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Keratocystic Odontogenic Tumours: Etiology, Pathogenesis and Treatment Revisited

  • Review Paper
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Journal of Maxillofacial and Oral Surgery Aims and scope Submit manuscript

Abstract

Introduction

Among the pathological entities that affect the maxillofacial region, Keratocystic odontogenic tumour has been subject to a lot of debates, controversies and speculations because of its diverse nature and high recurrence rates.

Materials and methods

The authors conducted a search in English literature using the following keywords; “Odontogenic keratocyst” and “Keratocystic odontogenic tumour”. The aim of the paper was to review all aspects of the entity, including etiology, pathogenesis, clinical and radiological manifestations, growth potential, recurrence and treatment modalities.

Conclusion

The controversial nature of the pathology not withstanding, there is in general a broad consensus on treating the entity conservatively with emphasis on a long term review.

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References

  1. Phillipsen H (1956) On keratocysts in the jaws. Tandleagebladet 60:963

    Google Scholar 

  2. Maurette PE, Jorje J, de Moraes M (2006) Conservative treatment of odontogenic keratocyst: a preliminary study. J Oral Maxillofac Surg 64(3):379–383

    Article  PubMed  Google Scholar 

  3. Brown RM (1970) The odontogenic keratocyst: clinical aspects. Br Dent J 128(5):228–231

    Google Scholar 

  4. Brannon RB (1976) The odontogenic keratocyst. A clinicopathologic study of 312 cases. Part 1. Clinical features. Oral Surg Oral Med Oral Pathol 42(1):54–72

    Article  CAS  PubMed  Google Scholar 

  5. Stoelinga PJW (2005) The treatment of odontogenic keratocysts by excision of the overlying, attached mucosa, enucleation, and treatment of the bony defect with Carnoy solution. J Oral Maxillofac Surg 63:1662–1666

    Article  PubMed  Google Scholar 

  6. Stoelinga PJW, Peters JH (1973) A note on the origin of keratocysts of the jaws. Int J Oral Surg 2:37

    Article  CAS  PubMed  Google Scholar 

  7. Stoelinga PJW (1976) Studies on the dental lamina as related to its role in the aetiology of cysts and tumours. J Oral Pathol 5:65

    Article  CAS  PubMed  Google Scholar 

  8. Kramer IRH, Pindborg JJ, Shear M (1992) Histological typing of odontogenic tumours. Springer, Berlin

    Book  Google Scholar 

  9. Stoelinga PJW (2001) Long-term follow-up on keratocysts treated according to a defined protocol. Int J Oral Maxillofac Surg 30:14

    Article  CAS  PubMed  Google Scholar 

  10. Toller P (1967) Origin and growth of cysts of the jaws. Ann R Coll Surg Engl 40(5):306–336

    CAS  PubMed Central  PubMed  Google Scholar 

  11. Ahlfors E, Larsson A, Sjogren S (1984) The odontogenic keratocyst: a benign cystic tumour? J Oral Maxillofac Surg 42(1):10

    Article  CAS  PubMed  Google Scholar 

  12. Barnes L, Eveson JW, Reichart P, Sidransky D (eds) (2005) Pathology and genetics of head and neck tumours. WHO classification of tumour series. IARC Press, Lyon

  13. Cohen MM Jr (1999) Nevoid basal cell carcinoma syndrome: molecular biology and new hypotheses. Int J Oral Maxillofac Surg 28:216–223

    Article  PubMed  Google Scholar 

  14. Lia R-F, Chena G, Zhaoa Y, Zhaoa Y-F, Liua B (2014) Increased expression of autophagy-related proteins in keratocystic odontogenic tumours: its possible association with growth potential. Br J Oral Maxillofac Surg 52:551–556

    Article  Google Scholar 

  15. Siar CH, Abbas SA (2013) Claudin expression and tight junction protein localization in the lining epithelium of the keratocystic odontogenic tumors, dentigerous cysts and radicular cysts. Oral Surg Oral Med Oral Pathol Oral Radiol 115:652–659

    Article  PubMed  Google Scholar 

  16. Piatelli A, Fioroni M, Rubini C (1998) Differentiation of odontogenic keratocysts from other cysts by the expression of bcl-2 immunoreactivity. Oral Oncol 34:404

    Article  Google Scholar 

  17. Gonzalez-Alva P et al (2008) Keratocystic odontogenic tumour: a retrospective study of 183 cases. J Oral Sci 50(2):205–212

    Article  PubMed  Google Scholar 

  18. Buckley PC, Seldin EB, Dodson TB, August M (2012) Multilocularity as a radiographic marker of the keratocystic odontogenic tumor. J Oral Maxillofac Surg 70:320–324

    Article  PubMed  Google Scholar 

  19. Partsch C (1892) Uber Kiefercysten. Dtsch Mschr Zahnheilkd 10:271

    Google Scholar 

  20. Melugin MB (2002) The role of marsupialization, local enucleation, and enucleation with peripheral ostectomy in the management of odontogenic keratocyst symposium: the odontogenic keratocyst revisited. J Oral Maxillofac Surg 60(8 Suppl):14–16

    Google Scholar 

  21. Marker P, Brondum N, Clausen PP et al (1996) Treatment of large odontogenic keratocyst by decompression and later cystectomy: a long term follow-up and histologic study of 23 cases. Oral Surg Oral Med Oral Path Oral Radiol Endod 82:122

    Article  CAS  Google Scholar 

  22. Ninomiya T, Kubota Y, Koji T et al (2002) Marsupialization inhibits interleukin 1a expression and epithelial cell proliferation in odontogenic keratocysts. J Oral Pathol Med 31:526

    Article  CAS  PubMed  Google Scholar 

  23. August M, Faquin WC, Troulis M et al (2003) Dedifferentiation of odontogenic keratocyst epithelium after cyst decompression. J Oral Maxillofac Surg 61:678

    Article  PubMed  Google Scholar 

  24. August M, Faquin WC, Troulis M et al (2000) Differentiation of odontogenic keratocysts from nonkeratinizing cysts by use of fine-needle aspiration biopsy and cytokeratin-10 staining. J Oral Maxillofac Surg 58:935; discussion 940

  25. Kubota Y, Imajo I, Itonaga R, Takenoshita Y (2013) Effects of the patient’s age and the size of the primary lesion on the speed of shrinkage after marsupialisation of keratocystic odontogenic tumours, dentigerous cysts, and radicular cysts. Br J Oral Maxillofac Surg 51:358–362

    Article  PubMed  Google Scholar 

  26. Wushou A, Zhao YJ, Shao ZM (2014) Marsupialization is the optimal treatment approach for keratocystic odontogenic tumour. J Cranio-Maxillofac Surg 42(7):1540–1544

  27. Maurette PE, Jorge J, de Moraes M (2006) Conservative treatment protocol of odontogenic keratocyst: a preliminary study. J Oral Maxillofac Surg 64:379–383

    Article  PubMed  Google Scholar 

  28. Schmidt BL, Pogrel MA (2004) Neurosensory changes after liquid nitrogen cryotherapy. J Oral Maxillofac Surg 62:1183–1187

    Article  PubMed  Google Scholar 

  29. Shear M (2002) The aggressive nature of the odontogenic keratocyst: is it a benign cystic neoplasm? Part 2. Proliferation and genetic studies. Oral Oncol 38:323

    Article  CAS  PubMed  Google Scholar 

  30. Shear M (2002) The aggressive nature of the odontogenic keratocyst: is it a benign cystic neoplasm? Part 3. Immunocytochemistry of cytokeratin and other epithelial cell markers. Oral Oncol 38:407

    Article  CAS  PubMed  Google Scholar 

  31. Kinard BE, Chuang SK, August M, Dodson TB (2013) Most patients with asymptomatic, disease-free third molars elect extraction over retention as their preferred treatment. J Oral Maxillofac Surg 71:1353–1358

    Article  PubMed  Google Scholar 

  32. Chirapathomsakul D, Sastravaha P, Jansisyanont P (2006) A review of odontogenic keratocysts and the behavior of recurrences. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 101:5–9

    Article  PubMed  Google Scholar 

  33. Stoelinga PJW, Bronkhorst FB (1988) The incidence, multiple presentation and recurrence of aggressive cysts of jaws. J Craniomaxillofac Surg 16:184

    Article  CAS  PubMed  Google Scholar 

  34. Johnson NR, Batstone MD, Savage NW (2013) Management and recurrence of keratocystic odontogenic tumor: a systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol 116:e271–e276

    Article  PubMed  Google Scholar 

  35. Cutler EC, Zollinger R (1933) Sclerosing solution in the treatment of cysts and fistulae. Am J Surg 19:441

    Article  Google Scholar 

  36. Voorsmit RACA, Stoelinga PJW, van Hadst UJGM (1981) The management of keratocysts. J Maxfac Surg 9:228–236

    Article  CAS  Google Scholar 

  37. Loescher AR, Robinson PP (1998) The effect of surgical medicaments on peripheral nerve function. BJOMS 36:327–332

    CAS  Google Scholar 

  38. Frerich B, Cornelius CP, Wiethijlter H (1994) Critical time of exposure of the rabbit inferior alveolar nerve to Carnoy’s solution. J Oral Maxillofac Surg 52:599–606

    Article  CAS  PubMed  Google Scholar 

  39. Júnior OR, Borba AM, Ferreira Alves CA, Júnior JG (2007) Carnoy’s solution over the inferior alveolar nerve as a complementary treatment for keratocystic odontogenic tumors. Rev Clín Pesq Odontol 3(3):199–202

    Google Scholar 

  40. Saulacic N, Stajcic Z, Stajcic LS, Piattelli A, Iizuka T, Lombardi T (2009) Effects of Carnoy’s solution on blood vessels of the axillary fossa of rats. Int J Oral Maxillofac Surg 38:876–879

    Article  CAS  PubMed  Google Scholar 

  41. Ecker J, Koslovsky DA (2014) Current role of carnoy’s solution in treating keratocystic odontogenic tumors. J Oral Maxillofac Surg 72(9 Suppl):e161–e162

    Article  Google Scholar 

  42. Salmassy DA, Pogrel MA (1995) Liquid nitrogen cryosurgery and immediate bone grafting in the management of aggressive primary jaw lesions. J Oral Maxillofac Surg 53:784

    Article  CAS  PubMed  Google Scholar 

  43. Tolstunov L, Treasure T (2008) Surgical treatment algorithm for odontogenic keratocyst: combined treatment of odontogenic keratocyst and mandibular defect with marsupialization, enucleation, iliac crest bone graft, and dental implants. J Oral Maxillofac Surg 66:1025–1036

    Article  PubMed  Google Scholar 

  44. Pogrel MA (1993) The use of liquid nitrogen cryotherapy in the management of locally aggressive bone lesions. J Oral Maxillofac Surg 51:269

    Article  CAS  PubMed  Google Scholar 

  45. Iwai T, Hirota M, Maegawa J, Tohnai I (2011) Use of methylene blue for precise peripheral ostectomy of keratocystic odontogenic tumour. Br J Oral Maxillofac Surg 49:e84–e85

    Article  PubMed  Google Scholar 

  46. Zhao YF, Wei JX, Wang SP (2002) Treatment of odontogenic keratocysts: a follow-up of 255 Chinese patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 94:151

    Article  PubMed  Google Scholar 

  47. Kaczmarzyk T, Mojsa I, Stypulkowska J (2012) A systematic review of the recurrence rate for keratocystic odontogenic tumour in relation to treatment modalities. Int J Oral Maxillofac Surg 41:756–767

    Article  CAS  PubMed  Google Scholar 

  48. MacIntosh RB (2002) The role of osseous resection in the management of odontogenic keratocysts symposium: the odontogenic keratocyst revisited. J Oral Maxillofac Surg 60(8):14–16

  49. Kolokythas A, Fernandes RP, Pazoki A, Ord RA (2007) 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

    Article  PubMed  Google Scholar 

  50. Shiva Bharani KSN, Shubha Lakshmi S, Rajay Kamath AD, Hammannavar R (2013) Case report. Keratocystic odontogenic tumor: treatment review and future diagnostic trends. J Oral Maxillofac Surg Med Pathol 25(1):85–92

    Article  Google Scholar 

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Menon, S. Keratocystic Odontogenic Tumours: Etiology, Pathogenesis and Treatment Revisited. J. Maxillofac. Oral Surg. 14, 541–547 (2015). https://doi.org/10.1007/s12663-014-0734-5

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  • DOI: https://doi.org/10.1007/s12663-014-0734-5

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