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M. Lalegani
Odontogenic Keratocyst
Keratocystic
Odontogenic Tumor
Epidemiology
Male
between 10 and 40 years of age
60%
An unerupted tooth is involved in the lesion
25% -40%
Female
60%
20%-40%
Slight predilection for male
Disease
Mechanism01
o Derived from the dental lamina and is distinctive for its thin,
keratinized epithelium (four to eight cells thick).
Your
Logo
White and Pharoah's Oral Radiology E-Book: Principles and Interpretation
Oral & Maxillofacial Pathology: Neville et al.
Your
Logo
 Viscous or cheesy material inside (If Aspirate.)
 In contrast to most cysts, which are thought to
enlarge solely by intraluminal osmotic pressure,
the epithelium in the OKC appears to have some
innate growth potential.
 Occasionally budlike proliferations of epithelium
grow from the basal layer of the epithelium into the
underlying connective tissue  Multilacularity
 Human homologue of Drosophila PTCH gene 
non-cyctic behavior.
OKC
1. Greater growth potential than most other
odontogenic cysts
2. Higher recurrence rate
3. Possible association with the nevoid
basal cell carcinoma syndrome Although
there
• In the latest WHO monograph on head
and neck tumors, this lesion has been
given the name Keratocystic odontogenic
tumor (KCOT).
• Molecular& genetic findings warrant
reclassification of the OKC as a neoplasm
(KCOT)
KCOT
Clinical
Features 02
KCOT
 OKCs can develop in association with an
unerupted tooth or as solitary entities in
bone.
 No symptoms / Mild swelling may occur
 Pain? Due to secondary infection
 Great propensity for recurrence  because
of small satellite cysts or fragments of
epithelium left behind after surgical removal
Imaging
Features 03
Your
Logo
Location
 The epicenter is located superior to the inferior alveolar canal.
 Assassinated with unerupted teeth difficult to distinguish
from Dentigerous cysts.
• A change to the
contour of the follicle
coronal to the
cementoenamel
junction in an OKC.
• where the follicle
enlarges smoothly
and uniformly from
the cementoenamel
junction.
Periphery
 A well-defined and corticated periphery.
 Border may scallop a thick bone cortex.
Your
Logo
 Most commonly radiolucent.
 Curved internal septa may be present, giving the
lesion a multilocular appearance.
Internal
structure
• An important characteristic of the OKC is its propensity to grow through the bone
without significant bone expansion
Your
Logo
 This “tunneling” type of growth  all body of the mandible
 Except for the ramus and coronoid process (where considerable
expansion may be seen due to the very thin nature of the bone in these
locations)
 Tunneling  Also in alveolar process of maxilla.
 Adjacent to an airspace such as the nasal fossa or maxillary
sinus, OKCs expand in a concentric and hydraulic manner As
the cyst enlarges, it can reduce the volume of the adjacent
airspace.
 The inferior alveolar nerve canal may be displaced inferiorly.
 Occasionally displace teeth and resorb tooth roots, but to a
lesser degree than dentigerous cysts.
• Axial (A) and buccal palatal (B)
cone beam computed
tomographic images of a
maxillary odontogenic
Keratocyst (OKC).
• Note that the OKC is generally
confined to the borders of the
bone except superiorly, where
there has been hydraulic
expansion of the nasal floor
Differential
Interpretation04
Your
Logo
 In a pericoronal position  Dentigerous cyst
 The lesion is likely to be an OKC if the 1- cyst
periphery is associated with the tooth at a point
apical or coronal to the CEJ or 2- if little or no
expansion of the bone has occurred.
Internal
structure
Differential
Diagnosis
 The scalloped margin or a multilocular appearance
 ameloblastoma.
 Expansion.
 In maxilla  Large lateral periodontal cysts.
 Expansion.
 The mild expansion and multilocular appearance of
the odontogenic myxoma.
 A simple bone cyst (SBC) often has a scalloped
border and minimal bone expansion.
 The margins of an SBC usually are more delicate and
often difficult to detect, and there is little or no
effect on the teeth or the supporting structures.
Management 06
Your
Logo
 OKC is suspected? Refer to OMFR.
 Cortical perforation? MDCT should be used to
investigate the possibility of soft tissue extension.
 No Cortical perforation? CBCT
 Recurrence rate is high  precise extent required
searching for soft tissue perforation using MDCT
 Resection/Curettage/Marsupialization(to reduce the
size of large lesions before surgical excision)
 Important to complete removal of the cystic walls
so as to reduce the chance of recurrence.
 After surgery  reexamine in regular intervals.
 Recurrence is common within first 5 years but can
occur as much as 10 years.
CASE
REPORTS
Case1
Case2
Case3
Thank For Your Kind Attention.

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Keratocystic odontogenic tumors(KCOT) or Odontogenic Keratocyst(OKC)OKC

  • 2. Epidemiology Male between 10 and 40 years of age 60% An unerupted tooth is involved in the lesion 25% -40% Female 60% 20%-40% Slight predilection for male
  • 4. o Derived from the dental lamina and is distinctive for its thin, keratinized epithelium (four to eight cells thick). Your Logo White and Pharoah's Oral Radiology E-Book: Principles and Interpretation Oral & Maxillofacial Pathology: Neville et al.
  • 5. Your Logo  Viscous or cheesy material inside (If Aspirate.)  In contrast to most cysts, which are thought to enlarge solely by intraluminal osmotic pressure, the epithelium in the OKC appears to have some innate growth potential.  Occasionally budlike proliferations of epithelium grow from the basal layer of the epithelium into the underlying connective tissue  Multilacularity  Human homologue of Drosophila PTCH gene  non-cyctic behavior.
  • 6. OKC 1. Greater growth potential than most other odontogenic cysts 2. Higher recurrence rate 3. Possible association with the nevoid basal cell carcinoma syndrome Although there • In the latest WHO monograph on head and neck tumors, this lesion has been given the name Keratocystic odontogenic tumor (KCOT). • Molecular& genetic findings warrant reclassification of the OKC as a neoplasm (KCOT) KCOT
  • 8. KCOT  OKCs can develop in association with an unerupted tooth or as solitary entities in bone.  No symptoms / Mild swelling may occur  Pain? Due to secondary infection  Great propensity for recurrence  because of small satellite cysts or fragments of epithelium left behind after surgical removal
  • 10. Your Logo Location  The epicenter is located superior to the inferior alveolar canal.  Assassinated with unerupted teeth difficult to distinguish from Dentigerous cysts. • A change to the contour of the follicle coronal to the cementoenamel junction in an OKC. • where the follicle enlarges smoothly and uniformly from the cementoenamel junction.
  • 11.
  • 12. Periphery  A well-defined and corticated periphery.  Border may scallop a thick bone cortex.
  • 13. Your Logo  Most commonly radiolucent.  Curved internal septa may be present, giving the lesion a multilocular appearance. Internal structure
  • 14. • An important characteristic of the OKC is its propensity to grow through the bone without significant bone expansion
  • 15. Your Logo  This “tunneling” type of growth  all body of the mandible  Except for the ramus and coronoid process (where considerable expansion may be seen due to the very thin nature of the bone in these locations)  Tunneling  Also in alveolar process of maxilla.  Adjacent to an airspace such as the nasal fossa or maxillary sinus, OKCs expand in a concentric and hydraulic manner As the cyst enlarges, it can reduce the volume of the adjacent airspace.  The inferior alveolar nerve canal may be displaced inferiorly.  Occasionally displace teeth and resorb tooth roots, but to a lesser degree than dentigerous cysts.
  • 16. • Axial (A) and buccal palatal (B) cone beam computed tomographic images of a maxillary odontogenic Keratocyst (OKC). • Note that the OKC is generally confined to the borders of the bone except superiorly, where there has been hydraulic expansion of the nasal floor
  • 18. Your Logo  In a pericoronal position  Dentigerous cyst  The lesion is likely to be an OKC if the 1- cyst periphery is associated with the tooth at a point apical or coronal to the CEJ or 2- if little or no expansion of the bone has occurred. Internal structure Differential Diagnosis  The scalloped margin or a multilocular appearance  ameloblastoma.  Expansion.  In maxilla  Large lateral periodontal cysts.  Expansion.  The mild expansion and multilocular appearance of the odontogenic myxoma.  A simple bone cyst (SBC) often has a scalloped border and minimal bone expansion.  The margins of an SBC usually are more delicate and often difficult to detect, and there is little or no effect on the teeth or the supporting structures.
  • 20. Your Logo  OKC is suspected? Refer to OMFR.  Cortical perforation? MDCT should be used to investigate the possibility of soft tissue extension.  No Cortical perforation? CBCT  Recurrence rate is high  precise extent required searching for soft tissue perforation using MDCT  Resection/Curettage/Marsupialization(to reduce the size of large lesions before surgical excision)  Important to complete removal of the cystic walls so as to reduce the chance of recurrence.  After surgery  reexamine in regular intervals.  Recurrence is common within first 5 years but can occur as much as 10 years.
  • 22. Case1
  • 23. Case2
  • 24. Case3
  • 25. Thank For Your Kind Attention.

Editor's Notes

  1. A 53-year-old female accidentally detected on a dental X-ray. Extraoral examination revealed left facial asymmetry, but no submandibular lymphadenopathy. The following anomalies were also found: inactive fistula (tooth 45); mandibular body bulging (teeth 31–35 . Diagnostic imaging demonstrated a 2-chamber osteolytic lesion in the area of teeth 42–36. Teeth 42, 41, 31, 32, 33, 34, and 35 remained within the cystic lumen The preparation for surgery consisted of the endodontic treatment of teeth 42, 41, 31, 32, and 33, and the extraction of teeth unsuitable for routine treatment (34 and 35). Then, intraoral cyst enucleation was performed (the area of teeth 33–36) and the root apex of tooth 33 was resected. . Based on the pathology reports, an initial diagnosis of mandibular body OKC was provided, and the decision was made to completely evacuate the lesion. A month later, cystectomy was performed in the area of teeth 42–32 with the apicectomy of teeth 42, 41, 31, and 32. Histological examination confirmed the initial diagnosis of OKC, a cyst with a connective tissue wall lined with parakeratinized stratified squamous epithelium .
  2. A 15-year-old female reported with a complaint of pain and pus discharge with respect to the left upper back teeth region for 3 months. The pain was intermittent, dull aching, of moderate intensity and was radiating to the ear and eye. It was also associated with pus discharge with respect to the upper left second molar for 3 months. Intra oral examination revealed a diffuse unnoticeable swelling on buccal aspect with obliteration of mucobuccal fold of 26, 27. The swelling was soft to firm in consistency and was tender on palpation with respect to mucobuccal fold, alveolar mucosa in relation to 26, 27 and distal to 27. Hard-tissue examination showed missing 28 and tender on percussion with respect to 26, 27. Panoramic revealed an ill-defined, radiolucent lesion associated with an impacted third molar displaced to the left maxillary sinus.
  3. A 12-year-old male patient was referred to the orthodontic department at King’s College Hospital. Extra-orally, the patient presented with a moderate skeletal II base, with average vertical proportions and no obvious transverse asymmetries. Panoramic view showed the presence of what appeared to be a well-defined, uniformly radiolucent, unilocular lesion extending from the distal surface of the lower right first molar towards the apical region of the lower right second molar measuring approximately 5 × 10 mm in size. DDX: Odontogenic keratocyst:/Dentigerous cyst/Lateral periodontal cyst/Solitary bone cyst/Odontogenic tumour