Odontogenic tumors-2002-02-slides (1)

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Odontogenic tumors-2002-02-slides (1)

  1. 1. •ODONTOGENIC KERATOCYST SUKESH KUMAR.V IV B.D.S
  2. 2. ODONTOGENIC KERATOCYST DEVELOPMENTAL CYST OF UNKNOWN ORIGIN FROM REMINANTS OF DENTAL LAMINA 11% OF ALL JAW DERIVED CYSTS ARE OKC ALSO KNOWN AS PRIMORDIAL CYST(BASED UPON PRIGIN)
  3. 3. CLINICAL FEATURES  AGE:-OCCURS OVER A WIDE RANGE,INTIATED IN EARLY LIFE,PEAK INCIDENCE IN 2nd & 3rd DECADES.  SEX:- MALES>FEMALES;BLAKS>WHITES  SITE:-MORE IN MANDIBLE;AT ANGLE MOSTLY  SYMPTOMS:-ASYMPTOMATIC TILL 2ndrly INFECTED IF 2ndrly INFECTD PID COMPLAINTS OF PAIN,SWELLING,EXPANSION OF BONE,PARASTHESIA OF LOWER LIP AND TEETH
  4. 4. TEETH:-MAY BE DISPLACED IF EXPANDS THROUGH CANCELLOUS BONE&BODY OF MANDIBLE SIGNS:-CAN LEAD TO PATHOLOGIC FRACTURE & AS THESE CYSTS GROW IN ANTEROPOSTERIOR DIRECTION THERE IS NO BONY EXPANSION IN MOST CASES ASPIRATION:-ON THIS GETS A ODORLESS,REAMY OR CASEOUS MATERIAL
  5. 5. SYNDROMES ASSOCIATED GORLIN-GOLTZ MARFANS EHLERS-DANLOS NOONAN’S MULTIPLE OKC’S ARE FOUND IN RELATION TO THESE
  6. 6. ROENTGENOGRAPHIC FEATURES 1) SITE:- >90% SEEN POSTERIOR TO CANINE IN MANDIBLE;AMONG THEM >50% AT ANGLE OF MANDIBLE. 2) CHARACTERISTIC:- 40%SUGGESTIVE DENTIGEROUS CYST 25% OF PRIMORDIAL CYST 25% OF LATERAL PERIODONTAL CYST 10% GLOBULO MAXILLARY CYST
  7. 7. Odontogenic Keratocyst
  8. 8. 3)INTERNAL STRUCTURE:- UNDULATING BORDERS WITH CLOUDY INTERIOR APPEARENCES SUGGESTIVE OF MULTILOCULARITY. 4)SIZE:- VARIES FROM 5Cm or MORE IN DIAMETER. 5)SHAPE:- USUALLY OVAL EXTENDING ALONG BODY OF MANDIBLE. 6)MARGINS ARE HYPEROSTOTIC 7)UNILOCULAR VARIETY:- MAJORITY OF LESIONS ARE UNILOCULAR WITH SMOOTH BORDERS OR LARGE IRREGULAR BORDERS.  RADIOLUCENCY IS HAZY DUE TO KERATIN FILLED CAVITY& SURRONDED BY THIN SCLEROTIC RIM.
  9. 9. IN SOME CASES IT CAN PERFORATE BUCCAL &LINGUAL CORTICAL PLATES OF BONE,DUE TO WHICH DISPLACEMENT OF INFERIOR ALVEOLAR CANAL OCCURS. CT FEATURES WILL DEMONSTRATE EXACT DIMENSIONS OF RADIOLUCENCY. RADIOLOGICAL TYPES OF KERATOCYST:ENVELOPMENTAL TYPE REPLACEMENT TYPE EXTRANEOUS TYPE COLLATERAL TYPE
  10. 10. HISTOLOGICAL FEATURES • LINING EPITHELIUM IS HIGHLY CHARACTERISTIC &COMPOSED OF 1)PARAKERATINISED SURFACE WHICH IS TYPICALLY CORRUGATED,RIPPLED. 2)6-10CELL THICKNESS OF EPITHELIUM 3)PROMINENT PALISADED POLARISED BASAL LAYER OF CELLS OFTEN DESCRIBE AS “PICKET FENCE” or “TOMBSTONE” appearance.
  11. 11. Odontogenic Keratocyst
  12. 12. FORMED WITH STRATIFIED SQUAMOUS EPITHELIUM THAT PRODUCES ORTHOKERATIN(10%) PARAKERATIN(83%). NO RETERIDGES ARE PRESENT. LUMEN IS FILLED WITH STRAW COLOUR FLUID WITH GR8 DEAL OF KERATIN. CHOLESTEROL,HYALINE BODIES ARE PRESENT AT SITE OF INFLAMMATION. DYSPLASTIC &NEOPLASTIC FEATURES OF LINING EPITHELIUM IS UNCOMMON. C.TISSUE HAS DAUGHTER or SATELLITE CYSTS
  13. 13. DIAGNOSIS  CLINICAL DIAGNOSIS- Not so specific.  RADIOLOGICAL- Radiolucency extending in anteroposterior direction with undulating borders suggest OKC.  LAB DIAGNOSIS-Biopsy reveals the related histological features.  DIFFERENTIAL DIAGNOSIS:  AMELOBLASTOMA  RESIDUAL CYST  TRAUMATIC CYST  FIBROMA  GAINT CELL GRANULOMA
  14. 14. MANAGEMENT  ENUCLEATION-WITH VIGOROUS CURETTAGE OF CYSTIC WALL.  PERIPHERAL OSTEOTOMY-REDUCES CHANCES OF RECURRENCE.  CHEMICAL CAUTERIZATION-WITH INTRALUMINAL Inj .OF CARNOY’S Sol.  DECOMPOSITION-WITH HELP OF POLYETHYLENE DRIANAGE TUBE KEPT IN BONY CAVITY.
  15. 15. RECURRENCE VERY HIGH DUE TO-SATELLITE CELLS NEW CYST FORMATION DIFFICULTY IN ENUCLEATION INTRINSIC GROWTH POTENTIAL PROLIFERATION OF BASAL CELL.
  16. 16. REFERENCES • ANIL GOVINDARAO GHOM • SHAFFER-HINE-LEVY. • BURKITT’S • SCULLEY
  17. 17. THANKYOU

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