Fifteen-Year Study on the Management of Odontogenic Keratocyst - What Works Best?

Abstract

Introduction: Odontogenic keratocysts (OKCs) are benign developmental cysts, typically originating from dental lamina, characterised by a locally aggressive nature and a high recurrence rate. On rare occasions, malignant transformation has been reported. Owing to its behavioural complexities, optimal management strategies for OKCs remain widely debated. This study evaluates the management approaches for OKCs over a 15-year period, identifying the most effective treatment modalities. Method(s): A retrospective analysis was conducted on 117 benign jaw cysts treated over 15 years at an inner-city London District General Hospital. The surgical pathways of 14 patients with OKC were evaluated, including details of the cyst, procedure type and the use of adjunctive therapies, namely; mechanical debridement, cryotherapy, and the use of Carnoy's solution. Result(s): Of the OKCs, 57% were unilocular and 43% multilocular; 86% were mandibular and 14% maxillary. Decompression without stent resulted in the lowest percentage (15%) size reduction, while decompression with stent achieved 32%. Enucleation provided the highest average reduction overall at 44%, with unilocular cases achieving 59% reduction after the initial enucleation procedure. Multilocular cases treated without stents reduced by 12%, whereas those with stents saw a 32% reduction. All OKCs required an additional procedure following first stage management. Conclusion(s): This review indicates that enucleation yielded the most significant reduction in lesion size, while decompression with stenting proved more effective than decompression alone. The findings highlight the need for further studies with high-quality evidence to establish the most effective management approach for OKCs.Copyright © 2025