The Need for Standardisation of Procedures in the Treatment of Odontogenic KeratocystsReport as inadecuate

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Acta stomatologica Croatica, Vol.38 No.4 December 2004. -

Odontogenic keratocysts comprise approximately 10% of all odontogenic cysts of the jaws and occur as solitary lesions or within the framework of Gorlin- Goltz-s syndrome, frequently in the mandible in the area of the angulus and ramus. According to Stoeling, they can be classified radiographically as unilocular, multilocular with osseous trabecules, multilocular without trabecules and those with wavy edges. The following are reported as possible causes of recurrence (3%-62%), the thin capsule and its incomplete scaling during the surgical procedure, satellite cysts, the presence of parakeratinisation -dropping down- of epithelial cells etc. Thirty odontogenic cysts were found in a clinical sample of the Clinic of Maxillofacial and Oral Surgery, University Hospital Dubrava, Zagreb, of which 12 recurred once and 3 several times, which amounts to 50%. Thus the incidence of recurrence in this sample was equal to the values of recurrence in ameloblastoma (50 - 90%). The behaviour of odontogenic keratocysts is therefore similar to the behaviour of ameloblastomas, which is sufficient reason for caution in the method of treatment. The following is recommended:

• Odontogenic keratocyst should be considered an odontogenic tumour with tendency to recurrence, because in the latest classification it is included under the term keratinising cystic odontogenic tumour.

• Cases of osseous translucency with the above radiographic characteristics, resembling odontogenic keratocystic prior to or during the operation should be histopathologically checked.

• Cases of cystic lesions in Gorlin-Goltz-s syndrome, even without prior histopathological verification, should be considered odontogenic keratocysts and thus treated, and patients continually monitored because of the constant possibility of new cysts forming.

• During the operation carefully denucleate the capsule and later whiten the bone with 3% hydrogen peroxide in order to see possible remains of the capsule and all places of eroded or perforated bone, and also undermined sites should be revealed and polished with a burr until the surface is smooth.

• Healing of the osseous cavity should be ensured by one of the usual methods (Partsch II+ decortication (Brosch), Partsch II+ postoperative suction).

• Marsupialisation should be applied in cases of exceptionally large cysts for drainage and eventual reduction of the osseous cavity, or in the case of patients with health risk, who are a risk for operation under general anaesthesia. Because of the determined changes in virility of the epithelia of marsupialized keratocysts wider application of the method is possible.

• Postoperatively the patient should be clinically and radiographically monitored until complete healing of the bone, from two to fifteen years after the operation. In cases with signs of recurrence surgical intervention should be immediate, in order to avoid uncontrolled expansion of the formation-mass.

Author: Klara Sokler -



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