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

Fidele,Nyimi  Bushabu; Bing,Liu; Sun,Yanfang; Wu,Tianfu; Zheng,Yueyu; Zhao,Yifang

doi:10.3892/ol.2019.10367

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

Authors:
- Nyimi Bushabu Fidele
- Liu Bing
- Yanfang Sun
- Tianfu Wu
- Yueyu Zheng
- Yifang Zhao
View Affiliations

Affiliations: Department of Oral Maxillofacial Head and Neck Oncology Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, Hubei 430079, P.R. China
Published online on: May 17, 2019 https://doi.org/10.3892/ol.2019.10367
Pages: 733-741
Copyright: © Fidele et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

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.

View Figures

View References

1	Speight PM and Takata T: New tumour entities in the 4th edition of the World Health Organization Classification of Head and Neck tumours: Odontogenic and maxillofacial bone tumours. Virchows Arch. 472:331–339. 2018. View Article : Google Scholar : PubMed/NCBI
2	Philipsen HP: Pathology and Genetics of Head and Neck Tumours. World Health Organization Classification of Tumours. Barnes L, Eveson JW, Reichart P and Sidransky D: IARC. (Lyon). 306–307. 2005.
3	Peacock ZS: Controversies in oral and maxillofacial pathology. Oral Maxillofac Surg Clin North Am. 29:475–486. 2017. View Article : Google Scholar : PubMed/NCBI
4	Al-moraissi EA, Dahan AA, Alwadeai MS, Oginni FO, Al-jamali JM, Alkhutari AS, Al-Tairi NH, Almaweri AA and Al-Sanabani JS: What surgical treatment has the lowest recurrence rate following the management of keratocystic odontogenic tumor?: A large systematic review and meta-analysis. J Craniomaxillofac Surg. 45:131–144. 2017. View Article : Google Scholar : PubMed/NCBI
5	Pitak-Arnnop P, Chaine A, Oprean N, Dhanuthai K, Bertrand JC and Bertolus C: Management of odontogenic keratocysts of the jaws: A ten-year experience with 120 consecutive lesions. J Craniomaxillofac Surg. 38:358–364. 2010. View Article : Google Scholar : PubMed/NCBI
6	Chirapathomsakul D, Sastravaha P and Jansisyanont P: A review of odontogenic keratocysts and the behavior of recurrences. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 101:5–9. 2006. View Article : Google Scholar : PubMed/NCBI
7	Yagyuu T, Kirita T, Sasahira T, Moriwaka Y, Yamamoto K and Kuniyasu H: Recurrence of keratocystic odontogenic tumor: Clinicopathological features and immunohistochemical study of the Hedgehog signaling pathway. Pathobiology. 75:171–176. 2008. View Article : Google Scholar : PubMed/NCBI
8	Sánchez-Burgos R, González-Martín-Moro J, Pérez-Fernández E and Burgueño-García M: Clinical, radiological and therapeutic features of keratocystic odontogenic tumours: A study over a decade. J Clin Exp Dent. 6:e259–e264. 2014. View Article : Google Scholar : PubMed/NCBI
9	Al-Moraissi EA, Pogrel MA and Ellis E III: Enucleation with or without adjuvant therapy versus marsupialization with or without secondary enucleation in the treatment of keratocystic odontogenic tumors: A systematic review and meta-analysis. J Craniomaxillofaciac Surg. 44:1395–1403. 2016. View Article : Google Scholar
10	Zecha JA, Mendes RA, Lindeboom VB and van der Waal I: Recurrence rate of keratocystic odontogenic tumor after conservative surgical treatment without adjunctive therapies-A 35-year single institution experience. Oral Oncol. 46:740–742. 2010. View Article : Google Scholar : PubMed/NCBI
11	Cunha JF, Gomes CC, de Mesquita RA, Andrade Goulart EM, de Castro WH and Gomez RS: Clinicopathologic features associated with recurrence of the odontogenic keratocyst: A cohort retrospective analysis. Oral Surg Oral Med Oral Pathol Oral Radiol. 121:629–635. 2016. View Article : Google Scholar : PubMed/NCBI
12	Pogrel MA and Jordan RC: Marsupialization as a definitive treatment for the odontogenic keratocyst. J Oral Maxillofac Surg. 62:651–655; discussion 655–656. 2004. View Article : Google Scholar : PubMed/NCBI
13	Mendes RA, Carvalho JF and van der Waal I: Characterization and management of the keratocystic odontogenic tumor in relation to its histopathological and biological features. Oral Oncol. 46:219–225. 2010. View Article : Google Scholar : PubMed/NCBI
14	Blanas N, Freund B, Schwartz M and Furst IM: Systematic review of the treatment and prognosis of the odontogenic keratocyst. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 90:553–558. 2000. View Article : Google Scholar : PubMed/NCBI
15	Kolokythas A, Fernandes RP, Pazoki A and Ord RA: Odontogenic keratocyst: To decompress or not to decompress? A comparative study of decompression and enucleation versus resection/peripheral ostectomy. J Oral Maxillofac Surg. 65:640–644. 2007. View Article : Google Scholar : PubMed/NCBI
16	Worrall SF: Recurrent odontogenic keratocyst within the temporalis muscle. Br J Oral Maxillofac Surg. 30:59–62. 1992. View Article : Google Scholar : PubMed/NCBI
17	Gosau M, Draenert FG, Müller S, Frerich B, Bürgers R, Reichert TE and Driemel O: Two modifications in the treatment of keratocystic odontogenic tumors (KCOT) and the use of carnoy's solution (CS)-a retrospective study lasting between 2 and 10 years. Clin Oral Investig. 14:27–34. 2010. View Article : Google Scholar : PubMed/NCBI
18	Jackson IT, Potparic Z, Fasching M, Schievink WI, Tidstrom K and Hussain K: Penetration of the skull base by dissecting keratocyst. J Craniomaxillofac Surg. 21:319–325. 1993. View Article : Google Scholar : PubMed/NCBI
19	Zhao YF, Wei JX and Wang SP: Treatment of odontogenic keratocysts: A follow-up of 255 Chinese patients. Oral Surg Oral Med Oral Pathol Oral Radiol. 94:151–156. 2002. View Article : Google Scholar
20	Stoelinga PJ: Long-term follow-up on keratocysts treated according to a defined protocol. Int J Oral Maxillofac Surg. 30:14–25. 2001. View Article : Google Scholar : PubMed/NCBI
21	August M, Faquin WC, Troulis MJ and Kaban LB: Dedifferentiation of odontogenic keratocyst epithelium after cyst decompression. J Oral Maxillofac Surg. 61:678–683; discussion 683–684. 2003. View Article : Google Scholar : PubMed/NCBI
22	Chrcanovic BR and Gomez RS: Recurrence probability for keratocystic odontogenic tumors: An analysis of 6427 cases. J Craniomaxillofac Surg. 45:244–251. 2017. View Article : Google Scholar : PubMed/NCBI
23	Sharif FN, Oliver R, Sweet C and Sharif MO: Interventions for the treatment of keratocystic odontogenic tumours. Cochrane Database Syst Rev CD008464. 2015. View Article : Google Scholar
24	Liu B, Cai Y, Wang SP and Zhao YF: Recurrent keratocystic odontogenic tumor in the masseter muscle overlying the boney perforations: A case report. Oral Surg Oral Med Oral Pathol Oral Radiol. 113:e1–e5. 2012. View Article : Google Scholar : PubMed/NCBI
25	Stoelinga PJ: Etiology and pathogenesis of keratocysts. Oral Maxillofac Surg Clin North Am. 15:317–324. 2003. View Article : Google Scholar : PubMed/NCBI
26	Warburton G, Shihabi A and Ord RA: Keratocystic odontogenic tumor (KCOT/OKC)-clinical guidelines for resection. J Maxillofac Oral Surg. 14:558–564. 2015. View Article : Google Scholar : PubMed/NCBI
27	Myoung H, Hong SP, Hong SD, Lee JI, Lim CY, Choung PH, Lee JH, Choi JY, Seo BM and Kim MJ: Odontogenic keratocyst: Review of 256 cases for recurrence and clinicopathologic parameters. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 91:328–333. 2001. View Article : Google Scholar : PubMed/NCBI
28	Giuliani M, Grossi GB, Lajolo C, Bisceglia M and Herb KE: Conservative management of a large odontogenic keratocyst: Report of a case and review of the literature. J Oral Maxillofac Surg. 64:308–316. 2006. View Article : Google Scholar : PubMed/NCBI
29	Ahlfors E, Larsson A and Sjögren S: The odontogenic keratocyst: A benign cystic tumour? J Oral Maxillofac Surg. 42:10–19. 1984. View Article : Google Scholar : PubMed/NCBI
30	Stoelinga PJ and Bronkhorst FB: The incidence, multiple presentation and recurrence of aggressive cysts of the jaws. J Craniomaxillofac Surg. 16:184–195. 1988. View Article : Google Scholar : PubMed/NCBI
31	Boyne PJ, Hou D, Moretta C and Pritchard T: The multifocal nature of odontogenic keratocysts. J Calif Dent Assoc. 33:961–965. 2005.PubMed/NCBI
32	Hidalgo DA and Pusic AL: Free-flap mandibular reconstruction: A 10-year follow-up study. Plast Reconstr Surg. 110:438–449; discussion 450–451. 2002. View Article : Google Scholar : PubMed/NCBI
33	Lyons AJ, James R and Collyer J: Free vascularised iliac crest graft: An audit of 26 consecutive cases. Br J Oral Maxillofac Surg. 43:210–214. 2005. View Article : Google Scholar : PubMed/NCBI