Biochemical and Cytological Comparison of Keratocystic Odontogenic Tumours to Nonkeratinising Odontogenic Cysts Fluid

An evidence-based surgical algorithm for management of odontogenic keratocyst

The effective management of odontogenic keratocyst (OKC) remains a subject of interest and confusion in the oral and maxillofacial surgery literature. Currently, there is a lack of consensus regarding the most appropriate treatment for patients with OKC. Of the various treatment options available, no modality to date has been shown to demonstrate a zero or near-zero recurrence rates except wide resection with clear margins. With the prevailing dearth of evidence based surgical protocols for the management of patients with OKC in the literature, this study aims to present a surgical algorithm, based on meta-analysis results, that hopefully will be beneficial in enhancing treatment of patients with this condition. Also, new meta-analysis was done to compare between modified Carnoy's solution (MCS) and 5-fluorouracil (5-FU) in respect of recurrence rate of OKC. Using parameters like size, lesion type (primary or secondary), syndromic or solitary nature of the lesion, presence of cortical perforations, and locularity; we present a decision tree, to aid treatment planning and help attain the least chance of recurrence in the management of the OKC. There was very low-quality evidence indicating that application of 5-FU, after enucleation and peripheral ostectomy of OKCs, significantly lowered recurrence rate when compared to MCS (RR = 0.087, CI: 0.017 to 0.436, P value = 0.003).

Cross-sectional observational study evaluating the association between odontogenic cystic content and size

OBJECTIVES

To evaluate and correlate the cystic content and the size of odontogenic cysts.

METHODS

The study included 29 cases of odontogenic cysts reported in the Outpatient Department of Sharad Pawar Dental College. The cystic aspirate was analyzed for levels of sodium, potassium, calcium, chloride, total protein, globulin, albumin, and cholesterol. The sodium/potassium ratio was calculated. Pearson's correlation coefficient (ρ) was used to correlate the size of the cyst with the sodium/potassium ratio and other cystic contents. P < 0.05 was considered statistically significant.

RESULTS

A positive and statistically significant correlation (ρ = 0.625, p = 0.020) was noted between the sodium to potassium ratio and the size of the cyst. The correlation between the other cystic contents and the size of the cyst was not statistically significant (p > 0.05).

CONCLUSION

The sodium to potassium ratio is positively correlated with the radiographic size of cysts. A thorough analysis of cystic fluid components could provide valuable insights into the potential expansion of odontogenic cysts.

Increased level of cell-derived microparticles in the cyst fluids of odontogenic keratocysts

The aim of this study was to examine the level and basic characteristics of cell-derived microparticles (MPs) in the cyst fluids of odontogenic keratocysts (OKCs). For this purpose, MPs from the cyst fluids (CFMPs) of OKCs were purified by a classic differential centrifugation method and characterized by a transmission electron microscope and fluorescence microscope. Flow cytometric analysis was used to determine the size, concentration and cellular origins of the CFMPs. Moreover, the expression level of receptor activator for nuclear factor-κB ligand in the OKCs was evaluated by immunohistochemical staining and then analyzed for its correlation with the concentration of CFMPs by Spearman's rank correlation test. In addition, reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and tartaric-resistant acid phosphatase (TRAP) staining were performed to examine the osteoclastogenesis of mouse bone marrow-derived macrophages (BMMs) in response to CFMPs. The results revealed that the levels of total CFMPs were significantly elevated in OKCs compared with dentigerous cysts (DCs) and radicular cysts (RCs). In addition, in vitro experiments further revealed that CFMPs derived from the OKCs of patients could be taken up by BMMs, leading to a significant increase in the mRNA expression levels of nuclear factor of activated T-cells 1 (NFATc1) and TRAP. Moreover, TRAP-positive multinucleated osteoclasts were successfully cultured in the presence of macrophage colony-stimulating factor (M-CSF) and CFMPs with BMMs. On the whole, our findings indicate that patients with OKCs have higher levels of CFMPs compared with patients with DCs and RCs, which may be associated with the bone resorption of OKCs.