ODONTOGENIC KERATOCYSTS TREATMENT – OUR EXPERIENCE

Overview

Introduction: Odontogenic keratocystics are benign intraosseous lesions. They are characterised by an local aggresive behaviour. Expansion is in anterior-posterior direction. This lesions were hidden for a long time. Orthopantomogram is gold standard examination, so nowadays diagnostics is not so difficult. But still there is relatively high recurrence rate and the choice of operation method is not definite. In this retrospective study is presented treatment modalities and succes rate.

Methods: In this retrospective study 62 patients are presented. This lesions were treated from 2000 to 2019 on Department of Oral and Maxillofacial Surgery in Faculty Hospital Olomouc. In this period 77 new and recurrence lesions of OKC were reported. This lesions were treated in local and general anaesthesia. OKC lesions are divided in several modalities: unilocular and multilocular and syndromic cysts. In this study, eight patients were treated with Gorlin-Goltz´s syndrome. Mutation of gen PTCH has been confirmed.

Result: Altogether 98 operations were carried out during nine years. Together 62 patients were treated. In local anaesthesia were treated 16 cases, in general anaesthesia 82 cases. The number of male and female was approximately same. Majority of cystic lesions
(57 cases = 74%) occured in lower jaw. Localization in lower jaw was majority in angle and branch of mandible.
(52 cases = 68%). More frequency on the right. five cysts (6%) were occured in frontal part of lower jaw. In maxilla, there were 20 cases (26%) of odontogenic keratocysts. Most number of OKC were diagnosed in second and sixth aged decade. Solitary OKC occured in 50 patients; eight patients with multiple OKC were genetic treated with confirmed Gorlin-Goltz syndrome. In one patient, seven years after first operation of OKC was malignancy on odontogenic carcinoma, 22 patients (35.5%) were reoperated for after surgery relaps. In relation between localization, postoperated relaps, authors compare succes of various operating methods (marsupialization, enucleation, enucleation with Carnoy´s solution, enucleation with augmentative methods, resection with and without free flap). 

Conclusion: The choice of the treatment has always been difficult. And correct treatment modality is not complete. Patients should know various operation modalities, risk of reccurence and recommendation for long term dispenzarization.

Keywords:

odontogenic keratocyst – Cystectomy – Carnoy´s solution – marsupialization