A Case Report On Odontogenic Keratocyst of Right Mandible

Volume 9, Issue 9, September – 2024 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165 https://doi.org/10.38124/ijisrt/IJISRT24SEP1109
A Case Report on Odontogenic

Keratocyst of Right Mandible
Vival NathashaPinto1; Prathvika Shetty2; Dr. Nisha Joseph3; Dr. Ashaya4; Dr. Muhsina5;
Dr. Raghavendra Kini6; Dr. Rashmi7; Dr. Sitara8
A.J. Institute of Dental Science
Abstract:- Odontogenic keratocysts (OKCs) are rare, II. CASE REPORT

aggressive cystic lesions originating from the dental
lamina remnants and basal cells of the oral epithelium. A 21-year male patient reported to Department of oral
Despite their typically asymptomatic presentation, OKCs medicine and radiology with the complaint of pain in lower
may be incidentally discovered on dental radiographs or right back tooth region for 5days.Pain was sudden in onset,
present with symptoms such as pain or swelling due to dull aching, continuous, non-radiating, aggravated on opening
infection or bone expansion. This case report describes a mouth and relieved on medication. No associated swelling,
21-year-old male who presented with pain in the lower history of fever or trauma, or any dischargereported. Patient’s
right molar region, This case highlights the diagnostic medical and past dental histories were non-contributory.
challenge of OKCs, which can mimic other odontogenic Patient was moderately built and nourished with vital signs
pathologies and underscores the importance of within normal limits.
radiographic assessment for early identification and
management of such lesions. Extra-orally no gross facial asymmetry noted, overlying
skin appeared normal with no erythema or ulcerations [Figure
Keywords:- Odontogenic Keratocyst, Odontogenic Tumour, 1]. Mouth opening appeared to be restricted to 25mm. On
CBCT, MRI. palpation therewas no tenderness or local rise in temperature.
Intra-orally on inspection, 48 was seen missing, overlying
I. INTRODUCTION mucosa appeared normal [Figure 2 ]. On palpation retromolar
region was tender, soft in consistency with discharge noted.
The term "odontogenic keratocyst" was introduced by Based on clinical manifestations, provisional diagnosis of
Philipsen in 1956, and in 1963, Pindborgand Hansen described Impacted teeth w.r.t 48 was given.
its essential features. It is called a keratocyst because the cyst
epitheliumproduces an abundance of keratin that fills the cyst
lumen. Additionally, characteristics of the odontogenic
keratocyst include flattening of the basement membrane and
palisading of the basal epithelial cells, which resemble
odontogenic epithelium. Toller (1967) proposed that OKC
could be considered benign cystic neoplasms [1]. In 2005, the
World Health Organization reclassified the odontogenic
keratocyst (OKC) as a benign odontogenic tumor. This entity
was renamed the keratocystic odontogenic tumor (KCOT).
The rationale for this reclassification included its aggressive
growth, tendency for recurrence after treatment, and, notably,
mutationsin the PTCH gene (protein patched homolog) [2].
OKC originates from remnants of the dentallamina and

basal cells of the overlying epithelium. Although it is a rare
cyst that accounts for about 19% of jaw cysts, it is often
asymptomatic and may be discovered incidentally on dental Fig 1: Shows Extraoral View with no Gross Facial
radiographs. Symptoms, if they occur, are typically due to Asymmetry
infection or bone expansion [3]. In this report, a case of large
OKC of the mandible is described.
IJISRT24SEP1109 www.ijisrt.com 1970

Radiographic investigations like orthopantomogram

(OPG) revealed the long axis of 48 is distally inclined to the
long axis of 47. It also revealed a well-defined multilocular
radiolucent lesion on right side of mandible of size
approximately (25x10 ) mm with corticated borders ,
extending superiorly from sigmoid notch till the level of angle
of the mandible inferiorly, anterio- posteriorly from anterior
aspect to mid portion of ramus [Figure 3]. The inferior most
aspect of the radiolucent lesion appears to be in close
approximation with roof of inferior alveolar canal.
Fig 2: Shows Missing 48 with Normal Overlying Mucosa
Fig 3: Shows Impacted 48 with Multilocular Radiolucent Lesion
Cone Beam Computed Tomography (CBCT) revealed a

well-defined multilocular radiolucentlesion on right mandible
extending 1.5cm posteriorly from anterior border of ramus.
Mild bucco- lingual expansion noted. Lingual cortical plate
destruction and thinning of buccal cortical plate noted w.r.t
48 region [Figure 5]. Radiographic diagnosis of dentigerous
cyst was given.
Fig 4: Shows Bone Destruction

III. DISCUSSION
The term "odontogenic keratocyst" was introduced by

Philipsen in 1956, and in 1963, Pindborgand Hansen outlined
its key characteristics. It is called a keratocyst because the
epithelium produces an abundance of keratin, which fills the
cyst lumen [1]. However, it can mimic otherjaw cysts in terms
of clinical, radiographic, and histological features [7]. OKC
represents 7.8%of all jaw cysts and can occur at any age, with
peak incidence in the second and fourth decadesof life. There
is a tendency for it to occur more frequently in males. In the
mandible, most cystsare found in the ramus. In the present
case also cyst was found with impacted mandibular third
molar extending into ramus. Mandibular cysts can cross the
midline, while maxillary cysts may involve the sinus, nasal
floor, premaxilla, and area around the maxillary third molars.
Commonsymptoms include pain, soft tissue swelling, tooth
displacement, drainage, and neurological signs such as lip or
Fig 5: Shows Thinning of Buccal and Destruction of Lingual tooth paresthesia. [6] In the present patient had mild pain with
Cortical Plates no soft tissue swelling.
On chair side investigation, Fine Needle Aspiration The presence of multiple OKCs is considered a key
Cytology (FNAC) yielded cheesy material admixed with criterion for diagnosing Nevoid Basal Cell Carcinoma
blood. A cyst enucleation was done followed by extraction of Syndrome (NBCCS). This autosomal dominant multi-
48 and biopsy of the lesion was taken .On histopathological systemic disorder is characterized by multiple nevoid basal
examination, a cystic cavity lined by parakeratinized stratified cell carcinomas, multiple OKCs, palmar or plantar pits,
squamous epithelium and connective tissue capsule were calcifications of the falx cerebri, and skeletal abnormalities
seen. Basal layer showing palisaded columnar epithelial cells [9]. Multiple OKCs can also occur in other syndromes,
and connective tissue is fibrous with focal areas of including Noonan syndrome, Ehlers-Danlos syndrome, and
inflammatory cells[Figure 6]. Histopathological findings orofacial- digital syndrome [8]
were suggestive of OKC.
Investigations can include chairside procedures like fine
needle aspiration cytology (FNAC), which typically reveals
shiny straw-colored fluid, as well as biopsies (both excisional
and incisional). Radiographic assessments may involve
intraoral radiographs, orthopantomograms(OPG), cone beam
computed tomography (CBCT), and MRI.
Radiographically, the majority of odontogenic

keratocysts (OKCs) are unilocular (40%), characterized by a
well-defined peripheral rim. Scalloping of the borders is a
common observation, indicating variations in the cyst's
growth pattern. Multilocular radiolucent OKCs (20%) can
also be seen, typically presenting as a central cavity with
satellite cysts, especially in the area of the third mandibular
molar, where they may be mistaken for ameloblastoma on
radiographs [1]. Often found in association with impacted
teeth in 25-40% of cases. [6]
The types of OKCs include: (a) Replacement type: cysts

Fig 6: Shows Para Keratinized Stratified Squamous that develop in place of normal teeth;(b) Extraneous type:
Epithelium with Palisaded Basal Layer cysts that occur in the ascending ramus, away from the teeth;
(c) Collateraltype: cysts located adjacent to the roots of teeth;
Hence, based on history, clinical and radiological (d) Envelopmental type: cysts that surround an adjacent
examinations and aspiration cytology, final diagnosis of unerupted tooth [Figure 7]. [6]
odontogenic keratocyst (OKC) was derived.

IV. CONCLUSION
The odontogenic keratocyst (OKC) is a unique

developmental cyst that presents diagnostic and therapeutic
challenges due to its aggressive behavior, high recurrence
rate, and association with syndromes such as nevoid basal cell
carcinoma syndrome. This case of a young male patient
highlights the importance of early detection and appropriate
treatment planning. Complete surgical excision, close follow-
up, and consideration of histopathological features are
essential for minimizing recurrence. This report underscores
the necessity for clinicians to remain vigilant and adopt an
individualized approach to managing OKC, particularly in
younger patients, to ensure optimal outcomes.
REFERENCES
Fig 7: Types of Odontogenic Keratocyst
[1]. Textbook of oral pathology-SHAFERS
Histologically, the lining epithelium is distinctive, [2]. Lunawat SD, Kunte VR, Bhoosreddy AR, Gade LP,
featuring a parakeratinized surface that is typically Patil RS. Odontogenic Keratocyst: A Rare
corrugated, rippled, or wrinkled. The epithelium exhibits a Presentation in Anterior Maxilla. J Coll Physicians
notable uniform thickness,usually between 6 to 10 cells. The Surg Pak 2020; 30(11):1226-1229
basal layer of cells is prominently palisaded and polarized, [3]. Dilsiz A, et al. Cysts of Oral Cavity: Odontogenic
often referred to as having a "picket fence" or "tombstone" Keratocyst; A Rare Case Report with a6-Year Follow-
appearance. These cysts are lined with stratified squamous Up. J Dental Sci 2023, 8(2): 000364
epithelium, and no rete ridges are present [1]. Small satellite [4]. Textbook of oral pathology- Neville
cysts, cords, or islands of odontogenic epithelium can be found [5]. J Nat Sci Biol Med. 2013 Jul-Dec; 4(2):282-285.
within the fibrous wall [4]. The lumenof the keratocyst may Doi:10.4103/0976-9668.116968
contain a thin, straw-colored fluid or a thicker, creamy [6]. Deepak Passi, International Journal of Current
substance [1]. Research Vol.9, Issue, 07, pp.54080-54086, July,
2017, ISSN: 0975-833X
The treatment of OKCs is determined by factors such as [7]. J of Evidence Based Med And hlthcare, pISSN- 2349-
the patient's age, the size and locationof the cyst, soft tissue 2562, eISSN- 2349-2570/ Vol. 1/ Issue 9/ Oct.31,
involvement, and the histological variant of the lesion. In 2014
1985, Eyre andZarezewska outlined the following treatment [8]. J Int Soc Prev Community Dent. 2016 Jan-Feb; 6(1):
options for OKC/KOT: (A) Enucleation: (a) with primary 84–88. doi: 10.4103/2231- 0762.175414.
closure, (b) with packing, (c) with chemical fixation, (d) with [9]. J Korean Assoc Oral Maxillofac Surg. 2022 Dec 31;
cryosurgery; (B) Marsupialization: (a) alone or (b) followed 48(6): 386–389. Published online 2022 Dec 31. doi:
by enucleation; (C) Resection. [5] .In the present case 10.5125/jkaoms.2022.48.6.386.
enucleation of cyst along with extraction of impacted 48 was [10].
done.
The recurrence rate of OKCs has ranged from 2.5% to

62%. This wide variation may be influenced by the length of
the follow-up period and the treatment methods employed,
particularly in patients with nevoid basal cell carcinoma
syndrome [5]. While many OKCs tend to recur within five
years of the initial surgery [4]. Some potential causes of
recurrence includeincomplete removal of the cystic lining, the
thin and fragile nature of the epithelial lining, increased cell
proliferative activity within the epithelium, adherence to
adjacent soft tissue, and the growth of new OKCs from
satellite cysts/ daughter cysts/ remnants/ or cell rests, etc. [6].
Aside from the tendency for recurrences, the overall
prognosis for most odontogenic keratocysts is favorable. [4]

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Volume 9, Issue 9, September – 2024 International Journal of Innovative Science and Research Technology

ISSN No:-2456-2165 https://doi.org/10.38124/ijisrt/IJISRT24SEP1109

A Case Report on Odontogenic

Abstract:- Odontogenic keratocysts (OKCs) are rare, II. CASE REPORT

OKC originates from remnants of the dentallamina and

IJISRT24SEP1109 www.ijisrt.com 1970

Radiographic investigations like orthopantomogram

Fig 2: Shows Missing 48 with Normal Overlying Mucosa

Fig 3: Shows Impacted 48 with Multilocular Radiolucent Lesion

Cone Beam Computed Tomography (CBCT) revealed a

Fig 4: Shows Bone Destruction

IJISRT24SEP1109 www.ijisrt.com 1971

The term "odontogenic keratocyst" was introduced by

Radiographically, the majority of odontogenic

The types of OKCs include: (a) Replacement type: cysts

IJISRT24SEP1109 www.ijisrt.com 1972

The odontogenic keratocyst (OKC) is a unique

The recurrence rate of OKCs has ranged from 2.5% to

IJISRT24SEP1109 www.ijisrt.com 1973

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