Vol. 116 No.

4 October 2013

Management and recurrence of keratocystic odontogenic tumor: a

systematic review
Nigel R. Johnson, BDSc (Hons), MBBS,a
Martin D. Batstone, MBBS, BDSc (Hons), MPhil (Surg), FRACDS (OMS), FRCS (OMFS),b and
Neil W. Savage, MDSc, PhD, FFOP (RCPA), FICD,c Brisbane, Queensland, Australia
ROYAL BRISBANE AND WOMENS HOSPITAL AND UNIVERSITY OF QUEENSLAND

Objectives. The objective of this study was to evaluate the most up-to-date treatment modalities and respective recurrence
rates for keratocystic odontogenic tumor (KCOT).
Study Design. A systematic review of the literature from 1999 to 2010 was undertaken examining treatment and recurrence
rates for KCOT. Four inclusion criteria were defined for articles to then be analyzed against 8 standards.
Results. Of the 2736 published articles, 8 met the inclusion criteria. When merging the data, enucleation and enucleation
with adjunctive measures (other than Carnoys solution) had recurrence rates of 25.6% and 30.3%, respectively.
Marsupialization with adjunctive measures produced a recurrence rate of 15.8%, whereas enucleation with Carnoys solution
presented a recurrence rate of 7.9%. Only one resection case had recurrence (6.3%).
Conclusions. The enucleation technique with the use of adjunctive procedures (other than Carnoys solution) provides a
higher recurrence rate than any other treatment modality. (Oral Surg Oral Med Oral Pathol Oral Radiol 2013;116:e271-e276)

Keratocystic odontogenic tumor (KCOT) is a unique

lesion because of its locally aggressive behavior, high
recurrence rate, and characteristic histologic appearance.1,2 Management of KCOT remains controversial
owing to multiple different treatment protocols with
varying recurrence rates. Historically, the following
modalities have been used in the management of
KCOT: decompression, marsupialization, peripheral
ostectomy with application of Carnoys solution, or
liquid nitrogen cryotherapy; with most options supplementing the enucleation technique. Resection generally
has been reserved for patients who have undergone
several surgical procedures to remove the same recurring KCOT.3-8 Patients also tend to require long follow-up because of the nature of KCOT and its intrinsic
position in nevoid basal cell carcinoma syndrome (NBCCS).1,2
To date, no randomized controlled trials have been
undertaken to establish which treatment modality pro-

Principal Researcher, Maxillofacial Department, Royal Brisbane and

Womens Hospital, Brisbane, Queensland, Australia.
b
Staff Specialist, Maxillofacial Department, Royal Brisbane and
Womens Hospital, Brisbane, Queensland, Australia; Clinical Senior
Lecturer, University of Queensland, Queensland, Australia.
c
Consultant, Oral Pathology and Oral Medicine, Maxillofacial Department, Royal Brisbane and Womens Hospital, Brisbane, Queensland, Australia; Reader, Oral Medicine and Pathology, The University of Queensland; Consultant, Oral Pathologist, Queensland
Medical Laboratory, Queensland, Australia.
Received for publication Oct 5, 2011; accepted Dec 19, 2011.
2013 Elsevier Inc. All rights reserved.
2212-4403/$ - see front matter
doi:10.1016/j.oooo.2011.12.028

vides the lowest recurrence rate. A review of the literature is the best available technique without the ethical
dilemma inherent in a clinical trial, to determine recurrence rates for the contrasting surgical options and the
most appropriate management of this lesion. A systematic review by Blanas et al.,9 published in 2000, included studies from 1970 to 1998. The aim of this
current systematic review was to provide an update on
the management and recurrence rates of KCOT, building on the work from Blanas et al.9 The data from 1999
to 2010 were analyzed and compared with the data
from Blanas et al.9 The data were then combined to
provide a current consensus on management and up-todate recurrence rates for the different treatment modalities.

MATERIAL AND METHODS

Blanas et al.9 conducted an English literature search
using the keywords keratocyst, odontogenic cyst,
basal cell naevus syndrome, keratin, and cyst to
identify articles that discussed treatment or prognosis of
KCOT. The authors defined 4 inclusion criteria for
articles to be selected and then tested the reported
results against 8 parameters (Table I). To compare
articles published after 1998 with those in the Blanas et
al.9 review, the same inclusion criteria and standards
were used in this current review, as described by Blanas
et al.9 in Table I. By replicating the Blanas et al.9
methodology, this enabled the results from both review
processes to be combined. It was a requirement for the
selected articles to state whether or not they included
patients with NBCCS in their cohorts.
e271

ORAL AND MAXILLOFACIAL SURGERY

e272 Johnson et al.

OOOO
October 2013

Table I. Criteria from Blanas et al.9 in selecting appropriate articles to review

Inclusion criteria
1. Keratocystic odontogenic tumor was diagnosed by
histopathologic evaluation.

8 standards of inclusion
1-4. Inclusion criteria.

2. Patient selection process was adequately described

and consisted of consecutive patients.

5. Assembly of an inception cohortidentifying patients at an early

and uniform stage of disease to assess the clinical course of the
disease.

3. An adequate description was given of the followup period.

6. Documentation of adverse outcomes.

4. Treatment rendered was specified in sufficient

detail to repeat the procedure, with each treatment
being correlated with a recurrence rate.

7. Adequate clinical and demographic informationto observe

whether each of the study groups had a similar set of patients.
8. Unbiased surveillance of patientsevaluate for adverse outcomes,
systematic use of objective methods and criteria for determining
outcomes and having the evaluation blinded to treatment and prior
events.

RESULTS
Using the keywords described in the preceding paragraph, 2736 articles were identified. Limiting the search
between the 1999 and 2010 produced 206 articles, with
28 articles having consecutive cases. Eight articles (Table II) met the inclusion criteria, which were then
analyzed using the 8 standards.
All studies confirmed that histopathology was used
to diagnose the KCOTs (Criterion 1). Most cases were
reviewed retrospectively, with 1 study prospective, but
all were consecutive (Criterion 2). Follow-up periods
were provided in all studies (Criterion 3); however, the
reporting of this varied between authors. Some stated a
range for follow-up, whereas others provided an average length of time. Treatment modalities were described in adequate detail so that they could be repeated
if necessary, with recurrence rates provided for each
treatment option (Criterion 4). The different treatment
modalities located in the literature and described by
Blanas et al.9 are presented as follows:
1. Curettage is the method where the wall of the cyst
cavity is surgically scraped with the removal of its
contents.14
2. Enucleation is the removal of a lesion intact.15 As
the lining of the cyst may be friable and thin, removal of the cyst in one piece is difficult.16 To
combat this feature, a number of studies suggest that
the general treatment of the primary KCOT should
include enucleation of the cyst, followed by mechanical curettage using methylene blue as a marking agent, followed by a 3-minute application of
Carnoys solution (a tissue fixative).1,3,8,15-19 This
treatment option has the advantage of preservation
of the adjacent bone, soft tissue, and dental structures. This results in reduced morbidity and cost of
treatment.8,16,20

The general chemical make-up of Carnoys solution is

a ratio of absolute alcohol (6 mL) chloroform (3 mL),
glacial acetic acid (1 mL), and ferric chloride (1
g).10,20-22 The original description on the use of Carnoys solution was to place it into the cyst cavity before
enucleation15; however, most clinicians apply it to the
bony cavity after enucleation.15,18
3. Radical enucleation involves removal of the entire
cyst lining together with any associated overlying
mucosa, followed by extensive cavity curettage with
reduction of the surrounding bone to remove residual cystic epithelium.23 This treatment option is very
similar to conventional enucleation without the use
of adjunctive measures.8,15-19
4. Marsupialization (also known as decompression)
is the process of exteriorizing the internal cyst contents by resecting the superficial wall and suturing
the cut edges of the remaining wall to adjacent
mucosa.24,25 Marsupialization is proposed as a nondestructive and a more physiologically acceptable
treatment method,24 as Carnoys solution is not used
and there is minimal surgical morbidity.11
5. Resection refers to either segmental resection or
marginal resectionmainly undertaken in the mandible.22 The difference between the 2 techniques is
that segmental resection removes a whole section of
bone with loss of continuity of the bone, whereas
marginal resection maintains the continuity of the
inferior or posterior borders of the mandible.22
Most studies excluded patients with NBCCS, with the
only exception being Nakamura et al.12 Five of 28
patients had NBCCS with only 1 having recurrence. It
is uncertain when this recurrence occurred, as the authors provided only an average follow-up time (3-14
years).12 As Blanas et al.9 included studies with pa-

OOOO
Volume 116, Number 4

ORIGINAL ARTICLE
Johnson et al. e273

Table II. Articles included in the systematic review for management and recurrence of KCOT with follow-up
periods noted
Stoelinga

Author

Year

Treatment

Cysts

Recurrence

Follow-up period

2001

E
E CS
E EoM
E EoM CS
M then E
R
M
M for at least 6 mo then E CE
E CE
M for 7-19 mo
E
EO
E CS
E O CS
R
E CE
D CE
M
E
E CS
E CE
R
EO
R
D then E
E
R

33
5
4
38
22
2
5
23
15
10
11
11
2
13
3
10
20
6
15
5
2
7
8
3
11
119
1

6 (18%)
0

1-25 y

Nakamura et al.12

2002

Pogrel and Jordan5

Morgan et al.10

2004
2005

Maurette et al.11

2006

Chirapathomsakul et al.13

2006

Kolokythas et al.6

2007

Pitak-Arnnop et al.1

2010

3 (7.8%)
0
0
6 (26.1%)
3 (20%)
0
6 (54.5%)
2 (18.2%)
1 (50%)
0
0
4 (20%)
1 (16.7%)
2 (13.3%)
1 (20%)
2 (100%)
1 (14.2%)
0
2 (18%)
28 (26%)
0

3-14 y

1.8-4.8 y
1-24 y

Average 2 y
1-14.6 y

1.5-9 y
1.5-3 y
1.5-12.5 y

CE, curettage; CS, Carnoys solution; D, decompression; E, enucleation; EoM, excision of mucosa; M, marsupialization; O, ostectomy; R,
resection.

tients with NBCCS, it is reasonable to assume this 1

recurrence does not bias the final results.
Only 1 study (in 20013) was prospective, thereby
having the advantage of an inception cohort (Criterion
5), whereas Blanas et al.9 in 2000, found none. The
criterion for inclusion was a histologic diagnosis of
KCOT,3 with no studies reporting any adverse outcomes, compared with only 1 study in the Blanas et al.9
review (Bataineh et al.22). All studies provided some
demographic data on their patients (Criterion 7). No
study specified the use of unbiased surveillance of the
patients within the investigations (Criterion 8). It was
assumed that as all treatments were undertaken at specific locations that the same surgeons monitored the
patients through their postoperative follow-up period,
concurring with Blanas et al.9
One author, Stoelinga (Stoelinga and Bronkhorst26),
had an article included in the Blanas et al.9 review, but
also an article included in the current review.3 On
further investigation of these 2 articles, it was apparent
that the more recent article3 incorporated the tumors
from the original article.26 The results of the original
article had a total of 42 KCOTs, 22 treated by enucleation with 2 recurrences and 20 treated with enucleation
plus Carnoys solution with no recurrence. Therefore,

these KCOTs were subtracted from the results of this

current review to exclude duplication.
Groups that used adjunctive measures with simple
enucleation (excision of overlying mucosa, curettage,
and ostectomy) were combined in this review (Table
III). The data from Blanas et al.9 for enucleation plus
adjunctive measures (radical enucleation and cryotherapy) were also combined to facilitate easy comparison
with the current review. A separate group was made for
KCOTs that were enucleated with Carnoys solution for
both groups.
For the marsupialization technique, several authors
used adjunctive measures (enucleation and curettage
following the initial marsupialization process), so these
data were combined in the current review, whereas,
Blanas et al.9 reported authors using only marsupialization as a treatment option.
A total of 578 KCOTs were reported in Blanas et
al.,9 compared with 362 in this current review (19992010), with similar recurrence rates for different treatment modalities, as seen in Table III. When combining
the data (Table IV) from the 2 systematic review processes, simple enucleation and enucleation with adjunctive measures (excluding Carnoys solution) had recurrence rates of 27.8% and 30.8%, respectively, followed

ORAL AND MAXILLOFACIAL SURGERY

e274 Johnson et al.

OOOO
October 2013

Table III. Comparison of data from Blanas et al.9 and current review (1999-2010)
Treatment
type

Total cysts
reported
Blanas et al.9

Total cysts
reported
1999-2010

Total
recurrences
Blanas et al.9

Total
recurrences
1999-2010

Calculated
recurrence rate, %,
Blanas et al.9

Calculated
recurrence rate, %,
1999-2010

26
387
22
60
45

38

156
33
63
21
76
16

5
111
6
1
11

40
10
5
1
12
1

19.2
28.7
27.3
1.6
24.4

25.6
30.3
7.9
4.8
15.8
6.3

CE
E alone
EA
E CS
M alone
MA
R

A, adjunctive measures other than Carnoys solution; CE, curettage; CS, Carnoys solution; D, decompression; E, enucleation; M, marsupialization;
R, resection.

Table IV. Combined data from Blanas et al.9 and current review (1999-2010)
Treatment Combined total Combined total Combined calculated
type
cysts reported
recurrence
recurrence rate, %
CE
E alone
EA
E CS
M alone
MA
R

26
543
52
123
66
76
54

5
151
16
6
12
12
1

19.2
27.8
30.8
4.8
18.2
15.8
1.85

A, adjunctive measures other than Carnoys solution; CE, curettage;

CS, Carnoys solution; D, decompression; E, enucleation; M, marsupialization; R, resection.

by marsupialization alone (18.2%%). The use of Carnoys solution reduced recurrence to 4.8%, and resection had the lowest recurrence rate (1.85%). Treatment
of recurrence was reported in only half of the articles,1,3,6,13 with management being enucleation with
adjunctive measures for all cases except 1 (patientelected resection1). Curettage alone was not a technique
reported by authors in this systematic review, therefore
only the data from Blanas et al.9 were provided for this
treatment option.

DISCUSSION
The purpose of this investigation was to build on the
foundation made by Blanas et al.9 and update their
systematic review with the research conducted between
1999 and 2010. With 940 KCOTs analyzed, this review
provides the largest, contemporaneous consensus on
the management of this tumor. There are many variables that preclude any uniform quantitative analysis
being undertaken with regard to the management of
KCOT, hence randomized controlled trials have not
been conducted. These variables include size and location of the lesion, presence of infection, and association
of any teeth. It is difficult to control these variables
because of the nature of the KCOT.
As there are no randomized controlled trials available in the literature, a meta-analysis cannot be used to

analyze the results. There are no odds ratios or risk

ratios supplied in any of the articles reviewed either,
therefore an effect size cannot be calculated for the
different management options. The most appropriate
method available for analyzing the data are to combine
the results from the various articles. The previous systematic review by Blanas et al.9 also did not conduct a
meta-analysis. Consequently, even if one was conducted for this current review, the results between the 2
review processes would not have been comparable.
Several recommendations can still be inferred from
the data, however. By fulfilling the inclusion criteria,
the studies selected were found to be the most acceptable in the literature, thereby stipulating which management techniques minimize the chance of recurrence.
The included studies all examined different population cohorts of varying size. Accordingly, the data have
been pooled to determine a more accurate recurrence
rate for the varying treatment modalities. Studies provided a range of follow-up, with all cases having at
least 1 year of review. The increased complexity of
cases of NBCCS, as distinct from sporadic cases, excluded their inclusion with the exception of Nakamura
et al.,12 and in this case, the specific treatment was not
specified.
Treatment of KCOT remains a controversial subject,
and several treatment options are available to the surgeon. The prediction of a particular protocol seems as
much a factor of surgical experience and training as the
presentation in the patient. Many surgeons are devotees
of a particular technique and the specific operation
undertaken is defined around this technique. The current study exploits this trend and offers a summation of
outcomes from the varying techniques. The use of
Carnoys solution, for example, is popular. It is based
on an understanding of the biological behavior of the
KCOT, and when used as an adjunct, it is aimed at
eradication of the remaining epithelial cells3 within the
peripheral cyst wall/capsule. Histologic review of the
KCOT will frequently show the convoluted luminal
profile of the KCOT encroaching on the external cap-

OOOO
Volume 116, Number 4

sular surface with little separation of the lining epithelium from the outer surface.
The average depth of bone penetration depends on
the duration of application (1.54 mm after 5 minutes).15
The Carnoys solution will prevent recurrence caused
by the presence of satellite cysts, budding of the cyst
lining, or remnants of cyst epithelium remaining after
enucleation.10,20,21
Marsupialization results in a considerable reduction
of the cystic volume and lessens the chance of injury to
important anatomical structures (such as the inferior
dental nerve).1,5-7,9,12,24,25 Some authors suggest using
the marsupialization technique to reduce the size of the
KCOT and then proceed to surgical enucleation of the
remaining cyst structure.7,11 This 2-stage technique
does not affect the recurrence rate.12,24,25 The main
advantage of the conservative treatment option is the
preservation of bone and teeth associated with the
KCOT.11 Reducing the size of the cystic cavity by
decompression, promotes new bone formation in a centripetal direction, with filling of the defect and reduction in cyst volume.11,12,24
As most patients with KCOT are young with high
regenerative capacity, these procedures are less traumatic and avoid the need to accomplish reconstruction
through grafts11; however, this technique necessitates
longer treatment (up to 14 months11,24), multiple-staged
procedures, and exceptional patient cooperation.1,5-7,9,24
These are the main causes for abandonment of the
treatment by the patient, along with loss of interest in
proper irrigation protocols.11 Enucleation and curettage
techniques have a clear advantage over marsupialization by providing a complete specimen for histopathologic analysis.1,7
One of 54 KCOTs recurred after resection, with
Chirapathomsakul et al.13 stating that this specific case
was treated with segmental resection. The authors13
hypothesized that the recurrence occurred within the
bone graft as a result of a new KCOT developing from
the overlying mucosa and penetrating the graft.13
Some authors question the acceptability of resection
for a benign condition, as it is a destructive procedure.9 It is suggested that aggressive resection should
be limited to recurrent KCOTs (3 or more times) or
those that have undergone ameloblastic or malignant
degeneration.6,8,9,21,27
Recurrence of KCOT occurs for several reasons.
Incomplete removal of the cystic lesion allows new cyst
formation or epithelial islands in the wall of the original
cyst remain in the surrounding bone or soft tissue.7,28,29
New KCOTs can also develop from the basal layer of
the oral epithelium.30 Patients with NBCCS are more
prone to continuous formation of new cysts.7 Size,
location, and inadequate surgical treatment of the

ORIGINAL ARTICLE
Johnson et al. e275

KCOT also contribute to possible recurrence.16 The

need for long-term follow-up of these patients cannot
be overemphasized, as recurrence is reported up to 10
years after treatment.6,8,10,23
In conducting this systematic review, the following
treatment recommendations for the KCOT are offered:
1. Simple enucleation of the KCOT is not endorsed
because of the high recurrence rate.
2. A small KCOT where the margins can be accessed
may be enucleated with adjunctive measures, such
as Carnoys solution.
3. A large, expanding KCOT is best treated with a
2-stage approach. Marsupialization first, followed
by enucleation and adjunctive measures to decrease
the surgical injury to the patient. If patient compliance with irrigating the cyst orifice is doubtful, then
enucleation with the use of adjunctive measures as
the primary operation is proposed.
4. Marginal or segmental resection offers the lowest
recurrence rate. It is not advocated as a primary
treatment modality for most tumors because of its
morbidity and the benign nature of the disease. It
may be considered in certain clinical scenarios, such
as multiple tumor recurrence.

CONCLUSIONS
This systematic review has analyzed the literature to
provide a balanced comparison among the different
treatment modalities for KCOT. The goals of management include elimination of the pathology and decrease
potential recurrence while minimizing harm to the patient. The issue surgeons encounter is whether to take a
conservative approach, minimizing the morbidity to the
patient, knowing that several operations may be required to eliminate recurrence; or being more aggressive and potentially more destructive, at the same time
establishing the maximum position to avoid recurrence.
The use of adjunctive measures beyond simple enucleation or marsupialization is justified. Enucleation with
Carnoys solution provides the least recurrence (4.8%)
from any of the conservative techniques. Resection
provides the lowest recurrence rate (1.85%), yet causes
the most suffering to the patient.
REFERENCES
1. Pitak-Arnnop P, Chaine A, Oprean N, Dhanuthai K, Bertrand JC,
Bertolus C. Management of odontogenic keratocysts of the jaws:
a ten-year experience with 120 consecutive lesions. J Craniomaxillofac Surg 2010;38:358-64.
2. Shear M. The aggressive nature of the odontogenic keratocyst: is
it a benign cystic neoplasm? Part 1. Clinical and early experimental evidence of aggressive behaviour. Oral Oncol 2002;38:
219-26.
3. Stoelinga PJ. Long-term follow-up on keratocysts treated according to a defined protocol. Int J Oral Maxillofac Surg 2001;30:
14-25.

ORAL AND MAXILLOFACIAL SURGERY

e276 Johnson et al.
4. 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; discussion: 26-7.
5. Pogrel MA, Jordan RC. Marsupialization as a definitive treatment for the odontogenic keratocyst. J Oral Maxillofac Surg
2004;62:651-5; discussion: 55-6.
6. 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.
7. Giuliani M, Grossi GB, Lajolo C, Bisceglia M, Herb KE. Conservative management of a large odontogenic keratocyst: report
of a case and review of the literature. J Oral Maxillofac Surg
2006;64:308-16.
8. Williams TP, Connor FA Jr. Surgical management of the odontogenic keratocyst: aggressive approach. J Oral Maxillofac Surg
1994;52:964-6.
9. Blanas N, Freund B, Schwartz M, Furst IM. Systematic review of
the treatment and prognosis of the odontogenic keratocyst. Oral
Surg Oral Med Oral Pathol Oral Radiol Endod 2000;90:553-8.
10. Morgan TA, Burton CC, Qian F. A retrospective review of
treatment of the odontogenic keratocyst. J Oral Maxillofac Surg
2005;63:635-9.
11. Maurette PE, Jorge J, de Moraes M. Conservative treatment
protocol of odontogenic keratocyst: a preliminary study. J Oral
Maxillofac Surg 2006;64:379-83.
12. Nakamura N, Mitsuyasu T, Mitsuyasu Y, Taketomi T, Higuchi
Y, Ohishi M. Marsupialization for odontogenic keratocysts:
long-term follow-up analysis of the effects and changes in
growth characteristics. Oral Surg Oral Med Oral Pathol Oral
Radiol Endod 2002;94:543-53.
13. Chirapathomsakul D, Sastravaha P, Jansisyanont P. A review
of odontogenic keratocysts and the behaviour of recurrences.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod
2006;101:5-9.
14. Gardner DG, Pecak AM. The treatment of ameloblastoma based
on pathologic and anatomic principles. Cancer 1980;46:2514-9.
15. Voorsmit RA. The incredible keratocyst: a new approach to
treatment. Dtsch Zahnarztl Z 1985;40:641-4.
16. Meiselman F. Surgical management of the odontogenic keratocyst: conservative approach. J Oral Maxillofac Surg 1994;52:
960-3.
17. Li TJ. The odontogenic keratocyst: a cyst, or a cystic neoplasm?
J Dent Res 2011;90:133-42.
18. Stoelinga PJ. The treatment of odontogenic keratocysts by excision of the overlying, attached mucosa, enucleation, and treatment of the bony defect with Carnoy solution. J Oral Maxillofac
Surg 2005;63:1662-6.

OOOO
October 2013
19. Jensen J, Sindet-Pedersen S, Simonsen EK. A comparative study
of treatment of keratocysts by enucleation or enucleation combined with cryotherapy. A preliminary report. J Craniomaxillofac
Surg 1988;16:362-5.
20. Chow HT. Odontogenic keratocyst: a clinical experience in Singapore. Oral Surg Oral Med Oral Pathol Oral Radiol Endod
1998;86:573-7.
21. Tolstunov L, Treasure T. Surgical treatment algorithm for odontogenic keratocyst: combined treatment of odontogenic keratocyst and mandibular defect with marsupialization, enucleation,
iliac crest bone graft, and dental implants. J Oral Maxillofac Surg
2008;66:1025-36.
22. Bataineh AB, al Qudah M. Treatment of mandibular odontogenic
keratocysts. Oral Surg Oral Med Oral Pathol Oral Radiol Endod
1998;86:42-7.
23. Irvine GH, Bowerman JE. Mandibular keratocysts: surgical management. Br J Oral Maxillofac Surg 1985;23:204-9.
24. Marker P, Brndum N, Clausen PP, Bastian HL. Treatment of
large odontogenic keratocysts by decompression and later cystectomy: a long-term follow-up and a histologic study of 23
cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod
1996;82:122-31.
25. Jung YS, Lee SH, Park HS. Decompression of large odontogenic
keratocysts of the mandible. J Oral Maxillofac Surg 2005;
63:267-71.
26. Stoelinga PJ, Bronkhorst FB. The incidence, multiple presentation and recurrence of aggressive cysts of the jaws. J Craniomaxillofac Surg 1988;16:184-95.
27. Chapelle KA, Stoelinga PJ, de Wilde PC, Brouns JJ, Voorsmit
RA. Rational approach to diagnosis and treatment of ameloblastomas and odontogenic keratocysts. Br J Oral Maxillofac Surg
2004;42:381-90.
28. Browne RM. The odontogenic keratocyst. Histological features
and their correlation with clinical behaviour. Br Dent J
1971;131:249-59.
29. Dammer R, Niederdellmann H, Dammer P, Nuebler-Moritz M.
Conservative or radical treatment of keratocysts: a retrospective
review. Br J Oral Maxillofac Surg 1997;35:46-8.
30. Stoelinga PJ, Peters JH. A note on the origin of keratocysts of the
jaws. Int J Oral Surg 1973;2:37-44.
Reprint requests:
Nigel Johnson, BDSc (Hons), MBBS
Maxillofacial Department
Royal Brisbane and Womens Hospital
996 Logan Road
Brisbane, Queensland, Australia
nigel.johnson1@uqconnect.edu.au