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Table 14.2 Major and minor criteria to establish the diagnosis of BCNS based on the consensus statement from the rst international colloquium on BCNS

Major criteria Minor criteria

First degree relative with BCNS Rib anomalies BCC prior to 20years old or excessive

numbers of BCCs out of proportion to prior sun exposure and skin type

Odontogenic keratocyst of the jaw prior to 20years old

Palmar or plantar pitting Cleft/lip palate Lamellar calcication of the falx cerebri Ovarian/cardiac broma Medulloblastoma/neuroectodermal tumor,

typically desmoplastic

This is a new major criterion that has led to the early establishment of the BCNS diagnosis as this

is a nding typically diagnosed at 2years or younger

Skeletal malformations and radiologic changes (i.e., vertebral anomalies, kyphoscoliosis, short fourth metacarpals, and postaxial polydactyly)

Macrocephaly

Lympho-mesenteric cysts Ocular abnormalities (i.e., strabismus,

hypertelorism, congenital cataracts, glaucoma, and coloboma)

M. A. Timoshchuk and W. Zaid

from environmental factors such as ultraviolet light and radiation. The inherited PTCH1 mutation is transmitted as autosomal-dominant inheritance with high penetrance and inconstant expressivity leading to broad phenotypic presentation [26, 27].

Dened by Gorlin and Goltz in 1960, the classical facial features that are present in 60% of patients with BCNS include frontal bossing, macrocephaly, overall coarse facial features, and facial milia [28]. Clinical and radiographic ndings are often utilized in numerous combinations as diagnostic criteria. These ndings have been classied as major and minor criteria, and they are summarized in Table14.2. The consensus from the BCNS Life Support Network suggested that a diagnosis of BCNS can be established in the following scenarios:

• The presence of one major criterion with molecular conrmation

• Two major criteria

• One major with three minor features

Despite the perception that genetic testing is the gold standard for diagnosis, it is not recommended and is rarely performed in clinical practice due to its elevated cost.

Treatment ofOKC

Before diving into the treatment of OKC as surgeons, we need to understand the recurrence rate, which is reportedly between 7% and 28% after surgical treatment [29]. This recurrence rate has been attributed to various causes: the persistence of residual epithelium, the retention of daughter cysts in the walls of the original cysts or from microcysts, and the continuous intrinsic epithelial proliferation due to genetic mutation. Most recurrences occur before 5years and decrease with time

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[30, 31]. There are three primary surgical treatments employed for OKC: marsupialization and decompression, enucleation, and en bloc resection. Along with these surgical techniques, there are four main adjunct techniques to help reduce the recurrence rate and they are peripheral ostectomy, Carnoy’s and modied Carnoy’s solution, cryosurgery with liquid nitrogen, and 5-FU.When treatment planning a lesion that is biopsy-proven or highly suspicious for OKC, it is important to consider the timeline for dental rehabilitation. Due to the high recurrence rate of OKC, it is typically recommended to postpone reconstructive treatments until after cyst excision or a period of decompression, though there have been successful case reports of bone grafting and immediate implant placement after enucleation [32, 33]. Bone grafting has the advantage of stabilizing the blood clot, provides osteoconductive properties increasing the migration of progenitor cells, and can potentially reduce the risk of pathologic fracture. However, bone grafting can be a potential source of infection and OKCs have been shown to recur in grafted sites leading to costly and stressful re-treatment for patients [34].

In a multicenter study performed by Lim etal., 305 cysts that had undergone enucleation and simultaneous bone grafting were retrospectively investigated for factors associated with bone graft failure [35]. Bone graft failure was observed in 48 cases (15.7%) with a mean duration of surgery time to failure of 38.7days. Graft failure was associated with younger age, smoking, preoperative infection, large cysts, impaction of the mandibular third molar in the cystic cavity, perilesional sclerosis, and the use of mixed non-autogenous and autogenous bone grafts. Similarly, Chacko etal. evaluated 44 consecutive patients with large maxillary and mandibular cysts, 20 of which were OKCs, treated with either enucleation or marsupialization with an average max lesion dimension of 58.2mm in max dimension and follow-up of 6months [36]. Uneventful healing and spontaneous lling of the residual cavities were obtained in all cases. Without the use of bone grafts, radiodensity of the cystic cavity recovers approximately 25% at 6months, 58% at 9months, 88% at 12months, and 91–100% at 2years [36, 37]. If bone grafting is not used, a period of 9–12months is typically recommended depending on the original lesion size and patient factors and comorbidities before pursuing implant treatment. When considering dental rehabilitation with a lesion biopsy-proven or concerning for OKC, the patient must be informed of the risk of recurrences and weigh these with early return to function.

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Marsupialization andDecompression

The concept of marsupialization and decompression was introduced by the German surgeon Partsch, who historically proposed marsupialization as a denitive treatment of cysts. Decompression involves any modality that relieves the pressure within the cyst that causes its expansion. It is alleged that cyst growth occurs from osmotic pressure and pressure resorption of the adjacent bone associated with prostaglandins and growth factors [38, 39]. The other signicant advantage of marsupialization and decompression is the change in the local intracystic microenvironment

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by decreasing interleukin-α. Surgeons who advocate for this procedure attest to some of the benets associated with this treatment modality, such as diminishing the cyst size and shrinking the cyst away from critical structures.

Technically, when performing a marsupialization, the surgeon needs to enter the cyst lumen and attempt to create a continuous pouch between the cyst lining and oral mucosa by suturing the cyst lining to the adjacent mucosa. The decision to marsupialize a cyst could be done during the incisional biopsy. As denitive management of OKC, marsupialization is associated with a 32.3% recurrence rate. Kolkythas etal. investigated whether decompression is associated with increased recurrence by comparing 22 patients with OKC treated either by (1) enucleation with peripheral ostectomy or resection or (2) decompression followed by enucleation and peripheral ostectomy [40]. The study found two recurrences in the decompression group compared to no recurrences in the enucleation and peripheral ostectomy group. Both recurrences, however, were themselves recurrent lesions that had previously undergone enucleation. This high recurrence rate has led clinicians to avoid marsupialization as the only surgical modality. Instead, clinicians favor combining residual cyst enucleation after the initial decompression, an approach that has reduced the recurrence rate down to 14.6% [41].

M. A. Timoshchuk and W. Zaid

Enucleation

The denition of enucleation is to try to create a plain of separation between the cyst and the surrounding bone while preserving the surrounding osseous infrastructure. Ideally, we advocate for the cyst to be enucleated in its entirety, something that allows the pathologist to study the complete specimen. Given the lining of OKC is typically 5–6 cells thick, enucleating the cyst lining may be friable and can cause the cyst to be enucleated in pieces, especially if the cyst did not undergo previous marsupialization. Ideally, at the end of the enucleation procedure, the bone cavity should be clean from any cyst lining. The recurrence rate of enucleation alone as a surgical modality of OKC is approximately 23.1%; however, enucleation in conjunction with adjuvant therapy decreases the recurrence rate down to 11.5–17.5% [41].

En Bloc Resection

En bloc resection with or without vascularized ap reconstruction is a treatment typically reserved for cases with multiple recurrences, possibly syndromic cases, or those that have undergone malignant transformation [41, 42]. Depending on the size of the lesion, the continuity of the mandible may be preserved by performing a marginal resection. This technique results in very low recurrence rates (0–8.4%) but

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has a much higher patient morbidity fueling surgeons to nd more conservating measures that can achieve similar recurrence outcomes [41, 43, 44]. Gosau et al. reported similar recurrence rates with enucleation with Carnoy’s solution and curettage when compared to that of resection [45]. Lone etal. found a high rate of recurrence in their institution with enucleation and Carnoy’s (66.6%); however, there were no recurrences in either the peripheral ostectomy with the 5-FU group or the segmental resection group [46]. Although radical resection remains the most certain option for obtaining the lowest recurrence rate compared to other modalities, it produces signicant morbidity with functional and aesthetic compromises and is typically reserved for select cases.

Since the bula free ap was introduced, the development of computer-assisted surgery has greatly increased the accuracy of mandibular reconstruction [47]. Computer-aided design and computer-aided manufacturing (CADCAM) allows surgeons to create personalized surgical devices and physical models, which greatly increases the accuracy of bula osteotomies with respect to mandibular resections. The “Jaw in a Day” (“JIAD”) technique consists of completing a virtually guided resection, a bula reconstruction, and the insertion of an implant-retained dental prosthesis all in one operation with assistance from CADCAM technology. This technique establishes immediate restoration of form and function. The immediate xation of the dental prosthesis also allows the patient to start dental rehabilitation in the early postoperative period. This technique will be described in greater detail in a separate chapter of this textbook.

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Adjunct Therapy

This is a group of surgical steps the surgeon usually performs after the completion of the enucleation procedure, and this can be subclassied into mechanical and chemical modalities.

Peripheral Ostectomy

With this procedure, the surgeon aims to mechanically eliminate any remnants of the cyst wall or any satellite cysts by removing the bone adjacent to the cystic lining. Rotary instruments are gently applied against the cyst wall. This maneuver reduces the risk of recurrence from 23.1% to 17.5% [41, 48]. Despite the simplicity of the peripheral ostectomy maneuver, this cannot be employed in every OKC case, especially with larger cysts approaching the inferior border of the mandible or with large cysts that are prone to a pathologic fracture by just enucleation of the cyst, thin lingual cortex, or proximity to adjacent teeth.

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M. A. Timoshchuk and W. Zaid

Carnoy’s Solution andModied Carnoy’s Solution

Carnoy’s solution was proposed by Cutler and Zollinger back in 1933 as a xative solution, hemostatic agent, and sclerosing agent, for the treatment of cervical cysts and stulas in general surgery literature. Voorsmit was the rst to describe the use of Carnoy’s solution as an adjunct therapy in the management of OKC.The solution was a mixture of 6mL of 100% alcohol/ethanol that allowed hardening of the tissue by the shrinking process, 3mL of chloroform to increase the xation speed, 1mL of glacial acetic acid that led to tissue swelling to prevent over-hardening of the tissues, and 1g of ferric chloride that helped with dehydration. The time-dependent penetration of Carnoy’s solution was a double-edged sword: it penetrated the bone adjacent to the enucleated cyst allowing xation of OKC remnant lining or daughter cysts, but it also possessed a risk of nerve injury, approximately 55% [46]. The recommended application time of Carnoy’s solution was between 3 and 5min. It is expected that with a 5-min application cycle of Carnoy’s solution, there will be nerve penetration of 0.15mm, 0.51mm mucosal penetration, and approximately

1.54mm bony penetration [49–51]. With all these properties, Carnoy’s solution has proven to be a successful adjunct modality to decrease the recurrence rate of OKC between 4.5% and 11.5% [41, 52]. In 2013, the FDA Compliance Policy Guide prohibited the use of chloroform as it was proven to be carcinogenic and a reproductive toxic agent that led to the abandoning of classical Carnoy’s solution that contained chloroform. This development pushed surgeons to explore the use of modied Carnoy’s solution, which did not contain chloroform. When compared to classical Carnoy’s solution, modied Carnoy’s solution only decreased the recurrence rate of OKC to 35–45% [31]. Donnelly et al. found a similar recurrence rate reduction between classical and modied Carnoy’s solution. It should be noted, however, that the group performed extractions of any necessary teeth, enucleation, peripheral ostectomy, and a 3-min application of either classical or modied Carnoy’s solution when showing a comparable recurrence rate of 14% [53].

Cryosurgery Using Liquid Nitrogen

Cryosurgery affects the cellular organic component of the contacted bone while maintaining the inorganic osseous framework [54]. Cryosurgery is usually effective when the temperature is below -20°C as this leads to the formation of ice crystals, which cause damage to the intracellular and extracellular components, osmotic disturbance, and electrolyte imbalance. Cryosurgery is useful after conventional enucleation is performed and then the treatment is applied to the surrounding bony bed [55, 56]. It is expected that 1min of cryosurgery results in approximately 1–3mm of penetration necrosis. Cryosurgery might be associated with normal local surgical bed complications like wound dehiscence, swelling, pain, local infection, and even weakening bone, which may result in pathologic fractures [31, 56].

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Bell and Derick described their cryosurgery technique as follows: after meticulous enucleation with peripheral ostectomy, the osseous bed of the OKC is isolated. Next, malleable retractors are positioned and sponges of gauze are used to insulate the soft tissues from the bony bed. Finally, with the use of the ladle and funnel, the liquid nitrogen is carefully transported to the OKC osseous bed, and a recommended three rounds of freeze-thaw are performed [55]. Cryotherapy has a higher recurrence rate than Carnoy’s solution, approximately 30%, but that is followed by a steep negative gradient over time; this same trend is observed with modied Carnoy’s [31, 56].

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5-FU

5-FU is a chemotherapy agent classied under the antimetabolic class that was rst formulated by Heidelberger, Pleven, and Duschinsky in 1957 [31, 57]. 5-FU has various mechanisms of action: rst by inhibiting the enzyme thymidylate synthase and second by misincorporation of uorinated nucleoside into both RNA and DNA instead of uracil. Inamed OKCs are associated with low thymidylate synthase and high thymidine phosphorylase and therefore may benet more from 5-FU application than non-inamed OKCs [58, 59]. Additionally, 5-FU induces cell apoptosis by downregulating the SHH pathway and SMO inhibition [60]. As discussed above, the SHH signaling pathway dysregulation has been identied as the driving factor for the development of multiple basal cell carcinomas in syndromic and nonsyndromic OKCs, and its treatment as a topical application for basal cell carcinoma is well established. Clinically, 5% 5-FU is used by coating a ribbon gauze and placing it in the cystic cavity after enucleation to be removed 24h postoperatively. The advantage of using the topical form is avoiding the side effects associated with systemic use of 5-FU such as mucositis, nausea, pancytopenia, cardiac toxicity, neuropathy, and death. The main contraindication for using any form of 5-FU is dihydropyrimidine dehydrogenase (DPD) deciency, which is the initial and ratelimiting enzyme in the catabolism of 5-FU, thus placing patients at high risk for developing severe 5-FU-associated toxicity. DPD deciency is seen in approximately 3–5% of the general population and up to three times higher in the AfricanAmerican female population, though how this translates to topical application as seen with OKC treatment is still unknown [61].

In a retrospective review conducted by Caminiti etal., 34 patients were treated with 5% topical 5-FU compared to 36 managed with modied Carnoy’s solution after enucleation and peripheral ostectomy. The median follow-up time was 22months in the 5-FU group and 27months in modied Carnoy’s group. No recurrences were identied in the 5-FU group compared to nine recurrences in modied Carnoy’s solution cohort. There were no differences in the incidence of permanent nerve paresthesia between groups [62].

5-FU has been shown to be safe around vital structures. Five percent 5-FU application twice weekly for 1 month after medial maxillectomy and

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sphenoethmoidectomy showed no adverse effects on the infraorbital nerve or sinus mucosa [63, 64]. Lone etal. compared 9 patients treated with enucleation and modied Carnoy’s solution and 11 with enucleation, peripheral ostectomy, and 5-FU with an average follow-up of 3.5years. Five percent 5-FU application was associated with 9% temporary paresthesia and 0 recurrences compared to modied Carnoy’s solution, which had 44% temporary paresthesia, 11% permanent paresthesia, and a 66.6% recurrence rate. Both 5-FU and modied Carnoy’s solution were not associated with any function or cosmetic adverse events [46]. While mucosal absorption rates of 5% 5-FU are currently unclear, 20mg/kg is the reported threshold for toxicity development providing a wide safety prole with the average 70kg patient requiring 1400mg of 5-FU to develop toxicity [31, 65].

In the authors’ experiences, 5-FU is often more accessible than modied Carnoy’s solution and technically simpler than cryotherapy allowing for reduced operating time. For biopsy-proven OKCs at our institution, patients are treated with a combination of enucleation +/− peripheral ostectomy and topical 5-FU application. During the treatment planning appointment, a script for 5% uorouracil (Efudex) cream is provided and the patient presents to their surgery date with their prescription. Enucleation of the cyst in its entirety is performed along with concomitant through peripheral ostectomy and then non-compressed Gelfoam impregnated with 5% 5-FU is packed in the surgical bed and excess 5-FU is removed and closure is performed in the standard fashion (Fig.14.2). This technique eliminates the need to

a b

Fig. 14.2 Description of the LSU 5-FU application technique. (a) Mandibular OKC postenucleation. (b) Peripheral ostectomy. (c) Non-compressed Gelfoam impregnated with 5% 5-FU. (d) Packing the cyst bed with Gelfoam impregnated with 5% 5-FU

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remove the impregnated ¼-in. gauze with 5-FU 24h after the original application of the technique that was described by Caminiti etal. [62].

While studies are few, they are promising showing decreased morbidity and recurrence compared to modied Carnoy’s solution. Despite promising initial data, there is currently an insufcient quantity and follow-up to determine long-term recurrence rates and efcacy to make denitive conclusions regarding the effectiveness of this technique and the most appropriate protocol for its use in OKC management.

References

1. Soluk-tekkesin M, Wright JM.The world health organization classication of odontogenic lesions: a summary of the changes of the 2022 (5th) edition. Turk J Pathol. 2022;38:168–84.

2. Wright JM, Vered M. Update from the 4th edition of the World Health Organization Classication of head and neck tumours: odontogenic and maxillofacial bone tumors. Head Neck Pathol. 2017;11:68–77.

3. Philipsen HP, Reichart PA, Nikai H, Takata T, Kudo Y.Peripheral ameloblastoma: biological prole based on 160 cases from the literature. Oral Oncol. 2001;37:17–27.

4. Dissanayake RKG, Jayasooriya PR, Siriwardena DJL, Tilakaratne WM.Review of metastasizing (malignant) ameloblastoma (METAM): pattern of metastasis and treatment. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011;111:734–41.

5. Allen ECM, Henderson JM, Sonnet JR, Schlesinger C, Ord RA. Pulmonary metastasis of ameloblastoma: case report and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2013;88:170–6.

6. Jayasooriya PR, Abeyasinghe WAMUL, Liyanage RLPR, Uthpali GN, Tilakaratne WM.Diagnostic enigma of adenoid ameloblastoma: literature review based evidence to consider it as a new sub type of ameloblastoma. Head Neck. Pathology. 2022;16:344–52.

7. Adorno-Farias D, etal. Ameloblastoma with adenoid features: a series of eight cases. Acta Histochem. 2018;120:468–76.

8. Almeida RAC, Andrade ESS, Barbalho JC, Vajgel A, Vasconcelos BCE.Recurrence rate following treatment for primary multicystic ameloblastoma: systematic review and meta- analysis. Int J Oral Maxillofac Surg. 2016;45:359–67.

9. Brown NA, etal. Activating FGFR2–RAS–BRAF mutations in ameloblastoma. Clin Cancer Res. 2014;20:5517–26.

10. Cha YH, etal. Frequent oncogenic BRAF V600E mutation in odontogenic keratocyst. Oral Oncol. 2017;74:62–7.

11. Sweeney RT, etal. Identication of recurrent SMO and BRAF mutations in ameloblastomas. Nat Genet. 2014;46:722–5.

12. Kurppa KJ, et al. High frequency of BRAF V600E mutations in ameloblastoma. J Pathol. 2014;232:492–8.

13. Flaherty KT, etal. Inhibition of mutated, activated BRAF in metastatic melanoma. New Engl J Med. 2010;363:809–19.

14. Shi HA, Ng CWB, Kwa CT, Sim QXC.Ameloblastoma: a succinct review of the classication, genetic understanding and novel molecular targeted therapies. Surgery. 2020;19:238–43.

15. Fernandes GS, Girardi DM, Bernardes JPG, Fonseca FP, Fregnani ER.Clinical benet and radiological response with BRAF inhibitor in a patient with recurrent ameloblastoma harboring V600E mutation. BMC Cancer. 2018;18:887.

16. Broudic-Guibert M, et al. Persistent response to vemurafenib in metastatic ameloblastoma with BRAF mutation: a case report. J Med Case Rep. 2019;13:245.

272

https://t.me/medicina_free

17. Tan S, Pollack JR, Kaplan MJ, Colevas AD, West RB.BRAF inhibitor treatment of primary BRAF-mutant ameloblastoma with pathologic assessment of response. Oral Surg Oral Med Oral Pathol Oral Radiol. 2016;122:e5–7.

18. Faden DL, Algazi A.Durable treatment of ameloblastoma with single agent BRAFi Re: clinical and radiographic response with combined BRAF-targeted therapy in stage 4 ameloblastoma. J Natl Cancer Inst. 2017;109:djw190.

19. Kaye FJ, Ivey AM, Drane WE, Mendenhall WM, Allan RW. Clinical and radiographic response with combined BRAF-targeted therapy in stage 4 ameloblastoma. J Natl Cancer Inst. 2015;107:dju378.

20. Brunet M, Khalifa E, Italiano A.Enabling precision medicine for rare head and neck tumors: the example of BRAF/MEK targeting in patients with metastatic ameloblastoma. Front Oncol. 2019;9:1204.

21. Neville BW, Chi AC, Damm DD, Allen CM.Oral and maxillofacial pathology. Amsterdam: Elsevier Health Sciences; 2015. https://doi.org/10.1016/b978- 1- 4557- 7052- 6.00022- 0.

22. Gaitán-Cepeda L, Quezada-Rivera D, Tenorio-Rocha F, Leyva-Huerta E.Reclassication of odontogenic keratocyst as tumour. Impact on the odontogenic tumours prevalence. Oral Dis. 2010;16:185–7.

23. Agaram NP, etal. Molecular analysis to demonstrate that odontogenic keratocysts are neoplastic. Arch Pathol Lab Med. 2004;128:313–7.

24. Bree AF, Shah MR, Group BC.Consensus statement from the rst international colloquium on basal cell nevus syndrome (BCNS). Am J Med Genet A. 2011;155:2091–7.

25. Zwaan SED, Haass NK.Genetics of basal cell carcinoma: basal cell carcinoma genetics. Austr J Dermatol. 2009;51:81–92.

26. Lam C, Ou JC, Billingsley EM. “PTCH”-ing it together: a basal cell nevus syndrome review. Dermatol Surg. 2013;39:1557–72.

27. Bresler SC, Padwa BL, Granter SR.Nevoid basal cell carcinoma syndrome (Gorlin Syndrome). Head Neck Pathol. 2016;10:119–24.

28. Gorlin RJ, Goltz RW.Multiple nevoid basal-cell epithelioma, jaw cysts and bid rib— a syndrome. New Engl J Med. 1960;262:908–12.

29. Antonoglou GN, Sándor GK, Koidou VP, Papageorgiou SN.Non-syndromic and syndromic keratocystic odontogenic tumors: systematic review and meta-analysis of recurrences. J Cranio-Maxillofac Surg. 2014;42:e364–71.

30. Fidele N-B, et al. Recurrence of odontogenic keratocysts and possible prognostic factors: review of 455 patients. Med Oral Patol Oral Y Cirug Bucal. 2019;24:e491–501.

31. Tay ZW, Sue WL, Leeson RMA.Chemical adjuncts and cryotherapy in the management of odontogenic keratocysts: a systematic review. Adv Oral Maxillofac Surg. 2021;3:100116.

32. Isler SC, Demircan S, Can T, Cebi Z, Baca E. Immediate implants after enucleation of an odontogenic keratocyst: an early return to function. J Oral Implantol. 2012;38:485–8.

33. Silva AGD, Alves M, Amorim M.Immediate implant following odontogenic keratocyst enucleation– clinical case. Clin Oral Implants Res. 2019;30:395.

34. Ogunsalu C, etal. Odontogenic keratocyst in Jamaica: a review of ve new cases and ve instances of recurrence together with comparative analyses of four treatment modalities. West Indian Med J. 2007;56:90–5.

35. Lim H-K, Kim J-W, Lee U-L, Kim J-W, Lee H.Risk factor analysis of graft failure with concomitant cyst enucleation of the jaw bone: a retrospective multicenter study. J Oral Maxillofac Surg. 2017;75:1668–78.

36. Chacko R, Kumar S, Paul A, Arvind. Spontaneous bone regeneration after enucleation of large jaw cysts: a digital radiographic analysis of 44 consecutive cases. J Clin Diagn Res. 2015;9:ZC84-9.

37. Chiapasco M, Rossi A, Motta JJ, Crescentini M.Spontaneous bone regeneration after enucleation of large mandibular cysts: a radiographic computed analysis of 27 consecutive cases. J Oral Maxillofac Surg. 2000;58:942–8.

M. A. Timoshchuk and W. Zaid

14 Advancements inMaxillofacial Benign Tumors andCysts

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38. Pogrel MA.Decompression and marsupialization as a treatment for the odontogenic keratocyst. Oral Maxillofac Surg Clin. 2003;15:415–27.

39. Harris M.Odontogenic cyst growth and prostaglandin-induced bone resorption. Ann R Coll Surg. 1978;60:85–91.

40. Kolokythas A, Fernandes RP, Pazoki A, Ord RA.Odontogenic keratocyst: to decompress or not to decompress? A comparative study of decompression and enucleation versus resection/ peripheral ostectomy. J Oral Maxillofac Surg. 2007;65:640–4.

41. Al-Moraissi EA, etal. What surgical treatment has the lowest recurrence rate following the management of keratocystic odontogenic tumor?: a large systematic review and meta-analysis. J Cranio-Maxillofac Surg. 2017;45:131–44.

42. Zaid WY, Alshehry S, Zakhary G, Yampolsky A, Kim B.Use of vascularized myo-osseous bula free ap to reconstruct a hemimandibular defect with a concomitant skull defect arising from stock condylar prosthesis displacement into the middle cranial fossa. J Oral Maxillofac Surg. 2019;77(1316):e1–1316.e12.

43. Kaczmarzyk T, Mojsa I, Stypulkowska J.A systematic review of the recurrence rate for keratocystic odontogenic tumour in relation to treatment modalities. Int J Oral Maxillofac Surg. 2012;41:756–67.

44. Chrcanovic BR, Gomez RS.Recurrence probability for keratocystic odontogenic tumors: an analysis of 6427 cases. J Cranio-Maxillofac Surg. 2017;45:244–51.

45. Gosau M, et al. Two modications in the treatment of keratocystic odontogenic tumors (KCOT) and the use of Carnoy’s solution (CS)—a retrospective study lasting between 2 and 10 years. Clin Oral Investig. 2010;14:27–34.

46. Lone PA, Wani NA, Janbaz ZA, Bibi M, Kour A.Topical 5-uorouracil application in management of odontogenic keratocysts. J Oral Biol Craniofac Res. 2020;10:404–6.

47. Levine JP, etal. Jaw in a day: total maxillofacial reconstruction using digital technology. Plast Reconstr Surg. 2013;131:1386–91.

48. Cassoni A, etal. Keratocystic odontogenic tumor surgical management: retrospective analysis on 77 patients. Eur J Inamm. 2013;12:209–15.

49. Voorsmit RACA, Stoelinga PJW, van Haelst UJGM. The management of keratocysts. J Maxillofac Surg. 1981;9:228–36.

50. Lal B, etal. Role of Carnoy’s solution as treatment adjunct in jaw lesions other than odontogenic keratocyst: a systematic review. Br J Oral Maxillofac Surg. 2021;59:729–41.

51. Cutler EC, Zollinger R.The use of sclerosing solutions in the treatment of cysts and stulae. Am J Surg. 1933;19:411–8.

52. Dashow JE, etal. Signicantly decreased recurrence rates in keratocystic odontogenic tumor with simple enucleation and curettage using Carnoy’s versus modied Carnoy’s solution. J Oral Maxillofac Surg. 2015;73:2132–5.

53. Donnelly LA, etal. Modied Carnoy’s compared to Carnoy’s solution is equally effective in preventing recurrence of odontogenic keratocysts. J Oral Maxillofac Surg. 2021;79:1874–81.

54. Bradley PF, Fisher AD.The cryosurgery of bone. An experimental and clinical assessment. Br J Oral Surg. 1975;13:111–27.

55. Bell RB, Dierks EJ. Treatment options for the recurrent odontogenic keratocyst. Oral Maxillofac Surg Clin N Am. 2003;15:429–46.

56. Schmidt BL, Pogrel MA.The use of enucleation and liquid nitrogen cryotherapy in the management of odontogenic keratocysts. J Oral Maxillofac Surg. 2001;59:720–5.

57. Duschinsky R, Pleven E, Heidelberger C.The synthesis of 5-uoropyrimidines. J Am Chem Soc. 1957;79:4559–60.

58. Ledderhof NJ, Caminiti MF, Bradley G, Lam DK.Topical 5-uorouracil is a novel targeted therapy for the keratocystic odontogenic tumor. J Oral Maxillofac Surg. 2017;75:514–24.

59. Leichman CG, etal. Quantitation of intratumoral thymidylate synthase expression predicts for disseminated colorectal cancer response and resistance to protracted-infusion uorouracil and weekly leucovorin. J Clin Oncol. 1997;15:3223–9.

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