Résumé

<p>The odontogenic keratocyst (OKC) is a benign uni or multicystic intraosseous entity presenting many controversies regarding the&nbsp;<br>clinical and biological behavior, potential morbidity and factors influencing the recurrence rates. The cyst occurs frequently in the second–<br>third decades of life with a marked tendency to involve the mandibular molar-ramus [1]. A number of suggested treatment techniques&nbsp;<br>have been well investigated [2,3]. All aforementioned studies attempted to decrease the recurrence rates. However, the recurrence rates&nbsp;<br>remain high up to 62% and most commonly varied from the published reports [4]. OKCs exhibiting a clinical aggressive behavior such&nbsp;<br>as perforations of the cortical plates of the jaws, extension into the adjacent tissues, the mandibular molar-ramus location of the cysts,&nbsp;<br>and multilocular larger lesions factors maybe help to evaluate the decision-making process for the choice of the treatment methods or to&nbsp;<br>detect the OKC with high-risk of recurrence. The choice of the treatment methods is one of the goals, however, the inability to known if all&nbsp;<br>OKC share the same propensity of the behaviors or recurrence maybe another one of the utmost dilemma.&nbsp;<br>The biological aspects of OKC have been investigated by numerous studies. Proliferative expression and anti-proliferative markers&nbsp;<br>included p53, Ki-67, PCNA, Bcl-2 , has been evaluated to elucidate any relationship between histological features of OKC and biological&nbsp;<br>potential with helpful in the choosing of surgical procedures to avoid the recurrence. But no much is known, about the relationship&nbsp;<br>[5]. OKC with PTCH1-truncation causing mutations had significantly higher Ki-67 labeling with increased proliferative activity, which&nbsp;<br>may related to the phenotype of high recurrence potential, and the immune-profile of Sonic hedgehog (SHH)-related proteins and the&nbsp;<br>SHH-induced bcl-2 oncoprotein have been suggested may be suitable to define the individual OKC phenotype and biologic behavior.&nbsp;<br>Additionally, the molecular and genetic alterations associated with OKC may predict an individual biological behavior [6]. Unfortunately,&nbsp;<br>the aforementioned findings remain not available to the clinician faced with an individual patient. Therefore, the lack of evidence to identify&nbsp;<br>the ability of the individual OKC and the risk of predicting recurrence may be the reason that leading to the choice of an inappropriate&nbsp;<br>treatment methods.&nbsp;<br>Accordingly, the high recurrence rates and the failure rationalization of the treatment of OKC appear maybe as a mirrored inability&nbsp;<br>between the unknown of individual odontogenic keratocysts behavior and the choice of surgical treatment methods. The experimental&nbsp;<br>studies are required to assist the clinicians by providing a suitable data that can permit to establish the effectiveness of treatments&nbsp;<br>methods adapted to individual OKC and the satisfactory prognostic for a long term after the removal of the cyst.</p>