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A large maxillary odontogenic cyst could intrude into the maxillary sinus. The traditional approach following surgery for such a cyst is the Caldwell–Luc procedure. However, the traditional CDL procedure is associated with more complications and damage of the sinus mucosa. The purpose of this study was to assess a new method with easier operation, which not only prevented postoperative infection but also caused less damage to the maxillary sinus mucosa. A large odontogenic cyst in the maxillary sinus of 40 patients was diagnosed through radiographic imaging and postoperative histopathology. Twenty patients were treated with maxillary sinus saline irrigation after surgery, while 20 patients underwent the traditional Caldwell–Luc procedure. The therapeutic efficacy was evaluated by clinical examination and radiographic imaging; the longest follow-up was 36 months. The postoperative reaction was evaluated. There was a statistically significant difference in facial swelling, visual analog scale (VAS) and temperature elevation between the 2 groups. Sinus irrigation following large odontogenic cyst surgery involving the maxillary sinus can serve as an alternative to standard CDL and has the advantages of fewer complications, reduced trauma, restoration of the mucosa and more satisfactory results.

Endoscopic sinus surgery (ESS) including middle meatus antrostomy (MMA) has been advocated as the technique of choice in the treatment of maxillary chronic odontogenic sinusitis (COS). However, recently the endoscopic canine fossa puncture (CFP) has been proposed as an alternative surgical technique of accessing the entire antrum when pathology is limited only to the maxillary sinus. This study was designed to assess the outcomes of the CFP approach versus ESS (comprising MMA) in the management of COS. A prospective study was performed on patients with COS produced by odontogenic infections (periapical granulomas or small inflammatory cysts of the molars or bicuspids), oroantral fistula (OAF), large odontogenic cysts, and maxillary foreign bodies (dental fillings, teeth roots, and implants). Patients were randomly allocated into two groups: 56 patients underwent CFP and in 54 patients the maxillary sinus was approached through MMA. After a mean follow-up of 18.5 months, recurrence rates were compared between the two groups. During the follow-up period, OAF recurred in 10 patients: 4 in the MMA group (7.4%) and 6 in the CFP group (10.7%). The difference is not statistically significant (p = 0.39, Fisher exact test). In patients with COS a conservative approach with avoidance of endonasal surgery is suggested: in COS without a fistula, CFP at the time of dental treatment will be sufficient. In OAF cases, CFP yielded similar results with MMA. Nevertheless, additional study with a larger sample and a longer follow-up is required to validate these results.

Background Peripheral odontogenic keratocyst (POKC) is a rare extraosseous manifestation of odontogenic keratocyst (OKC). Because of their anatomical locations, OKCs and POKCs necessitate slightly different treatment approaches. However, the reported literature has not yet reached a definitive conclusion on this matter. Methods This study included 2 patients who experienced postoperative recurrence of POKCs in the right buccal mucosa from 2018 to 2020. Additionally, we reviewed the reported cases and summarized the clinical features, treatment and prognosis of the POKCs. Results The two patients with POKCs in this report experienced recurrence after the first surgery, and the second operation involved microscopic excision of the lesion with its adherent tissue. No recurrence was observed. Conclusions Because POKCs are located in the soft tissue, they are difficult to remove and therefore prone to recur. In the treatment of POKCs, the surrounding adhesions can also be removed. Microscopic excision should be performed as well. Highlights This is the first report on the primary and recurrence of POKCs in the buccal mucosa, with a long follow-up period. Complete excision is effective for POKCs, especially when the cyst wall is hard to separate from the surrounding tissue. Using a surgical microscope can improve separation accuracy and reduce damage to adjacent tissue.

Objectives Odontogenic keratocysts exhibit frequent recurrence, distinctive histopathological traits, a tendency towards aggressive clinical behavior, and a potential linkage to the nevoid basal cell carcinoma syndrome. The aim of this systematic review is to compile insights concerning the control of this condition and assess the effectiveness of various treatment approaches in reducing the likelihood of recurrence. Materials and methods The following systematic review adhered to the PRISMA guidelines. The systematic revision was registered on PROSPERO and  structured around the questions related to the population, intervention, control, outcome and study design (PICOS). Results After conducting a search on the PubMed database, we initially identified 944 records. After using end-note software to remove duplicate entries, results totally with 462 distinct records. A thorough review of the titles and abstracts of these articles led to the selection of 50 papers for in-depth examination. Ultimately, following the application of our eligibility criteria, we incorporated 11 articles into our primary outcome analysis. Conclusion Among the studies examined, the most common location for these lesions was found to be in the area of the mandibular ramus and the posterior region of the mandible. In cases where the exact location wasn’t specified, the mandible emerged as the predominant site. When we considered the characteristics of these lesions in studies that mentioned locularity, most were described as unilocular in two studies, while in two other studies, the prevalence of multilocular lesions was observed. Risk factors associated with keratocyst recurrence include younger patient age, the presence of multilocular lesions, larger lesion size, and a longer anteroposterior dimension. Certain treatment methods have demonstrated a lack of relapses. These include the use of 5-fluorouracil, marsupialization, enucleation with peripheral ostectomy or resection, enucleation and curettage, as well as resection without creating continuity defects. However, it is important to note that further research is essential. Prospective studies and randomized trials are needed to collect more comprehensive evidence regarding the effectiveness of various treatment approaches and follow-up protocols for managing odontogenic keratocysts. Clinical relevance Odontogenic keratocysts still enter into differential diagnoses with other lesions that affect the jaw bones such as ameloblastama and other tumor forms, furthermore it is not free from recurrence, therefore the therapeutic approach to the lesion aimed at its elimination can influence both the possible recurrence and complications, knowledge of the surgical methods that offer the most predictable and clinically relevant result for the management of follow-up and recurrences.

The effective management of odontogenic keratocyst (OKC) remains a subject of interest and confusion in the oral and maxillofacial surgery literature. Currently, there is a lack of consensus regarding the most appropriate treatment for patients with OKC. Of the various treatment options available, no modality to date has been shown to demonstrate a zero or near-zero recurrence rates except wide resection with clear margins. With the prevailing dearth of evidence based surgical protocols for the management of patients with OKC in the literature, this study aims to present a surgical algorithm, based on meta-analysis results, that hopefully will be beneficial in enhancing treatment of patients with this condition. Also, new meta-analysis was done to compare between modified Carnoy’s solution (MCS) and 5-fluorouracil (5-FU) in respect of recurrence rate of OKC. Using parameters like size, lesion type (primary or secondary), syndromic or solitary nature of the lesion, presence of cortical perforations, and locularity; we present a decision tree, to aid treatment planning and help attain the least chance of recurrence in the management of the OKC. There was very low-quality evidence indicating that application of 5-FU, after enucleation and peripheral ostectomy of OKCs, significantly lowered recurrence rate when compared to MCS (RR = 0.087, CI: 0.017 to 0.436, P value = 0.003).

Background This retrospective cohort study primarily assessed three-dimensional changes in mandibular jaw cysts over time following decompression surgery. Secondary aims included evaluating factors potentially affecting the monthly reduction rates and assessing intra- and interexaminer reliability in the measurements. Methods Patients who underwent decompression therapy for mandibular cysts and histopathological diagnosis were included. Cone-beam computed tomography (CBCT) scans obtained before decompression surgery (baseline CBCT) and prior to enucleation surgery (follow-up CBCT) were analyzed using a specialized 3D software to measure cyst dimensions based on preview and final lesion outlines by two examiners. Patient demographics, cyst types, localization, and cortical bone perforation were recorded and evaluated for their influence on dimensional change rates. Results Forty patients (15 females and 25 males) with a median age of 47 years (range: 11 to 76 years) and treated with decompression of radicular ( n  = 10), dentigerous ( n  = 14), botryoid ( n  = 1), or odontogenic keratocysts ( n  = 15) were analyzed. The lesions were predominantly located in the posterior mandible ( n  = 32) and exhibited single ( n  = 14), multiple ( n  = 17), or no cortical bone perforations ( n  = 9). Mean lesion volumes decreased from baseline (3764 mm³) to follow-up (1413 mm³, p  < 0.0001), corresponding to an average monthly volumetric reduction rate of -5.2%, without significant differences between the cyst types. Female and younger patients showed higher reduction rates ( p  ≤ 0.04), whilst localization and cortical bone perforation did not significantly influence the dimensional changes. Both inter- and intraexaminer reliability of measurements were high (intraclass correlation coefficients > 95%). Conclusions Decompression surgery is an effective first-stage treatment to reduce the dimensions of large mandibular odontogenic cysts. Within a range of limited clinical relevance, patient-related factors such as sex and age may influence dimensional changes, whereas lesion-specific characteristics did not. Cyst measurements on CBCT were consistent across observers, indicating good reproducibility.

Background The postoperative recurrence of mandibular odontogenic keratocyst (OKC) accompanied by secondary actinomycotic osteomyelitis is extremely rare and presents significant challenges in clinical diagnosis and treatment. This case study combines imaging, pathological data, and relevant literature to offer guidance for clinical management. Patient information A 21-years-old female patient underwent surgical treatment for a polycystic OKC of the mandible 4 years ago. She was hospitalized again due to sharp subgingival sensation under the labial gums in the mandibular anterior tooth area. Pathological examination revealed OKC and chronic actinomycetic osteomyelitis. Mandibular mass resection and curettage of chronic osteomyelitis were performed. Clindamycin was used continuously for 4 weeks after operation, and the prognosis was good. Conclusion OKC frequently recurs after surgery and can damage the oral mucosal barrier, potentially leading to actinomycotic osteomyelitis. Pathology is crucial for accurate diagnosis. Surgical resection of secondary OKC, and postoperative administration of standard antibiotics are effective treatment methods.

Objectives To assess changes and factors influencing in buccolingual width and cyst cavity depth at the stoma site during marsupialization with cyst plug decompression for jaw cystic lesions. Materials and methods Data were collected from patients who underwent marsupialization and cyst plug decompression for mandibular cystic lesions. A total of 15 cases were analyzed, including 10 odontogenic keratocysts (OKC), 1 unicystic ameloblastoma (UA), and 4 dentigerous cysts (DC). Cone beam computed tomography (CBCT) scans were conducted pre-surgery (T 0 ), three months post-surgery (T 1 ) and at the end of marsupialization (T 2 , > 2 months post-T 1 ). Three-dimensional models were created to analyze bone dimensional changes in buccolingual width, vertical depth, and cyst volume. Results The Friedman two-way rank analysis and subsequent pairwise comparisons demonstrated the cyst volume significantly decreased from T 0 to T 1 , T 1 to T 2 , respectively ( p  < 0.05). The buccolingual width remained basically unchanged from T 0 to T 1 ( p  = 0.423), but gradually decreasing from T 1 to T 2 ( p  < 0.001). Meanwhile, the cyst cavity depth consistently decreased throughout the study ( p  < 0.05). The Spearman rank correlation coefficient test indicated the final change in buccolingual width positively correlated with the initial width of the stoma site ( p  < 0.001). Conclusions Buccolingual width remains stable before decreasing, whereas cyst cavity depth and cyst volume decreases continuously. The larger the initial width of the stoma site, the greater change in width at the end of marsupialization. Clinical relevance During marsupialization, cyst plug modifications should align with bone remodeling patterns in jaw cystic lesions. Initially, only the plug’s depth is adjusted, while in later stages, both stoma width and depth are gradually reduced. This understanding can contribute to the digital prefabricated series of cyst plugs by integrating clinical insights to develop more minimally invasive treatment strategies and to appropriately lengthen the decompression period during marsupialization.

Background This 18-year retrospective analysis of pediatric odontogenic cysts reviewed characteristics, treatment approaches, and associated risks, including root canal treatment (RCT) and tooth extraction. Methods The clinical records of patients treated for odontogenic cysts between 2005 and 2023 included demographics, symptoms, radiographic findings, cyst size and location, histopathological diagnoses, treatment methods, and follow-up results were analyzed. Statistical analysis was performed using SPSS, with significance set at p  < 0.05. Results Among the 97 patient records analyzed, there were 43 females (44%), and 54 males (56%) with a mean age of 13.32 ± 3.55. The histopathological diagnosis were dentigerous cysts ( n  = 58, 60%), followed by radicular cysts ( n  = 28, 29%) and odontogenic keratocysts ( n  = 9, 9%), mainly in the posterior mandible. Root canal treatment (RCT) was performed in 18% of the patients, and 72% underwent extraction of at least one permanent tooth. The need for RCT and extraction was higher in larger cysts significantly ( p  = 0.013). The recurrence rate was low, occurring in 3.1% of with two cases of dentigerous cysts and one odontogenic keratocyst recurring, with an average follow-up of 46 months. Conclusion The findings suggest that mandibular posterior cysts in the pediatric population often needed tooth extraction, underscoring the importance of early diagnosis by radiographic screening to prevent complications. There is a need for multi-center collaboration and national registries for development of protocols and uniform treatment guidelines in pediatric population.

Odontogenic keratocyst (OKC) is a challenging jaw lesion known for its aggressive behavior and high recurrence rate. Concerns about the safety and effectiveness of existing adjuvant treatments have encouraged the search for safer alternatives such as 5-Fluorouracil (5-FU). This systematic review and meta-analysis evaluated the efficacy of 5-FU as an adjunctive therapy for OKC. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, a comprehensive search was conducted in PubMed, Embase, Scopus, and Google Scholar up to August 1, 2024. Eligible studies included OKC cases treated with 5-FU, alone or combined with surgery. Risk of bias was assessed using the Cochrane ROB-2 tool for randomized controlled trials and the Newcastle–Ottawa Scale for cohort studies. Data were pooled using inverse variance weighting, and heterogeneity was evaluated using the I² statistic. Fourteen studies (282 lesions) were included, comprising randomized controlled trials, cohort studies, and case reports of varying quality. Moderate heterogeneity was observed (I² = 37–57%). In five comparative studies, no recurrences occurred in the 5-FU group versus 24.21% in the modified Carnoy’s solution (MCS) group ( p  < 0.001). Postoperative paresthesia as also lower with 5-FU (18.82% vs. 37.89%, p  = 0.012). Compared with segmental resection, 5-FU achieved similar recurrence prevention but with much lower morbidity, including fewer permanent sensory deficits (9.09% temporary in 5-FU vs. 100% permanent in segmental resection, p  < 0.001). Bone density was significantly higher after 5-FU treatment than with enucleation alone ( p  < 0.001). No systemic or severe local side effects were reported. 5-FU appears to be a highly promising adjunctive therapy for OKC, offering effective recurrence prevention with minimal morbidity However, current evidence remains limited by small sample sizes, study heterogeneity, and non-randomized designs. Larger, well-designed trials with long-term follow-up are needed to confirm these findings.