The odontogenic keratocyst:
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Philadelphia [u.a.]
Saunders
2003
|
| Schriftenreihe: | Oral and maxillofacial surgery clinics of North America
15,3 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | VIII S., S. 312 - 465 Ill., graph. Darst. |
Internformat
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| 245 | 1 | 0 | |a The odontogenic keratocyst |c M. Anthony Pogrel ..., guest eds. |
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| 300 | |a VIII S., S. 312 - 465 |b Ill., graph. Darst. | ||
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Datensatz im Suchindex
| _version_ | 1804130316927893504 |
|---|---|
| adam_text | CONTENTS
Preface xi
M. Anthony Pogrel and Brian L. Schmidt
The History of the Odontogenic Keratocyst 311
M. Anthony Pogrel
Over a period of more than 100 years, we have arrived at the conclusion that keratiniza
tion can occur in the lining of many different types of dental cysts but that there is a spe¬
cific type in which the keratin is predominantly of the parakeratinizing variety. They are
found most commonly at the angles of the mandible, with or without a relationship to
the crown of the tooth, and these cysts have a higher recurrence rate than other types of
cysts. Researchers believe that these cysts have been parakeratinized since their forma¬
tion. Other types of cysts that display keratinization often show the orthokeratinized
type, and it is still unclear whether this is caused by metaplasia in response to irritation
or they are orthokeratinized from the start.
Etiology and Pathogenesis of Keratocysts 317
Paul J.W. Stoelinga
In the past, odontogenic keratocysts (OKCs) were considered to originate from the pri
mordium of a tooth before mineralization had taken place. This is why they were also
called primordial cysts. As the years passed, the thought gained ground that remnants
of the dental lamina played a role, particularly because many OKCs seemed to have an
atypical relation to teeth when presenting in the dentate area. Their frequent presentation
in the ascending ramus of the mandible was explained by the hypothesis that offshoots
of the dental lamina were probably responsible for the development of keratocysts in
this region. The term laminal cysts was even suggested. The likelihood that investiga¬
tions of the basal layer of the oral epithelium play a role in the etiology of some OKCs
is emphasized.
Histology and Ultrastructural Features of the Odontogenic Keratocyst 325
Richard C.K. Jordan
In comparison to other cysts of the jaws, the odontogenic keratocyst (OKC) is unusual
because it shows characteristic clinical features, including potentially aggressive behav¬
ior, high recurrence rate, and an association with the nevoid basal cell carcinoma syn¬
drome. The defining histologic feature—the presence of parakeratin—is unique among
the myriad inflammatory and developmental cysts that occur in the jaws. The presence
of keratin coupled with other characteristic histologic findings is so distinctive that
VOLUME 15 • NUMBER 3 • AUGUST 2003 v
microscopic diagnosis is usually obvious. Histologically, the OKC is composed of para
keratinized stratified squamous epithelium but may show foci of orthokeratinization. This
cyst occurs sporadically or may be associated with the nevoid basal cell carcinoma syn¬
drome. The orfhokeratinized odontogenic cyst is composed exclusively of epithelium that
shows orthokeratinization. Although initially believed to be a subtype of OKC, it is estab¬
lished that it has clinical, histologic, and biologic features that set it apart from the OKC.
This cyst does not occur in association with the nevoid basal cell carcinoma syndrome.
Odontogenic Keratocysts: Clinical Features 335
Mervyn Shear
The odontogenic keratocyst long has been recognized as an aggressive lesion with a
propensity for recurrence unless completely removed surgically. Convincing evidence has
accumulated to regard this lesion as a benign cystic neoplasm. This article on clinical fea¬
tures covers the keratocyst s frequency and incidence, its age, gender and site distribu¬
tions, its clinical presentation, and the possible reasons for its frequent recurrences. The
association of the keratocyst with the nevoid basal cell carcinoma syndrome (Gorlin Goltz
syndrome) is explored in some detail, particularly as it influences clinical behavior.
Odontogenic Keratocysts: Natural History and Immunohistochemistry 347
Mervyn Shear
Researchers generally agree that the keratocyst arises from remnants of the dental lamina
and, in some instances, from basal cell offshoots of the covering gingival epithelium, par¬
ticularly in the case of cysts that develop distal to the third molar tooth. From the time
that it was established that keratocysts may be associated with the nevoid basal cell car¬
cinoma syndrome, researchers suspected that these cysts might have a genetic determi¬
nant. The considerable evidence of aggressive behavior of the keratocyst, particularly
those that are syndrome related, has led many workers in the field to regard it as a
benign neoplasm. Recent immunocytochemical and genetic studies have provided con¬
firmatory molecular evidence for both suppositions.
Correlative MRI and CT Imaging of the Odontogenic Keratocyst: A Review of
Twenty One Cases 363
Leon Janse van Rensburg, Manon Paquette, Jean A. Morkel, and
Christoffel J. Nortje
Odontogenic keratocysts (OKCs) are developmental cysts that have been associated with
a high recurrence rate. Based on a 10 year review of 21 patients with histologically con¬
firmed solitary or multiple OKCs, this study describes the correlative CT and MRI and
histopathologic features that are diagnostic of OKCs and determines the imaging fea¬
tures that indicate an increased postsurgical recurrence risk.
Surgical Management of the Odontogenic Keratocyst 383
G.E. Ghali and M. Scott Connor
Treatment of odontogenic keratocysts (OKCs) varies from enucleation and curettage to
osseous resection. Various factors that should be considered in the selection of the appro¬
priate treatment include size and extent, location, presence of perforation or soft tissue
involvement, age of individual, and primary or recurrent nature of lesion. Long term
follow up is suggested because OKCs have been known to have late recurrences. These
factors may support emerging molecular evidence that the OKC is more likely to be a
benign cystic neoplasm than a simple odontogenic cyst.
vi CONTENTS
The Use of Liquid Nitrogen Cryotherapy in the Management of the
Odontogenic Keratocyst 393
Brian L. Schmidt
Data suggest that liquid nitrogen helps to decrease the recurrence rate of odontogenic kera¬
tocysts, especially for lesions with a history of recurrence. Other indications for cryosurgery
include large, complex mandibular lesions in which enucleation of the cyst lining might be
difficult and lesions in which conventional management might involve vital structures, such
as the inferior alveolar nerve. Decompression also can be used for large, complex lesions
and lesions that involve the inferior alveolar nerve. Decompression requires significant
patient compliance and follow up, however. For patients for whom compliance is an issue,
liquid nitrogen cryotherapy might offer more definitive management.
Excision of the Overlying, Attached Mucosa, in Conjunction with Cyst
Enucleation and Treatment of the Bony Defect with Carnoy Solution 407
Paul J.W. Stoelinga
The advised treatment strategy of cystic lesions of the jaws and the protocol for the man¬
agement of odontogenic keratocysts give rise to a low number of recurrent keratocysts.
Complete elimination of recurrences is probably not possible for two reasons. First, some
cysts are still treated like ordinary odontogenic cysts because a preoperative diagnosis
was not made and the cysts were not treated according to the suggested protocol.
Second, despite excision of the overlying mucosa there may still be epithelial islands or
even microcysts left behind in the mucosa, which may develop into a new keratocyst.
Decompression and Marsupialization as a Treatment for the
Odontogenic Keratocyst 415
M. Anthony Pogrel
Decompression and marsupialization of cysts of the jaws were first suggested by Partsch
in the German literature, and in many parts of the world they are still described as the
Partsch I procedure. This treatment was put forward at that time as a definitive treatment
for cysts, and it consisted of the removal of the overlying epithelium and bone and the
deroofing of the cyst. In the preantibiotic era, it was often the treatment of choice, because
attempts at enucleating the cyst with primary closure met with failure, wound break¬
down, and subsequent infection. With the advent of antibiotics and the routine use of
endotracheal intubation, the management of dental cysts changed. Enucleation and pri¬
mary closure, with or without simultaneous or subsequent bone grafting, became the
more accepted treatment.
Treatment Options for the Recurrent Odontogenic Keratocyst 429
R. Bryan Bell and Eric J. Dierks
The purpose of this article is to review the pathophysiology of recurrence as it relates to
odontogenic keratocysts, define the recurrence risk associated with various treatment
modalities, and provide the clinician with a logical rationale for treating recurrences,
lesions with unusual presentations, or malignant tumors associated with keratocysts.
CONTENTS v
Molecular Approaches to the Diagnosis of Sporadic and Nevoid Basal Cell
Carcinoma Syndrome Associated Odontogenic Keratocysts 447
Randy Todd and Meredith August
Recent advances in molecular studies promise future biology based diagnostic strategies
for the management of patients with odontogenic keratocysts (OKCs). Disease associated
alterations in critical factors that control important cell pathways/pathway networks
can be detected by various techniques. As we better understand OKC biology, we can
identify novel biomarkers based on these molecular alterations. In the future, OKC diag¬
nosis using biomarker panels may allow a minimally invasive means to manage these
patients more accurately using existing therapeutic modalities and may uncover new
treatment approaches.
Index 463
viii CONTENTS
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| title | The odontogenic keratocyst |
| title_auth | The odontogenic keratocyst |
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