Management of mandibular odontogenic keratocyst through radical resection: Report of 35 cases

Abstract

The present study reported the clinical outcomes of 35 patients with mandibular odontogenic keratocysts (OKCs) following treatment by radical resection and immediate defect reconstruction. Amongst 565 patients with OKCs that were treated between April 2003 and May 2015, 35 patients underwent segmental or marginal mandibulectomy. The use of radical resection was based on clinical and/or radiographic evidence of size, cortical perforation and subsequent soft tissue involvement, and on the history of previous recurrence of the same lesion. Recurrence, justifications of the main major factor for resection, and functional and cosmetic results of the patients following mandibular reconstruction were systematically evaluated. There were 26 OKCs in the mandibular molar-ramus region, eight in the mandibular anterior-premolar region and one in the mandibular molar-ramus and anterior-molar regions. Among the 35 patients, 20 had primary OKCs and 15 had recurrent OKCs. A total of 31 patients underwent segmental mandibulectomy, of which 28 were immediately reconstructed with a vascularized flap, whereas four patients underwent marginal mandibulectomy. The functional and cosmetic outcomes of patients were evaluated as satisfactory. The length of the follow-up period ranged from 2 to 17 years following operation (average, 5.82 years). Recurrence was identified in one patient who had been treated with marginal mandibulectomy. In conclusion, the findings from the present study suggested that radical resection may be recommended for patients with OKCs and locally aggressive features. Immediate mandibular reconstruction with a vascularized flap may be a crucial part of this aggressive treatment method that may reduce OKCs-associated morbidity.

Odontogenic Keratocyst in an Edentulous Patient: Report of an Unusual Case

“…Many studies showed the lowest recurrence rates with aggressive resection, but at the cost of high morbidity, increased risk of local complications, such as pathologic bone fractures, and reduced quality of life [4,13]. Therefore, some authors criticize this approach and point out that epithelial residues or microcysts may persist at soft tissue extensions [14]. Enucleation is the treatment of choice because of its lower recurrence rate and conservative technique [12].…”

Odontogenic Keratocyst: The Dos and Don’ts in a Clinical Case Scenario

“…The conservative treatment by enucleation can be sufficient for particular OKCs, with or without any adjuvant application of Carnoy’s solution [ 19 , 20 ]. Moreover, our patient was young, and, in general, a more radical treatment of the lesion could reduce the quality of life by increasing morbidity and risk of local complication (eg, pathological bone fracture) [ 21 , 22 ]. Pereira Santana et al used the same protocol in a similar posterior mandible lesion.…”

Odontogenic keratocyst in the mandibular condyle base region: A case report

“…When OKCs originate in the mandible, the most common location is the posterior sextant, the angle or the ramus (4,5). Cases of OKCs often progress to the condyle because of their aggressive nature (6,7); however, to the best of our knowledge, only two reports of OKCs in the condyloid process that are not continuous with the surrounding areas have been reported (8,9). In both cases, OKCs occurred in the condylar head, which was resected.…”