Five years follow-up of a keratocyst odontogenic tumor treated by marsupialization and enucleation: A case report and literature review

Long-term investigation of minimally invasive alcohol-based therapy as the treatment of odontogenic keratocyst:A retrospective cohort study

The aim of this study was to evaluate the clinical efficacy of alcohol-based therapy for patients with large odontogenic keratocysts (OKCs). The study was implemented as a retrospective, single-center study. Patients treated with ethanol-based therapy for odontogenic keratocyst were retrospectively evaluated for baseline and postoperative data. The pre- and postoperative clinical situation and the extent of radiographic shrinkage were compared. The event is defined as the achievement of >50% reduction in cyst volume. The cyst reduction rate calculated on panoramic radiographs ranged from 7.4% to 99.9% (mean [standard deviation] 55.3% [27.9%]) and was statistically significant (P < 0.05). Specifically, it has been found that, radiographically, 47.6% of patients achieved >50% reduction in cyst volume within 12 months. The continuous cortical bone was rebuilt, and the cyst cavity was filled with regenerated trabecular bone. The 22 included patients presented with nonclinical problems, had no need for further intervention, and exhibited persistent impaction of the teeth. The results of this study demonstrated that ethanol-based therapy triggered marked radiographic reductions of large OKC, indicating that using this technique is efficient.

A 3-year follow-up clinical study on the preservation for vitality of involved tooth in jaw cysts through an innovative method

Jaw cysts commonly affect the oral and maxillofacial region, involving adjacent tooth roots. The management of these teeth, particularly regarding root canal therapy and apicoectomy, lacks consensus. This study introduces a novel treatment concept and refined surgical approach to preserve pulp viability in teeth involved in jaw cysts. The objective was to investigate the effectiveness and potential benefits of this approach over a 36-month follow-up period. A conservative management approach prioritized vitality preservation, reserving root canal treatment and apicectomy for cases with post-operative discomfort. A comprehensive follow-up of 108 involved teeth from 36 jaw cyst cases treated with the modified method was conducted. Clinical observation, X-ray imaging, cone-beam computed tomography (CBCT), and pulp vitality testing assessed changes in cyst size, tooth color, pulp vitality, root structure, and surrounding alveolar bone. After 36 months, our modified surgical approach successfully preserved tooth vitality in 84 involved teeth. Adverse symptoms in 19 teeth, such as redness, swelling, fistula, and pain, resolved with postoperative root canal therapy. Follow-up was lost for five teeth in two cases. No cyst recurrences were observed, and in 34 cases, the bone cavity gradually disappeared, restoring normal bone density during long-term follow-up. Our modified surgical method effectively preserves tooth vitality in jaw cysts. This innovative approach has the potential to improve the management of teeth involved in jaw cysts.

The clinical importance of marsupialization treatment of the cystic lesion of the jaws: Analysis of the dental pulp vitality

BACKGROUND

Jaw cyst is the most common pathology in the oral and maxillofacial region. The management of the teeth involved in cystic lesions is highly controversial. However, if the teeth involved in the cystic lesion could be preserved with their pulp vitality, the life span of these teeth will be considerably lengthened to improve the masticatory function of these patients after surgery. The present retrospective study over 10 years; with 92 patients that had cystic lesions of the jaws aimed to evaluate the effect of marsupialization on the preservation of the vitality teeth involved in the cystic lesion before and after treatment taking.

MATERIAL AND METHODS

clinical retrospective study between January 2013 and January 2022, included 92 patients with a cystic lesion of jaw treated by marsupialization were carried out. The clinical data were collected; the number of teeth involved in the cystic lesion, the vitality of these teeth before and after marsupialization, the number of teeth that have undergone root canal treatment, the number of cases of failure (teeth that were extracted during surgery to open the cystic lesion and teeth that were extracted after surgery) as well as the duration of treatment for each patient were assessed.

RESULTS

Of 92 patients, 54 were men and 38 women with ages ranged from 7 years to 62 years were enrolled in this study.380 teeth were involved in the cystic lesion of that 352 teeth were positive and 28 teeth were negative before marsupialization. 28 teeth underwent root canal treatment before surgery. After surgery, 338 teeth were positive and 42 were negative. Among the 42 negative teeth, 31 teeth failed (extracted) and 11 teeth recovered their vitality before the end of the treatment.321 teeth were saved and preserved their pulp vitality.

CONCLUSION

The effect of marsupialization is good; it saves and preserves the vitality of the teeth involved in the cystic lesion and it reduces the cost of treatment for the patients.

Eruption of the Permanent First Premolar Associated with a Mandibular Keratocystic Odontogenic Tumor after Marsupialization in a 9-year-old Boy: A Case Report with 2 years of follow-up

Amongst odontogenic cysts, keratocystic odontogenic tumor (KOT) is a benign intra-osseous lesion, characterized by corrugated parakeratinized uniform stratified squamous epithelium, with potential for aggressive behavior and high tendency to recur. There are multiple treatment modalities for this cyst. Some surgeons prefer the conservative treatments such as marsupialization while the others prefer invasive treatments such as radical resection. The aim of this study was to present a case of KOT involving the right mandibular premolar area with an impacted tooth in a 9-year-old boy treated by marsupialization. The treatment resulted in eruption of the mandibular first premolar, and no signs of recurrence were observed after two years. Marsupialization was found to be an effective treatment in inducing the eruption of mandibular premolar associated with KOT in preadolescents and can be a reliable procedure to reduce recurrence tendency of KOT.

Effect of Decompression on Jaw Cystic Lesions Based on Three-Dimensional Volumetric Analysis

Background and objectives: This study aimed to evaluate the effectiveness of decompression on jaw cysts according to various parameters by volumetric analysis using three-dimensional computed tomography. Materials and methods: Fifty patients who underwent surgical decompression of the jaw cystic lesion were selected, and their preoperative and postoperative computed tomography results between 3 and 27 months were collected. Volumetric analysis was performed to evaluate any differences in the rate of volumetric change according to the sex, age, initial volume of the lesion, duration, location of the lesion, tooth extraction, expansion of the cortical layer, and pathological diagnosis. Multiple linear regression and generalised linear mixed models were used for statistical analyses. Results: The mean reduction rate among all patients was 54.68%. Multiple linear regression analysis revealed that higher reduction rates were associated with a long decompression period, young patient age, and location of the cyst in the posterior maxilla. Generalised linear mixed models revealed that higher reduction rates were associated with a long decompression period and young patient age. Conclusions: Decompression was an effective treatment for reducing the cyst size in all patients. Its effectiveness increased with a long treatment duration, young patient age, and cyst location in the posterior maxilla three-dimensionally.

Histological changes in odontogenic parakeratinized keratocysts treated with marsupialization followed by enucleation

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.

p63 Expression and its Relation to Epithelial Cells Proliferation in Dentigerous Cyst, Odontogenic Keratocyst, and Ameloblastoma

The current controversy about the classification of odontogenic keratocyst reflects the shortage in the understanding of the odontogenic cysts and tumors. The aim of the present study was to investigate p63 immunoexpression and its relation to the proliferation of the epithelial lining in dentigerous cyst (DC), odontogenic keratocyst (OKC), and follicular type of ameloblastoma (AB). The study involved 36 samples, which are DC (n = 12), OKC (n = 9), and AB (n = 15). p63 protein expression was evaluated by immunohistochemistry. The results on Ki-67 expression were obtained from our previous studies and correlated with p63 expressions. p63 was expressed differently in the studied lesions with various distribution in different study samples. Statistical analysis using Kruskal-Wallis test showed a significant difference in the expression of p63 protein among DC, OKC, and AB (p = 0.048). Subsequently, Mann-Whitney U test revealed the expression of p63 protein was significantly higher in OKC than DC (p = 0.018). Interestingly, Spearman's correlation analysis showed a positive correlation between the expression of p63 and Ki-67 in the odontogenic epithelium of DC (σ = 0.757, P = 0.004) and OKC (σ = 0.741, P = 0.022). While no such a positive correlation was found between the two studied markers in AB group (σ = 0.006, P = 0.983). In conclusion, the present results indicated various expression and correlation of p63 with the proliferation of odontogenic epithelial cells in DC, OKC, and AB. This diversity could reflect a different role and pathways of ΔNp63 in odontogenic tumor than that in odontogenic cyst. These together will help in better understanding the pathogenesis and biological behavior of odontogenic cysts and tumors.

Expression of keratin 15 in dentigerous cyst, odontogenic keratocyst and ameloblastoma

The etiology and pathogenesis of odontogenic lesions are poorly understood. Keratin 15 (K15) is a type I cytoskeletal protein that provides structural support to the cells and has been considered to be a stem cell marker. The aim of the present study was to evaluate the expression of K15 in the epithelial lining of dentigerous cysts (DCs), odontogenic keratocysts (OKCs) and ameloblastomas (ABs). The study included 41 samples of DCs (n=13), OKCs (n=12), and AB tissues (n=16). K15 protein expression was evaluated via immunohistochemistry and data were statistically analyzed using a Kruskal-Wallis test. K15 was expressed in the majority of the studied lesions with various distributions in the different study samples. The Kruskal-Wallis test revealed non-significant differences in the expression of K15 among the three odontogenic lesions (P=0.380). The present study confirmed the high expression of K15 in the different epithelial layers of DC, OKC and AB. This type of expression excludes the reliability of regarding K15 as a stem cell marker in DC, OKC and AB. However, K15 may reflect the abnormal differentiation of pathological epithelial cells in these lesions.

Volume change pattern of decompression of mandibular odontogenic keratocyst

Objectives

This study was aimed to analyze the reducing pattern of decompression on mandibular odontogenic keratocyst and to determine the proper time for secondary enucleation.

Materials and methods

Seventeen patients with OKC of the mandible were treated by decompression. Forty-five series of CT data were taken during decompression and measured by using InVivo software (Anatomage, San Jose, Calif) and were analyzed.

Results

The expected relative volume during decompression is calculated using the following formula: V(t) = V _initial × exp.(at + 1/2bt ²) (t = duration after decompression (day)). There was no significant directional indicator in the rate of reduction between buccolingual and mesiodistal widths.

Conclusion

The volume reduction rate gradually decreased, and 270 days were required for 50% volume reduction following decompression of OKC. The surgeon should be aware of this pattern to determine the timing for definitive enucleation.

Clinical relevance

The volume reduction rate and pattern of decompression of the OKC can be predicted and clinicians should be considered when treating OKC via decompression.

Marsupialization Followed by Curettage of an Extensive Periapical Cyst in the Incisive and Maxillary Bone in a Dog

A 7-year-old male intact border terrier (8.5 kg) was presented with a large, painless mass apical to the right maxillary incisors. Diagnostic imaging and histopathology confirmed the diagnosis of periapical cyst due to a nonvital maxillary incisor. Extensive cysts are often multilocular and therefore difficult to debride without risk of iatrogenic damage. Complete resection can cause damage to adjacent structures and may compromise function. Due to the large size of the cyst, it was decided to perform staged treatment with extraction of the nonvital tooth and marsupialization. Following marsupialization, gradual bone regrowth caused size reduction. The stoma from the marsupialization was kept open for 8.5 months before the cyst was curetted and the wound closed. Complete obliteration of the cyst cavity was seen at short- and long-term follow-up examinations (7 and 24 months after curettage, respectively).

Treatment For The Large Aggressive Benign Lesions Of The Jaws

Objectives

Our aim was to evaluate the clinical outcome of the conservative management of the significantly large benign aggressive lesions of the jaws.

Subjects and Methods

Twenty-two patients were reviewed regarding the demographic, radiographic, and operative findings. Patients were treated by decompression followed by curettage or only with curettage.

Results

No bone grafts were used. Mean follow-up time was 56.2 months. The mandible was more affected than the maxilla. Two of the ameloblastoma, two of the keratocystic odontogenic tumours, and one odontogenic myxoma were recurred.

Conclusions

Despite the low number of the patients, it is concluded that the conservative management is predictable for the management of the benign aggressive lesions in order to reduce morbidity instead of directly performing radical surgery. The life during follow-up is mandatory in the situation of performing conservative surgery for the management of large aggressive lesions with high recurrence rate.

Long-term observation of a large keratocystic odontogenic tumour of the mandible treated by a single enucleation procedure: A case report and literature review

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Keratocystic odontogenic tumours (KCOTs) are rare, benign lesions of the jaw.

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We present a 49-year-old woman with a rare, large KCOT of the mandible.

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We describe a treatment method involving enucleation with Carnoy’s solution plus inserting a titanium plate.

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Although the patient showed recurrence once, she has not shown recurrence since 2010.

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Our approach was effective for the treatment of a large KCOT with tooth preservation.

Introduction

Keratocystic odontogenic tumours (KCOTs) are benign lesions of the jaw that are characterised by expansive growth and high rates of recurrence. Herein, we present a novel minimally invasive method for the surgical treatment of KCOTs.

Case presentation

We present a 49-year-old woman with a rare, large KCOT of the mandible extending from tooth 37 to tooth 47. A single enucleation procedure was selected as the surgical technique combined with a titanium plate. Teeth interfering with the cystic lumen were preserved. The bone surrounding the cyst was partially removed and rinsed with Carnoy’s solution. Recurrence was observed 1 year later between teeth 43 and 45, and was treated by single enucleation with Carnoy’s solution. After the second operation, the teeth interfering with the KCOT still elicited a positive response to dental pulp testing. No further signs of recurrence were observed after a total observation period of 7 years.

Discussion

Various surgical interventions have been described for KCOTs. However, a general guideline for a specific surgical intervention has not yet been established owing to the heterogeneity of these tumours.

Conclusion

Immediate enucleation in combination with a titanium plate offers an effective surgical approach for the treatment of large KCOTs of the mandible without the need for radical tooth removal or resection of the afflicted side.

Enucleation of large keratocystic odontogenic tumor at mandible via unilateral sagittal split osteotomy: a report of three cases

Keratocystic odontogenic tumor (KCOT) is a common benign tumor of osseous lesions in dental and maxillofacial practice. We describe three cases of large KCOT located in the posterior part of the mandible extending to the angle and ramus region, which were enucleated via sagittal split osteotomy (SSO) of the mandible. There are cases in which a conventional enucleation procedure does not ensure complete excision of the entire lesion without damage to vital structures like the inferior alveolar nerve. In such cases, a SSO approach could be a better choice than conventional methods. The purpose of this article is to describe our experience using unilateral mandibular SSO for removal of a KCOT from the mandible.