Treatment options for keratocyst odontogenic tumour (KCOT): a systematic review

Management and recurrence of the odontogenic keratocyst: an overview of systematic reviews

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.

Odontogenic Keratocysts: Presentation and Surgical Outcome in a Sample of Sudanese Patients

Background

Odontogenic keratocyst (OKC) is a benign intraosseous lesion relatively frequent in the oral cavity. It has a locally aggressive behavior and exhibits a high propensity to recur after treatment. The present study aimed to investigate the clinicoradiographic presentations and outcomes of surgical treatment of OKC at Khartoum Teaching Dental Hospital. Material and Methods. Fifty-five cases of OKC files at the Department of Oral and Maxillofacial Surgery in Khartoum Teaching Hospital between 2012 and 2022 were reviewed and studied using a descriptive prospective cross-sectional study. Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 27.

Results

Out of 55 cases studied, the mean age at the time of diagnosis was 30 ± 17.6 years; of them, 28 (50.9%) were males and 27 (49.1%) were females. The most common clinical manifestation was swelling (34.9%), followed by pain (28.0%). Sixty-five percent of the OKCs were located in the posterior mandible, and multilocular radiolucency (73.6%) was the most prevalent radiological finding. Enucleation with Carnoy's solution (CS) (55.2%) was the most common surgical modality that was used in more than half the patients, and only six patients had a recurrence. Marsupialization and segmental resection had no recurrence, while marginal resection and curettage had the highest recurrence rate of 20%. Patients with consanguineous parents had a higher recurrence rate (15%) compared with patients who had nonconsanguineous parents (8.6%). None of the patients died or had a malignant transformation.

Conclusion

The most common location for the cyst was the mandible, and multilocular radiolucency was the most prevalent radiological finding. Enucleation with CS was the most commonly used surgical modality, used in more than half of the patients, with only six patients experiencing recurrence.

[Techniques for the treatment of keratocyst, review of the literature and case report]

The odontogenic keratocystic tumor (OKT) or also currently known as odontogenic keratocyst (OK) is a benign pathology derived from the remains of the dental lamina characteristic for possessing variable amounts of desquamated keratin. It usually rises as solitary or with the presence of satellite cysts, the appearance of these satellite cysts is frequently related to the possible recurrence of OK, according to the literature, this recurrence can vary between 0 - 50%. As for the treatment stage of (OKT), it can be mentioned that at present there is a well-defined histological and clinical criterion, which facilitates its recognition and therefore its treatment. According to the literature, there are several treatment procedures that can be classified into non-conservative or radical treatments and conservative treatments accompanied by adjuvant methods. Within the non-conservative or radical treatments, we find en bloc resection, which is the most aggressive way to treat a keratocyst; however, it is the most effective way to avoid recurrence. Within the conservative treatments, marsupialization, decompression, and enucleation with or without adjuvant therapy are described. It is paramount to know how to recognize the different types of treatment for (OKT) since this will be conditioned by multiple factors, such as the location of nearby bone structures and the size of the lesion considering the possible involvement of dental structures. The objective is to seek the lowest-risk treatment possible, which avoids recurrence and finally puts an end to this pathology.

Unveiling metabolic changes in marsupialized odontogenic keratocyst: A pilot study

OBJECTIVE

We aimed to assess which metabolic pathways would be implicated in the phenotypic changes of the epithelial lining of odontogenic keratocyst after marsupialization, comparing pre- and post-marsupialized lesions with adjacent oral mucosa.

MATERIALS AND METHODS

Eighteen formalin-fixed and paraffin-embedded tissues from six subjects were divided into three paired groups: odontogenic keratocyst pre- (n = 6) and post-marsupialization (n = 6), and adjacent oral mucosa (n = 6). The metabolic pathways found in these groups were obtained by high-performance liquid chromatography-mass spectrometry-based untargeted metabolomics performed.

RESULTS

Through putative metabolite annotation followed by pathway enrichment and predictive analysis with automated algorithms (Mummichog and Gene Set Enrichment Analysis), we found differences in many cellular processes that may be involved in inflammation, oxidative stress response, keratinocyte-basal membrane attachment, differentiation, and proliferation functions, all relevant to odontogenic keratocyst pathobiology and the phenotype acquired after marsupialization.

CONCLUSION

Our study was able to identify several metabolic pathways potentially involved in the metaplastic changes induced by marsupialization of odontogenic keratocysts. An improved comprehension of this process could pave the way for the development of targeted therapies.

Relapses after using Carnoy's solution in treating aggressive benign odontogenic lesions

BACKGROUND

Chemical curettage has become popular in the definitive treatment of benign aggressive odontogenic lesions. Therefore, this study aims to verify the relapse rate and associated factors after the enucleation protocol, peripheral ostectomy and Carnoy's solution.

METHODS

This is a retrospective sectional study with 30 patients, selected by non-probabilistic convenience sampling, submitted to the protocol from 2008 to 2018. The study was composed by the data collection phase of the medical records and clinical and radiographic analysis of the patients in order to verify the presence of relapses. Descriptive and statistical analyzes were performed using the Stata/IC version 14.0 program (StataCorp, College Station, TX, USA). The Mann-Whitney Test, Fisher's Exact Test and the χ2 Test, as well as the Kaplan Meier method and the Log-rank Test were used to verify the possible prognostic factors for relapses, adopting P<0.05.

RESULTS

The sample consisted of 22 patients with odontogenic keratocysts (73.3%), 3 odontogenic myxomas (10%) and 5 ameloblastomas (16.7%). Relapses affected 7 patients (23.3%), all in odontogenic keratocysts, and the relapse time was between 12-34 months. There was no statistical difference between the evaluated factors and relapse development. Patients who remained with teeth adjacent to the lesion after treatment had an earlier relapse time, a cumulative risk of more than 80% for relapse after 29 months postoperatively, and a 5.5 times greater chance of developing relapses than patients who had their teeth extracted.

CONCLUSIONS

The protocol is advantageous when compared to isolated treatments and can be used as an alternative to resection.