Management of the odontogenic keratocysts from diagnosis to treatment: an algorithm derived from the comparison of a single institution experience and literature review

Background: The aim of this study is to define an algorithm for the management of odontogenic keratocysts (OKCs) in order to reduce the recurrence rate (RR), morbidity and to analyse relapse risk factors. Material and Methods: This article is a 10-years retrospective study on 67 patients treated for odontogenic ker-atocysts with different surgical options established on clinical and radiological evaluations. Recurrence free survival (RFS) and relapse risk factors were analysed with Kaplan-Meier method and log-rank tests, with a confidence interval set at 95 %. A literature research was performed using PubMed to find the most relevant and recent papers about the argument. Results: Fifty-five subjects were included: 38 out of 55 patients presented the disease only once, while the others 17 patients presented at least one relapse. The total amount of histological examined lesions and relative surgical procedures was 75. More aggressive treatments showed lower recurrence rate but higher morbidity; more conservative ones had better functional and aesthetic outcomes but higher recurrence rate. Considering the literature, conservative treatments plus adjuvant procedures can reduce the RR. The recurrence rate was esti-mated to be 25.3 % with a median time to relapse of 24 months. Multilocularity resulted a negative prognostic factor significantly associated with recurrence free survival (p = 0.048). Conclusion: According to our results and to the literature, we propose a management algorithm from diagnosis to treatment of the OKCs based on dimensions and internal arrangement of lesions, type (primary lesion or recurrence), presence of bony erosions, noble structure/teeth involvement. Multilocularity represented a sta-tistically significant risk factor for relapse.