Treatment options for keratocyst odontogenic tumour (KCOT): a systematic review

Abstract

Background: The keratocystic odontogenic tumour (KCOT) is a benign intraosseous odontogenic lesion relatively frequent in the oral cavity. It has a locally aggressive behaviour and exhibits a high propensity to recur after treatment. All the singular characteristics of this pathology have originated controversy in the scientific community regarding the most appropriate surgical approaches for the successful treatment of this tumour. Objectives: To analyse the optimal treatment choice for this tumour, ensuring high success rates of treatment, preventing future recurrences and allowing the maintenance of the patient's quality of life. Materials and methods: A search was conducted in Cochrane -1 resultand in PubMed -756 results. The selection of articles was based on abstracts and inclusion and exclusion criteria. Three research studies were considered for the final analysis. Results: One hundred and nineteen lesions were identified (73 males and 46 females). Twenty-nine tumours were found in the maxilla and 91 in the mandible; the applied therapeutic methods were: marsupialization/decompression, marsupialization followed by enucleation and adjunctive therapies (peripheral ostectomy and Carnoy's solution), solely enucleation, enucleation and Carnoy's solution, enucleation followed by peripheral ostectomy and Carnoy's solution and resection. Discussion and conclusions: Treatment by enucleation, in combination with adjunctive measures, is associated with minor recurrence rates when compared with enucleation alone. The small number of KCOT that were treated with en bloc resection did not obtain statistically relevant results. Therefore, more studies with well-established criteria are necessary to enable an adequate analysis of recurrence rates associated with each treatment modality.

Técnicas para el tratamiento del queratoquiste, revisión de la literatura y presentación de un caso

“…Estos tratamientos mostraron en nuestra revisión, según Dias et al . 21 , un índice de recidiva del 26,08%, 50%, 40% y 0%, respectivamente, en relación con el número de pacientes tratados; esto nos ayuda a deducir que, si bien la enucleación simple sigue siendo el tratamiento más empleado, sigue presentando altos índices de recidiva.…”

Combined conservative treatment of a recurrent mandibular keratocyst by enucleation, diode laser, 5-Fluorouracil and dental implants: a case report with 18 years-follow up

“…Consequently, recurrence may be dependent on the treatment modality and its success. Thus there have been numerous attempts to decrease the high recurrence rate by refining the surgical techniques [7][8][9][10].…”

“…Recurrence of OKCs is triggered by inadequate elimination of the epithelial remnants from the lining of the cyst, satellite and/or microcyst, and remnants left in the basal cell layer of the oral epithelium [ 2 , 7 – 9 ].…”

“…OKCs are managed surgically with careful complete excision due to their high recurrence rate. The thin and friable cyst lining is behind the surgical challenges of OKCs [7][8][9]. To avoid the recurrence potential of OKC, chemical solutions such as Carnoy's solution (CS) (1 g of ferric chloride (FeCl 3 ) dissolved in 6 mL of absolute alcohol, 3 mL of chloroform, 1 mL of glacial acetic acid), modified Carnoy's solution (MCS) (absolute alcohol 6 mL, chloroform 3 mL, glacial acetic acid 1 mL, ferric chloride 0.1 gm/ mL), 5-Fluorouracil (5-FU) and liquid nitrogen cryotherapy have been associated with surgical treatment [7][8][9][10][11][12].…”

Unveiling metabolic changes in marsupialized odontogenic keratocyst: A pilot study

“…This maneuver promotes an opening that exposes the cystic cavity to the oral environment. The opening patency must be ensured in order to reduce the lesion size and the thickening of the cystic lining, which facilitates its surgical enucleation (Dias et al., 2017; Pogrel & Jordan, 2004). In addition to these modifications, other biological changes found in the OKC epithelium after marsupialization have already been evaluated from a morphological, molecular, and immunohistochemical perspective (Cserni et al., 2019; Diniz et al., 2012; Mendes et al., 2010; Oh et al., 2018).…”