Gorlin-Goltz Syndrome - A Rare Case Entity in Young Child.

Gorlin-Goltz syndrome (GGS) is an infrequent multisystemic disease with an autosomal dominant trait, which depicted presence of numerous basal cell carcinoma in conjunction with multiorgan abnormalities. This syndrome may be diagnosed early by a dentist by routine radiographic exams in the first decade of life, since the keratocystic odontogenic tumour are usually one of the first manifestations of the syndrome. This article includes a case report of the GGS with regard to its history, incidence, etiology, features, investigations, diagnostic criteria, keratocystic odontogenic tumour and treatment modalities.

Laser-capture microdissection of murine lung for differential cellular RNA analysis.

The lung tissue contains a heterogeneous milieu of bronchioles, epithelial, airway smooth muscle (ASM), alveolar, and immune cell types. Healthy bronchiole comprises epithelial cells surrounded by ASM cells and helps in normal respiration. In contrast, airway remodeling, or plasticity, increases surrounding of bronchial epithelium during inflammation, especially in asthmatic condition. Given the profound functional difference between ASM, epithelial, and other cell types in the lung, it is imperative to separate and isolate different cell types of lungs for genomics, proteomics, and molecular analysis, which will improve the diagnostic and therapeutic approach to treat cell-specific lung disorders. Laser capture microdissection (LCM) is the technique generally used for the isolation of specific cell populations under direct visual inspection, which plays a crucial role to evaluate cell-specific effect in clinical and preclinical setup. However, maintenance of tissue RNA quality and integrity in LCM studies are very challenging tasks. It is obvious to believe that the major factor affecting the RNA quality is tissue-fixation method. The prime focus of this study was to address the RNA quality factors within the lung tissue using the different solvent system to fix tissue sample to obtain high-quality RNA. Paraformaldehyde and Carnoy's solutions were used for fixing the lung tissue and compared RNA integrity in LCM captured lung tissue samples. To further confirm the quality of RNA, we measured cellular marker genes in collected lung tissue samples from control and mixed allergen (MA)-induced asthmatic mouse model using qRT-PCR technique. RNA integrity number showed a significantly better quality of RNA in lung tissue samples fixed with Carnoy's solution compared to paraformaldehyde solution. Isolated RNA from MA-induced asthmatic murine lung epithelium, smooth muscle, and granulomatous foci using LCM showed a significant increase in remodeling gene expression compared to control which confirm the quality and integrity of isolated RNA. Overall, the study concludes tissue fixation solvent can alter the quality of RNA in the lung and the outcome of the results.

Carnoy's solution fixation with compression significantly increases the number of lymph nodes yielded from colorectal cancer specimens.

BACKGROUND AND OBJECTIVES: Carnoy's fixation and compression represents a novel technique to enhance lymph node evaluation and accuracy of staging after colorectal cancer resection. METHODS: This study was performed in all adults undergoing colorectal cancer operations by Kaiser Permanente surgeons at two separate facilities. Patients were assigned to either location based upon surgeon and patient availability. One group of patients had their lymph nodes examined with current standard manual technique (MT). The other group had their specimens fixed with Carnoy's solution and then compressed (CT) to assess for lymph nodes. RESULTS: A total of 157 patients were enrolled. Seventy-eight patient specimens underwent MT and 79 patient specimens underwent the new compression technique (CT). CT resulted in a significant increase in total lymph node yield per specimen (37.6 ± 18.5 nodes with CT vs 18.9 ± 8.8 nodes with MT; P < 0.0001). CT also resulted in sufficient lymph node sampling (>12 nodes) in all 79 patients in the group compared with 13 of 78 patients (17%) with an insufficient lymph node evaluation in the MT group ( P = 0.0002). CONCLUSION: This study demonstrated that Carnoy's fixation with compression can significantly increase lymph node yields in colorectal cancer specimens and allow for a higher rate of adequate lymph node sampling.

Basal cell nevus syndrome (Gorlin syndrome): genetic insights, diagnostic challenges, and unmet milestones.

In this article, we present three clinical case reports on Basal Cell Nevus Syndrome (Gorlin Syndrome). Gorlin syndrome is an inherited medical condition with challenges that manifest in multiple body systems and complicate early diagnosis. We examine the epidemiology of the disease and benefits of genetic testing, molecular pathophysiology, and advancement in the molecular-based therapy of Basal Cell Nevus syndrome. The goal of this paper is to shed light on both unmet challenges and advancements in the management of Gorlin syndrome and to provide a new clinical perspective and guidance for future research. Furthermore, the FDA approved Hedgehog pathway inhibitors Vismodegib and Sonidegib designed for advanced basal cell carcinoma have opened a new door for treatment that may ultimately decrease the number of surgeries for a patient with Gorlin syndrome. The role of these agents in syndromic odontogenic keratocyst has not been studied extensively, but one study found that hedgehog pathway inhibitors decrease the size of syndromic odontogenic keratocyst. Ideal surgical treatment that balances low recurrence rates with low impact on one's quality of life for syndromic odontogenic keratocyst is another unanswered question for oral and maxillofacial surgeons. Per survey studies, treatment options practiced for syndromic odontogenic keratocyst range from marsupialization to segmental osteotomy. Future studies performed should take a comprehensive long-term approach with at least three years of follow-up in order to determine the most appropriate treatment.

Carnoy's solution increases the number of examined lymph nodes following gastrectomy for adenocarcinoma: a randomized trial.

BACKGROUND: Pathological examination of a minimum of 16 lymph nodes is recommended following surgery for gastric adenocarcinoma, despite this a longer survival is expected when 30 or more lymph nodes are examined. Small lymph nodes are difficult to identify, and fat-clearing solutions have been proposed to improve this, but there is no evidence of their clinical benefit. METHODS: Fifty D2 subtotal gastrectomy specimens were randomized for fixation in Carnoy's solution (CS) or 10% neutral buffered formalin (NBF), with subsequent fat dissection. After dissection, the residual fat from the NBF group, instead of being discarded, was immersed in CS and dissected again. Data from 25 D2 subtotal gastrectomies performed before the study were also analyzed. RESULTS: The mean number of examined lymph nodes was 50.4 and 34.8 for CS and NBF, respectively (p < 0.001). Missing lymph nodes were found in all cases from the residual fat group (mean of 16.9), and in eight of them (32%) metastatic lymph nodes were present; this allowed the upstaging of two patients. Lymph nodes in the CS group were smaller than those in the NBF group (p = 0.01). The number of retrieved lymph nodes was similar among the NBF and Retrospective groups (p = 0.802). CONCLUSIONS: Compared with NBF, CS increases lymph node detection following gastrectomy and allows a more accurate pathological staging. No influence of the research protocol on the number of examined lymph nodes was observed.

Carnoy's solution is an adequate tissue fixative for routine surgical pathology, preserving cell morphology and molecular integrity.

AIMS: To compare Carnoy's solution (CS) and 10% neutral buffered formalin solution (NBF) as tissue fixatives in colorectal cancer specimens. METHODS AND RESULTS: Surgical specimens from patients with colorectal cancer were analysed. Three groups were studied, as follows: group 1 consisted of 16 paired samples fixed in CS and NBF; and groups 2 and 3 consisted of 14 prospective and 80 retrospective samples, respectively, both randomized for fixation in CS or NBF. Groups 1 and 2 were analysed for amount, quality and integrity of DNA. Morphological analysis, including some of the usual special stains and polymerase chain reaction (PCR), were also performed for group 1, and Sanger sequencing for group 2. Immunohistochemical (IHC) reactions for mismatch repair proteins were studied in groups 1 and 3. Fixative performances were similar for morphology, special stains, and IHC reactions, as well as for the amount, quality and integrity of extracted DNA. PCR amplification was not possible in two cases from CS group 1. Sanger sequencing gave conclusive results for the CS samples tested. CONCLUSIONS: Carnoy's solution and NBF are equivalent fixatives for colorectal cancer specimens and are adequate for routine utilization in surgical and molecular pathology.

Keratocystic Odontogenic Tumour with Extraosseal Spread: Evaluation of the Effect Carnoy's Solution.

Keratocystic odontogenic tumour is relatively rare benign tumour. It is characterized by its fast aggressive growth and high risk of recurrence. Treatment is always surgical: conservative (enucleation, marsupialization) or aggressive (enucleation followed by application of Carnoy's solution, cryotherapy; peripheral ostectomy or en block resection of the jaw). Authors analysed retrospectively 22 patients who fulfilled inclusion criteria, i.e. had odontogenic keratocystic tumour of mandible, wherein antero-posterior dimension was at least 30 mm, and the tumour penetrated into the surrounding soft tissues. All patients underwent tumour enucleation, in 11 patients Carnoy's solution was given into the bone cavity after enucleation. The recurrence rate in the evaluation at least 36 months after surgery was both patient groups the same: 45.4%.

Assessing Conservative Treatment Options for Odontogenic Keratocyst in a 12-Year-Old Patient, with 1-Year Follow-up.

The odontogenic keratocyst (OKC) is a frequently developing odontogenic cyst that accounts for 10%-14% of all jaw cysts. Due to the high recurrence rate, aggressive therapeutic techniques such as jaw resection and marsupialization are indicated. Following a conservative marsupialization procedure in which Carnoy's solution and an iodoform packing were used, the clinical, radiological, and histological evaluation of OKC in a 12-year-old female patient revealed no evidence of recurrence over the subsequent year of follow-up.

Unicystic ameloblastoma: Clinico-radiological and histopathological correlation with management.

Unicystic ameloblastoma is a distinct entity of ameloblastoma characterized by slow growth and locally aggressive behavior. This retrospective study aimed to assess the efficacy of different treatment modalities of unicystic ameloblastoma, focusing on clinico-radiological and histopathological features. Data from patients diagnosed with unicystic ameloblastoma were retrospectively analyzed. Patients were categorized into luminal and intraluminal (Group A) and mural (Group B) variants based on the Ackermann classification, which has a significant influence on their biological behavior, treatment approaches, and prognosis. Patients in Group A underwent enucleation with chemical cauterization, peripheral ostectomy, and iodoform packing, whereas those in Group B were treated with resection and reconstruction. Post-operatively, the patients were subjected to radiographic assessments via digital orthopantomogram at regular intervals. Because of the rarity of unicystic ameloblastoma, only 17 patients were included in the study (Group A: 9 patients; Group B: 8 patients), with a mean follow-up of 4.9 years (range: 1.4-11.8 years). The primary outcome measure was the absence of recurrence, which indicated treatment success. No patient in either group experienced recurrence within the follow-up period. This study provides evidence supporting the successful treatment of luminal and intraluminal variants of unicystic ameloblastoma in young individuals using a conservative approach. However, the more aggressive mural variant demonstrated favorable outcomes with radical treatment. These findings emphasize the importance of the Ackermann classification in guiding treatment decisions for unicystic ameloblastoma and contribute valuable insights into optimizing therapeutic strategies based on clinico-radiological and histopathological findings.

Comparative evaluation of the effect of three types of fixatives (formalin, Bouin and Carnoy) on histomorphological features of various viscera.

Tissue shrinkage is one of the problems in preparing tissue sections. This study compares the use of 10% formalin, Bouin and Carnoy as fixatives on several mouse tissues to determine histomorphological features. In this experimental study, liver, kidney, heart, lung, testicle, spleen, brain and cartilage tissues were isolated from five BALB/c mice. Then, they were fixed with three types of fixatives. After dehydrating, clarifying and embedding, all samples were stained with haematoxylin and eosin. Then, the tissue structure of the viscera was evaluated qualitatively. The results showed that each fixative is more suitable for evaluating a specific part of the tissue. However, relative shrinkage appeared in the tissue sections fixed with 10% Formalin, (1) in the heart as spaces between muscle fibre bundles, (2) in the liver as the dilation of the liver sinusoidal spaces, (3) in the kidney tissue as the expansion of the lumens of the convoluted proximal and distal tubules, (4) in the spleen as open spaces inside the red and white pulps and (5) in the brain as an increase in the space between the cells of the granular and pyramidal cell layers of the cortex. In tissues that were soft and fragile, such as testis, liver and brain, Bouin's fixative was more suitable. Carnoy's fixative was more suitable for the spleen and kidney tissue. Based on the study results, formalin and Bouin were more suitable for heart and cartilage tissue. Considering that in the histopathological evaluation both the cytoplasm and the nucleus are evaluated, it is suggested to choose the fixative suitable for the type of tissue.

The Role of 5-Fluorouracil in Preventing Recurrence After Enucleation of Odontogenic Keratocyst: A Case Report.

The odontogenic keratocyst (OKC) is known for its high recurrence rate and disputed treatment modalities. In this report, we review the literature elucidating the efficacy of 5-fluorouracil (5-FU) topical application for recurrent OKC, and discuss the management of an OKC with 5-FU after enucleation and a 12-month follow-up. A 38-year-old female patient with an aggressive OKC in the right mandible underwent surgical curettage followed by topical application of 5-FU. Regular follow-up examinations for 12 months (radiological evaluation at three, six, and 12-month intervals) showed no signs of recurrence, with complete resolution of the cystic lesion and gradual bone regeneration. New bone formation was identified in the radiographic follow-up.  This case demonstrates the potential efficacy of topical 5-FU as a promising treatment modality for OKC, warranting further research and validation. A novel and successful therapy for OKC is the topical application of 5-FU. After enucleation, topical application of 5-FU efficiently treats OKC, leading to normal bone healing and regeneration without any adverse local or systemic effects.

Is modified Carnoy's solution as effective as Carnoy's solution in terms of amount of bone necrosis and depth of penetration?

Carnoy's solution, a chemical cauterisation agent, has been indicated as one of the adjuvant treatment modalities for odontogenic keratocyst. In 2000, after the ban of chloroform many surgeons adopted the use of Modified Carnoy's solution. The purpose of this study is to compare the depth of penetration and amount of bone necrosis of Carnoy's versus Modified Carnoy's solution on the mandible of Wistar rats at different time intervals. Twenty-six male Wistar rats of six to eight weeks old, weighing approximately 150-200 grams, were allocated for this study. The predictor variables were type of solution and application time. The outcome variable was depth of penetration and amount of bone necrosis. Carnoy's solution was applied on the defect on the right side of the mandible and Modified Carnoy's solution on the left side for five minutes on eight rats, eight minutes on eight rats, and 10 minutes on eight rats. All specimens were subjected to histomorphometric analysis done using Mia image AR software. Univariate ANOVA test, and paired sample t test was done to compare the results. The depth of penetration for Carnoy's solution was more than Modified Carnoy's solution in the three different exposure times. Statistically significant results were observed at five minutes and eight minutes. The amount of bone necrosis was more in Modified Carnoy's solution. The results were not statistically significant at the three different exposure times. To conclude, when one wants to use Modified Carnoy's solution, the minimum exposure time should be 10 minutes to achieve similar results as those of Carnoy's solution.

Modified Carnoy's Versus Carnoy's Solution in the Management of Odontogenic Keratocysts-A Single Center Experience.

To date, few studies have been conducted to test the effectiveness of Carnoy's (CS) versus modified Carnoy's (MC) solution for preventing the recurrence of odontogenic keratocysts, which are potentially aggressive lesions. To evaluate the efficacy of MC application, we conducted a retrospective cohort study over an 18-year period, from October 2004 to October 2022, in 122 patients treated surgically with adjunctive chemical cautery, with either CS (n = 73; median age: 30 years) or MC (n = 49; median age: 42 years), by a single surgeon. The primary outcome variables were observed recurrence and interval to recurrence. Independent variables were demographics, location, clinical presentation at baseline, adjacent tooth extraction, and bone grafting. Males predominated in both groups. No statistically significant differences were observed between the two arms in terms of recurrences in particular months, with six patients (8.2%) in the CS arm and 5 (10.2%) in the MC arm. Of the 11 recurrences, 10 were observed within the first 2 years post-surgery, with only one occurring in the 7th year of follow-up. Thus, when used as adjunctive therapy, the application of MC has an efficiency comparable to that of CS for lowering the recurrence rate of odontogenic keratocysts.

The Role of Adjunctive Chemical Solutions in the Treatment of Odontogenic Keratocysts: A Scoping Review.

Odontogenic keratocysts (OKC) are aggressive cysts with a high recurrence potential. Treating them with surgical enucleation procedures alone is associated with high recurrence rates; therefore, additional or supportive treatment approaches, such as peripheral osteotomy, cryotherapy, and chemical solutions, are warranted. The objective of the present review was to evaluate the existing literature on the efficacy of chemical approaches, such as Carnoy's solution (CS), in preventing recurrence after the enucleation of OKC. An electronic search was conducted on PubMed, Scopus, and Google Scholar databases to find articles published from January 2010 to December 2022 by using the Medical Subject Headings (MeSH) terms "Odontogenic Keratocyst" "Carnoy's Solution," "Treatment," and "Enucleation." Articles published in the English language were selected for the study. The PICOS criteria (population: patients with non-syndromic OKC with histopathological diagnosis and a minimum follow-up of six months; intervention and comparison: enucleation followed by adjunctive chemical therapy and standard procedure; outcome: recurrence rates; study design: retrospective and prospective studies, randomized controlled trials, and case series involving at least 10 cases of OKC) were employed. Studies involving syndromic (nevoid basal cell carcinoma) cases were excluded from the search. Seventeen studies fulfilled the inclusion criteria and the majority of them were retrospective studies, with a few case series. OKC was found more frequently in the mandible, with a recurrence rate of 11%, when treated with CS following enucleation after four years of follow-up. Modified Carnoy's solution (MC) was used in two studies. The mean follow-up period was 44 months. Based on our findings, adjuvant therapy using a chemical approach following enucleation is a more effective and beneficial modality for the treatment of OKC.

Unicystic Ameloblastoma Associated with Primary Mandibular Second Molar: A Case Report.

Background: Unicystic ameloblastoma is a rare, benign, locally invasive odontogenic neoplasm of young age that shows clinical, radiographic, or gross features of an odontogenic cyst but histologically shows typical ameloblastomatous epithelium lining part of the cyst cavity, with or without luminal and/or mural tumor growth. Aim: To report a case of an asymptomatic unicystic ameloblastoma in a 12-year-old child, along with its management and follow-up. Case description: A 12-year-old boy presented with swelling with respect to the left body of the mandible. The orthopantomogram (OPG) and computed tomography scan revealed a large unilocular radiolucency in the left mandible associated with the primary second mandibular molar. Complete enucleation of the cyst and extraction of the associated primary teeth and underlying permanent teeth were done under general anesthesia. Carnoy's solution was applied in the bone cavity for 3 minutes with cotton applicators. Postoperative healing was uneventful. Prosthetic rehabilitation was done during the follow-up period. Conclusion: Unicystic ameloblastoma is rarely seen in younger children, so a pediatric dentist must be cautious while diagnosing an intraoral swelling. Timely intervention and conservative surgical treatment, along with a proper follow-up, improved the treatment outcome and prevented potential complications in the future. Clinical significance: This report highlights the salient features of unicystic ameloblastoma to be able to accurately diagnose and manage the lesion. How to cite this article: Peter J, Emmatty TB, Jose B, et al. Unicystic Ameloblastoma Associated with Primary Mandibular Second Molar: A Case Report. Int J Clin Pediatr Dent 2023;16(S-3):S335-S338.

Massive Infected Dentigerous Cyst in a Young Child.

Dentigerous cysts are odontogenic cysts that form on the crown of an unerupted or partially erupted tooth. They are specifically anchored to the cementoenamel junction. Dentigerous cysts are known to rarely involve impacted deciduous teeth. Because of this rarity, this article reports a unique case of a five-year-old female patient who developed a dentigerous cyst in relation to a developing permanent left mandibular first molar tooth with its surgical treatment and histopathological features.

Volumetric changes in the size of odontogenic keratocysts after decompression followed by enucleation, peripheral ostectomy, and Carnoy's solution: A retrospective study.

The study aimed to retrospectively analyze the reduction pattern of odontogenic keratocysts (OKCs) after decompression, followed by enucleation (EN), peripheral ostectomy (PO), and Carnoy's solution (CS) to establish the appropriate time for inserting implants, along with assessing the long-term success of conservative treatment with adjunctive therapy. The predictable variables were the reduction pattern and the study's treatment option. The outcome variable was the volumetric changes in the size of bony defects. These changes were determined using a percentage difference and a reduction rate. They were recorded after decompression and one, three, six, twelve, and eighteen months after EN. P-values of .05 were considered significant. The study included 66 patients with 71 OKCs. Males, younger ages, and mandibular OKCs significantly predominated. The decompression significantly changed the initial volume from 135.40 ± 1.2 cm3 to 101.55 ± 0.1 cm3 with 28.6 percentage difference and 25% reduction rate. At the end of the first and third months after EN, the reduction pattern is 50.0%-75.5% of the initial volume, with no significant prediction for the direction of the reduction pattern. After 18 months, all bony defects disappeared, with no recurrences for the next 18 years. In conclusion, the reduction pattern is 75.5% of its initial volume at the end of the third month after OKC management. Therefore, within the limitations of the study, its treatment approach seems to be an option amongst other protocols that includes a view to early implant based dental rehabilitation.

An Unusual Case of Maxillary Sinus Odontogenic Keratocyst: An Insightful Report With Review of the Literature.

Maxillary sinus odontogenic keratocyst (OKC) is very rare and occupies less than 1% of the total OKC cases reported in the literature. OKCs have characteristic features that are unique compared to other cysts of the maxillofacial region. Considering their peculiar behaviour, varied origin, debated development, discourse treatment modalities, and high recurrence rate, OKCs have been a subject of interest for various oral surgeons and pathologists globally. This case report presents an unusual case of invasive maxillary sinus OKC into the orbital floor, pterygoid plates, and hard palate in a 30-year-old female. The case report confers that cystic maxillary sinus lesions should always be treated very extensively irrespective of the nature of the lesion as the site makes it highly susceptible to secondary infection and recurrence. The case also establishes a set of imaging modalities and specific treatment approaches to be followed for maxillary sinus OKC based on the literature of all the previous cases reported.

Effectiveness of different treatments for odontogenic keratocyst: a network meta-analysis.

Odontogenic keratocysts (OKC) are benign but aggressive lesions. As there is a lack of well randomized clinical studies assessing the effectiveness of the different treatment options for OKC, a network meta-analysis (NMA) was performed to identify the best treatment option with the lowest recurrence rate. An electronic search was performed following the PRISMA guidelines to identify all clinical studies comparing treatment options against enucleation alone. The outcome variable was recurrence. The predictor variables were treatments. The eight included treatments were: enucleation with peripheral ostectomy/curettage (E + PO/curettage); enucleation with cryotherapy (E + CRYO); enucleation with/without PO followed by modified Carnoy's solution (E ± PO+MCS); enucleation with PO and with topical 5-fluorouracil (E + PO+5FU); enucleation with/without PO followed by original Carnoy's solution (E ± PO+CS); marsupialization alone (MARS); marsupialization followed by secondary enucleation with/without PO (MARS+2°E ± PO); and resection. The odds ratio was used to estimate the recurrence rate. A frequentist NMA was performed using Stata software. A total of 2989 patients in 40 studies were included. Both direct pairwise meta-analysis and NMA showed that E + 5FU+PO was significantly superior to E ± PO+MCS. However, no statistically significant difference was found between E ± PO+CS vs E + 5FU+PO, E ± PO+MCS, and resection, respectively (all very low quality evidence). The three most effective treatments in reducing the recurrence rate were E + PO+ 5FU (98.1%; very low quality evidence), resection (83.5%; very low quality evidence), and E ± PO+CS (63.8%; moderate quality evidence). The findings from this study suggest that CS remains the most effective fixative agent after enucleation and PO until proven otherwise. Additionally, 5FU appears to be an effective method with promising results that needs further research. Finally, the efficacy of MCS remains controversial; further in vivo and in vitro studies are required to determine new protocols. As this NMA included retrospective studies, the results should be interpreted with great caution (level of evidence: type III).

Fourteen-year study of the management of the odontogenic keratocyst. Are adjunctive therapies all they are cut out to be?

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.