The keratocystic odontogenic tumour (KCOT, odontogenic keratocyst (OKC)) is classified as a benign odontogenic tumour. It most commonly occurs as a solitary lesion and accounts for between 2-11% of jaw cysts. Management of KCOTs is complicated by their tendency to recur with recurrence rates reports ranging from 3-60%. A range of treatments have been used, enucleation, marsupialisation often later followed by enucleation together with a range of adjunctive treatments, cryotherapy (freezing) with liquid nitrogen, the use of the fixative Carnoy’s solution,removal of the peripheral bone (ostectomy) or resection of the cyst with surrounding bone.

The aim of this review was to assess the available evidence comparing the effectiveness of interventions for the treatment of KCOTs.

Methods

Searches were conducted in the Cochrane Oral Health Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase the US National Institutes of Health Trials Register (http://clinicaltrials.gov) and the WHO Clinical Trials Registry Platform. There were no restrictions on the language or date of publication when searching the electronic databases. Randomised controlled trials (RCTs) comparing one modality of intervention with another with or without adjunctive treatment for the treatment of KCOTs were considered. Patients with known Gorlin syndrome were to be excluded. Two reviewers independently screened studies for inclusion.

Results

• No randomised controlled trials that met the inclusion criteria were identified.

Conclusions

The authors concluded:

There are no published randomised controlled trials relevant to this review question, therefore no conclusions could be reached about the effectiveness or otherwise of the interventions considered in this review. There is a need for well designed and conducted randomised controlled trials to evaluate treatments for KCOTs.

Comments

This is an update of a Cochrane review first published in 2010. Since that time will a number of other reviews have been published (Dental Elf -2^nd Jul 2014) but none of these have been able to draw on any randomised controlled trials to improve our knowledge on how best to manage this locally aggressive tumour. Most of the reviews have concluded that there is little evidence on which to base treatment approaches so as the authors of this review concluded these is a clear need for high quality RCTs on this topic.

Links

Primary paper

Sharif FNJ, Oliver R, Sweet C, Sharif MO. Interventions for the treatment of keratocystic odontogenic tumours. Cochrane Database of Systematic Reviews 2015, Issue 11. Art. No.: CD008464. DOI: 10.1002/14651858.CD008464.pub3.

Other references

Dental Elf – 2^nd Jul 2014 – Another review finds limited evidence for making treatment recommendations for keratocystic odontogenic tumors

Dental Elf – 28^th Mar 2012 – Keratocystic odontogenic tumour recurrence rates