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The British Journal of Oral &... Jun 2023The odontogenic keratocyst (OKC) is a common cystic lesion in the jaw. Its management, however, is highly debated with no consensus on the best treatment option.... (Review)
Review
The odontogenic keratocyst (OKC) is a common cystic lesion in the jaw. Its management, however, is highly debated with no consensus on the best treatment option. Clinicians base their approach on treatment efficacy and associated morbidity. Management often consists of enucleation with peripheral ostectomy and adjunctive therapy to prevent recurrence. The aim of our systematic review was to evaluate the safety and efficacy of these different modalities. Embase, Medline, and Cochrane were searched according to the PRISMA guidelines for articles that presented non-syndromic patients with histopathologically confirmed OKC treated with 5-fluorouracil (5FU), Carnoy's solution (CS), or modified Carnoy's solution (MCS) as adjunctive therapy after enucleation and peripheral ostectomy. The outcomes of interest were safety (measured as adverse events) and efficacy (expressed as recurrence). Risk of bias was evaluated using the Newcastle-Ottawa scale. Four studies were included and 62 patients were evaluated. The results show that recurrence occurred only in patients treated with MCS. Reported adverse events were mostly limited to paraesthesia that could be permanent (in the CS and MCS treatment groups) or transient (across all adjunctive therapies). With the prohibition of CS, both MCS and 5FU are promising replacement adjunctive therapies. From a safety and efficacy perspective we consider 5FU, which was associated with the lowest recurrence and fewest adverse events, to be the most viable option. More high-evidence prospective studies, such as randomised controlled trials, with a longer follow-up period are necessary to draw definite conclusions.
Topics: Humans; Prospective Studies; Odontogenic Cysts; Acetic Acid; Chloroform; Odontogenic Tumors
PubMed: 37248124
DOI: 10.1016/j.bjoms.2023.04.006 -
The British Journal of Oral &... Jul 2022Odontogenic keratocyst (OKC) is known for its benign but aggressive clinical behaviour, and presents a challenge in its management due to high recurrence rate following... (Meta-Analysis)
Meta-Analysis Review
Odontogenic keratocyst (OKC) is known for its benign but aggressive clinical behaviour, and presents a challenge in its management due to high recurrence rate following surgical intervention. The sourcing of Carnoy's solution, the widely used adjunct in OKC treatment, has lately become difficult especially after its banning by the United States Food and Drugs Agency (FDA). This has generated interest in exploring alternative chemical agents such as 5-Fluorouracil (5-FU) and Modified Carnoy's solution (MCS). We conducted a systematic review and meta-analysis to assess the effectiveness of 5-FU as an adjunct following surgical intervention of OKC. A protocol was registered in PROSPERO prior to the literature search. All studies reporting the use of 5-FU in OKC treatment were included in the initial search of multiple literature databases. Of the 148 initially identified articles, three met the criteria for the final appraisal. The relevant data were extracted and a meta-analysis was undertaken in relation to recurrence rate and nerve paraesthesia. There were no recurrence observed in cases treated with 5-FU (n=56), and the incidence of nerve paraesthesia was 20% (none permanent). This systematic review has revealed early encouraging results for 5-FU as an adjunct, however a caution is recommended due to overall low quality of evidence related to individual studies. We present the cumulative evidence on the effectiveness of 5-FU in OKC treatment with discussion on its mechanism of action, safety profile, application protocol, and the implications for clinical practice.
Topics: Adjuvants, Immunologic; Fluorouracil; Humans; Odontogenic Cysts; Odontogenic Tumors; Paresthesia
PubMed: 35314081
DOI: 10.1016/j.bjoms.2022.02.001 -
Oral and Maxillofacial Surgery Clinics... Aug 2024Pediatric odontogenic cysts and tumors are rare and often associated with developing or impacted teeth. Odontogenic cysts are broadly categorized as inflammatory or... (Review)
Review
Pediatric odontogenic cysts and tumors are rare and often associated with developing or impacted teeth. Odontogenic cysts are broadly categorized as inflammatory or developmental while odontogenic tumors are classified histologically as epithelial, mesenchymal, or mixed tumors. This article will discuss the presentation, diagnosis, and treatment of odontogenic cysts and tumors in the pediatric population.
Topics: Humans; Odontogenic Cysts; Child; Odontogenic Tumors; Diagnosis, Differential; Jaw Neoplasms
PubMed: 38462396
DOI: 10.1016/j.coms.2024.01.006 -
Medicine Dec 2019The odontogenic keratocyst (OKC), previously known as keratocystic odontogenic tumor has been the most disputable pathologies of the maxillofacial region. Patients with... (Review)
Review
INTRODUCTION
The odontogenic keratocyst (OKC), previously known as keratocystic odontogenic tumor has been the most disputable pathologies of the maxillofacial region. Patients with OKC are often asymptomatic but may present with pain, swelling, or discharge. Despite the aggressive nature, previous literature as early as 1970s reported the fact that parakeratinized OKC can be treated by means of marsupialization alone.
PATIENTS CONCERNS
The patient had reported with a complaint of pain and swelling in relation with a tooth in mandibular right quadrant.
DIAGNOSIS
This case report discusses features of a rare, extensive, panmandibular OKC that is only second of its kind mentioned in the literature.
INTERVENTION
As a usual treatment protocol, marsupialization was attempted first. Immunohistochemical analysis revealed reduced expression of Ki-67 and B cell lymphoma 2 (bcl-2) markers after marsupialization from 2 separate sites. However, due to incomplete resolution in the lower right anterior region, an aggressive approach was taken by curetting it out surgically along with associated teeth and cortical plate followed by application of Carnoy's solution.
OUTCOME
Postsurgery uneventful healing of the lesion was noted on regular follow-up visits with complete resolution at 40 months. The case has been followed for 10 years with no sign of relapse and reoccurrence.
CONCLUSIONS
Based on the expression of markers it can thus be concluded that Ki-67 and bcl-2 are site specific and bear strong relationship with the recurrence of OKCs.
Topics: Adult; Biopsy, Needle; Dentistry, Operative; Female; Follow-Up Studies; Humans; Immunohistochemistry; Mandibular Diseases; Odontogenic Cysts; Preoperative Care; Radiography, Dental; Rare Diseases; Risk Assessment; Severity of Illness Index; Time Factors; Treatment Outcome
PubMed: 31860950
DOI: 10.1097/MD.0000000000017987 -
Pediatric and Developmental Pathology :... 2023Cysts encountered in the head and neck typically arise from epithelium that would normally be programmed to form teeth or tooth-supporting structures (odontogenic... (Review)
Review
Cysts encountered in the head and neck typically arise from epithelium that would normally be programmed to form teeth or tooth-supporting structures (odontogenic epithelium). These cysts come with a confusing array of similar-sounding names and histopathologic features that are sometimes shared between conditions. Here we describe and contrast the relatively-common lesions: hyperplastic dental follicle, dentigerous cyst, radicular cyst, buccal bifurcation cyst, odontogenic keratocyst, glandular odontogenic cyst, and the less-common gingival cyst of the new-born and thyroglossal duct cyst. The goal of this review is to help clarify and simplify these lesions for the general pathologist, pediatric pathologist, and surgeon.
Topics: Humans; Child; Dentigerous Cyst; Odontogenic Cysts; Radicular Cyst; Odontogenic Tumors; Epithelium
PubMed: 37212213
DOI: 10.1177/10935266231176245 -
Journal of Stomatology, Oral and... Nov 2022The aim of this study was to review the literature on extra-osseous odontogenic keratocysts, and to present the best possible approach to these lesions. (Review)
Review
INTRODUCTION
The aim of this study was to review the literature on extra-osseous odontogenic keratocysts, and to present the best possible approach to these lesions.
MATERIAL AND METHODS
A comprehensive literature search was performed using the strategy: (keratocyst) and (soft tissue)). A total of 25 articles were included, 20 reported on extra-osseous odontogenic keratocysts in the soft tissues of the mouth and 17 presented as gingiva cysts.
DISCUSSION
Almost all articles were published in the last 20 years and 16 even in the last 10 years. Extra-osseus odontogenic keratocysts are usually found in the cheek or present as gingiva cysts of adults. Muscle abutment of the cheek lesions is common but infiltration of muscles has also been reported.
CONCLUSION
In almost none of the reported cases was a preoperative diagnosis available. Based on the clinical presentation and available laboratory tests it is suggested to always do an aspiration biopsy to ascertain the diagnosis preoperatively. This is particularly relevant for those who appear in the soft tissues of the mouth.
Topics: Adult; Humans; Odontogenic Cysts; Odontogenic Tumors; Biopsy, Fine-Needle
PubMed: 35798194
DOI: 10.1016/j.jormas.2022.07.001 -
Current Opinion in Otolaryngology &... Feb 2020To give an overview of technical considerations and relevant literature in the management odontogenic pathology with involvement of the maxillary sinus. (Review)
Review
PURPOSE OF REVIEW
To give an overview of technical considerations and relevant literature in the management odontogenic pathology with involvement of the maxillary sinus.
RECENT FINDINGS
Infections, cysts, benign neoplasms (odontogenic and nonodontogenic), and inflammatory conditions impact the maxillary sinus in various ways, could result in significant expansion within the maxillary sinus and significant infections.
SUMMARY
This manuscript provides an overview of common pathologic entities of the oral cavity proper that impacts the maxillary sinus health, with discussion of the role of the otorhinolaryngologist and the dental specialist.
Topics: Humans; Jaw; Maxillary Sinus; Maxillary Sinusitis; Odontogenic Cysts; Oroantral Fistula; Orthognathic Surgical Procedures; Osteonecrosis; Patient Care Team; Tooth Diseases
PubMed: 31851019
DOI: 10.1097/MOO.0000000000000603 -
Oral Health & Preventive Dentistry Jun 2022To present updated information on odontogenic keratocyst (OKC) classification, etiology, genetic and molecular alterations, epidemiology, clinical presentation,... (Review)
Review
PURPOSE
To present updated information on odontogenic keratocyst (OKC) classification, etiology, genetic and molecular alterations, epidemiology, clinical presentation, radiographic characteristics, histological and immune histochemical features, differential diagnosis, treatment, and controversies, as well as a literature review of case frequencies in different countries.
MATERIALS AND METHODS
Studies were selected using the key words 'odontogenic keratocyst,' 'odontogenic cysts,' 'odontogenic keratocyst and clinical study'. Full-text papers were reviewed on the basis of the inclusion and exclusion criteria. The literature search aimed to find articles that would show the frequency of OKC, dentigerous cyst, radicular cyst, and other cysts.
RESULTS
OKC presents local aggression and high recurrence; therefore, a better understanding of its clinical characteristics and the genetic and molecular factors involved in this peculiar and controversial lesion is required. It is always essential to discuss treatment alternatives. Although OKC is an entity with a high recurrence, aggressive treatment is not advisable in all cases because factors such as commitment to anatomical structures and possible complications should be considered. However, periodic radiographic controls are advised.
CONCLUSION
To reduce the high number of present cases worldwide, it is important to improve knowledge on this pathology so that accurate diagnoses can be achieved and appropriate treatment can be provided. OKC presents local aggression and high recurrence; therefore, a better understanding is needed of the clinical characteristics and genetic and molecular factors involved in OKC. Furthermore, it is always essential to discuss treatment alternatives.
Topics: Humans; Odontogenic Cysts
PubMed: 35866678
DOI: 10.3290/j.ohpd.b3240829 -
Journal of the College of Physicians... Jan 2020
Topics: Adult; Humans; Male; Mandibular Neoplasms; Odontogenic Cysts; Radiography, Panoramic; Treatment Outcome
PubMed: 31931946
DOI: 10.29271/jcpsp.2020.01.104 -
Journal of Stomatology, Oral and... Apr 2017Calcifying odontogenic cysts (COC) represent 0.3-0.8% of all odontogenic cysts. We describe the finding and the treatment of a COC in a 67-year-old female.
INTRODUCTION
Calcifying odontogenic cysts (COC) represent 0.3-0.8% of all odontogenic cysts. We describe the finding and the treatment of a COC in a 67-year-old female.
OBSERVATION
An asymptomatic well-limited radioluscent mandibular lesion was fortuitously discovered on the panoramic X-ray in the periapical region of teeth No. 33 and 34. Treatment consisted in enucleation and curettage. Histologic examination was in favour of a COC. At 6 years follow-up, X-ray control showed new bone formation and the patient was free of symptoms. Pulp vitality was maintained in all teeth in the operated area.
DISCUSSION
Total enucleation is the preferred treatment of COC. Absence of recurrence is attested by X-ray controls and pulp vitality tests.
Topics: Aged; Female; Humans; Jaw Neoplasms; Odontogenic Cyst, Calcifying
PubMed: 28345512
DOI: 10.1016/j.jormas.2016.10.007