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Odontogene Keratozyste – Ätiologie, Pathogenese und Therapie

  • M. DauEmail author
  • B. Frerich
CME Zahnärztliche Fortbildung

Zusammenfassung

Die odontogene Keratozyste (OKZ) wird – als zweithäufigster odontogener Tumor – häufig erstmals als radiologischer Zufallsbefund im Orthopantomogramm (OPT) bei klinischer Beschwerdefreiheit diagnostiziert. Die OKZ können auch nach Jahrzehnten noch Rezidive bilden. In seltenen Fällen ist auch eine Entartung der OKZ zu einem primär intraossären Plattenepithelkarzinom möglich. Neben dem OPT als zahnärztlichem Basisdiagnostikmittel können zusätzliche radiologische Untersuchungen wie die digitale Volumentomographie (DVT), Computertomographie (CT) und Magnetresonanztomographie (MRT) prätherapeutisch Informationen bzgl. Ausdehnung der Zyste und wichtiger anatomischer Nachbarstrukturen liefern, was v. a. im Bereich der Oberkieferfront hilfreich sein kann. Die Diagnosestellung erfolgt letztlich über die Histologie. Differenzialdiagnostisch ist das Ameloblastom abzugrenzen sowie auch an das Gorlin-Goltz-Syndrom zu denken. Das Gorlin-Goltz-Syndrom weist neben OKZ weitere Symptome wie multiple Basalzellkarzinome (BZK) auf und erfordert einen interdisziplinären Behandlungsansatz. Therapeutisches Mittel der Wahl beim OKZ ist die Enukleation mit Carnoy-Lösung, wobei der Stellenwert alternativer Behandlungsmethoden wie Enukleation mit Kryotherapie oder Enukleation mit modifizierter Carnoy-Lösung aufgrund von fehlenden Studien nicht bewertet werden kann. Der Einsatz der Carnoy-Lösung in Nervennähe kann zu Nervennekrosen und damit zu Nervenschädigungen führen. Die Marsupialisation sowie die alleinige Dekompression sind aufgrund der hohen Rezidivraten als obsolet anzusehen.

Schlüsselwörter

Odontogene Keratozyste Rezidiv Diagnostik Therapie Kopf-Hals-Tumoren 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

M. Dau und B. Frerich geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Copyright information

© Freier Verband Deutscher Zahnärzte (FVDZ) and Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  1. 1.MKG-ChirurgieUniversitätsmedizin RostockRostockDeutschland

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