Recurrence challenge in odontogenic keratocyst variants, two clinical cases

Abstract

-Introduction:After radicular and follicular cysts, odontogenic keratocysts are the third most common cyst of the jaws. They can be unique or multiple when included in basal cell nevus syndrome. The odontogenic keratocyst is known for its high recurrence rate and local aggressiveness. It has been classified into two histologic variants: orthokeratinized or parakeratinized. The aim of this report is to highlight the clinical and radiological characteristics, the histopathological features, as well as the risk factors for recurrence of odontogenic keratocysts. Case report: Two clinical cases of odontogenic keratocysts with different histologic features are reported. Discussion: Radiological and histological features, localization, extension and evolutionary aspect of the lesion are risk factors for recurrence, and therefore have an impact on the treatment of keratocysts. Through critical analysis of the first case report, the authors identify therapeutic errors to avoid, particularly when histologic confirmation of the lesion has been obtained. Résumé -Introduction :Après le kyste périapical et le kyste folliculaire, le kératokyste odontogène est le troisième plus fréquent des kystes des maxillaires. Il peut être unique ou multiple s'il est associé à la naevomatose baso-cellulaire. Le kératokyste a un risque élevé de récurrence et une agressivité locale. Il a été classé en deux variétés histologiques : orthokératinisé ou parakératinisé. Observation : Deux cas de kératokystes odontogènes sont décrits sur un plan clinique, radiologique et histopathologique. Discussion : Le type histologique, l'image radiologique, la localisation, l'extension et l'aspect évolutif de la lésion sont des facteurs de risque de récidive. Ces facteurs doivent être pris en compte dans la décision thérapeutique. À travers une analyse critique du premier cas, les auteurs mettent en exergue les erreurs thérapeutiques à éviter, notamment lorsqu'une confirmation histologique a été obtenue.

The Odontogenic Keratocyst Detected Accidentally With Radiological Features

“…The patient who experienced this case was 24 years old. She was in the range of 20-30 years old, the age which is likely to experience OKC [9]. Odontogenic keratocyst, in this case, appeared along with frequent pain when the patient chewed food in the area of tooth 38.…”

A clinicopathological study and management of odontogenic keratocyst

“…8 Aggressive treatment, such as ostectomy is necessary in cases associated with soft tissue invasion, a multi recurrent keratocyst, malignant transformation. 2 Peripheral ostectomy should be used with caution as it may disperse microcysts embedded in peripheral bone to cause recurrence. 11 In our study 09 (12%) patients were treated with enucleation and curettage, 22(29.33%) cases received enucleation, curettage & peripheral ostectomy.…”

“…Odontogenic Keratocyst (OKC) is an aggressive odontogenic cyst arising from dental lamina and is unique for its innate growth potential like tumours with an aggressive clinical patterns and association with high recurrence rate. 1 After radicular and follicular cysts, odontogenic keratocysts are the third most common cyst 2 and approximately 12-14% of all odontogenic cysts of jaws. 3 It has been retermed to Keratocystic odontogenic tumour (KCOT) as it better reflects its aggressive behavior, high recurrence rate and neoplastic nature but recently it has been re classified and retermed into the cystic category by WHO 2017 classification.…”

“…The orthokeratinized variant not only lacks of the typical characteristics of the parakeratinized one but also has different biological characteristics and consequently a much lower recurrence rate. 2 Various treatment modalities have been published in literature for odontogenic keratocyst but the universally accepted approach remains undecided. Treatment generally includes from conservative methods such as marsupialization, enucleation, curettage, chemical cauterization, peripheral ostectomy to much aggressive treatments such as marginal or segmental resection.…”