Treatment of odontogenic keratocysts: a follow-up of 255 Chinese patients

OBJECTIVE: The purpose of this study was to report our experience in the surgical treatment of 484 Chinese patients with follow-up in 255 cases. METHODS: A retrospective analysis was conducted of all odontogenic keratocysts that were surgically treated and histopathologically diagnosed between 1962 and 1998. The odontogenic keratocysts were surgically treated with enucleation, marsupialization followed by secondary enucleation, and resection with or without continuity defects. The recurrence rate was evaluated for the patients followed more than 3 years. RESULTS: Of a total of 489 odontogenic keratocysts, 327 (66.87%) were found in the mandible and 162 (33.13%) in the maxilla. Follow-up data were obtained in 255 patients. Recurrence was found in 31 cases (15.27%) in 203 patients treated with enucleation after an observation period of 3 to 29 years. Twenty-nine recurrences (17.79%) were found in 163 patients treated with enucleation alone, two recurrences (6.70%) were seen in 29 patients who received Carnoy's solution fixation of the cyst wall before enucleation, and no recurrence was found in 11 cases treated with marsupialization in combination with secondary enucleation. No recurrence was seen in 52 patients treated with resection. CONCLUSION: Odontogenic keratocysts treated with enucleation alone have a higher recurrence rate. Enucleation with adjunctive treatment can decrease recurrence rate. Radical excision has no recurrence but does have the highest morbidity rate and should be reserved for multiple recurrent cysts after conservative means.