• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제49권5호
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• pp.287-291
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• 2023

Odontogenic keratocysts (OKCs) located in the maxillae have rarely been reported in the literature. Standard treatment modalities for OKC range from marsupialization to marginal resection. However, most of the studies on OKC treatment have been related to mandibular OKCs. The anatomical structure and loose bone density of the maxillae and the empty space of the maxillary sinus could allow rapid growth of a lesion and the ability to tolerate tumor occupancy in the entire maxilla within a short period of time. Therefore, OKCs of the maxillae require more aggressive surgery, suchas resection. As an alternative, this report introduces a modified Carnoy's solution, a strong acid, as an adjuvant chemotherapy after cyst enucleation. This report describes the clinical outcomes of enucleation using a modified Carnoy's solution in patients with large OKCs on the posterior maxillae. In three cases, application of a modified Carnoy's solution had few side effects or morbidity. Each patient was followed for four to six years, and none showed any signs of recurrence. In conclusion, adjuvant treatment with a modified Carnoy's solution can be considered a treatment option capable of reducing the recurrence rate of OKC in the maxillae.

• Imaging Science in Dentistry
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• 제35권1호
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• pp.51-54
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• 2005

Purpose : To acquire the useful diagnostic information through the analysis of the clinical and radiological characteristics of mandibular odontogenic keratocyst. Materials and Methods : The researchers compared and analysed the clinical and radiological features of 112 cases of mandibular odontogenic keratocyst confirmed by histopathlogic examination. Results : Mandibular odontogenic keratocysts occurred more frequently in males than in females and the incidence is the highest in the 2nd and 3rd decades. These cysts occurred in the mandibular posterior area, angle-ramus area and anterior area $51.8\%$, $31.2\%$ and $17.0\%$ respectively. These cysts had undulating border ($69.6\%$) rather than smooth border ($30.4\%$). Most of these cysts had well-defined hyperostotic border ($94.6\%$). These cysts caused cortical thinning or expansion ($78.6\%$) rather than no cortical reaction ($21.4\%$). Loss of lamina dura was observed in $72.3\%$, displacement of tooth appeared in $35.7\%$ and root resolution appeared in $12.5\%$ of cases. In $71\%$ of cases, displacement of mandibular canal was observed. Internal patterns of lesional radiolucency were even ($61.6\%$) or uneven ($38.4\%$). Conclusion : These results would be helpful in diagnosing of mandibular odontogenic keratocyst. (Korean J Oral Maxillofac Radiol 2005; 35 : 51-4)

• 대한두개안면성형외과학회지
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• 제11권1호
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• pp.23-27
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• 2010

목적: 모반양 기저세포암 증후군 (Nevoid basal cell carcinoma syndrome) 또는 골린-골츠 증후군은 한국에서는 흔하지 않은 증후군으로 주로 상염색체 우성으로 유전하고 다기관 장애가 나타날 수 있으며 높은 표현율과 다양한 표현도를 특징으로 한다. 모반양 기저세포암 증후군의 진단 기준에는 다발성 기저세포암, 이소성 석회화(ectopic calcification), 손 또는 발바닥 오목 (palma or plantar pits), 치성 각화 낭종(odontogenic keratocysts), 가족력 및 골격계, 신경계, 안, 비뇨생식계 및 심장혈관의 이상 등이 있다. 본원에서 주로 두부의 다발성 기저세포암을 가진 모반양 기저세포암 증후군 환자를 경험하여 보고하고자 한다. 방법: 환자는 2007년 4월 두부의 색소성 모반으로 피부과에서 시행한 펀치 생검에서 기저세포암을 진단받고 의뢰되었으며, 이후 2009년 7월까지 14회의 추가적인 절제 및 조직 검사를 시행하였다. 환자는 갑상샘 유두암종의 재발로 인해 갑상샘 절제술을 2회 시행한 과거력이 있었으며 이학적 검사와 일반 혈액, 소변, 간 기능 및 갑상선 기능 검사를 시행하였고, 흉부와 늑골 방사선 검사, 심전도와 안면부 및 두부 컴퓨터단층촬영과 유전자 검사를 시행하였다. 결과: 두부와 안면부에서 절제한 27개의 병변 중 23개(85%)가 기저세포암으로 진단되었으며, 치성 각화 낭종과 대뇌겸 석회화, 이학적 검사에서 손바닥 오목이 발견되었다. 하복부 초음파에서 난소 낭종이 발견되었으나 조직 검사는 시행되지 않았다. 결론: 한국에서 모반양 기저세포암 증후군에 대한 연구는 주로 치과와 피부과 영역에서 국한되었으며, 특히 치과 영역에서의 보고는 치성 각화 낭종 및 손바닥 오목에 초점을 둔 것이 대부분이었다. 이에 본원에서는 주로 두부의 다발성 기저세포암을 가진 모반양 기저세포암의 환자를 경험하였으며, 초기에 발견된 작은 병변의 제거 시 2mm의 정상 조직을 포함하여 절제하였어도 3년간의 경과관찰 중 재발없이 좋은 결과를 얻을 수 있어 이를 보고하는 바이다.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제39권4호
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• pp.182-187
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• 2013

Keratocystic odontogenic tumors (KCOT) - previously termed odontogenic keratocysts (OKC) - are characterized by aggressive behavior and a high rate of recurrence. Histopathologically, the basal layer of KCOT shows a higher cell proliferation rate and increased expression of anti-apoptosis genes. Clinically, KCOT is frequently involved in the mandibular posterior region but is not common in the posterior maxilla. However, it should be noted that due to its expansive characteristics, KCOT involved near the maxillary sinus could easily expand to an enormous size and occupy the entire maxilla. To achieve total excision of these expanded cystic tumors in the maxilla, a more aggressive approach would be needed. In this report, we describe two cases of expansile KCOT involving the entire unilateral maxilla and maxillary sinus; they were completely excised using the Weber-Ferguson approach, showing no evidence of recurrence during the follow-up period of more than two years. In immunohistochemical analyses of the tumor specimens, p53 and p63 showed strong expression, and B-cell lymphoma 2 (BCL2) and MKI67 (Ki-67) showed moderate or weak expression, however, detection of BCL2-associated X protein (BAX) was almost negative. These data indicate that expansile KCOT possesses increased anti-apoptotic activity and cell proliferation rate but decreased apoptosis. These properties of KCOT may contribute to tumor enlargement, aggressive behavior, and high recurrence rate.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제30권2호
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• pp.162-164
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• 2004

Odontogenic keratocysts are developmental odontogenic cysts which derived from rests of dental laminas and often found in posterior area of mandible. Because this lesion has tendency of frequent recurrence, treatment of choice is often radical removal of the lesion. Sometimes in case of large cysts, however, conservative therapy like marsupialization is often selected in treatment plan. A 39-years old woman referred to our department for evaluation of large radiolucent lesion that occupies the areas from mandible angle to upper part of ramus and condyle. In cytology, the lesion was identified as odontogenic keratocyst. Marsupialization was our treatment of choice, and the result was so favorable. 2 years later, there was small radiolucent lesion on upper part of mandibular ramus on panoramic view. It was suspected as recurred lesion, and excisional biopsy was done. On biopsy result, it was not a cystic lesion but fibrosis.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제36권1호
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• pp.7-12
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• 2014

Nevoid basal cell carcinoma syndrome (NBCCS) is inherited as an autosomal dominant trait with variable conditions, including multiple basal cell carcinoma, numerous keratocystic odontogenic tumors (KOTs) in the jaws, ectopic calcification of the falx cerebri, bifid ribs, macrocephaly, kyphoscoliosis, cleft palate, frontal and temporal bossing, mild ocular hypertelorism, mild mandibular prognathism, vertebral fusion, and so on. A 16-year-old boy visited the Dong-A University Medical Center, requiring diagnosis and treatment of multiple cystic lesions. He presented with many conditions related to NBCCS, including multiple KOTs, bifid rib, cleft lip, frontal bossing, mild ocular hypertelorism, and mild mandibular prognathism. No characteristic cutaneous manifestations (nevoid basal cell carcinoma) were observed in this patient. We report on a case of multiple KOTs associated with NBCCS with a review of the literature.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제37권3호
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• pp.161-168
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• 2011

Purpose: The odontogenic keratocysts demonstrated a high recurrence rate and a biologically aggressive nature. This might be due to unknown factors inherent in the epithelium or enzymatic activity in the fibrous wall. Bcl-2 protein is characterized by its ability to inhibit apoptosis. The aim of this study was to evaluate the expression and distribution of bcl-2 in the OKCs, its possible relationship with the tumorous characteristics, such as the aggressive nature and high recurrence rate, and its usefulness to differentiate OKCs from dentigerous cysts. Materials and Methods: Formalin fixed paraffin-embedded tissue sections of 53 OKCs, and 44 dentigerous cyst were immunohistochemically analyzed quantitatively for the immunoreactivity of the bcl-2 protein with i-solution. Results: More Bcl-2 expression was observed in the OKCs (mean34.387%) than dentigerous cyst (mean11.144%) with statistical significance (P<0.001). Seventeen and 15 of the 32 OKCs in this study showed positivity in the basal layer and basal/suprabasal layers, respectively. In dentigerous cyst, 2 of 3 showed positivity in the basal cell layer. Conclusion: Considering that bcl-2 over expression may lead to the increased survival of epithelial cells, this study demonstrated a possible relationship between the aggressive nature of OKC and the intrinsic growth potential of its lining epithelium. Furthermore, the basal/suprabasal distribution of bcl-2 positive cells was observed in some OKCs, which might have a significant impact on the behavior of cysts. The bcl-2 expression of OKCs can be useful for differentiating OKCs from dentigerous cysts.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제34권4호
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• pp.485-489
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• 2008

Basal cell nevus syndrome is a hereditary disease of an autosomal dominant trait with variable conditions such as basal cell carcinomas of the skin, deformity of rib, fusion of vertebrae, mental retardation, hypertelorism, and multiple odontogenic keratocysts. A 32 years old man with pus discharge from fistula on the vestibule of left upper 1st molar visited to Chosun University Dental Hospital. Radiographic evaluation revealed multiple maxillary and mandibular cysts that had multilocular radiolucency on left mandibular body area, thining of inferior border of left border of ramus and well defined unilocular radiolucency above right upper 1st and 2nd molar and from left upper 1st premolar to 2nd molar. In chest PA view, he had a forked rib in the left 4th rib and in skull PA view the calcification of falx cerebri was observed. There was not any skin lesion. After the preliminary evaluation, the patient was diagnosed with basal cell nevus syndrome and he underwent marsupialization for decreasing the size of cystic lesion and came to hospital for dressing 3days a week. As time goes by, the size of lesion decreased. So, one and half year after marsupialization, he underwent cyst enucleation and iliac bone graft for the mandibular lesion and buccal fat pad grafts for the maxillary lesions. After the surgery, the patient experienced normal healing without any complications and he is on long-term follow-up.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제50권3호
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• pp.153-160
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• 2024

Objectives: This study identifies factors for differential diagnosis among lesions by retrospectively comparing panoramic and cone-beam computed tomography images and analyzing the characteristics of lesions associated with impacted mandibular third molars (IMTs). Materials and Methods: A retrospective cohort study was conducted in patients who simultaneously underwent IMT extraction surgery and related benign tumor resection or cyst enucleation at our institution from 2017 to 2021. To compare the characteristics of each group, two comparative analyses were conducted. The first comparison considered the most frequently observed lesions associated with IMTs: dentigerous cysts, odontogenic keratocysts (OKCs), and ameloblastoma. The second comparison involved placing dentigerous cysts, which have a relatively low recurrence rate, into group A and placing OKC, ameloblastoma, and odontogenic myxoma, which have high recurrence rates, into group B. Results: Significant differences in the size of the lesion were found in the order of ameloblastoma, OKC, and dentigerous cyst (P<0.05). The buccolingual width of ameloblastoma differed significantly from that of the other groups, with no significant difference observed between the OKCs and dentigerous cysts (P=0.083). Conclusion: Patient age and lesion size differed significantly among lesion types associated with IMTs, with younger age and larger lesions for OKCs and odontogenic tumors. OKCs are likely to have a larger mesiodistal width than dentigerous cysts. The buccolingual width of ameloblastomas was larger than those of dentigerous cysts and OKCs.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제30권1호
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• pp.43-48
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• 2004

Purpose: Among the various surgical methods used for the effective treatment of cystic lesion in the jaws historically, decompression procedure has some of superior prognosis compare to direct enucleation. In order to propose the efficacy of decompression we performed this retrospective study to compare decompression procedure with one-stage enucleation in clinical results and prognosis. Patients and Methods: We reviewed 175 patients who had been histopathologically diagnosed cystic lesions from 1996 to 2000 in our department. Patients who had been received decompression alone or secondary enucleation after decompression were 31 cases, and enucleation alone were 144 cases. The age and sex of the patients, the area, size, and histological type of the lesions, and detailed operation and complications including recurrence were investigated. The minimal follow-up period was 2 years. Results: In 31cases of decompression, male patients were 22cases(71%) similar to male predilection(62.3%) in total 175 cases. Cystic lesions were developed evenly in all age groups totally. Decompression was mainly performed in teenagers but enucleation was used in elder decades. In decompression cases the lesions were located in mandibular posterior, maxillary posterior, mandibular anterior, and maxillary anterior in order, which had some differences in total and enucleation cases. In enucleation cases, less than 3cm in size was 77.1% but larger than 3cm was 93.5% in decompression cases. Histopathologically, dentigerous cysts(54.8%), unicystic ameloblastomas(16.1%), and odontogenic keratocysts(12.9%) were seen in decompression cases and no recurrence or metaplasia and infection was observed. On the other hand, permanent tooth loss, numbness, recurrence, and so on were accompanied after enucleation. Conclusion: Although decompression procedure has disadvantages such as many of visiting times and slow recovery of the surgical defect, decompression is the best choice of treatment for large cystic lesions of the jaws, because it prevents functional and cosmetic defect, allows bone regeneration, and makes easy secondary enucleation.