Is Cystic Enucleation With Peripheral Osteotomy Sufficient Treatment for Okcs of the Jaws?

Abstract

Background - Odontogenic Keratocyst (OKC) is a developmental cyst of odontogenic origin behaving aggressively in term of high recurrence rate. Aggressive behavior and tendency to recur are related to greater proliferative activity of the epithelial lining. There have been many arguments made and still controversial regarding the treatment option for OKCs. Aim- The aim of the study is to investigate the Prevalence and incidence of OKC Riyadh city and the Assessment of recurrence rate of different management scheme for treatment of OKC. Objective- The objective of this study is to study the efficacy of enucleation with peripheral osteotomy versus resection method in management of OKC. Material and Method-Data has been obtained through a retrospective review of patients admitted at five main oral and maxillo-facial surgery departments in Riyadh City with a diagnosis of OKC. A retrospective review of OKC patients was conducted between July 2010 and December 2022. After excluding patient files with incomplete, unclear data. The data of the patients with a diagnosis of OKC, complete record patients were included in the study. The following data were recorded for each patient: Gender, age, medical history, date of diagnosis, radiology type, location, radiology description, associate complications (local/systematic) biopsy date, biopsy type, histopathology, surgery performed, date primary procedure, post-operative complications (numbness/infection/limited mouth opening/lymphadenopathy) and whether it resolved or not, recurrence, date of recurrence, number of recurrence, time between first surgery and recurrence, secondary procedure for the recurrence, date of secondary procedure, type of the second procedure, complications after the second procedure, date of diagnosis of second recurrence, date of third procedure, type of the third procedure, complications of the third procedure, date of forth procedures, type of the forth procedure, complications after the forth procedure, date of follow- up. Results - The total of 30 patients with clear medical records and at least one follow-up record, with the age ranged from 5 to 53 years, the mean age for patients without recurrence was 30.8 ± 11.7 years, while for those with recurrence, it was 25.3 ± 14.3. The p-value of 0.072 suggests that there is no statistically significant difference between the age of patients who had a recurrence and those who did not. Gender-wise, there were 11 (36.7%) females, 3 of them experienced recurrence. and 19 (63.3%) males, and 9 of them experienced recurrence (table 1). The majority of the patients underwent radiology using CT at the rate of 56.7%, followed by CBCT at the rate of 23.3%. The majority of the patients had a mandible location at the rate of 93.3%, with 70% of them diagnosed with a Unicystic radiological description and the rest were Multicystic. Conclusion - Enucleation was the most common first procedure for treating OKCs of the jaws, and most patients did not experience post-operative complications, but about 40% of the cases has been recurred whatever the procedure was except for the decompression procedure there were no recurrence. Patients who required a secondary procedure were most likely to undergo enucleation. Overall, 60% of patients did not have a recurrence, 33.3% had one recurrence, and 6.7% had two recurrences.