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A Novel Bone Conservation Strategy Using Staged Decompression, Resection, and Chemoablative Therapy with Supplemental Allograft Bone Graft: Management of Keratocystic Odontogenic Tumors in a Pediatric
Brian H. Gander, MD
John Keating, DMD
Brian Martin, DMD
Anand Kumar, MD
University of Pittsburgh Medical Center Department of Plastic Surgery
2014-03-01
Presenter: Brian H. Gander, MD
Affidavit:
Dr. Gander made significant contributions to this work
Director Name: Joseph Losee, MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Purpose: Treatment of Gorlin Syndrom in patients with keratocystic odontogenic tumors is a challenge for the pediatric plastic surgeon. This study evaluates a bone conservation strategy using decompression, resection, chemoablative thereapy and bone grafting.
Methods: A retrospective review of Gorlin Syndrome patients with KCOT treated using a staged treatment over 36 months was performed. One patient met criteria. Treatment of small lesions included resection, chemoablation and bone grafting. Treatment of larger lesions included decompression, resection, chemoablation and bone grafting (DBX mix). Pre and post-intervention CT scans were analyzed for bone erosion, cyst dimensions and bone healing.
Results: A 7 year old female with multiple KCOT was identified. Large lesions of the maxilla (Cyst a), mandible (Cyst b) were treated in two stages. Cyst dimensions decreased from 38.7mL to 9.2mL (cyst 1) and 9.9mL to 2.5mL (cyst 2) after stage 1 treatment. The destroyed nasomaxillary buttress, orbital floor and anterior ramus underwent complete remodeling after decompression alone. A smaller mandibular cyst (c) and non-erosive maxilla cyst (d) were treated in one stage a procedure.
Conclusion: Staged decompression, resection, chemoablation and bone allografting can provide treatment and reconstruction of the residual bone defects. Advantages including reduced risk of pathologic fracture, decreased impact on adjacent structures, decreased need for extensive surgical resection and reconstruction and avoidance of donor bone harvest are seen. However, this technique necessitates patient compliance and an increased number of procedures to obtain the final result.
