Interventions for the treatment of keratocystic odontogenic tumours (KCOT, odontogenic keratocysts (OKC))

Sharif FNJ, Oliver R, Sweet C, Sharif MO

Published Online:

September 8, 2010

The keratocystic odontogenic tumour is a bone tumour which is relatively uncommon and benign, however it is very aggressive and has a high recurrence rate after treatment. Some reports have stated 6 out of 10 of these tumours will recur after treatment. Treatment to prevent recurrence can lead to the removal of large amounts of bone surrounding the lesion and this carries major risks (nerve damage, loss of facial form and function). Currently uncertainty exists regarding the best treatment option, this review aimed to help to inform on the strength and direction of available evidence in this respect. This review revealed that there is no high quality evidence for the effectiveness of available treatments and so there is a need for further research to help clinicians and patients to make informed choices about treatment options.

Abstract (click to read)

Background:

The keratocystic odontogenic tumours (KCOTs) account for between about 2% and 11% of all jaw cysts and can occur at any age. They are more common in males than females with a male:female ratio of approximately 2:1. Although they are benign, KCOTs are locally very aggressive and have a tendency to recur after treatment, reported recurrence rates range from 3% to 60%. The traditional method for the treatment of most KCOTs is surgical enucleation. However, due to the lining of the cyst being delicate and the fact that they frequently recur, this method alone is not sufficient. Adjunctive surgical treatment has been proposed in addition to the surgical enucleation, such as removal of the peripheral bone (ostectomy) or resection of the cyst with surrounding bone (en-bloc) resection. Other adjunctive treatments proposed are: cryotherapy (freezing) with liquid nitrogen and the use of the fixative Carnoy's solution placed in the cyst cavity after enucleation; both of which attempt to address residual tissue to prevent recurrence.

Objectives:

To assess the available evidence comparing the effectiveness of surgical interventions and adjuncts for the treatment of KCOTs.

Search strategy:

Databases searched were: the Cochrane Oral Health Group's Trials Register (to 28th July 2010), CENTRAL (The Cochrane Library 2010, Issue 3), MEDLINE (from 1950 to 28th July 2010), and EMBASE (from 1980 to 28th July 2010). The reference lists of all trials identified were cross checked for additional trials. There were no language restrictions and several articles were translated.

Selection criteria:

Randomised controlled trials comparing one modality of surgical intervention with another with or without adjunctive treatment for the treatment of KCOTs. Adults, over the age of 18 with a validated diagnosis of solitary KCOTs arising in the jaw bones of the maxilla or mandible. Patients with known Gorlin syndrome were to be excluded.

Data collection and analysis:

Review authors screened trials for inclusion. Full papers were obtained for relevant and potentially relevant trials. If data had been extracted, it would have been synthesised using the fixed-effect model, if substantial clinical diversity were identified between studies we planned to use the random-effects model with studies grouped by action provided there were four or more studies included in the meta-analysis, and we would have explored the heterogeneity between the included studies.

Main results:

No randomised controlled trials that met the inclusion criteria were identified.

Authors' conclusions:

There are no published randomised controlled trials relevant to this review question, therefore no conclusions could be reached about the effectiveness or otherwise of the interventions considered in this review. There is a need for well designed and conducted randomised controlled trials to evaluate treatments for KCOTs.

This record should be cited as:

Sharif FNJ, Oliver R, Sweet C, Sharif MO. Interventions for the treatment of keratocystic odontogenic tumours (KCOT, odontogenic keratocysts (OKC)). Cochrane Database of Systematic Reviews 2010, Issue 9. Art. No.: CD008464. DOI: 10.1002/14651858.CD008464.pub2

Assessed as up to date:

July 28, 2010

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Primary Review Group:

Oral Health Group

Health topics:

Cancer > Oral > Treatment

Dentistry & oral health > Oral cancer > Treatment

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Interventions for the treatment of keratocystic odontogenic tumours (KCOT, odontogenic keratocysts (OKC))

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