Different Factors Contributing to the recurrence and different treatment modalities of keratocysts: Monocentric Study

Abstract

Odontogenic keratocysts (OKCs) are developmental cysts of the jaw that arise either from the
dental lamina or from the primordial dental epithelium. These types of lesions have been studied to have a locally aggressive nature and a high tendency to recurrence after treatment.
Okc show frequent recurrence, distinctive histopathological traits, and a high nature of
aggressive clinical behavior. During the years many conservative and aggressive treatments
have been proposed to reduce the high rate of recurrence, but none of them has been
recognized as the gold standard for this lesion. The surgical treatment may consist on simple
enucleation with or without curettage or marsupialization/decompression, with or without
second therapeutic measures, peripheral ostectomy, chemical curettage with Carnoy’s
solution, cryotherapy, electrocautery, or resection en bloc or marginal. The recurrence rate
described in literature ranges between 5% and 62% [12]; this difference may be related to
characteristics of the lesion and the kind of treatment performed.
The purpose of the study was critically study analyse and report our experience about the
recurrence rate of odontogenic keratocysts. The specific aim of this study was to compare the
recurrence rate of OKC treated with 2 different protocols and to identify the features of the
cyst that might influence and affect the recurrence.
Inspite of many efforts to find a surgical treatment which can minimize recurrence rate of
OKCs, this still remains an unsolved problem yet. Factors such as the cortical bone erosion
with soft tissue involvement, the teeth involvement and the syndromic presentation of the
OKCs may influence the recurrence, but more studies are requested to confirm this trend. For
this reason, an accurate diagnosis with the screening of Gorlin Goltz syndrome, the execution
of complete clinical and radiological exams, and if indicated cytological and
immunohistochemical analysis are mandatory to plan the best surgical treatment for each
single case. The use of FNAB, incisional biopsy and cell block technique may be really
helpful to early diagnose OKCs and to perform more conservative treatment for those lesions
without teeth involvement and cortical bone perforation, or more aggressive surgical plan for
OKCs with periosteum involvement, up to justify jaw resection for recurred lesions with high