Surgical removal of keratocystic odontogenic tumours via a Le Fort I osteotomy approach: a retrospective study of the recurrence rate

Int J Oral Maxillofac Surg. 2017 Apr;46(4):434-439. doi: 10.1016/j.ijom.2017.01.006. Epub 2017 Feb 8.

Abstract

The keratocystic odontogenic tumour (KCOT) is one of the most aggressive odontogenic cysts and has a high recurrence rate. The treatment of these tumours is the subject of debate. A KCOT in the posterior maxilla with sinus involvement is rare. Few reports have been published in the literature. The purpose of this study was to evaluate the recurrence rate after surgical removal of maxillary KCOTs via a Le Fort I osteotomy. A search was performed to identify patients with a follow-up time of at least 5 years. Nine patients were included in the study. The following clinical variables were analyzed: age at surgery, sex, symptoms, site and size of the tumour, surgical approach, and recurrence rate. The surgical approaches were curettage (n=6) and enucleation (n=3). Recurrence was seen in three patients (33%); all had multilocular tumours. No recurrence was seen in patients with unilocular tumours. The Le Fort I osteotomy approach allows direct visualization and ensures wide excision, minimizing the risk of recurrence. In this series, cases with a multilocular KCOT showed a higher risk of recurrence due to the difficulty of removing the tumour in total. All recurrences took place within 2 years of the intervention; a 5-year follow-up is recommended.

Keywords: Le Fort I osteotomy; cysts; keratocystic odontogenic tumour; odontogenic keratocyst; recurrence; tumours.

MeSH terms

  • Adolescent
  • Adult
  • Biopsy
  • Female
  • Humans
  • Male
  • Maxillary Neoplasms / diagnostic imaging
  • Maxillary Neoplasms / pathology*
  • Maxillary Neoplasms / surgery*
  • Middle Aged
  • Neoplasm Recurrence, Local
  • Odontogenic Cysts / diagnostic imaging
  • Odontogenic Cysts / pathology*
  • Odontogenic Cysts / surgery*
  • Odontogenic Tumors / diagnostic imaging
  • Odontogenic Tumors / pathology*
  • Odontogenic Tumors / surgery*
  • Osteotomy, Le Fort*
  • Retrospective Studies
  • Treatment Outcome