Surgical Mini-Lectures and Clinics
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Friday, October 1, 2010
1:00PM - 3:00PM
S321
Odontogenic Keratocyst: Surgical Treatment Algorithm
Handouts Not
Currently Available
Len Tolstunov, DDS, DMD
OMFS, UOP Dental School
San Francisco, CA
Synopsis
Odontogenic keratocyst (OKC) has been one of the most controversial pathological entities in the maxillofacial region since it was first described by Philipsen in 1956.OKC is a distinctive pathological cystic lesion of the jaws that occurs more often in the mandible than in the maxilla with predilection for male gender and the posterior mandible (body, ramus), as well as prevalence at age 20 to 40. Various surgical techniques have been proposed for treating OKCs. These range from the more conservative procedures (eg, marsupialization, enucleation) to more aggressive approaches (eg, en bloc resection). Although marsupialization approach has been used for many years, only recently has it become a commonly accepted treatment modality for some pathological cystic lesions of the jaws. Factors limiting the more widespread use of this technique include the prolonged time it takes to eradicate the lesion as well as the possibility of cyst recurrence (average, 25% to 50%). Common indications for marsupialization of OKCs include a large cyst size, significant collateral hard and soft tissue trauma associated with the enucleation surgery, difficulty of surgical access, others. Bases on the literature reports and clinical experience, the author proposes an algorithm for surgically treating OKC. This algorithm gives indications for the 3 main (marsupialization, enucleation, and resection) and 3 adjunctive (cryotherapy, Carnoy's solution, and peripheral ostectomy) surgical techniques commonly used to treat OKC. A logical "decision tree" approach is emphasized. This algorithm is intended to guide an oral and maxillofacial surgeon in choosing the optimum treatment to eradicate the lesion with the lowest recurrence rate and lowest morbidity. If the chosen treatment approach proves unsuccessful, then the algorithm provides a logical decision tree for selecting the next best surgical option. The 2.0 hr presentation will be supported by a case report of combined treatment of OKC and mandibular defect with marsupialization, enucleation, iliac bone graft, and dental implants.
Learning Objectives
At the conclusion of this presentation, participants should be able to:
- Identify the position and classification of this lesion;
- Identify the algorythm of treatment to get tid off the lesion; and
- Identify the combined treatment of odontogenic keratocyst and mandibular defect with marsupialization, enucleation, iliac bone graft, and dental implants is described in a logical manner (case report- an example to how to treat these lesions).