Motaleb L, Zakai D, Stocker J
Department of Oral and Maxillofacial Surgery, University Hospital Coventry, Clifford Bridge Road, Coventry, UK.
Br J Oral Maxillofac Surg. 2022 Feb;60(2):105-112. doi: 10.1016/j.bjoms.2021.01.021. Epub 2021 Apr 1.
Odontogenic keratocysts (OKC) are benign, developmental, locally-aggressive odontogenic cystic lesions with a high risk of recurrence. As such, the most effective treatment modalities remain controversial. The mainstay of treatment remains enucleation with or without decompression. The use of adjunctive therapies is widely reported. Our aim was to review our experience of OKCs and therefore identify the treatment modality, if there is any single one, with the lowest rate of recurrence. We also aimed to identify any common themes linking those patients experiencing cystic recurrence. Data were collected on 50 patients treated at UHCW NHS Trust over a 14-year period (2005-2018) via an anonymised database. Surgical pathways were analysed, including details of the location of the cysts and the use of adjunctive therapies, namely; mechanical debridement, cryotherapy, and the use of Carnoy's solution. Fifty-six keratocysts, both primary (91%, n = 51) and recurrent (9%, n = 5) were included. A total of 6% of patients had a pre-existing diagnosis of Gorlin-Goltz Syndrome (n = 3). Enucleation was performed in an approximately 3:1 ratio to decompression with secondary enucleation (n = 41:15). Twenty-seven percent of patients had adjunctive therapies (n = 15). There was a 12% recurrence rate (n = 6) found only within the group of primary cysts that had been enucleated only. Notably, there were no recurrences in those cysts that had undergone adjunctive therapy. None of the cysts that underwent initial decompression or marsupialisation recurred. Following surgical intervention, no tertiary recurrent cysts were detected postoperatively. This study demonstrated the advantage of establishing a correct diagnosis prior to definitive treatment. Initial decompression in selected patients followed by enucleation, along with adjunctive therapies showed a benefit in reducing recurrences. However, in the absence of high-quality evidence for the most effective management of odontogenic keratocysts, finding a common approach will remain controversial.
牙源性角化囊肿（OKC）是一种良性、发育性、具有局部侵袭性的牙源性囊性病变，复发风险较高。因此，最有效的治疗方式仍存在争议。治疗的主要方法仍然是摘除囊肿，可伴有或不伴有减压。辅助治疗的应用已有广泛报道。我们的目的是回顾我们治疗OKC的经验，从而确定复发率最低的治疗方式（如果存在单一的治疗方式）。我们还旨在确定那些囊肿复发患者之间的任何共同特征。通过一个匿名数据库收集了在14年期间（2005 - 2018年）于UHCW国民保健服务信托基金接受治疗的50例患者的数据。分析了手术路径，包括囊肿位置的详细信息以及辅助治疗的使用情况，即机械清创、冷冻疗法和使用卡诺氏溶液。纳入了56个角化囊肿，包括原发性囊肿（91%，n = 51）和复发性囊肿（9%，n = 5）。共有6%的患者既往诊断为戈林 - 戈茨综合征（n = 3）。摘除囊肿与减压加二次摘除囊肿的比例约为3:1（n = 41:15）。27%的患者接受了辅助治疗（n = 15）。仅在单纯接受囊肿摘除的原发性囊肿组中发现有12%的复发率（n = 6）。值得注意的是，接受辅助治疗的囊肿无一复发。接受初始减压或袋形缝合术的囊肿均未复发。手术干预后，术后未检测到三级复发性囊肿。这项研究证明了在进行确定性治疗之前建立正确诊断的优势。对选定患者先进行初始减压，然后摘除囊肿，同时辅以辅助治疗，显示出在降低复发率方面的益处。然而，由于缺乏关于牙源性角化囊肿最有效管理的高质量证据，找到一种通用方法仍存在争议。
