Clinical indications for radical resection of odontogenic keratocyst: A systematic review

The aim of this study was to identify clinico pathological indications for radical resection of odontogenic keratocysts (OKCs) in the literature and formulate clinical guidelines for the management of OKCs based on these findings. A systematic review of the literature was undertaken in September 2021 in PubMed/Medline, Scopus, Web of Science, Google Scholar, and Cochrane databases. The following MeSH Keywords terms were used in the search strategies: (odontogenic keratocyst) OR (keratocystic odontogenic tumor) OR (primordial cyst) AND (treatment) OR (Radical resection) OR (Resection of OKC) OR (Treatment methods). Eligibility criteria included publications of clinical studies on histologically confirmed OKCs which underwent radical resection. Studies with less than 5 OKCs, experimental studies, epidemiological studies, studies that included orthokeratinized odontogenic cyst, and review papers were excluded. Ten studies on OKCs reporting on segmental or marginal resections were identified and analyzed qualitatively. Of the total of 221 OKCs that underwent radical resection, 67 OKCs were primary, 30 were recurrent, and the remaining were unclear whether they were primary or recurrent. Segmental mandibulectomy was performed in 131 OKCs, marginal mandibulectomy in 87 OKCs, and 3 OKCs were treated by partial maxillectomy. The main indications for radical resection were multilocular appearance, large OKCs (> 5 cm), multiple recurrent OKCs with or without cortical perforation, and malignant transformation. In conclusion, radical resection has its place in the management of OKC. It is indicated when there is an aggressive lesion with bony perforation, involvement of the pterygoid musculature or skull base, and malignant transformation. The surgeon should aim to identify these features to manage OKC appropriately and to prevent multiple recurrences. Clinical guidelines for the management of OKCs are proposed.