Different Modalities of Management of Odontogenic Keratocysts

Study Overview
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Brief Summary
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Background The odontogenic keratocysts (OKCs) have been one of the maxillofacial region's most contentious pathological phenomena. Decompression/marsupialization (D/M), enucleation (E), enucleation + chemical cauterization with Carnoy's solution (E+CS), enucleation + peripheral ostectomy (E + PO), as opposed to enucleation + chemical cauterization with Carnoy's solution + peripheral ostectomy (E + CS + PO), were used during surgery to ensure that no epithelial remnants were left behind. Rationale Through the management of OKC a recurrence could occur, the effectiveness of Decompression/marsupialization (D/M), Enucleation (E), Enucleation+Carnoy's solution chemical cauterization (E+CS), Enucleation+peripheral ostectomy (E+PO), Enucleation+Carnoy's solution chemical cauterization + peripheral ostectomy (E+CS + PO), will be analyzed

Detailed Description
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Since the middle of the 20th century, the odontogenic keratocyst (OKC) has been one of the maxillofacial region's most contentious pathological phenomena. It was initially misdiagnosed as a primordial cyst. After that, because of its severe clinical behavior and tendency to recur, it was no longer considered to be a part of its classification, also known as a odontogenic tumor. Then, In 2017, the OKC are re-classified as a cystic lesion. But still there is debate about their management. So, this study will be enrolled with the following objectives: to describe how odontogenic keratocysts are managed, to Discover the most favorable approach to manage OKC with the need to stop it from happening again To categorize the odontogenic keratocyst management outcomes into to the subsequent groups: (1) total resolution, (2) partial resolution; (3) Recurrence.

Official Title
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Analysis of Odontogenic Keratocyst Treated With Various Modalities Over a 10-year

Conditions
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Odontogenic Cysts

Intervention / Treatment
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* Procedure: Enucleation+ Peripheral Ostectomy+Carnoy's solution chemical cauterization (E+CS + PO)
* Procedure: Decompression/ marsupialization (D/M)
* Procedure: Enucleation (E)
* Procedure: Enucleation+Carnoy's solution (E+CS)
* Procedure: Enucleation+ Peripheral Ostectomy (E+ PO)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All odontogenic keratocysts that are treated by the following surgical treatment modalities: Enucleation followed by peripheral ostectomy and Carnoy's solution Decompression/ marsupialization Enucleation Enucleation and Carnoy's solution Enucleation and Peripheral Ostectomy Follow-up period 10 years Exclusion Criteria: Cases treated with resection Cases showed neoplastic transformation in their pathology Cyst Like lesions

Ages Eligible for Study
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Minimum Age: 10 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: The patents will be divided into five groups according to the treatment modalities used to treat their odontogenic cysts
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Enucleation + Peripheral ostectomy + Carnoy's solution chemical cauterization (E+ PO+ CS)<br>The odontogenic keratocysts will be treated using enucleation, followed by peripheral ostectomy and then Carnoy's solution | Procedure: Enucleation+ Peripheral Ostectomy+Carnoy's solution chemical cauterization (E+CS + PO)<br>* The enucleation procedures, which were meticulously carried out in order to remove the odontogenic keratocyst in one piece without breaking its lining or leaving any epithelial remnants.The peripheral ostectomy treatment will be carried out with a large spherical bur and plenty of irrigation.After filling the bone cavity with more sterile gauze, the Carnoy's solution was slowly injected into it with a plastic syringe. The gauze was continuously injected with CS until it was fully saturated without leaking too much into the surrounding tissues. The CS was held in place for 3 minutes.<br>* Other names: (E + PO+ CS);|
| Experimental: Decompression/marsupialization (D/M)<br>The odontogenic keratocysts will be managed by either Decompression or marsupialization | Procedure: Decompression/ marsupialization (D/M)<br>* A surgical window will be created in the cyst wall to drain the contents while retaining continuity between the cyst and the oral cavity<br>* Other names: D/M;|
| Experimental: Enucleation (E)<br>The odontogenic keratocysts will only be managed by Enucleation (E) | Procedure: Enucleation (E)<br>* The enucleation will be accomplished in the same manner that it will be performed in the group of Enucleation+ Peripheral Ostectomy+Carnoy's solution chemical cauterization (E+ PO+ CS).<br>* Other names: E;|
| Experimental: Enucleation+Carnoy's solution (E+CS)<br>odontogenic keratocysts will be managed by Enucleation, followed by Carnoy's solution | Procedure: Enucleation+Carnoy's solution (E+CS)<br>* Both enucleation and Carnoy's solution will be carried out as planned in the group Enucleation+ Peripheral Ostectomy+Carnoy's solution chemical cauterization (E+ PO+ CS).<br>* Other names: (E+CS);|
| Experimental: Enucleation+ Peripheral Ostectomy (E+PO)<br>The odontogenic keratocysts will be treated using Enucleation, followed by peripheral ostectomy (E+PO) | Procedure: Enucleation+ Peripheral Ostectomy (E+ PO)<br>* Both enucleation and peripheral ostectomy will be carried out as planned in the group Enucleation+ Peripheral Ostectomy+ Carnoy's solution chemical cauterization (E+ PO+ CS).<br>* Other names: (E+PO);|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Healing period | The bone filling will monitored by using computed tomography scans | Starting from the postoperative third month up to the postoperative ninth month | 
| Measurement of the bony cavity | A presence of radiolucent area in the computed tomography scans | At the end of the postoperative ninth month | 
| Recurrence rate | The new occurrence of the previously removed odontogenic keratocyst will be documented | At the end of the postoperative fifth year | 
| Recurrence rate | The new occurrence of the previously removed odontogenic keratocyst will be documented | At the end of the postoperative tenth year | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Odontogenic cysts, Odontogenic Keratocysts