Odontogenic keratocysts (OKC) are benign, developmental, locally-aggressive odontogenic cystic lesions with a high risk of recurrence. As such, the most effective treatment modalities remain controversial. The mainstay of treatment remains enucleation with or withoutdecompression. The use of adjunctive therapies is widely reported. Our aim was to review our experience of OKCs and therefore identifythe treatment modality, if there is any single one, with the lowest rate of recurrence. We also aimed to identify any common themes linkingthose patients experiencing cystic recurrence. Data were collected on 50 patients treated at UHCW NHS Trust over a 14-year period (20052018) via an anonymised database. Surgical pathways were analysed, including details of the location of the cysts and the use of adjunctivetherapies, namely; mechanical debridement, cryotherapy, and the use of Carnoy's solution. Fifty-six keratocysts, both primary (91%, n = 51) and recurrent (9%, n = 5) were included. A total of 6% of patients had a pre-existing diagnosis of Gorlin-Goltz Syndrome (n = 3). Enucleationwas performed in an approximately 3:1 ratio to decompression with secondary enucleation (n = 41:15). Twenty-seven percent of patients hadadjunctive therapies (n = 15). There was a 12% recurrence rate (n = 6) found only within the group of primary cysts that had been enucleatedonly. Notably, there were no recurrences in those cysts that had undergone adjunctive therapy. None of the cysts that underwent initialdecompression or marsupialisation recurred. Following surgical intervention, no tertiary recurrent cysts were detected postoperatively. Thisstudy demonstrated the advantage of establishing a correct diagnosis prior to definitive treatment. Initial decompression in selected patientsfollowed by enucleation, along with adjunctive therapies showed a benefit in reducing recurrences. However, in the absence of high-qualityevidence for the most effective management of odontogenic keratocysts, finding a common approach will remain controversial. Crown Copyright (c) 2021 Published by Elsevier Ltd on behalf of The British Association of Oral and Maxillofacial Surgeons. All rightsreserved.
