Treatment and 2-Year Follow-up of a Large Odontogenic Keratocyst

Öz

Odontogenic keratocyst (OKK) is a developmental cyst that originates from the remnants of the dental lamina within the jaw bones. The “ideal” treatment of OCC remains controversial for both surgeons and pathologists. Despite ongoing research, there is currently no consensus on the optimal treatment strategy to reduce therecurrence rate of odontogenic keratocysts (OKCs). Treatment selection is influenced by multiple factors, including lesion characteristics, anatomical location, and surgeon preference. Due to the high recurrence potential of OKCs, long-term follow-up and careful clinical and radiographic monitoring are essential for early detection of recurrence. This case report describes a conservative treatment approach adapted to the patient’s clinical condition and the biological behavior of the lesion. It is intended to support clinical decision-making and serve as a reference for similar cases, highlighting the importance of extended surveillance in managing OKCs.

Anahtar Kelimeler

• odontogenic cysts
• conservative treatment
• quality of life
• multidisciplinary approach

Yaygın Odontojenik Keratokist Olgusunun Tedavisi ve İki Yıllık

Öz

Odontojenik keratokist (OKK), çene kemikleri içindeki dental lamina kalıntılarından kaynaklanan gelişimsel bir kisttir. OKK'nin “ideal” tedavisi hem cerrahlar hem de patologlar için tartışmalı olmaya devam etmektedir. Bugüne kadar, OKK’ler için nüks oranını düşürmek ve en uygun tedavi protokolünü belirlemek konusunda fikir birliği yok gibi görünmektedir. Mevcut bazı faktörler ise uygun tedavi seçeneklerinin seçimini etkilemektedir ve bunlar cerrahların tercihlerine ve mevcut koşullara göre değişmektedir. Bu lezyonlar için tedavi edilen hastaların uzun süreli takibi ve izlenmesi, nüksün erken tespit edilmesi açısından önemlidir. Bu olgu raporu, hastanın özel gereksinimlerine ve lezyon özelliklerine uygun olarak OKK’nin konservatif bir şekilde yönetimini ele almaktadır. Hasta ve lezyon odaklı tedavi planının doğruluğunu vurgulayarak klinisyenlere kılavuzluk etmek ve benzer olgular için referans oluşturmak amacıyla tedavi ve hasta takibi sunulmaktadır.

Anahtar Kelimeler

• odontojenik kistler
• konservatif tedavi
• yaşam kalitesi
• multidisipliner yaklaşım

Kaynakça

1. Abdullah, W. A. (2011). Surgical treatment of keratocystic odontogenic tumour: A review article. The Saudi Dental Journal, 23(2), 61–65. https://doi.org/10.1016/j.sdentj.2011.01.002
2. Al-Moraissi, E. A., Kaur, A., Gomez, R. S., & Ellis, E. (2023). Effectiveness of different treatments for odontogenic keratocyst: a network meta-analysis. International Journal of Oral and Maxillofacial Surgery, 52(1), 32–43. https://doi.org/10.1016/j.ijom.2022.09.004
3. August, M., Faquin, W. C., Troulis, M. J., & Kaban, L. B. (2003). Dedifferentiation of odontogenic keratocyst epithelium after cyst decompression. Journal of Oral and Maxillofacial Surgery, 61(6), 678–683. https://doi.org/10.1053/joms.2003.50137
4. Chen, P., Liu, B., Wei, B., & Yu, S. (2022). The clinicopathological features and treatments of odontogenic keratocysts. American Journal of Cancer Research, 12(7), 3479.
5. Chrcanovic, B. R., & Gomez, R. S. (2017). Recurrence probability for keratocystic odontogenic tumors: An analysis of 6427 cases. Journal of Cranio-Maxillofacial Surgery, 45(2), 244–251. https://doi.org/10.1016/j.jcms.2016.11.010
6. Dammer, R., Niederdellmann, H., Danuner, P., & Nuebler-Moritz, M. (1997). Conservative or radical treatment of keratocysts: a retrospective review. British Journal of Oral and Maxillofacial Surgery, 35(1), 46–48. https://doi.org/10.1016/S0266-4356(97)90009-7
7. Dashow, J. E., McHugh, J. B., Braun, T. M., Edwards, S. P., Helman, J. I., & Ward, B. B. (2015). Significantly Decreased Recurrence Rates in Keratocystic Odontogenic Tumor With Simple Enucleation and Curettage Using Carnoy’s Versus Modified Carnoy’s Solution. Journal of Oral and Maxillofacial Surgery, 73(11), 2132–2135. https://doi.org/10.1016/j.joms.2015.05.005
8. de Castro, M. S., Caixeta, C. A., de Carli, M. L., Ribeiro Júnior, N. V., Miyazawa, M., Pereira, A. A. C. … Hanemann, J. A. C. (2018). Conservative surgical treatments for nonsyndromic odontogenic keratocysts: a systematic review and meta-analysis. Clinical Oral Investigations, 22(5), 2089–2101. https://doi.org/10.1007/s00784-017-2315-8

9. Dioguardi, M., Quarta, C., Sovereto, D., Caloro, G. A., Ballini, A., Aiuto, R. … Di Cosola, M. (2024). Factors and management techniques in odontogenic keratocysts: a systematic review. European Journal of Medical Research, 29(1), 287. https://doi.org/10.1186/s40001-024-01854-z
10. Forssell, K., Forssell, H., & Kahnberg, K.-E. (1988). Recurrence of keratocysts. International Journal of Oral and Maxillofacial Surgery, 17(1), 25–28. https://doi.org/10.1016/S0901-5027(88)80224-8
11. Giuliani, M., Grossi, G. B., Lajolo, C., Bisceglia, M., & Herb, K. E. (2006). Conservative Management of a Large Odontogenic Keratocyst: Report of a Case and Review of the Literature. Journal of Oral and Maxillofacial Surgery, 64(2), 308–316. https://doi.org/10.1016/j.joms.2005.10.013
12. Gonçalves, T. O. de F., Rangel, R. M. R., Marañón-Vásquez, G. A., Soares-Silva, L., Agostini, M., Abrahão, A. C. … Maia, L. C. (2024). Management and recurrence of the odontogenic keratocyst: an overview of systematic reviews. Oral and Maxillofacial Surgery, 28(4), 1457–1478. https://doi.org/10.1007/s10006-024-01277-4
13. Hamied, M. A., Al-Shaikhani, S. M., & Ali, Z. D. (2021). Odontogenic Keratocyst. AL-Kindy College Medical Journal, 17(2), 52–61. https://doi.org/10.47723/kcmj.v17i2.266
14. Johnson, N. R., Gannon, O. M., Savage, N. W., & Batstone, M. D. (2014). Frequency of odontogenic cysts and tumors: a systematic review. Journal of Investigative and Clinical Dentistry, 5(1), 9–14. https://doi.org/10.1111/jicd.12044
15. Khan, A. A., Qahtani, S. Al, Dawasaz, A. A., Saquib, S. A., Asif, S. M., Ishfaq, M. … Ibrahim, M. (2019). Management of an extensive odontogenic keratocyst. Medicine, 98(51), e17987. https://doi.org/10.1097/MD.0000000000017987
16. Nayak, M., Singh, A., Singhvi, A., & Sharma, R. (2013). Odontogenic keratocyst: What is in the name? Journal of Natural Science, Biology and Medicine, 4(2), 282. https://doi.org/10.4103/0976-9668.116968
17. Neville, B. W., Damm, D. D., Allen, C. M., & Chi, A. C. (2018). Color Atlas of Oral and Maxillofacial Diseases: Color Atlas of Oral and Maxillofacial Diseases-E-Book. Elsevier Health Sciences.
18. Oginni, F. O., Alasseri, N., Ogundana, O. M., Famurewa, B. A., Pogrel, A. … Al-Moraissi, E. A. (2022). An evidence-based surgical algorithm for management of odontogenic keratocyst. Oral and Maxillofacial Surgery, 27(2), 201–212. https://doi.org/10.1007/s10006-022-01064-z
19. Pereira Santana, D., Garcia, J., Lins-Kusterer, L., Sardinha, S., & Cavalcante, W. (2021). Odontogenic Keratocyst: Eight-Year Follow-Up After Conservative Treatment. International Journal of Odontostomatology, 15, 520–525. https://doi.org/10.4067/S0718-381X2021000200520
20. Pogrel, M. A. (2005). Treatment of Keratocysts: The Case for Decompression and Marsupialization. Journal of Oral and Maxillofacial Surgery, 63(11), 1667–1673. https://doi.org/10.1016/j.joms.2005.08.008
21. Rajendra Santosh, A. B., & Ogle, O. E. (2020). Odontogenic Tumors. Dental Clinics of North America, 64(1), 121–138. https://doi.org/10.1016/j.cden.2019.08.008
22. Ravi, J., Wadhwan, V., & Gotur, S. P. (2022). Orthokeratinized versus parakeratinized odontogenic keratocyst. Journal of Oral and Maxillofacial Pathology, 26(1), 60–64. https://doi.org/10.4103/jomfp.jomfp_498_20
23. Shear, M. (2002). The aggressive nature of the odontogenic keratocyst: is it a benign cystic neoplasm? Part 1. Clinical and early experimental evidence of aggressive behaviour. Oral Oncology, 38(3), 219–226.
24. Slusarenko da Silva, Y., Stoelinga, P. J. W., & Naclério-Homem, M. da G. (2019). Recurrence of nonsyndromic odontogenic keratocyst after marsupialization and delayed enucleation vs. enucleation alone: a systematic review and meta-analysis. Oral and Maxillofacial Surgery, 23(1), 1–11. https://doi.org/10.1007/s10006-018-0737-3
25. Soluk-tekkesin, M., & Wright, J. M. (2022). The world health organization classification of odontogenic lesions: a summary of the changes of the 2022 (5th) edition. Turkish Journal of Pathology. https://doi.org/10.5146/tjpath.2022.01573
26. Tabrizi, R., Hosseini Kordkheili, M. R., Jafarian, M., & Aghdashi, F. (2019). Decompression or Marsupialization; Which Conservative Treatment is Associated with Low Recurrence Rate in Keratocystic Odontogenic Tumors? A Systematic Review. Journal of Dentistry (Shiraz, Iran), 20(3), 145–151. https://doi.org/10.30476/DENTJODS.2019.44899
27. Vered, M., & Wright, J. M. (2022). Update from the 5th Edition of the World Health Organization Classification of Head and Neck Tumors: Odontogenic and Maxillofacial Bone Tumours. Head and Neck Pathology, 16(1), 63–75. https://doi.org/10.1007/s12105-021-01404-7
28. Wang, L. L., & Olmo, H. (2025). Odontogenic Cysts. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing
29. Winters, R., Garip, M., Meeus, J., Coropciuc, R., & Politis, C. (2023). Safety and efficacy of adjunctive therapy in the treatment of odontogenic keratocyst: a systematic review. British Journal of Oral and Maxillofacial Surgery, 61(5), 331–336. https://doi.org/10.1016/j.bjoms.2023.04.006
30. Wushou, A., Zhao, Y. J., & Shao, Z.-M. (2014). Marsupialization is the optimal treatment approach for keratocystic odontogenic tumour. Journal of Cranio-Maxillofacial Surgery, 42(7), 1540–1544. https://doi.org/10.1016/j.jcms.2014.04.027