Daegu, Korea
| | - Chin-Soo Kim
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University, Daegu, Korea
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Keratocystic Odontogenic Tumor (Odontogenic Keratocyst): Preliminary Retrospective Review of Epidemiologic, Clinical, and Radiologic Features of 261 Lesions From University of Turin. J Oral Maxillofac Surg 2010; 68:2994-9. [DOI: 10.1016/j.joms.2010.05.068] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2010] [Revised: 03/13/2010] [Accepted: 05/18/2010] [Indexed: 11/22/2022]
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45
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Case report: endodontic and surgical treatment of an upper central incisor with external root resorption and radicular cyst following a traumatic tooth avulsion. ACTA ACUST UNITED AC 2010; 110:e61-7. [DOI: 10.1016/j.tripleo.2010.04.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2009] [Revised: 04/06/2010] [Accepted: 04/20/2010] [Indexed: 11/23/2022]
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Abstract
Benign lesions involving the mandibular condyle are rare. Odontogenic keratocyst has been always an interesting subject to debate since Philipsen first described it as a distinct entity in 1956. Nevertheless, the large variability and the lack of homogeneity between patients in the different studies did not allow to develop universally recognized guidelines for the keratocyst odontogenic tumor treatment. The aim of this article was to present a new surgical technique to approach high-dimension benign lesion located at the level of the mandibular ramus and condyle, consisting enucleation and curettage under endoscopic vision.
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Management of odontogenic keratocysts of the jaws: A ten-year experience with 120 consecutive lesions. J Craniomaxillofac Surg 2010; 38:358-64. [DOI: 10.1016/j.jcms.2009.10.006] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2009] [Revised: 09/13/2009] [Accepted: 10/05/2009] [Indexed: 11/24/2022] Open
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49
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Relationship between the prevalence of the dentigerous cyst and the odontogenic keratocyst tumor and the current etiologic hypothesis. J Craniofac Surg 2010; 20:2036-40. [PMID: 19881373 DOI: 10.1097/scs.0b013e3181be8773] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Cysts are considered as nonneoplastic benign lesions that, when present for a long period of time, can cause some discomfort, especially related to the treatment form. Among the types of cysts of the maxilla, the dentigerous cyst (DC) presents substances between the dental follicle and the crown of the tooth with high potential for resorption, and the odontogenic keratocyst tumor (OKT) characterizes for its noticed rapid growth pattern and the possibility to develop carcinomas in the lesion wall. The DC is the most common type among the developing odontogenic cystic lesions, while the OKT represents 10% of these lesions. The prevalence of the OKT found in the current study was superior to the DC, opposing data of the evaluated literature, as well as the predominance in relation to the age group. Dentigerous cyst cases were found mostly in younger individuals, whereas the OKT was observed mainly in individuals between the third and fourth decades of life. This fact reflects the fragility of these features while establishing the presumptive diagnosis and insinuates the strong relation with a probable genetic predisposition. In relation to sex and race, the findings in this article were similar to those found in the literature, highlighting the possibility of a hormonal involvement. However, the anatomopathologic examination remains essential to define the main diagnosis of the lesions observed by means of imaging examinations, providing for safer diagnoses to plan the treatment.
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Mendes RA, Carvalho JFC, van der Waal I. Characterization and management of the keratocystic odontogenic tumor in relation to its histopathological and biological features. Oral Oncol 2010; 46:219-25. [PMID: 20189443 DOI: 10.1016/j.oraloncology.2010.01.012] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Revised: 01/19/2010] [Accepted: 01/19/2010] [Indexed: 11/24/2022]
Abstract
Keratocystic odontogenic tumor (KCOT), formerly referred to as odontogenic keratocyst, is a benign neoplasm of odontogenic origin which may present an aggressive and infiltrative behavior leading to high recurrence rates. A review of the various treatment modalities, ranging from simple enucleation to radical surgery is portrayed in relation to clinical, radiological, histopathological and molecular features. Although prognostic factors based on clinico-pathologic and immunohistochemical findings for determining the potential for recurrence of KCOT still remains unclear, its use for determining the potential for recurrence of KCOT after surgical treatment may become important to successfully manage this neoplasm's aggressive behavior. The key element for future management of KCOTs will probably be based on thorough knowledge of the biological basis of this tumor, thereby enabling a more tailored treatment approach.
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