A review of odontogenic keratocysts and the behavior of recurrences

doi:10.1016/j.tripleo.2005.03.023

Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology

Volume 101, Issue 1, January 2006, Pages 5-9

https://doi.org/10.1016/j.tripleo.2005.03.023 Get rights and content

Objective

The purpose of this study is to report experiences of odontogenic keratocysts (OKCs) and analyze information regarding recurrences to better understand the nature of recurrences.

Study design

Fifty-one cases of OKC treated at the Faculty of Dentistry, Chulalongkorn University, from 1988 to 2003 were studied retrospectively. Clinicoradiographic features, histologic features, and methods of treatment were reviewed. Recurrences were analyzed and compared with respect to sites of involvement, relationship to the remaining teeth, and methods of treatment.

Results

OKCs occurred predominantly in the 11- to 40-year-old age group. The body-angle-ramus area of mandible was the most common site of occurrence. Radiographically, the unilocular to multilocular radiolucency ratio was 2.5:1. Multilocular lesions occurred more frequently in the mandible (P < .05). Most of the lesions were diagnosed histologically as parakeratinized OKC (93.7%). The patients were followed from 1-14.6 years. However, 20 patients were lost to follow-up after a short period of time, and recurrences were found in 7 out of 31 cases (22.6%). The recurrent tumors occurred more frequently in patients who had an OKC associated with the remaining teeth and were treated by enucleation or enucleation with adjuvant therapy.

Conclusions

According to a high recurrent rate of OKCs treated by enucleation, clinicians should give more attention to the dentate area if the enucleation is chosen as the treatment of choice.

Section snippets

Materials and methods

Fifty-one cases of OKC treated in the Faculty of Dentistry, Chulalongkorn University, from 1988 to 2003 were studied retrospectively. There were a total of 67 lesions in 51 patients, of which multiple lesions were present in 6 patients. Clinicoradiographic information including age and sex of patients, site of involvement, clinical manifestation, radiographic features, histologic features, treatment modalities, and recurrence were reviewed and compared to other studies. Recurrences were

Results

This series consisted of 67 lesions in 23 (45.1%) male patients and 28 (54.9%) in female patients. Male to female ratio was 1:1.2. The average age at the time of presentation was 36.9 years with a range from 9 to 65 years. Most of the cases were found in the second to fourth decades (33 out of 51; 64.7%), and only 1 patient was younger than 10 years old (Fig. 1). The duration of symptoms varied from 1 month to 6 years, and a majority of patients had a duration of symptoms of less than 3 months

Discussion

The age distribution in this study was quite similar to those of most other studies,13, 25, 29, 30 with a peak incidence between 11 and 40 years of age and rare occurrence in individuals older than age of 70. OKCs were reported as having a male predilection in most other studies, but in our study the lesions were more commonly found in females than males.3, 10, 14, 22, 25, 26, 29, 30, 31

The presenting symptoms were chiefly swelling and combined symptoms such as pain, infection, or both, which

Summary

The results of our study are similar to previous studies of OKCs. We found that OKCs occurred predominantly in the second to fourth decade. There was a fairly equal sex distribution although some studies showed a male predilection. It occurred twice as frequently in the mandible than maxilla, with the posterior region the most common location. A unilocular radiographic pattern predominated.

All types of treatment, except marginal resection, gave rise to recurrence in this study. The recurrent