Early reconstruction of bone defect created after initial surgery of a large keratocystic odontogenic tumor: a case report.

INTRODUCTION: Keratocystic odontogenic tumor (KCOT) is defined as a benign cystic neoplasm of the jaws of odontogenic origin with a high rate of recurrence. The most lesions occur in the posterior part of the mandible. Treatment of KCOT remains controversial, but the goals of treatment should involve eliminating the potential for recurrence while minimizing surgical morbidity. However, another significant therapeutic problem related to the management of KCOT is an adequate and early reconstruction of the existing jaw defect, as well as appropriate aesthetic and functional rehabilitation of a patient, especially in cases of a very large destruction of the jaws bone. CASE REPORT: We presented a 65-year-old female patient with very large KCOT of the mandible. Orthopantomographic radiography showed a very large elliptical multilocular radiolucency, located on the right side of the mandible body and the ascending ramus of the mandible, with radiographic evidence of cortical perforation at the anterior border of the mandibular ramus and the superior border of the alveolar part of the mandible. The surgical treatment included two phases. In the first phase, the tumor was removed by enucleation and additional use of Carnoy solution, performing peripheral ostectomy and excision of the affected overlying mucosa, while in the second phase, restorative surgery of the existing mandibular defect was performed 6 months later. Postoperatively, we did not register any of postoperative complications, nor recurrence within 2 years of the follow-up. CONCLUSION: Adequate and early reconstruction of the existing jaw defect and appropriate aesthetic and functional rehabilitation of the patient should be the primary goal in the treatment of KCOT, having in mind the need for a long-term post-surgical follow-up.

Peripheral ostectomy with the use of Carnoy's solution as a rational surgical approach to odontogenic keratocyst: a case report with a 5-year follow-up.

INTRODUCTION: Odontogenic keratocyst (OKC) is a rare developmental, epithelial and benign cyst of the jaws of odontogenic origin with high recurrence rates. The third molar region, especially the angle of the mandible and the ascending ramus are involved far more frequently than the maxilla. The choice of treatment approach was based on the size of the cyst, recurrence status, and radiographic evidence of cortical perforation. Different surgical treatment options like marsupialization, decompression, enucleation, enucleation with Carnoy's solution, peripheral ostectomy with or without Carnoy's solution, and jaw resection have been discussed in the literature with variable rates of recurrence. CASE REPORT: We presented a 52-year-old male with orthokeratinized odontogenic keratocyst. Elliptical unilocular radiolucency located in the third molar region and the ascending ramus of the mandible, 40 x 25 mm in diameter with radiographic evidence of cortical perforation at the anterior ramus border of the mandible 20 mm in diameter, was registrated on orthopantomographic radiography. Surgical treatment included enucleation of the cyst and peripheral ostectomy with the use of Carnoy's solution and excision of the overlying attached mucosa. Postoperatively, no paresthesia in the inervation area of the inferior alveolaris nerve was registrated. Recurrences were not registrated within 5 years post-intervention. CONCLUSION: Treatment of odontogenic keratocyst with enucleation and peripheral ostectomy with the use of Carnoy's solution and excision of the overlying attached mucosa had a very low rate of recurrence. Radical and more aggressive surgical treatments as jaw resection should be reserved for multiple recurrent cysts and when OKC is associated with nevoid basal cell carcinoma syndrome (NBCCS). Following the treatment protocol in the management of OKC and systematic and long-term postsurgical follow-up are considered key elements for successful results.