Reclassification and treatment of odontogenic keratocysts: A cohort study

Abstract

The odontogenic keratocyst (OKC) is a recurrent cyst that has been recently reclassified from an odontogenic tumor to an odontogenic cyst. The aim of the present study was to investigate its treatment and address issues related to its association with nevoid basal cell carcinoma syndrome (NBCCS). Lesions from the cohort of patients included in the present study consisted of 40 OKCs, of which 27 lesions were treated by enucleation (GE) and 13 underwent decompression (GD). Complementary treatment occurred in 38 (95%) lesions, of which 10 underwent isolated peripheral ostectomy (GO) and 28 underwent peripheral ostectomy combined with Carnoy's solution (GC). Thirteen lesions were associated with NBCCS (GS), while the others (n=27) were non-syndromic lesions (GnS). The recurrence-free periods (RFP) in the sample groups were compared using the Kaplan-Meier function and log-rank test at a significance level of 5% (p < 0.05) and were used to calculate the cumulative risk of recurrence (CRR) in each postoperative year. During the follow-up period, which had a mean of 43.5 months (range: 12-102 months), six (15%) recurrences were diagnosed. There was no significant difference among the RFP for the compared groups (p > 0.05) or increased CRR for the decompression (15.4%) over five years. Application of Carnoy's solution did not increase the efficacy of the peripheral ostectomy, but was related to a CRR of 0% for the syndromic lesions over five years. Therefore, 1) decompression did not increase the recurrence risk; 2) peripheral ostectomy demonstrated a similar efficacy as the combination with Carnoy's solution; 3) the association of NBCCS did not seem to significantly influence OKC recurrence; and 4) syndromic lesions seem to behave in the same manner as non-syndromic lesions when submitted to complementary treatments.

Nonsyndromic Examples of Odontogenic Keratocysts: Presentation of Interesting Cases with a Literature Review

“…In addition to the question of classification, it is even more interesting to consider the therapeutic possibilities for OKC. There are two methods in the treatment of these lesions, one conservative and the other aggressive [9, 28–37]. The conservative method involves enucleation with or without curettage [38], decompression [39], and marsupialization [7].…”

“…The orthokeratinized type was classified as an orthokeratinized odontogenic cyst (OOC) as part of the entity of odontogenic developmental cysts. According to the newest WHO classification from 2017, keratocystic odontogenic tumors (KCOT) were again reclassified as odontogenic keratocysts (OKCs) but still diagnostically distinctive from orthokeratinized odontogenic cysts (OOC) [9, 10].…”

Large odontogenic keratocyst of the mandible: A combined intra/extra oral approach followed by enucleation

“…Some lesions can be indistinguishable from other osteolytic jaw lesions on imaging; therefore, histopathology is always necessary for a definitive diagnosis. A prospective study of 82 OKC's reported that 40% were not suspected before surgery [1,22,24]. The surgeons chose not to execute a preoperative incisional biopsy as it can cause inflammation and interfere in the histopathological analysis of the possurgical specimen.…”

“…The result can be indicative, but a negative result can never rule out a possible diagnosis of OKC until investigation of the final resection specimen. Baykul et al showed a correlation of 89.95% between cytological and histopathological diagnosis for cystic lesions in the maxillofacial region [22,29,30,31]. With this in mind, diagnosis and subsequent treatment of OKC's poses a challenge.…”

Factors influencing the recurrence of keratocysts: monocentric study

“…At histopathological analysis OKCs are characterized by five to eight layers of parakeratinized epithelial lining and may present with areas of squamous metaplasia if inflammation in the capsule occurs [7]. Moreover, the epithelium may present budding of the basal layer into the underlying connective tissue with formation of detached microcysts, named daughter cysts [8].…”