Five years follow-up of a keratocyst odontogenic tumor treated by marsupialization and enucleation: A case report and literature review

Abstract

Odontogenic cysts are considered as nonneoplasic benign lesions. Among the cysts, keratocyst odontogenic tumor (KCOT) is an intra-osseous tumor characterized by parakeratinized stratified squamous epithelium and a potential for aggressive, infiltrative behavior, and for the possibility to develop carcinomas in the lesion wall. Thus, the aim of this study was to describe a clinical case of KCOT in a young patient and discuss the treatment alternatives to solve this case. A 15-year-old male was referred for treatment of a giant lesion in his left side of the mandible. After the biopsy, a diagnostic of KCOT was made, and the following procedures were planned for KCOT treatment. Marsupialization was performed for lesion decompression and consequent lesion size reduction. Afterward, enucleation for complete KCOT removal was performed followed by third mandibular molar extraction. After 5 years, no signs of recurrence were observed. The treatment proposed was efficient in removing the KCOT with minimal surgical morbidity and optimal healing process, and the first and second mandibular molars were preserved with pulp vitality. In conclusion, this treatment protocol was an effective and conservative approach for the management of the KCOT, enabling the reduction of the initial lesion, the preservation of anatomical structures and teeth, allowing quicker return to function. No signs of recurrence after 5 years were observed.

Long-term observation of a large keratocystic odontogenic tumour of the mandible treated by a single enucleation procedure: A case report and literature review

“…In our case, a satisfactory intraoperative assessment of the surgical site and achievement of macroscopic simple enucleation of the afflicted bone, combined with the young age of the patient and positive vitality of the teeth, helped us decide to pursue the path of minimally disruptive enucleation without removing the teeth. Different treatment options may also be considered to support teeth preservation [1]. For example, marsupialisation (which is primarily used for large KCOTs) can reduce damage to anatomical structures and may facilitate new bone formation to fill the defect by relieving intracystic pressure, enabling the cavity to gradually decrease in size [1].…”

“…Different treatment options may also be considered to support teeth preservation [1]. For example, marsupialisation (which is primarily used for large KCOTs) can reduce damage to anatomical structures and may facilitate new bone formation to fill the defect by relieving intracystic pressure, enabling the cavity to gradually decrease in size [1]. However, only instruction-compliant patients are eligible for this procedure as it requires irrigation of the exposed lesion over a sufficient number of months to prevent infection [16].…”

“…Keratocystic odontogenic tumours (KCOTs) were first described in 1956 as benign neoplasms of the jaw that have a high risk of recurrence [1]. Considering their aggressive infiltrative behaviour that often leads to penetration of the surrounding tissues, KCOTs exhibit the combined characteristics of cysts and benign tumours [1], [2].…”

“…Considering their aggressive infiltrative behaviour that often leads to penetration of the surrounding tissues, KCOTs exhibit the combined characteristics of cysts and benign tumours [1], [2]. KCOTs are usually characterised by an 8–10 cell thick parakeratinised epithelium and represent 12–14% of all odontogenic cysts of the jaw [1], [3]. Clinical symptoms of odontogenic keratocysts are rarely observed; they are often discovered incidentally through radiographic examination [4].…”

Marsupialization Followed by Enucleation and Chemical Cauterization for Treatment of Odontogenic Keratocyst Involving Maxillary Sinus: A Case Report

“…A perceptible number of cases are diagnosed incidentally during regular dental inspections. 4,5 Radiographs show unilocular or multilocular radiolucency with uniform sclerotic borders which may be involving an unerupted tooth, mostly impacted third molar. Bone expansion is not well noted.…”