Clinical profile and prevalence of odontogenic keratocysts in children and adolescents: A systematic review

Odontogenic keratocyst (OKC) exhibits aggressive behavior and a high potential for recurrence. Despite being well-documented in adults, its characteristics in the pediatric population remain poorly understood. This systematic review aimed to analyze the clinical profile and treatment modalities of OKCs in children and adolescents, as well as their association with recurrence and follow-up duration. This systematic review was conducted following PRISMA guidelines and registered in PROSPERO (CRD42024612291). Risk of bias was assessed using the ROBINS-E tool, and statistical analysis was performed with the chi-square test. A total of 34 studies published between 2014 and 2024 were included, comprising 98 pediatric cases, both sporadic and syndromic. Both groups showed a slight male predominance, with a mean age of 12 years, and the most common symptom was extraoral swelling, with or without pain. The cases showed a predominance of lesions in the posterior mandible. Conservative approaches were the most frequently adopted treatment modality. The chi-square test revealed a statistically significant association between treatment modality and recurrence (p = 0.031), as well as between recurrence and follow-up duration (p = 0.005). Despite the variety of therapeutic strategies, recurrence was more strongly associated with follow-up duration than with the treatment approach itself. Based on these findings, we strongly recommend that all pediatric patients diagnosed with OKC undergo clinical and radiographic monitoring for a minimum of five years, regardless of the treatment performed, to ensure early detection and management of late recurrences.