Odontogenic keratocysts/keratocystic odontogenic tumours: biological characteristics, clinical manifestation and treatment

Jindrich Pazdera,Peter Tvrdy,Richard Pink,Zdenek Kolar,Vitezslav Zboril

doi:10.5507/bp.2012.048

Abstract

Odontogenic keratocysts (OKCs) now reclassified as Keratocystic odontogenic tumours (KCOTs) are a clinical entity with a characteristic microscopic picture, kinetic growth and biological behaviour. They arise from the proliferation of the epithelial dental lamina in both maxilla and mandible and occur in patients of all ages. 70-80% of keratocysts are found in the mandible commonly in the angle between the jaw and mandibular branch and maxillary region of the third molar. The cysts are long latent, often symptomless and may attain remarkable dimensions without significant deformation of the jaw bones. They are often found during routine dental X-ray examination. Compared to other types of jaw cyst, odontogenic cysts have a striking tendency to rapid growth and re-occurrence. This review focuses on the biological characteristics, clinical behaviour and treatment of KCOTs. The databases searched were the PubMed interface of MEDLINE and LILACS. Ondontogenic keratinocysts are not currently a diagnostic problem. Orthopantomograms which are today ordinary tools of dental investigation enable diagnosis of clinically asymptomatic cystic lesions. The problem remains the optimal therapeutic approach to reduce the still high likelihood of postoperative recurrence. There is no complete consensus on the ideal operating procedure but cystectomy with delayed extirpation is favoured. An open question also remains the timeliness of screening for postoperative recurrences. Given that the first clinical manifestation of Nevoid Basal Cell Carcioma Syndome (NBCCS) may be lesions of this type, routine histopathological classification supplemented by analysis of immunophenotype should be done. Patients with proven sporadic and especially syndromic OKC should be long term screened. In patients with NBCC preventive X ray examination is recommended only once a year.

Highlights

Cysts of the jaw are a common clinicopathological finding
They arise from proliferation of the epithelial dental lamina of the upper and lower jaw. In most cases they are benign lesions with aggressive behaviour and a significant tendency to recurrence following surgical removal. They occur in patients of all ages though diagnosis is most common in the second and third decades of life. 70-80% keratocysts are found in the lower jaw most commonly in the angle between jaw and mandibular branch and in the maxilla in the area of the third molar[1,2,3]
They differ from radicular and follicular cysts identifiable by the typical alveolar bulge caused by expansive growth in that the developing odontogenic keratocysts are long covert, often without clinical symptoms and discovered during incidental X ray examination

Summary

Background

Odontogenic keratocysts (OKCs) reclassified as Keratocystic odontogenic tumours (KCOTs) are a clinical entity with a characteristic microscopic picture, kinetic growth and biological behaviour. They arise from the proliferation of the epithelial dental lamina in both maxilla and mandible and occur in patients of all ages. The cysts are long latent, often symptomless and may attain remarkable dimensions without significant deformation of the jaw bones. They are often found during routine dental X-ray examination. The problem remains the optimal therapeutic approach to reduce the still high likelihood of postoperative recurrence.

INTRODUCTION

Findings

CONCLUSIONS