Approaches to the management of aggressive cystic lesions of the jaws

Odontogenic keratocyst (OKC) and unicystic ameloblastoma (UAM) are the two most common aggressive cystic lesions affecting the jaws. This work highlights evidence-based management strategies from the recent literature. Two main factors play a role in the successful management of these lesions, firstly identifying high-risk clinico-pathological features and secondly deploying appropriate surgical methods based on these presenting features. High-risk features common in both lesions include large size, cortical perforations and non-extraction of associated dentition. Other features associated with aggressive OKC include age, multilocular lesions, presence of daughter cysts and epithelial budding. High Ki67 and AgNOR count were also implicated. Aggressive UAM behaviour was linked with root resorption and mural histological subtype. In the majority of lesions, conservative methods including enucleation and decompression followed by application of adjuvant therapies (Carnoy’s solution, 5-Fluorouracil, peripheral ostectomy) are appropriate first-line treatment. Radical options should be reserved for recurrent lesions, multiple cortical perforations and malignant transformation.