A retrospective review of treatment of the odontogenic keratocyst.

PURPOSE: The purpose of this study was to evaluate different surgical treatment methods for odontogenic keratocysts and the outcome of those treatments over a 25-year period.

PATIENTS AND METHODS: A retrospective review was performed of 40 patient charts treated at the University of Iowa Hospitals and Clinics (Iowa City, IA) from 1977 to 2002 with the diagnosis of odontogenic keratocyst. Demographic data were collected along with lesion location, symptoms present at initial presentation, surgical treatment rendered, length of follow-up, and incidence of recurrence.

RESULTS: Surgical treatments included enucleation, enucleation with Carnoy's solution, peripheral ostectomy, peripheral ostectomy with Carnoy's solution, and en bloc resection. Recurrence was found in 9 to 40 patients. Seven of 9 recurrences (78%) occurred in 5 years or less, with 2 (22%) occurring more than 5 years after initial treatment. Patients treated with enucleation had a recurrence rate of 54.5% (6 of 11 patients). One of 2 patients treated with enucleation and Carnoy's solution had a recurrence. Those treated with peripheral ostectomy had a recurrence rate of 18.2% (2 of 11). Peripheral ostectomy with Carnoy's solution had no recurrences (0/13).

CONCLUSION: Treatment of an odontogenic keratocyst with peripheral ostectomy, with or without the use of Carnoy's solution, had a significantly lower rate of recurrence. Treatment with enucleation, with or without the use of Carnoy's solution was associated with a significantly higher recurrence rate.