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Odontogenic tumors-2002-02-slides (1)

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OKC

OKC


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  • 1. •ODONTOGENIC KERATOCYST SUKESH KUMAR.V IV B.D.S
  • 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. 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. TEETH:-MAY BE DISPLACED IF EXPANDSTHROUGH CANCELLOUS BONE&BODY OF MANDIBLE SIGNS:-CAN LEAD TO PATHOLOGIC FRACTURE & AS THESE CYSTS GROW INANTEROPOSTERIOR DIRECTION THERE IS NO BONY EXPANSION IN MOST CASES ASPIRATION:-ON THIS GETS AODORLESS,REAMY OR CASEOUS MATERIAL
  • 5. SYNDROMES ASSOCIATED GORLIN-GOLTZ MARFANS EHLERS-DANLOS NOONAN’SMULTIPLE OKC’S ARE FOUND IN RELATION TO THESE
  • 6. ROENTGENOGRAPHIC FEATURES • SITE:- >90% SEEN POSTERIOR TO CANINE IN MANDIBLE;AMONG THEM >50% AT ANGLE OF MANDIBLE.• CHARACTERISTIC:- 40%SUGGESTIVE DENTIGEROUS CYST 25% OF PRIMORDIAL CYST 25% OF LATERAL PERIODONTAL CYST 10% GLOBULO MAXILLARY CYST
  • 7. Odontogenic Keratocyst
  • 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. IN SOME CASES IT CAN PERFORATE BUCCAL&LINGUAL CORTICAL PLATES OF BONE,DUE TOWHICH 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. HISTOLOGICAL FEATURES • LINING EPITHELIUM IS HIGHLY CHARACTERISTIC &COMPOSED OF1)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. Odontogenic Keratocyst
  • 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. DIAGNOSIS  CLINICAL DIAGNOSIS- Not so specific. RADIOLOGICAL- Radiolucency extending inanteroposterior 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. 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. RECURRENCE VERY HIGH DUE TO-- SATELLITE CELLS NEW CYST FORMATION DIFFICULTY IN ENUCLEATIONINTRINSIC GROWTH POTENTIALPROLIFERATION OF BASAL CELL.
  • 16. REFERENCES• ANIL GOVINDARAO GHOM• SHAFFER-HINE-LEVY.• BURKITT’S• SCULLEY
  • 17. THANKYOU

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