In a case, toward enucleation with complication, other case toward resection. Envelopmental this is an odontogenic keratocyst which embraces or envelopes an adjacent unerupted tooth. Odontogenic keratocyst in the mandible, surgical treatment. The odontogenic keratocyst is a very well known odontogenic cyst. The odontogenic keratocyst okc, currently designated by the world health organization as a keratocystic odontogenic tumor is a locally aggressive, cystic jaw lesion with a putative high growth potential and a propensity for recurrence. It is characterized by its fast aggressive growth and high risk of recurrence. Odontogenic infections, consisting primarily of dental caries and periodontal disease gingivitis and periodontitis, are common and have local eg, tooth loss and, in some cases, systemic implications. Surgical treatment of odontogenic keratocyst tumour. Dentigerous cyst with 15% and a radicular cyst with 10% were in the second and third place.
Although there are promising new techniques to treat an odontogenic keratocyst, the most common method of treatment is simply going into the jawbone and removing the odontogenic keratocyst. Although it was always thought by some that odontogenic keratocysts could be marsupialized, this has not been the treatment of choice, and in fact in many hands treatment of the odontogenic keratocyst has be. Radiographically, most okcs are unilocular when presented at the periapex and can be mistaken for radicular or lateral periodontal cyst. There are many types of cysts of the jaws, but what makes the odontogenic keratocyst unusual are its characteristic histopathological and clinical features, including potentially aggressive behaviour, high recurrence rate, and an association with the nevoid basal cell carcinoma syndrome. Enucleation of a multilocular odontogenic keratocyst using. Odontogenic keratocyst okc is a developmental cyst that was first described by philipsen 1956. The term odontogenic keratocyst was first used by philipsen in 1956. Immunohistochemical demonstration of bone morphogenic protein in odontogenic tumors. Keratocystic odontogenic tumour is relatively rare benign tumour. Recommendations vary from enucleation, with or without adjunctive therapy such as application of carnoy solution, to marsupialization or decompression, to marginal or segmental resection.
It can occur anywhere in the jaw, but commonly seen in the posterior part of the mandible. Case report a 28year old man was referred to the department of oral surgery complaining of painless swelling in the. The okc is classified as a developmental epithelial cyst and comprises approximately 11% of all cysts of jaws. Odontogenic keratocyst is a locally aggressive and highly recurrent lesion, which occurs mostly on the posterior mandible with a slightly higher rate in males. We analyzed the etiopathogenetic, clinical, radiographic, and histopathologic aspects of keratocystic odontogenic tumors, particularly in association with dental anomalies of number, with the aim of providing useful information for their correct diagnosis, treatment, and prognosis within a multidisciplinary approach. Okc is now referred to by the world health organization who as a keratocystic odontogenic tumour kcot, and who defined it as a benign uni or multicystic, intraosseous tumour of odontogenic origin, with a characteristic lining of parakeratinized stratified. The odontogenic keratocyst arises by proliferation of the residues of the dental lamina, possibly as a hamartomatous abnormality. Odontogenic keratocysts appear distinct from other jaw cysts. Half the cysts were histologically proven odontogenic keratocysttumor okc. Surgical treatment of odontogenic keratocyst by enucleation. Surgical treatment algorithm for odontogenic keratocyst. Odontogenic keratocyst because of its behavior, many oral pathologists now consider the okc an odontogenic tumor that has a cystic form 2005 classi. Recurrent glandular odontogenic cyst additional references mervyn shear and paul speight.
Odontogenic cysts are largely classified based on their location, viability of the associated tooth and clinical setting the principal exception to this is the odontogenic keratocyst, which can occur in any site or setting unlike most of the other cysts, it has aggressive potential. Radiographically, it may appear unilocular or multilocular, with or without defined borders. Pdf keratocystic odontogenic tumour with extraosseal. It is thought to originate from dental laminae residues. In this report, a 35yearold male patient was admitted to our clinic with numbness in the left mandible. Upon the establishment of intravenous sedation and local anesthesia, the. Odontogenic keratocyst in the mandible, surgical treatment and reconstruction. Histologic examination revealed an odontogenic keratocyst with no evidence of mineralization or calcification within the lesion. The odontogenic keratocyst okc is a jaw cyst with a proclivity for local invasion and recurrence. Okc is now referred to by the world health organization who as a keratocystic odontogenic tumour kcot, and who defined it as a benign uni or multicystic, intraosseous tumour of odontogenic origin, with a characteristic lining of parakeratinized stratified squamous epithelium. The patient accepted the treatment plan and following a standard history and physical examination, the patient was consented for surgery.
Conservative surgical removal and longterm followup is the treatment of choice by most clinicians. Keratocystic odontogenic tumours are known for their peculiar behaviour, varied origin, debated development, unique tendency to recur and disputed treatment modalities. First described by philipsen in 1956, the odontogenic keratocyst is characterized by a large squamous keratinization of its border, an aggressive growth and a high recurrent rate. The case for decompression and marsupialization mandible chapter 12. Reclassification and treatment of odontogenic keratocysts. There is no uniform agreement as to the most appropriate method of treatment of odontogenic keratocysts.
Odontogenic keratocyst okc is the cyst arising from the cell rests of dental lamina. Presentation of a keratocystic odontogenic tumor with. It is one of the most aggressive odontogenic cysts of the oral cavity. Okc is now referred to by the world health organization who as a keratocystic odontogenic tumour kcot, and who defined it as a benign uni or multicystic, intraosseous tumour of odontogenic origin, with a characteristic lining of parakeratinized. Conservative treatment protocol of odontogenic keratocyst. An expansile lesion in the body of the left mandible had high attenuation 225 hu on nonenhanced ct scans. The radiographic odonogenic of aot frequently resemble other odontogenic lesions such as dentigerous cysts, calcifying odontogenic cysts, calcifying odontogenic tumors, globulemaxillary cysts, ameloblastomas, odontogenic keratocysts and periapical disease 10. Clinically, the kot is manifested by an asymptomatic growth. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Glandular odontogenic cyst, calcifying epithelial odontogenic. Thus, it has been the subject of much research over the last 40 years.
The treatment was chosen in order to preserve the associated permanent teeth with complementary orthodontic treatment to direct eruption of the associated permanent teeth. Keratinocystic odontogenic tumor odontogenic keratocyst keratinocystic odontogenic tumor three important things associated with this diagnosis. Orthokeratinized odontogenic keratocyst is a lessaggressive nonsyndromic variant of odontogenic keratocyst okc. Okc received its new title as keratocystic odontogenic tumour. In the united states, it is estimated that 25 percent of adults over the age of 60 have lost all their teeth edentulism, approximately one. Odontogenic keratocysts are significant cysts of the jaw that are characterized by aggressive behavior and a high tendency to recur. The odontogenic keratocyst okc is a recurrent cyst that has been recently reclassified from an odontogenic tumor to an odontogenic cyst. Odontogenic keratocysts are aggressive lesions characterised by a high recurrence risk ratio due to dental lamina residues in mandibular and maxillary regions. Odontogenic keratocyst looks can be deceptive, causing. Odontogenic keratocysts are dentigerous cysts derived from the proliferation of residues of the dental lamina. These lesions are fairly aggressive locally and they have a high.
When the cyst is multilocular and located at the molar ramus area, it. Unusual ct appearance in an odontogenic keratocyst of the. Surgical management of dentigerous cyst and keratocystic. It enlarges by both multicentric expansion due to the proliferation of localized groups of epithelial cells in the lining and by unicentric expansion from the hydrostatic pressure of its contents. The word odontogenic keratocyst okc was coined by phillipsen in 1956 cakur et al, 2008. Transnasal marsupialization using endoscopic sinus surgery. Odontogenic keratocysts okcs are benign, developmental cystic lesions of epithelial origin and involve the maxilla or mandible. Odontogenic keratocyst marsupialization and decompression.
The odontogenic keratocyst okc is a cystic lesion of odontogenic origin, which is classified as a developmental cyst derived from the dental lamina. The odontogenic keratocyst thus appeared in both the 1st 1971 and 2nd 1992 editions of the who classifications. Cysts of the oral and maxillofacial regions, 4th edition, 2007, head neck pathol 2011. Combined treatment of odontogenic keratocyst and mandibular defect with marsupialization, enucleation, iliac crest bone graft, and dental implants. The odontogenic keratocyst okc has been a controversial entity with regard to its terminology, recurrence tendency, and varied treatment options. This lesion was first described in 1956 by phillipsen. Updates in the surgical management of odontogenic keratocyst. In case of unilocular lucencies dentigerous cyst, eruption cyst, coc, aot, unicystic ameloblastoma etc. Odontogenic keratocysts were first reported by philipsen in 1956. Odontogenic keratocysts potentially behave aggressively, and the rate of recurrence is high, varying from 0 to 62% according to the various treatments. Surgical treatment of keratocystic odontogenic tumour. Keratocystic odontogenic tumour kcot misdiagnosed as a. The orthokeratinizing odontogenic cyst is considered an unrelated entity without risk of recurrence or aggressive growth or association with nevoid basal cell carcinoma syndrome.
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