Approaches to the diagnosis and management of odontogenic and maxillofacial bone lesions

  • Fadi Titinchi

    Student thesis: Doctoral Thesis

    Abstract

    Odontogenic and maxillofacial bone lesions are rare destructive conditions that result in significant morbidity. These lesions range from benign cysts to aggressive tumours and are broadly classified as odontogenic or non- odontogenic in origin. They pose significant diagnostic and therapeutic challenges due to similarities in their presentation and varied surgical management.

    The aim of this work was to describe practical approaches to diagnosis and management of these lesions based on twelve peer-reviewed studies involving 390 patients which have been published over the last ten years.

    Studies on odontogenic keratocysts highlighted certain clinico-pathological features that were significantly associated with recurrences, including young/old age, nevoid basal cell carcinoma syndrome, retention of associated dentition, large (>4cm), multilocular lesions and cortical perforations. The presence of daughter cysts and epithelial budding were also implicated along with certain histochemical markers. Studies on odontogenic tumours have highlighted the role of imaging in diagnosis. Computed tomography and magnetic resonance imaging have demonstrated the extent and content of odontogenic myxomas which play a critical role in their management.

    Enucleation was shown to be insufficient in the management of odontogenic keratocysts and unicystic ameloblastomas. This treatment modality should be supplemented with adjuvant methods including application of Carnoy’s solution

    and/or peripheral ostectomy to reduce recurrences while limiting morbidity to the patient. Moreover, management of unicystic ameloblastomas should not be solely based on histopathological subtype as previously described but rather based on clinico-pathological features.

    Studies on non-odontogenic lesions have established that site should not be one of the major criteria in the diagnosis of juvenile ossifying fibromas as previously reported. Moreover, curettage with peripheral ostectomy displayed low recurrences with reduced morbidity.

    Based on the overall presented evidence in this series of peer-reviewed papers, clinico-pathological features play a significant role in the management of these lesions. Management should be customized with the least invasive surgical methods as first-line therapy. Radical options should be reserved for aggressive and recurrent lesions.
    Date of Award27 Sep 2022
    Original languageEnglish
    SupervisorLatha Davda (Supervisor) & Caroline Machuca Vargas (Supervisor)

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