Large<unk>  with impacted wisdom teeth superficial to lesion As the condition is quite rare, opinions among experts about how to treat<unk> s differ. A 2015 Cochrane review found that there is currently no high quality evidence to suggest the effectiveness of specific treatments for the treatment of<unk> s. Treatment depends on extent of multilocularity and cyst. Small multilocular and unilocular cysts can be treated more conservatively through enucleation and curretage. Treatment options for KTOC may vary according to its size, extent, site, and adjacent structures. Treatment options: *Surgical enucleation: surgical removal of the entire epithelial lining of the cyst. *Marsupialisation followed by enucleation: this method is carried out by surgeons for larger cysts. *Curettage involving simple excision and scraping-out of cavity. *Carnoy's solution fixative (ethanol, chloroform and acetic acid) which is usually used in conjunction with excision and curretage. Cavity wall can be treated with the fixative either before enucleation to kill the lining of the wall or added after curretage to bony walls, killing any residual epithelial cells to a depth of 1-2mm. Used with care near mandibular canal and the neurovascular bundle within. *Marsupialization which involves the surgical opening of the cyst cavity and a creation of a marsupial-like pouch. This allows the cavity to be in contact with the outside of the cyst for an extended period of time. Marsupialisation results in slow shrinkage of the cyst allowing later enucleation. However, resolution can take up to 20 months and patients are required to clean the open cavity and irrigate it. * Peripheral ostectomy after curettage and/or enucleation. Extensive cysts may require a bone graft after bone resection and reconstruction of the area. *Simple excision *Enucleation and cryotherapy. Decompression followed by enucleation has been shown to be most successful with lowest recurrence rates. * Topical application of 5FU after enucleation *Ostectomy or En – bloc resection: in addition to the above treatments, these may be required due to the issue of recurrence. Ostectomy is removal of peripheral bone. En – block resection is removal of the cyst with the surrounding tissue. Extensive cysts may require a bone graft after bone resection and reconstruction of the area. Follow-up Annual radiographic review has been recommended. Long-term clinical follow-up is also recommended due to recurrences occurring many years after treatment. Recurrence and neoplastic nature Malignant transformation to squamous cell carcinoma may occur, but is unusual. Recurrence is likely when treated by simple enucleation. Contributing causes include thin and fragile epithelium leading to incomplete removal, cyst extensions extending into cancellous bone, satellite cysts found in the wall, experience of the surgeon, formation of further new cysts from other remnants of the dental epithelium. With current treatment techniques the recurrence rate is around 2-3% but can be as high as 50%. Recurrence can occur as early as 5 years and as late as 40 years after removal. Recurrence is usually seen within 5 years of treatment. Early findings of recurrence can be easily treated with minor surgery and curretage. Any fragment of the cyst that is left behind has the potential to survive and grow. Therefore, the success of enucleation depends on how well the cyst is removed. Larger cysts have a higher rate of recurrence after enucleation as they are more difficult to remove. Pronto genie<unk> s are well known to recur in the posterior mandible. A substantial amount of<unk> s also recur in the tooth-bearing area of the jaws, requiring attention from clinicians. The neoplastic nature of<unk> s has been debated. Due to high recurrence rate, late detection when the cyst has grown very large and causation by tumour suppressor gene inactivation, some have classified<unk> s as benign neoplasms. The best evidence to suggest that this type of cyst is not a neoplasm is that it responds very well to marsupialisation.
Odontogenic keratocyst
Dentigerous cyst
Glandular odontogenic cyst
Cholesteatoma
Pseudolymphoma
Aquarium granuloma
Enamel pearl
Idiopathic facial aseptic granuloma