Oral and Maxillofacial Surgery Expert Forum
Reccurrent KCOT in Right Maxillary Sinus (Odontogenic Kerotocyst)
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Questions in the Oral and Maxillofacial Surgery forum are answered by Dr. Michael H Kirsch and Dr. Mario Tuchman. Topics covered include teeth extractions, wisdom teeth, dental implants, bone grafting, orthognathic surgery, facial bones realignment, facial trauma repair, jaw alignment, anesthesia , jaw cyst or tumor diagnosis, reconstructive jaw surgery, temporomandibular joint syndrome (TMJ) and TMJ surgery.

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Reccurrent KCOT in Right Maxillary Sinus (Odontogenic Kerotocyst)


     I am a 17 year old male entering my senior year in high school. I have had two surgeries, in April and December of 2007, to remove an inflamed keratocystic odontogenic tumor (KCOT) in my right posterior maxillary sinus. Now, one and a half years later, a localized CT scan at an oral surgeon's office confirms that the cyst has once again returned, even though it did not appear as a solid mass on my current panoramic x-ray like it did on the orthodontist's x-ray that diagnosed the cyst in the first place. This has come as a surprise, since I am not suffering any symptoms of swelling of the surrounding gums or oral discharge that I experienced before my first diagnosis.
     My oral surgeon strongly suggests that I have the 4x5 centimeter cyst removed using the LeFort 1 operation, removing the entire upper jaw in order to gain access the cyst and have the best chance of removing it completely. Unfortunately, I do not want to undergo such a radical procedure at this point in my life. Before this third diagnosis, I was informed in the past by this same surgeon that cryotherapy following removal by conventional methods would be the next step should the cyst return. However, this oral surgeon, a different doctor from the one that performed my first two surgeries, now refuses to perform a standard procedure with cryotherapy as he claims he will be unable to reach every "nook and cranny" in which the cells might be hiding.
     Is the LeFort 1 operation absolutely necessary at this point? Wouldn't it be worth it to try having it removed one more time through conventional methods, but this time adding cryotherapy? Also, since the surgeon has informed me that the cyst is benign, what are the chances of it becoming cancerous?

Thank you.
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If you do not wish to undergo the LeFort I osteotomy you should seek out the oral surgeon that was considering attempting the more conservative treatment.  Being that this is the 3rd recurrence I would have to agree that the best access for treatment would be the LeFort.  Cryotherapy in the posterior maxilla to treat every "nook and cranny" is a bit of a challenge, but might be worth the attempt.
Although extremely rare, the are cases in the literature in which there has been malignant transformation of these tumors.
I would discuss your options and concerns with both oral surgeons and come to a final decision.
Good Luck.

Information contained within this reply is intended solely for general educational purposes and is not intended nor implied to be a medical diagnosis or treatment recommendation.  This is not a substitute for professional medical advice relative to your specific medical condition or question. Always seek the advice of your own doctor for medical condition. Only your doctor can provide specific diagnoses and therapies.
A related discussion, My tooth hurts was started.
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Dr. Michael H. Kirsch
Caldwell, NJ
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