Maxillary Sinus Odontogenic Keratocyst: Risks and Concerns

Q: Maxillary Sinus Odontogenic Keratocyst: Risks and Concerns

Hello： 1. <br>It is advisable to relax for now; you have already undergone the most proactive surgical treatment available, and there is no need to dwell on negative thoughts. <br>2. <br>After recurrence, it is important to determine whether it is malignant or has spread to other

Regarding maxillary sinus odontogenic keratocyst?

Hello, I have been experiencing discomfort on the left side of my face since last year.
After undergoing a biopsy at the hospital, I was diagnosed with a maxillary sinus odontogenic keratocyst.
Following decompression treatment, there has been no sign of reduction.
Recently, the hospital scheduled surgery to completely excise the cyst.
After the surgery, the attending physician informed me that most of the cyst has been removed, but there may still be some remnants hidden in corners or enveloped in the proliferative bone.
I am quite worried upon hearing that if it recurs in the future, it may require partial resection of the maxilla.
I found online that the recurrence rate of keratocysts is quite high, and it may be unavoidable in the future.
I would like to ask: Is it true that the recurrence rate for this type of keratocyst is very high? If this situation recurs, is it really necessary to remove part of the maxilla? Will the reconstruction affect my appearance? How should I express my concerns to my physician? If it recurs, would switching to another hospital be a better option? Thank you.

Xiao Chen, 20~29 year old female. Ask Date: 2023/04/26

Dr. Lin Jiayong reply Dentistry

Hello: 1.
It is advisable to relax for now; you have already undergone the most proactive surgical treatment available, and there is no need to dwell on negative thoughts.
2.
After recurrence, it is important to determine whether it is malignant or has spread to other areas.
If it is localized and the area is small, the need for another surgery may depend on the subsequent situation and should be discussed with the surgeon.
3.
If the affected area is small, the changes in appearance should not be drastic, and the scarring should be limited to the oral cavity.
4.
You can seek a second or third opinion, but it is essential to have the original surgeon continue monitoring, as they will have the relevant long-term data, including pre-operative, post-operative, and follow-up X-ray images.

Reply Date: 2023/04/26

More Info

Understanding the risks and concerns associated with a maxillary sinus odontogenic keratocyst (OKC) is crucial for patients facing this diagnosis. An odontogenic keratocyst is a type of cyst that originates from the dental tissues and is known for its aggressive behavior and potential for recurrence.
Firstly, the recurrence rate of OKCs is indeed a significant concern. Studies indicate that the recurrence rate can be as high as 30% to 60%, depending on various factors such as the surgical technique used for removal and the completeness of the excision. The cysts can be challenging to remove entirely, especially if they are located in areas that are difficult to access or if they are enveloped in surrounding bone. This is why your surgeon mentioned the possibility of residual cystic tissue that may lead to recurrence.

If the cyst does recur, the treatment often involves more extensive surgical intervention, which may include the removal of a portion of the maxillary bone. This is typically done to ensure that all remnants of the cyst are eliminated, as leaving any behind can lead to further complications and recurrence. The concern about how this might affect your appearance is valid. Surgical removal of bone can lead to changes in facial contour, especially if a significant amount of bone is removed. However, reconstructive techniques are available, and many patients achieve satisfactory aesthetic outcomes. Discussing these concerns with your surgeon can provide you with a clearer understanding of what to expect and the options available for reconstruction.

When expressing your concerns to your doctor, it’s important to be open and specific. You might say something like, "I am worried about the recurrence of the cyst and the potential need for further surgery. Can you explain the likelihood of recurrence and what the next steps would be if it does come back? Additionally, I would like to understand how bone removal might affect my appearance and what reconstructive options are available." This approach encourages a dialogue and allows your doctor to address each of your concerns thoroughly.

As for considering a different hospital or specialist, it can be beneficial to seek a second opinion, especially if you feel uncertain about the proposed treatment plan. Different institutions may have varying levels of expertise and experience with OKCs. Researching hospitals that specialize in oral and maxillofacial surgery or those with a strong track record in treating odontogenic keratocysts can provide you with more options and potentially better outcomes.

In conclusion, while the diagnosis of a maxillary sinus odontogenic keratocyst can be daunting, understanding the risks, recurrence rates, and treatment options available can empower you to make informed decisions about your care. Open communication with your healthcare provider is essential, and seeking additional opinions can help ensure that you receive the best possible treatment for your condition.

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