Odontogenic keratocyst involving maxillary antrum / dental courses

INDIAN DENTAL ACADEMYINDIAN DENTAL ACADEMY
Leader in continuing Dental EducationLeader in continuing Dental Education
ODONTOGENIC KERATOCYST INVOLVINGODONTOGENIC KERATOCYST INVOLVING
MAXILLARY ANTRUMMAXILLARY ANTRUM
-A CASE REPORT-A CASE REPORT
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Odontogenic keratocyst first described asOdontogenic keratocyst first described as CholesteatomaCholesteatoma byby
HauerHauer (1926) and named so by(1926) and named so by PhilipsenPhilipsen (1956) is a cystic(1956) is a cystic
lesion of odontogenic origin derived from remnants of dentallesion of odontogenic origin derived from remnants of dental
lamina having biologic behaviour similar to benign neoplasm,lamina having biologic behaviour similar to benign neoplasm,
with distinctive lining of six to ten palisaded basal cell layerwith distinctive lining of six to ten palisaded basal cell layer
and corrugated parakeratin surfaceand corrugated parakeratin surface
Posterior mandible being the commonest site, its occurrencePosterior mandible being the commonest site, its occurrence
in maxilla is unusual and its appearance in maxillary sinus isin maxilla is unusual and its appearance in maxillary sinus is
very uncommonvery uncommon

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Dentigerous Cyst i.r.t 18Dentigerous Cyst i.r.t 18

ADENOMATOID ODONTOGENIC TUMOURADENOMATOID ODONTOGENIC TUMOUR
ODONTOGENIC KERATOCYSTODONTOGENIC KERATOCYST
AMELOBLASTIC FIBROODONTOMAAMELOBLASTIC FIBROODONTOMA

AspirationAspiration

Vitality TestVitality Test
Hematological ExaminationHematological Examination

IMPACTED 18IMPACTED 18

ODONTOGENIC KERATOCYSTODONTOGENIC KERATOCYST
INVOLVINGINVOLVING
RIGHT MAXILLARY SINUSRIGHT MAXILLARY SINUS

Odontogenic keratocyst (OKC) is a cystic lesion of
odontogenic origin which accounts for 11.2% of all cysts in
jaws
WHO in 2005 reclassified it as Keratocystic Odontogenic
Tumour (KCOT) and defined it as “benign unicystic or
multicystic, intraosseous tumour of odontogenic origin, with
characteristic lining of parakeratinized stratified squamous
epithelium and potential for aggressive infiltrative behaviour”
DISCUSSIONDISCUSSION

It arises from remnants of dental lamina or from
proliferation of basal cells of oral mucosa and tends to
extend along the cancellous component of bone
without producing much expansion of cortical plates
Toller showed that osmolality of cyst was higher than that of
serum which results in growth of keratocysts.

It occurs over wide age range peak being 2nd and 4th
decades with men being more affected especially in blacks.
Higher preponderance in females (17:1) has been observed
when associated with Gorlin Goltz Syndrome
Mandible is more frequently involved than maxilla with
posterior part being the most common location.

Payne has reported equal distribution between anterior and
third molar tuberosity area, Pandres et al has found anterior
maxilla being the favoured site while Myoung et al reported
posterior maxilla being predominant site.
Voorsmit et al has suggested that less than 1% of all cases of
odontogenic keratocyst occur in maxilla involving sinus

Odontogenic keratocyst generally represents with
asymptomatic swelling, mobility and displacement of
teeth with occasional expansion of cortical plates and
aggressive growth sometimes.
Displacement and destruction of floor of orbit and
proptosis of eyeballs have been reported by Voorsmit et al
in keratocyst involving maxillary sinus

Unilocular well-circumscribed radiolucent lesions
surrounded by a thin sclerotic border is common
radiographic finding. Scalloped margins if present suggests
unequal growth activity taking place in different parts of
cystic lining are a common feature of mandibular lesions.
Multilocular appearance is rare

It can displace and resorb teeth and inferior alveolar canal
may be displaced inferiorly.
In maxilla, this cyst can invaginate and occupy entire
maxillary antrum.

Browne has shown bony expansion in approximately 60% of
cases with 1/3rd of maxillary cyst causing buccal expansion
but palatal expansion being rare.
Donoff et al demonstrated presence of collagenase within the
cyst wall & believed that enzymatic degradation may
contribute to expansion

Kubota et al have demonstrated IL-1α enhances type 1
collagen-induced activation of matrix metalloproteinase 2,
which stimulates enzymatic degradation of extracellular
matrices of bone around odontogenic keratocyts, causing
expansion

Li et al found levels of parathyroid hormone related
proteins within the parakeratinized lining of odontogenic
keratocyst significantly high and thus speculated that these
might modulate growth and bone resorption in odontogenic
keratocyst through its effect on osteoclasts and osteoblast
activity

Epithelial lining is of regular stratified squamous epithelium
usually composed of parakeratin surface which is
corrugated, wrinkled, or rippled ranging from 6 to 8 cells
thick and lacking rete pegs
Prominent palisaded, polarized basal cells with a tendency of
nuclei to be polarized away from the basement membrane, is
present often described as tomb stone or picket fence
appearance

Connective tissue wall often show small satellite or
daughter cysts.
Lumen may be filled with a thin straw colored fluid or with
thick yellow, cheesy material indicating presence of keratin
with total protein content below 4 g per 100 ml
Cholesterol and hyaline bodies is present at the site of
inflammation

Report of recurring rates, occurring 5-7 years after
treatment, ranges from 14% ( Voorsmit et al 1981) to 58%
(Myoung et al 2001) with recurrence associated with
Gorlin-Goltz syndrome being higher (82%)
Binali et al has emphasized that it can undergo malignant
transformation at frequency of 5% to 62.5%.

Morgan et al has categorized surgical treatment methods as
conservative or aggressive
Conservative treatment includes enucleation with or
without curettage or marsupalization
Aggressive treatment includes peripheral ostectomy,
chemical curettage with Carnoy’s solution or en bloc resection

Odontogenic keratocyst is a cystic lesion characterized by a
high recurrence rate with involvement of maxillary antrum
being relatively uncommon which may not be diagnosed on
routine intra oral radiographs.
Extraoral radiographs and Computed Tomography are
important in assessing the full extent of the lesions
preoperatively thus aiding in correct diagnosis complete
treatment and prevention of recurrences.

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Odontogenic keratocyst involving maxillary antrum / dental courses

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