TREATMENT OF A LARGE ODONTOGENIC KERATOCYST: A 5-YEAR FOLLOW-UP

Yıl 2024, Cilt: 13 Sayı: 1, 161 - 166, 26.01.2024

Gülin Acar , Selen Adiloğlu , Alper Aktaş

https://doi.org/10.54617/adoklinikbilimler.1380700

Öz

The Odontogenic Keratocyst (OKC) presents a unique challenge in the field of dentistry and oral pathology. This locally aggressive lesion has been a subject of debate in the literature, with discussions revolving around its classification as either a cyst or a tumor. Its prominence as the third most common cyst in the jaw bones has captured the attention of clinicians and researchers alike. Given its aggressive clinical behavior and high recurrence rate, various treatment methods have been proposed to address OKC and mitigate the risk of recurrence, yet the ideal treatment approach and surgical margins remain elusive. This case report highlights the management of a large circumscribed OKC and underscores the importance of long-term patient follow-up. The patient has undergone 5 years of vigilant monitoring without any signs of recurrence. Ultimately, this case underscores the significance of adopting a personalized treatment approach that considers the patient's specific needs and lesion characteristics. By prioritizing patient-centered and lesion-oriented decision-making, this case offers valuable insights for clinicians and serves as a reference for future similar cases.

Anahtar Kelimeler

Oral Pathology, Keratocysts, Surgical Pathology

Büyük Boyutlu Odontojenik Keratokist Olgusunun Tedavisi ve 5 yıllık Takibi

Öz

Özet
Odontojenik Keratokist (OKK), literatürde kist veya tümör olup olmadığı tartışmaları hala devam ancak günümüzde odontojenik kist sınıflamasında olan lokal agresif bir kisttir. Çene kemiklerinde en sık görülen 3.kist olduğu için klinik davranışı ve histolojik karakteri hem klinisyenlerin hem de araştırmacıların ilgisini çekmektedir. Agresif klinik davranışı ve yüksek nüks oranı nedenleri ile tedavi OKK'nin tedavisi ve nüks riskini azaltmak için bir çok yöntem önerilmiştir, ancak optimal tedavi yöntemi ve cerrahi sınırlar hala net değildir. Bu olgu raporu, geniş sınırlı bir OKK'nin yönetimini ele almaktadır ve hastanın uzun vadeli izlemine vurgu yapmaktadır. Hastanın takip süreci, 5 yıl boyunca nüks belirtileri olmaksızın devam etmektedir. Sonuç olarak, hastanın özel gereksinimlerine ve lezyon özelliklerine uygun olarak kişiselleştirilmiş bir tedavi yaklaşımı benimsenmiştir. Bu olgu, hastaya odaklı ve lezyon-odaklı tedavi kararının doğruluğunu vurgulayarak klinisyenlere kılavuzluk etmek ve gelecekteki benzer olgular için referans oluşturmak amacıyla sunulmaktadır.

Anahtar Kelimeler

oral Patoloji, Keratokistler, cerrahi patoloji

Kaynakça

• Referans1. Kaczmarzyk T, Stypułkowska J, Tomaszewska R. Update of the WHO classification of odontogenic and maxillofacial bone tumours. J. Stomatol 2017;70:484-506.
• Referans2. Soluk-Tekkesin M, Wright JM. The World Health Organization Classification of Odontogenic Lesions: A Summary of the Changes of the 2022 (5th) Edition. Turk Patoloji Derg 2022;38:168-84.
• Referans3. Pogrel MA, Jordan R. Marsupialization as a definitive treatment for the odontogenic keratocyst. J Oral Maxillofac Surg 2004;62:651-5.
• Referans4. Bhargava D, Deshpande A, Pogrel MA. Keratocystic odontogenic tumour (KCOT)—a cyst to a tumour. Oral Maxillofac Surg 2012;16:163-70.
• Referans5. El-Naggar AK, Chan JKC, Grandis JR, Takata T, Slootweg PJ. WHO Classification of Head and Neck Tumours: IARC ; 2017.
• Referans6. Kolář Z, Geierová M, Bouchal J, Pazdera J, Zbořil V, Tvrdý P. Immunohistochemical analysis of the biological potential of odontogenic keratocysts. J Oral Pathol Med 2006;35:75-80.
• Referans7. Al-Moraissi EA, Dahan AA, Alwadeai MS, Oginni FO, Al- Jamali JM, Alkhutari AS, et al. What surgical treatment has the lowest recurrence rate following the management of keratocystic odontogenic tumor?: A large systematic review and metaanalysis. J Craniomaxillofac Surg 2017;45:131-44.
• Referans8. Voorsmit RA, Stoelinga PJ, van Haelst UJ. The management of keratocysts. J Maxillofac Surg 1981;9:228-36.
• Referans9. Esmael W, Aly L, El Kammar H, Magdy A, Taher S, Abo Zekry A. Optimum time of enucleation following marsupialization as a treatment strategy for large odontogenic keratocyst.(Radiologic and histopathologic study). Egypt Dent J 2023;69:949-56.
• Referans10. Mohanty S, Dabas J, Verma A, Gupta S, Urs A, Hemavathy S. Surgical management of the odontogenic keratocyst: A 20-year experience. Int J Oral Maxillofac Surg 2021;50:1168-76.
• Referans11. Titinchi F. Protocol for management of odontogenic keratocysts considering recurrence according to treatment methods. J Korean Assoc Oral Maxillofac Surg 2020;46:358-60.
• Referans12. Blanas N, Freund B, Schwartz M, Furst IM. Systematic review of the treatment and prognosis of the odontogenic keratocyst. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;90:553-8.
• Referans13. Stoelinga PJ. Long-term follow-up on keratocysts treated according to a defined protocol. Int J Oral Maxillofac Surg 2001;30:14-25.
• Referans14. Yu L, Xie Z, Yu L, Xu D, Yao N, Zhang Z. Efficacy and duration of odontogenic keratocyst treated with decompression: A systematic review and meta-analysis. J Oral Maxillofac Surg Med Pathol 2022;34:673-8.
• Referans15. Brøndum N, Jensen VJ. Recurrence of keratocysts and decompression treatment: a long-term follow-up of forty-four cases. Oral Surg Oral Med Oral Pathol 1991;72:265-9.
• Referans16. Telles DC, Castro WH, Gomez RS, Souto GR, Mesquita RA. Morphometric evaluation of keratocystic odontogenic tumor before and after marsupialization. Braz Oral Res 2013;27:496- 502.