03 July 2019

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Odontogenic keratocysts: analysis of recurrence

Lara Figini

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Odontogenic keratocyst (OKC), also known as keratoconus odontogenic tumor, is locally aggressive and frequently relapses, with most relapses occurring within 5 years of treatment. It originates from the epithelial tissue residues that participate in tooth formation (dental lamina). It can be uni- or multilocular, it has an invasive growth, and it tends to expand inside the bone tissue, inducing its reabsorption. If not diagnosed and treated it can lead to deformation of the affected bone and soft tissue, cause pain, tooth displacement, paresthesia and anesthesia due to nerve compression.
The treatment is mainly surgical, and involves the removal of the lesion, followed by a careful remote follow-up.  

MATERIALS AND METHODS
The study published by Kinard et al. investigated the overall percentage of recurrence of odontogenic keratocysts 5 years after treatment and what factors were associated with their recurrence.This multicenter retrospective cohort study considered patients for the evaluation and management of OKC previously never treated for this issue. The predictive variables have been grouped into demographic, medical, radiographic and operational categories. The primary outcome variable was represented by the recurrence time of the lesion. Data analyzes were performed using bivariate analysis and univariate or multivariate Cox proportional risk models. 

RESULTS
231 keratocysts (OKC) were analyzed. Of these, 57 (24.7%) were treated by decompression and residual cystectomy, 86 (37.2%) by enucleation without adjuvant therapy and 78 (33.8%) by enucleation with peripheral ostectomy.
44 relapses were recorded with an average recurrence time of 26.7 months.  

CONCLUSIONS
From the data emerging from this study, which must be confirmed with other similar studies, it can be concluded that, using the appropriate time-to-event survival analysis, which also takes into account the cases lost to follow-up, 5 years after treatment of keratocysts has a cure rate without recurrence of 29%. Mandibular lesions, multilocular lesions and lesions treated by decompression and residual cystectomy were found to be more associated with recurrence.

For additional informations:
How well do we manage the odontogenic keratocyst? A multicenter study