Bushabu Fidele N, Titinchi Fadi, Bing Liu, Davda Latha
Department of Oral and Maxilla-Facial Surgery, Oral Maxillofacial Head and Neck Oncology Service, Faculty of Dental Medicine, University of Kinshasa, Kinshasa, The Democratic Republic of the Congo, Head and Director of the National Center Laboratory of Oral Biomedicine, Ministry of Research Innovation and Technology, Democratic Republic of the Congo.
Department of Maxillo-Facial and Oral Surgery, Faculty of Dentistry and WHO Collaborating Centre, University of the Western Cape, Cape Town, South Africa.
Natl J Maxillofac Surg. 2023 May-Aug;14(2):177-184. doi: 10.4103/njms.njms_90_22. Epub 2023 Jul 13.
The aim of this study was to identify clinico pathological indications for radical resection of odontogenic keratocysts (OKCs) in the literature and formulate clinical guidelines for the management of OKCs based on these findings. A systematic review of the literature was undertaken in September 2021 in PubMed/Medline, Scopus, Web of Science, Google Scholar, and Cochrane databases. The following MeSH Keywords terms were used in the search strategies: (odontogenic keratocyst) OR (keratocystic odontogenic tumor) OR (primordial cyst) AND (treatment) OR (Radical resection) OR (Resection of OKC) OR (Treatment methods). Eligibility criteria included publications of clinical studies on histologically confirmed OKCs which underwent radical resection. Studies with less than 5 OKCs, experimental studies, epidemiological studies, studies that included orthokeratinized odontogenic cyst, and review papers were excluded. Ten studies on OKCs reporting on segmental or marginal resections were identified and analyzed qualitatively. Of the total of 221 OKCs that underwent radical resection, 67 OKCs were primary, 30 were recurrent, and the remaining were unclear whether they were primary or recurrent. Segmental mandibulectomy was performed in 131 OKCs, marginal mandibulectomy in 87 OKCs, and 3 OKCs were treated by partial maxillectomy. The main indications for radical resection were multilocular appearance, large OKCs (> 5 cm), multiple recurrent OKCs with or without cortical perforation, and malignant transformation. In conclusion, radical resection has its place in the management of OKC. It is indicated when there is an aggressive lesion with bony perforation, involvement of the pterygoid musculature or skull base, and malignant transformation. The surgeon should aim to identify these features to manage OKC appropriately and to prevent multiple recurrences. Clinical guidelines for the management of OKCs are proposed.
本研究的目的是在文献中确定牙源性角化囊肿（OKCs）根治性切除的临床病理指征，并基于这些发现制定OKCs的临床管理指南。2021年9月在PubMed/Medline、Scopus、Web of Science、谷歌学术和Cochrane数据库中对文献进行了系统回顾。搜索策略中使用了以下医学主题词（MeSH）：（牙源性角化囊肿）或（角化囊性牙源性肿瘤）或（始基囊肿）与（治疗）或（根治性切除）或（OKC切除）或（治疗方法）。纳入标准包括组织学确诊的OKCs接受根治性切除的临床研究出版物。少于5例OKCs的研究、实验研究、流行病学研究、包括正角化型牙源性囊肿的研究以及综述文章均被排除。确定了10项关于OKCs节段性或边缘性切除的研究并进行了定性分析。在总共221例接受根治性切除的OKCs中，67例为原发性，30例为复发性，其余病例原发性或复发性情况不明。131例OKCs行节段性下颌骨切除术，87例OKCs行边缘性下颌骨切除术，3例OKCs行部分上颌骨切除术。根治性切除的主要指征为多房性表现、大型OKCs（>5 cm）、有或无皮质穿孔的多发性复发性OKCs以及恶变。总之，根治性切除在OKC的管理中有其地位。当存在侵袭性病变伴骨质穿孔、翼状肌组织或颅底受累以及恶变时适用。外科医生应旨在识别这些特征以适当管理OKC并防止多次复发。提出了OKCs的临床管理指南。
