This document presents a case study of a 20-year-old female patient diagnosed with an odontogenic keratocyst. Examination found a swelling in her lower right back tooth region. Imaging showed a large multilocular radiolucency. Biopsy and histopathology of the cyst lining confirmed the diagnosis of keratocystic odontogenic tumor. Odontogenic keratocysts require aggressive treatment like resection due to their high recurrence rate from rapid proliferation and presence of satellite cysts. Carnoy's solution can be used as a chemical cauterizing agent during treatment.

1. Case Presentation Of
Odontogenic Keratocyst
By: Rawan Galal Eldin Mohamed.

2. Patient Details :
A 20 year old Female sought care in Outpatient ,
Oral and Maxillofacial Surgery Faculty of Dentistry
, AlNeelain University .
On Extra-Oral Examination: Observed swelling in
lower Right back tooth region , and was gradually
increased in last 2 months. It was not associated
with pain.
-On Palpation: The mass is hard, non-fluctuant, and
non-tender to palpation

3.  On Intra-Oral Examination :
 Occlusion is stable , and the right mandibular third molar appeared to be
impacted.
 There’s buccal expansion of the right mandible, Extending from the right
mandibular first molar area posteriorly toward the ascending ramus.
 The oral mucosa is normal in appearance with no signs of acute inflammatory
processes

4. Investigations :
Radiograph:
- OPG was done , which revealed :
A Large multilocular Radiolucent lesion
with possiple displacement of the right
mandibular third molar .

5. Lab Tests:
- Fine Needle Aspiration(FNA) revealed:
Aspirate is Dirty, Creamy white viscid suspention, and also contains Parakeratinized
squames cells in the fluid.
Total Protein level is <4gm100ml , and most of protein content is albumin.

6. Differential diagnosis of radiographic multilocular
radiolucency ????
 Ameloblastoma
 Keratocystic Odontogenic Tumor .
 Dentigerous cyst .
 Ameloblastic fibroma
 Central giant cell tumor
 Odontogenic myxoma
 Aneurysmal bone cyst
 Traumatic bone Cyst
 Lateral Periodontal Cyst.
 Calcifying Odontogenic Cyst .
 Calcifying epithelial odontogenic
tumor (CEOT)

7. Biopsy and Histopathology :
Biopsy :
Incisional Biopsy was performed.
Histologic features :
•Thin squamous cell epithelial lining
•The epithelial surface is parakeratinized and corrugated
(wavy) .
•Fibrous wall contains epithelial islands that showes central
keratinization and cyst formation (daughter- satellite cells )

8. Final Diagnosis :
This Patient is Diagnosed with Keratocystic Odontogenic tumor (Odontogenic
Keratocyst) according to the invistigation that has been performed

9. Treatment
 Conservative treatment generally includes simple enucleation, with or without
curettage, using spoon curettes of marsupialization. Aggressive treatment
generally includes peripheral ostectomy, chemical curettage with carnoy's
solution and resection.

10. Contents of (Carnoy Solution) :
 Carnoy solution is a cauterizing agent used for chemical fixation and it is applied
to residual cavities of odontogenic keratocyst
 Contents: 6 ml of absolute alcohol, 3 ml of chloroform, and 1 ml of 100% acetic
acid and ferric chloride.
 It penetrates the bone to a depth of 1.54mm after a 5 minutes application
 The use of this agent and soft tissue excision gave a low incidence of relapse
(from 62% to 2.5%).
 The surrounding soft tissues should be protected

11. Why we Treat OKC Aggressively ?
 High Recurrence Rate (11-62) due to :
1. Thin friable cyst wall.
2. Presence of microcysts.
3. Scalloped margin.
4. Enucleation or incomplete removal of cyst
5. Rapid proliferation of this cyst(high mitotic activity)
6. Finger like projection into cancellous bone.

12. Odontogenic Keratocyst
Keratocystic Odontogenic tumor
Primordial cyst
Cholesteatoma

13.  It is a developmental odontogenic epithelialized jaw cyst
 It comprises 3-10% of jaw cystic lesions
 It mimics benign tumours in its behavior
 Characterized by aggressive growth and tendency to recur following surgical
removal
 Origin:
 Cystic degeneration of primordium of the tooth .
 Remnants of dental lamina (epithelial rests & gland of serres)
 Basal cells layer of oral mucosa.

14. Clinical Features :
•Asymptomatic unless secondary
infected.
•Often discovered on routine
radiographic examination.
Basal Cell Naevus Syndrome

15. Basal cell naevus syndrome:
(Gorlin-Goltz syndrome)
Autosomal dominant condition.
Multiple keratocysts.
Multiple naevoid basal cell carcinoma in unexposed skin or anywhere in
the body.
Skeletal abnormalities:
Bifid rib
Vertebral deformity
Short metacarpals

16. Radiographically :
 Small lesions: well defined unilocular radiolucency.
 Large lesions: well defined multilocular radiolucency.
 It may sometimes be in close association of the crown
of unerupted tooth. But crown are separated from cyst
cavity
 It may be in between roots (scalloped outline).
 It is not associated with root resorption

17. Histopathology :
 The cyst wall is thin and devoid of inflammatory infiltrate. It is
often folded and lined by keratinized stratified squamous
epithelium 5-10 cell thickness
 Surface is corrugated , mitotic activity is higher found in basal
and suprabasal cells
 It is usually parakeratinized but occasionally orthokeratinized.
 Presence of independent satellite cysts or microcysts
(daughter cysts) and basal proliferation.

18. Treatment :
 Decompression by marsupializtion
 Marsupialization followed by enucleation
 Enucleation followed by curettage alone
 Enucleation followed by chemoablation or cryotherapy
 Enucleation with peripheral ostectomy
 Enucleation with peripheral ostectomy and chemoablation or cryotherapy
 Resection: Enbloc resection or mandibular segmental resection

19. THANK YOU !