[Odontogenic kertocysts. Review of a series of cases and long-term clinical control]

The aim of this retrospective study was to identify and evaluate the clinical characteristics and incidence of recidivation in a series of 40 cases of keratocyst consisting of 31 primary lesions, 7 cases of primary recidivation (17.5%) and 2 cases of secondary recidivation (5%). All the lesions were large sized and were treated using surgery. All patients underwent an annual clinical control for a minimum follow-up of seven years.

The authors present a series of 40 odontogenic keratocysts treated between 1985 and 1996 by the Division of Maxillofacial Surgery at Turin University. The series consisted of 40 keratocysts including 31 primary lesions, 7 cases of primary recidivation (17.5%) and 2 cases of secondary recidivation (5%); 12 patients were female (38.7%) and 19 were male (61.3%). The mean age of patients was 42 years old. The clinical records and enclosed X-ray documentation (OPT X-ray, head X-ray, face X-ray) were examined for each patient, together with histological findings. Each case then underwent an annual follow-up.

The review of clinical data and the examination of X-ray documentation showed that 28 lesions developed in the mandible and only 3 cases in the upper jaw. From a therapeutic point of view, keratocysts localised in a mandibular site were managed using cystectomy in 19 cases and in 18 cases this was followed by marsupialisation. Caldwell-Luc's operation was used in 2 cases of intrasinusal maxillary development, whereas the single case of extrasinusal development underwent cystectomy. Recidivation always involved the mandible and occurred in 22% of cases within 5 years of surgery. Of the 19 cases undergoing simple cystectomy, 8 cases (42%) revealed recidivation. Only one (5.5%) of 18 cases treated using cystectomy and marsupialisation showed recurrence.

On the basis of their experience and in view of the specific characteristics of keratocysts, in particular the tendency to undergo recidivation, the authors affirm that annual clinical and radiological controls are indispensable and important, including biopsy where necessary, in order to diagnose new lesions promptly irrespective of the surgical technique used.