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O.442 Is the keratocyst a benign cystic neoplasm?
120 Journal of Cranio-Maxillofacial Surgery 34(2006) Suppl. S1 colloquial language. Five children suffered from bilateral complete CLP, 13 children from unilateral complete CLP, and 7 had complete clefts of the hard and soft palate. In 13 children a twostage procedure was performed: at the age of 9–12 months an intravelar veloplasty for repair of the soft palate, and at the age of 24–36 months a bilateral bridge flap plasty for closure of the hard palate. In 12 children the same techniques were used in a one-stage procedure. Results: The children having a one-stage cleft repair showed less hypernasality and less nasal emission as those children having a two-stage repair. The colloquial language was more easily to understand. There were also slight differences in articulation errors and mimic. In both groups no velopharyngoplasty was necessary. Conclusion: The one-stage repair of cleft palate at the age of 9–12 months seems to have a more positive influence on speech development than the two-stage procedure.
Friday, 15 September 2006, 11.00−13.00
Hall 4
Odontogenic cysts and tumors O.441 Conservative treatment of large odontogenic keratocysts of the mandible ¨ A. Varol, Y. Ozkan, C. Sahin. ¸ Marmara University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Nisantasi-Istanbul, Turkey Introduction and Objectives: Various methods were described for treatment of odontogenic keratocysts (OKC). Surgery ranges from enucleation, Carnoy’s solution, crytherapy, aggressive curettage, decompression, secondary enucleation, Brosch procedure to boneresection. High recurrence rate and risk of malignant transformation of cyst lining obliges radical solutions. OKC can be treated in conservative manner without injuring vital structures and preventing recurrences. Materials and Methods: Two patients (a male and a female) with OKC were treated with decompression. The cysts were discovered incidentally during clinical examinations. CT and panaromic radiographs were obtained pre-operatively. OKC were localized between mandibular angles of both patients. All teeth of both patients were vital. Partial cortical perforation were detected in lingual and buccal sites. Decompressions were done with two windows in anterior mandible. The first patient had episodes of infection treated with administration of i.v. antibiotics. Lavage of intracystic cavity was continued for 1 year until the desired reduction of cystic cavity occurred. Late enucleation and curettage was performed under general anasthesia. Reconstruction of cyst defect was performed by tibial grafting for female patient. Gradual ossification of both OKCs cavities was observed with panaromic radiographs and CTs. Results: No complication occurred during overall treatment phases. All cyst cavities regenerated with new bone. Recurrence was not observed for a year. Conclusions: Decompression of large odontogenic keratocysts of mandible reduces cystic size therefore enables enucleation without damage to vital structures. The recurrence rate of decompressed cyst is reduced by transformation of cystic epithelium to less aggressive keratinized lining which makes easier secondary enucleation.
Abstracts, EACFMS XVIII Congress y Anatom´ıa Patol´ogica, Hospital Universitario Central de Asturias, Facultad de Medicina, Oviedo, Spain Introduction and Objectives: Recently, the classical odontogenic keratocyst has been regarded as a neoplasm, under the term of keratinizing cystic odontogenic tumour. The purpose of this paper is to provide arguments to support this neoplastic nature of odontogenic keratocyst. Material and Methods: We have study 20 odontogenic keratocyst (OK), 10 dentigerous cyst (DC), and 10 radicular, inflammatory cysts (IC), using immunohistochemical analysis of pancytokeratins, EGFR, Ki-67, and CEA. Results: The immunostaining positivities, and statistical analysis, were: (i) EGFR: 10 (50%) of OK, 4 (40%) of DC, 3 (30%) of IC (Fisher exact test = 1.125; p = 0.6); (ii) pancytokeratins: 20 (100%) of OK, 6 (60%) of DC, and 8 (80%) of IC (Fisher exact test = 8.545; p = 0.009); and (iii) CEA: 19 (95%) of OK, 3 (30%) of DC, and 0 (0%) of IC (Fisher exact test = 30.5; p = 0.0005). The proliferative index of cystic cells, measured by the immunostaining of Ki-67, and expressed as the mean of immunopositivity, was the following for the three studied entities: 38% (OK), 17% (DC), and 15.5% (IC) (ANOVA, F = 14.615; p < 0.0005; Kruskal–Wallis, p < 0.0005; Tukey HSD: OK vs DC, p < 0.0005; OK vs. IC, p < 0.0005; DC vs. IC, p = 0.9). Conclusions: OK shows a proliferative index higher than DC and IC. Expression of cytokeratins and carcinoembryonic antigen is also higher in OK than in the other studied cysts. O.443 Marsupialization or drainage of large keratocyst assists the nature in filling the bone defects of the jaws L.J. Stojcev-Stajcic1 , Z. Stajcic2 . 1 Faculty of Stomatology, Clinic of Oral Surgery 2 Dental/Medical Clinic of Maxillofacial Surgery, “Beograd-centar”, Belgrade, Serbia This article is intended to propose surgical protocol for the treatment of large keratocysts of the jaws based on the experience collected in 13 patients with 31 keratocysts. Of those 22 cysts were located in the mandible and 9 in the maxilla. Marsupialization was performed in all cysts in the maxilla and 3 cysts in the mandible by creating an opening into the cyst cavity and suturing the cyst lining to the adjacent vestibular mucosa. In the mandible, cyst cavities created after removal of the cyst lining that had been treated by Carnoy solution were drained by packing lightly the iodoform gauze into the cavity and pulling out the other end through the soft tissue tunnel that was created by placing an additional stab incision at the minimal distance of 2 cm from the surgical wound. The gauze was removed in stages at the fifth to seventh day after surgery. Both marsupialization and drainage prevented the formation of a ‘dead space’. Two cysts in the drainage group recurred and responded to the second procedure. In one case of drainage, the cavity in the body of the mandible became infected a month after the operation. Drainage showed best results for the cysts in the ramus and the angle of the mandible whereas marsupialization proved to be most efficient in the maxilla. Cyst defects were filled by the bone with quality that was sufficient to accommodate dental implants without the need for bone grafts. O.444 Gorlin syndrome: 2 case reports with extremely large odontogenic keratocysts
O.442 Is the keratocyst a benign cystic neoplasm?
L. Seres, A. Kovacs. Department of Oral and Maxillofacial Surgery, University of Szeged, Hungary
A. Torre Iturraspe, J.C. de Vicente, A.M. Guti´errez Palacios, M.F. Fresno Forcelledo. Servicios de Cirug´ıa Maxilofacial
Introduction and Objectives: Gorlin syndrome is an autosomal dominant cancer disease with a rare incidence. Diagnostic
Friday, 15 September 2006, 11.00−13.00
Hall 4
Odontogenic cysts and tumors O.441 Conservative treatment of large odontogenic keratocysts of the mandible ¨ A. Varol, Y. Ozkan, C. Sahin. ¸ Marmara University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Nisantasi-Istanbul, Turkey Introduction and Objectives: Various methods were described for treatment of odontogenic keratocysts (OKC). Surgery ranges from enucleation, Carnoy’s solution, crytherapy, aggressive curettage, decompression, secondary enucleation, Brosch procedure to boneresection. High recurrence rate and risk of malignant transformation of cyst lining obliges radical solutions. OKC can be treated in conservative manner without injuring vital structures and preventing recurrences. Materials and Methods: Two patients (a male and a female) with OKC were treated with decompression. The cysts were discovered incidentally during clinical examinations. CT and panaromic radiographs were obtained pre-operatively. OKC were localized between mandibular angles of both patients. All teeth of both patients were vital. Partial cortical perforation were detected in lingual and buccal sites. Decompressions were done with two windows in anterior mandible. The first patient had episodes of infection treated with administration of i.v. antibiotics. Lavage of intracystic cavity was continued for 1 year until the desired reduction of cystic cavity occurred. Late enucleation and curettage was performed under general anasthesia. Reconstruction of cyst defect was performed by tibial grafting for female patient. Gradual ossification of both OKCs cavities was observed with panaromic radiographs and CTs. Results: No complication occurred during overall treatment phases. All cyst cavities regenerated with new bone. Recurrence was not observed for a year. Conclusions: Decompression of large odontogenic keratocysts of mandible reduces cystic size therefore enables enucleation without damage to vital structures. The recurrence rate of decompressed cyst is reduced by transformation of cystic epithelium to less aggressive keratinized lining which makes easier secondary enucleation.
Abstracts, EACFMS XVIII Congress y Anatom´ıa Patol´ogica, Hospital Universitario Central de Asturias, Facultad de Medicina, Oviedo, Spain Introduction and Objectives: Recently, the classical odontogenic keratocyst has been regarded as a neoplasm, under the term of keratinizing cystic odontogenic tumour. The purpose of this paper is to provide arguments to support this neoplastic nature of odontogenic keratocyst. Material and Methods: We have study 20 odontogenic keratocyst (OK), 10 dentigerous cyst (DC), and 10 radicular, inflammatory cysts (IC), using immunohistochemical analysis of pancytokeratins, EGFR, Ki-67, and CEA. Results: The immunostaining positivities, and statistical analysis, were: (i) EGFR: 10 (50%) of OK, 4 (40%) of DC, 3 (30%) of IC (Fisher exact test = 1.125; p = 0.6); (ii) pancytokeratins: 20 (100%) of OK, 6 (60%) of DC, and 8 (80%) of IC (Fisher exact test = 8.545; p = 0.009); and (iii) CEA: 19 (95%) of OK, 3 (30%) of DC, and 0 (0%) of IC (Fisher exact test = 30.5; p = 0.0005). The proliferative index of cystic cells, measured by the immunostaining of Ki-67, and expressed as the mean of immunopositivity, was the following for the three studied entities: 38% (OK), 17% (DC), and 15.5% (IC) (ANOVA, F = 14.615; p < 0.0005; Kruskal–Wallis, p < 0.0005; Tukey HSD: OK vs DC, p < 0.0005; OK vs. IC, p < 0.0005; DC vs. IC, p = 0.9). Conclusions: OK shows a proliferative index higher than DC and IC. Expression of cytokeratins and carcinoembryonic antigen is also higher in OK than in the other studied cysts. O.443 Marsupialization or drainage of large keratocyst assists the nature in filling the bone defects of the jaws L.J. Stojcev-Stajcic1 , Z. Stajcic2 . 1 Faculty of Stomatology, Clinic of Oral Surgery 2 Dental/Medical Clinic of Maxillofacial Surgery, “Beograd-centar”, Belgrade, Serbia This article is intended to propose surgical protocol for the treatment of large keratocysts of the jaws based on the experience collected in 13 patients with 31 keratocysts. Of those 22 cysts were located in the mandible and 9 in the maxilla. Marsupialization was performed in all cysts in the maxilla and 3 cysts in the mandible by creating an opening into the cyst cavity and suturing the cyst lining to the adjacent vestibular mucosa. In the mandible, cyst cavities created after removal of the cyst lining that had been treated by Carnoy solution were drained by packing lightly the iodoform gauze into the cavity and pulling out the other end through the soft tissue tunnel that was created by placing an additional stab incision at the minimal distance of 2 cm from the surgical wound. The gauze was removed in stages at the fifth to seventh day after surgery. Both marsupialization and drainage prevented the formation of a ‘dead space’. Two cysts in the drainage group recurred and responded to the second procedure. In one case of drainage, the cavity in the body of the mandible became infected a month after the operation. Drainage showed best results for the cysts in the ramus and the angle of the mandible whereas marsupialization proved to be most efficient in the maxilla. Cyst defects were filled by the bone with quality that was sufficient to accommodate dental implants without the need for bone grafts. O.444 Gorlin syndrome: 2 case reports with extremely large odontogenic keratocysts
O.442 Is the keratocyst a benign cystic neoplasm?
L. Seres, A. Kovacs. Department of Oral and Maxillofacial Surgery, University of Szeged, Hungary
A. Torre Iturraspe, J.C. de Vicente, A.M. Guti´errez Palacios, M.F. Fresno Forcelledo. Servicios de Cirug´ıa Maxilofacial
Introduction and Objectives: Gorlin syndrome is an autosomal dominant cancer disease with a rare incidence. Diagnostic