Amaç: Bu çalışmanın amacı, insizyonel biyopsi ile odontojenik keratokist (OKK) tanısı konan 10 hastanın, cerrahi tedavileri sonrasında uzun dönem klinik ve radyolojik takip sonuçları ile nüksetme risklerini değerlendirmektir. Gereç ve Yöntemler: Yaşları 19-44 yıl arasında değişen 10 hastaya, cerrahi tedavi olarak enükleasyon ve küretaj veya ilk aşama olarak marsüpyalizasyon ve sonrasında enükleasyon ve küretaj uygulanmıştır. Lezyonları büyük olan iki hastaya, tedavilerinin ilk aşaması olarak 12 ay süreyle marsüpyalizasyon uygulanmıştır. Bu iki hastada marsüpyalizasyon tedavileri boyunca, haftada iki gün normal salin solüsyonu ile lezyonun içi yıkanmıştır. Hastalardan enükleasyon ve küretaj cerrahisi sonrası 6. ayda ve sonrasında senede bir defa olmak üzere takip amaçlı panoramik film alınmıştır. Bulgular: Hastalar, 14-120 ay arasında değişen sürelerde takip edilmiştir. Yaş ortalaması 29,7 yıl olan hastaların 3'ünde maksillada, kalan 7'sinde ise mandibulada OKK tespit edilip tedavileri yapılmıştır. On hastanın 1'inde OKK multiloküler formda olup, kalanları uniloküler tarzdadır. Hastaların 2 (%20)'sinde 23 ve 27. aylarda nüks tespit edilmiş ve tekrar ameliyat edilmiştir. Bu 2 hastadan 1'i ikinci enükleasyon operasyonundan sonra 32 ay, diğeri ise 93 ay daha klinik ve radyolojik olarak takip edilmiştir. Sonuç: OKK'lerin tedavileri esnasında doğru cerrahi tedavi protokolünü seçmek önemlidir. Bununla birlikte bu hastaların uzun dönem klinik ve radyolojik takiplerinin yapılması ve nüksetmesi durumunda tekrar ameliyat edilmesi başarıyı direkt olarak etkileyen faktörlerdendir.
Anahtar Kelimeler: Odontojenik kistler; oral cerrahi işlemleri
Objective: The aim of this study is to evaluate the postoperative recurrence risk by long term radiological and clinical follow ups of 10 patients, who were diagnosed with odontogenic keratocyst (OKC) by the incisional biopsy. Material and Methods: The patients, who were between the age of 19 and 44, were offered a surgical procedure consisting of enucleation and curettage or first marsupialisation followed by secondary enucleation and curettage of the lesion. Marsupialisation was offered to the 2 patients with large lesions for a period of 12 month. During the marsupialisation treatment of these patients, twice-weekly irrigations with normal saline solution were performed. After enucleation and curettage procedure, all of the patients were evaluated at the 6th month and first year postoperatively, and annually thereafter by panoramic radiographs. Results: Patients were postoperatively follow-up for a period of 14 to 120 months. Three of the patients had OKC in maxilla and seven in mandible with a mean age of 29.7. One of the patient' OKC was in multilocular and others were unilocular form. Postoperatively, 2 (20%) of the cases, one at the 23. and other at the 27. months, were diagnosed with recurrent OKC and treated by a second enucleation and curettage procedure. One of these 2 cases were follow-up for further 32 months and the other for 93 months clinically and radiographically. Conclusion: It is important to choose the right surgical treatment method for OKC. Also long term clinic and radiographic follow-up of these patients and re-operate them in case of recurrence is mandatory for a successful treatment.
Keywords: Odontogenic cysts; oral surgical procedures
- Philipsen HP. On keratocysts in the jaw. Tandlaegebladet. 1956;60:963-80.
- Madras J, Lapointe H. Keratocystic odontogenic tumour: reclassification of the odontogenic keratocyst from cyst to tumour. J Can Dent Assoc. 2008;74(2):165-165h.
- Pogrel MA. The keratocystic odontogenic tumor. Oral Maxillofac Surg Clin North Am. 2013;25(1):21-30. [Crossref] [PubMed]
- Stoelinga PJ. The treatment of odontogenic keratocysts by excision of the overlying attached mucosa, enucleation, and treatment of the bony defect with carnoy solution. J Oral Maxillofac Surg. 2005;63(11):1662-6. [Crossref] [PubMed]
- Habibi A, Saghravanian N, Habibi M, Mellati E, Habibi M. Keratocystic odontogenic tumor: a 10-year retrospective study of 83 cases in an Iranian population. J Oral Sci. 2007;49(3):229-35. [Crossref] [PubMed]
- Pitak-Arnnop P, Chaine A, Oprean N, Dhanuthai K, Bertrand JC, Bertolus C. Management of odontogenic keratocysts of the jaws: a ten-year experience with 120 consecutive lesions. J Craniomaxillofac Surg. 2010;38(5):358-64. [Crossref] [PubMed]
- Chirapathomsakul D, Sastravaha P, Jansisyanont P. A review of odontogenic keratocysts and the behavior of recurrences. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2016;101(1):5-9. [Crossref] [PubMed]
- Carlson ER, Oreadi D, McCoy JM. Nevoid basal cell carcinoma syndrome and the keratocystic odontogenic tumor. J Oral Maxillofac Surg. 2015;73(12 Suppl):S77-86. [Crossref] [PubMed]
- Philipsen HP. Tumours of the oral cavity and oropharynx. In: Barnes L, Eveson JW, Reichart P, Sidransky D, eds. World Health Organization Classification of Tomours. Pathology and Genetic of Head and Neck Tumours. 3rd ed. Lyon, France: IARC; 2005. p.308-9.
- Titinchi F, Nortje CJ. Keratocystic odontogenic tumor: a recurrence analysis of clinical and radiographic parameters. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012;114(1):136-42. [Crossref] [PubMed]
- MacDonald D, Gu Y, Zhang L, Poh C. Can clinical and radiological features predict recurrence in solitary keratocystic odontogenic tumors? Oral Surg Oral Med Oral Pathol Oral Radiol. 2013;115(2):263-71. [Crossref] [PubMed]
- Finkelstein MW, Hellstein JW, Lake KS, Vincent SD. Keratocystic odontogenic tumor: a retrospective analysis of genetic, immunohistochemical and therapeutic features. Proposal of a multicenter clinical survey tool. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013;116(1):75-83. [Crossref] [PubMed]
- Cunha JF, Gomes CC, de Mesquita RA, Andrade Goulart EM, de Castro WH, Gomez RS. Clinicopathologic features associated with recurrence of the odontogenic keratocyst: a cohort retrospective analysis. Oral Surg Oral Med Oral Pathol Oral Radiol. 2016;121(6):629-35. [Crossref] [PubMed]
- Kuroyanagi N, Sakuma H, Miyabe S, Machida J, Kaetsu A, Yokoi M, et al. Prognostic factors for keratocystic odontogenic tumor (odontogenic keratocyst): analysis of clinico-pathologic and immunohistochemical findings in cysts treated by enucleation. J Oral Pathol Med. 2009;38(4):386-92. [Crossref] [PubMed]
- Li TJ, Browne RM, Matthews JB. Epithelial cell proliferation in odontogenic keratocysts: a comparative immunocytochemical study of Ki67 in simple, recurrent and basal cell naevus syndrome (BCNS)-associated lesions. J Oral Pathol Med. 1995;24(5):221-6. [Crossref] [PubMed]
- Soluk-Tekkeşin M, Wright JM. The World Health Organization Classification of Odontogenic Lesions: a summary of changes of the 2017 (4th) edition. Turk Patoloji Derg. 2018;34(1). doi:10.5146/tipath.2017.01410.
- Kahraman D, Gunhan O, Celasun B. A series of 240 odontogenic keratocysts: should we continue to use the terminology of 'keratocystic odontogenic tumour' for the solid variant of odontogenic keratocyst? J Craniomaxillofac Surg. 2018;46(6):942-6. [Crossref] [PubMed]
- Donoff RB, Harper E, Guralnick WC. Collagenolytic activity in keratocysts. J Oral Surg. 1972;30(12):879-84.
- Auluck A, Pai KM. Treatment of recurrent odontogenic keratocyst: a known but forgotten point. Br J Oral Maxillofac Surg. 2006;44(1):74-5. [Crossref] [PubMed]
- Andisheh-Tadbir A, Fakharian M. HSP70 expression in dentigerous cyst, odontogenic keratocyst, and ameloblastoma. Oral Maxillofac Surg. 2015;19(3):287-91. [Crossref] [PubMed]
- Sanchez-Siles M, Camacho-Alonso F, Lopez-Jornet P, Salazar-Sanchez N. Keratocystic odontogenic tumor. Case report and review of the literature. N Y State Dent J. 2013;79(2):44-7.
- August M, Faquin WC, Troulis MJ, Kaban LB. Dedifferentiation of odontogenic keratocyst epithelium after cyst decompression. J Oral Maxillofac Surg. 2003;61(6):678-83. [Crossref] [PubMed]
- Kolokythas A, Fernandes RP, Pazoki A, Ord RA. Odontogenic keratocyst: to decompress or not to decompress: a comparative study of decompression and enucleation versus resection/peripheral ostectomy. J Oral Maxillofac Surg. 2007;65(4):640-4. [Crossref] [PubMed]
- Myoung H, Hong SP, Hong SD, Lee J, Lim CY, Choung PH, et al. Odontogenic keratocyst: review of 256 cases for recurrence and clinicopathologic parameters. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001;91(3):328-33. [Crossref] [PubMed]
- Meara JG, Shah S, Li KK, Cunningham MJ. The odontogenic keratocyst: a 20-year clinicopathologic review. Laryngoscope.1998;108(2):280-3. [Crossref] [PubMed]
- Li TJ. The odontogenic keratocyst: a cyst, or a cystic neoplasm? J Dent Res. 2011;90(2):133-42. [Crossref] [PubMed]
- Marker P, Brøndum N, Clausen PP, Bastian HL. Treatment of large odontogenic keratocysts by decompression and later cystectomy: a long term follow-up and a histologic study of 23 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1996;82(2):122-31. [Crossref]
- Buckley PC, Seldin EB, Dodson TB, August M. Multilocularity as a radiographic marker of the keratocystic odontogenic tumor. J Oral Maxillofac Surg. 2012;70(2):320-4. [Crossref] [PubMed]
- Tabrizi R, Omidi M, Dehbozorgi M, Hekmat M. Correlation of radiographic features and treatments with the frequency of recurrence in odontogenic keratocysts of the mandible. J Craniofac Surg. 2014;25(5):e413-7. [Crossref] [PubMed]
- MacIntosh RB. The role of osseous resection in the management of odontogenic keratocysts symposium: the odontogenic keratocyst revisited. J Oral Maxillofac Surg. 2002;60(8): 14-6. [Crossref]
- Kinard BE, Chuang SK, August M, Dodson TB. How well do we manage the odontogenic keratocyst? J Oral Maxillofac Surg. 2013;71(8):1353-8. [Crossref] [PubMed]
- Kinard BE, Chuang SK, August M, Dodson TB. For treatment of odontogenic keratocysts, is enuclation, when compared to decompression, a less complex management protocol? J Oral Maxillofac Surg. 2015;73(4):641-8. [Crossref] [PubMed]
- Johnson NR, Batstone MD, Savage NW. Management and recurrence of keratocystic odontogenic tumor: a systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013;116(4):e271-6. [Crossref] [PubMed]
- Nakamura N, Mitsuyasu T, Mitsuyasu Y, Taketomi T, Higuchi Y, Ohishi M. Marsupialization for odontogenic keratocysts: long-term follow-up analysis of the effects and changes in growth characteristics. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002;94(5):543-53. [Crossref] [PubMed]
- Vedtofte P, Praetorius F. Recurrence of the odontogenic keratocyst in relation to clinical and histologic features. A 20 year follow-up study of 72 patients. Int J Oral Surg. 1979;8(6):412-20. [Crossref]
- Williams TP, Connor FA Jr. Surgical management of the odontogenic keratocyst: aggressive approach. J Oral Maxillofac Surg. 1994;52(9):964-6. [Crossref]
- Tabrizi R, Özkan BT, Dehgani A, Langner JN. Marsupialization as a treatment option for the odontogenic keratocyst. J Craniofac Surg. 2012;23(5):e459-61. [Crossref] [PubMed]
- Rangiani A, Motahhary P. Evaluation of bax and bcl-2 expression in odontogenic keratocysts and orthokeratinized odontogenic cysts: a comparison of two cysts. Oral Oncol. 2009;45(7):e41-4. [Crossref] [PubMed]
- Piattelli A, Fioroni M, Rubini C. Differentiation of odontogenic keratocysts from other odontogenic cysts by the expression of bcl-2 immunoreactivity. Oral Oncol. 1998;34(5):404-7. [Crossref]
- Siqua-Rodriquez EA, Goulart DR, Sverzut A, Asprino L, de Moraes M. Is surgical treatment based on a 1-Step or 2-Step protocol effective in managing the odontogenic keratocyst? J Oral Maxillofac Surg. 2019;77(6):1210.e1-1210.e7. [Crossref] [PubMed]
- Cottom HE, Bshena FI, Speight PM, Craig GT, Jones AV. Histopathological features that predict the recurrence of odontogenic keratocysts. J Oral Pathol Med. 2012;41(5):408-14. [Crossref] [PubMed]
- Chang N, Shyu V, Chen C. Maxillary reconstruction for a huge odontogenic keratocyst. J Craniofac Surg. 2011;22(3):1165-7. [Crossref] [PubMed]
- Sheethal HS, Rao K, H S U, Chauhan K. Odontogenic keratocyst arising in the maxillary sinus: a rare case report. J Oral Maxillofac Pathol. 2019;23(Suppl 1):74-7.
- Böke F, Arpak MN, Eroğlu HS. [Odontogenic keratocyst: 3 year follow-up: case report]. Turkiye Klinikleri J Dental Sci. 2012;18(2):214-8.
- Antonoglou GN, Sándor GK, Koidou VP, Papageorgiou SN. Non-syndromic and syndromic keratocystic odontogenic tumors: systemic review and meta-analysis of recurrences. J Craniomaxillofac Surg. 2014;42(7):e364-71. [Crossref] [PubMed]
- Hyun HK, Hong SD, Kim JW. Recurrent keratocystic odontogenic tumor in the mandible: a case report and literature review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;108(2):e7-10. [Crossref] [PubMed]
.: Process List