In this current review we have tried to find out if there are special features of odontogenic keratocyst in children regarding the behavior and management. During our search it became very conspicuous to us that most of the literature is either case reports or case series or miscellaneous studies. This reflects the dearth of information concerning the behavior and management of odontogenic keratocyst.The odontogenic keratocyst (OKC) is regarded as an aggressive lesion due to its characteristic high tendency to recur ,and to invade adjacent tissues [15-18]. In 1967, Toller suggested that the OKC should be classified as a benign tumor rather than a cyst based on its characteristic clinical features .
The abundance of, research papers supporting the tumorigenic characterstics of odontogenic keratocyst have encouraged the WHO to categorize the lesion as a tumor. This decision was based on several factors:
PTCH (‘patched’), a tumor suppressor gene involved in both nevoid basal cell carcinoma syndrome and sporadic KCOTs, commonly found on chromosome 9q22.3-q31.36-40 normally, PTCH together with the oncogene SMO (‘smoothened’) forms receptor complex for the SHH (‘sonic hedgehog’) ligand. PTCH binding to SMO inhibits growth-signal transduction. SHH binding to PTCH releases this inhibition. If the normal function of PTCH is lost, the proliferation-stimulating effects of SMO are allowed to predominate [20, 21].
Management of odontogenic keratocyst particularly in children still remains a subject of debate. The decision on the treatment treatment option should be established on the size and site of the lesion, recurrence status and radiographic evidence of cortical destruction and histologic variety as it is well known that parakeratotic type is more common in young age. Guided by the aforementioned characteristics, there is a general accord in the literature, for aggressive surgical approaches with complete lesion eradication, such as resection with or without reconstruction. These aggressive manipulations may lead to deformities, which may lead to serious psychosocial outcomes, especially in adolescents. Thence, the priority has been given to the reduction of complications as much as possible [22-27].
Most of the studies revealed high tendency to recurrence where enucleation is the only surgical manipulation, but this can be considerably decreased when combined with adjunctive procedures [23, 28, 29]. However, adjunctive manipulations, including Peripheral Ostectomy, Carnoy' s solution, and Cryotherapy, have their own risks . For instance, Carnoy's solution and other chemical cauterization might cause damage to nearby vital structures such as the IAN and/or permanent tooth buds in mixed dentition. When the cystic lesion lies adjacent to vital structures, marsupialization or decompression is more wise approach in this situation [25, 29]. On the other hand, if lesions are away from these vital structures, then chemical cauterization utilizing Carnoy's solution would be more acceptable given its ability to permeate and fix tissues up to a depth of 1.54 mm into the bone after 5 minutes of application [23, 24, 29, 30]. Cryotherapy is another procedure which can give similar outcomes, but may produce complications such as wound dehiscence noted in most cases [24, 31]. Peripheral Ostectomy is impractical in cases where cysts are large owing to the presence of very thin bony walls, and is not advised in cases with ameloblastoma because it may lead to seeding of ameloblastoma foci deeper in the bone [13, 24]. However, a large cavity following enucleation it is more prudent to allow it to heal by secondary intention rather than primary wound closure to avoid the hazards of postoperative infection [22, 24, 28].
The ideal properties of dressing material used for dressin wounds in the oral cavity should consist of following: alleviation of postoperative pain, upgrading of healing and safeguard against infection. Iodoform is regarded as a dressing material owing to its capability to reduce wound fluids by Fibrinolytic activity, exhibits antimicrobial activity after topical application and covers exposed bone surfaces to reduce pain [32, 33]. Recently investigators have shown that decompression and marsupialization change the epithelial lining of keratocystic odontogenic tumor into a less aggressive form, and some tumors have undergone complete resolution with these treatment modalities [22, 24]. Based on the above results, they recommended performing enucleation with or without chemical cauterization utilizing Carnoy's solution followed by iodoform gauze dressing for all cases specially in children.
Yildirim et al.  and Hadziabdic et al.  have shown that radiographically complete bone resolution was achieved in about 12 and 16 months in their respective studies.
In children with unerupted teeth, aggressive manipulations endanger the eruption process and the development of the involved jaw, hence conservative approach should be given first priority . Thus, in young patients conservative treatment should be considered rather than aggressive one. On the other hand, en bloc resection is thought of in the following cases:
Cases of cyst’s recurrence in spite of prior enucleation with an adjunctive procedure.
When odontogenic keratocysts recur inspite of prior marsupialization followed by enucleation with an adjunctive procedure.
In cases of multiple nonsyndromic or syndromic odontogenic keratocysts of NBCCS.
Where diagnosed odontogenic keratocysts show particularly aggressive clinical behavior which require radical resection as the first treatment option .
Finally this review reflects very clearly the lack of literature relating to behavior and management of keratocyst in children as most of the papers were case reports or case series.