Endoscope-Assisted Enucleation of Mandibular Odontogenic Keratocyst Tumors.

The keratocyst odontogenic tumor (KCOT) represents a rare and benign but locally aggressive developmental cystic lesion usually affecting the posterior aspect of the mandible bone, the treatment of which has always been raising debate, since Philipsen first described it as a distinct pathological entity in 1956.Recent studies have proposed the use of endoscope-assisted surgical technique, due to the possibility given by the endoscope of improving the effectiveness of the treatment of these lesions thanks to a better visualization of operative field and though a better understanding of the pathology. In this article, we would like to present our experience with the endoscope-assisted treatment of KCOT of the posterior region of the mandible.From April 2000 to April 2012, 32 patients treated for KCOT were enrolled in our retrospective study: patients were divided in 2 groups according to the type of treatment, that is, 18 were treated with traditional enucleation surgery (TES), and 14 patients underwent endoscopic assisted enucleation surgery (EES).Fischer exact test and Kaplan-Meier curves were used to compare the outcomes between the 2 focusing on the recurrence and complication rates. In the TES group, patients we found a higher recurrence rate (39%) and higher postoperative complication rate at 5-year follow-up.Our data suggested, though, that EES seems to be a feasible alternative for the treatment of posterior mandibular KCOT. Further studies and larger series are needed to confirm these results.

Recurrence rate of keratocystic odontogenic tumor after conservative surgical treatment without adjunctive therapies - A 35-year single institution experience.

The recurrence rate in conservative surgical treatment, without adjunctive treatment, of the keratocystic odontogenic tumor (KCOT) has been studied. A total number of 68 patients, previously untreated and fulfilling the histopathological criteria provided by the 2005 WHO classification, has been retrospectively reviewed. The study period lasted from 1975 to 2009. Treatment consisted of enucleation (n=58) or marsupialization (n=10). The mean follow-up period was 65 months. No involved or adjacent teeth were removed, except for wisdom teeth, if applicable, and badly decayed teeth. After enucleation, the recurrence rate was 20.7% in a mean follow-up period of 46 months, while 40% of the marsupialized KCOTs recurred in a mean follow-up period of 58 months. In none of the patients permanent loss of nerve function has been observed. Due to the recurrence rate observed in the present study, and in view of the potential benefit of adjunctive treatment in KCOT, particularly with regard to the use of Carnoy's solution, there is a need for prospective studies to test its usefulness with regard to the risk of recurrences.