Keratocyst Research Articles

Odontogenic Kerato Cysts: Clinical and Radiographic Presentations

Introduction: Odontogenic keratocysts (OKCs) are developmental odontogenic cysts of epithelial origin. The initial terminology for an odontogenic keratocyst (OKC) was “primordial cyst,” as the origin of the lesion was thought to be the tooth primordium. Objective: To determine the frequency of clinical features and radio graphical appearance of odontogenic keratocyst. Subjects and methods: This Cross Sectional Study was conducted in Akhtar saeed trust hospital Lahore from 2020 to March 2021. A total of 216 patients of both genders with odontogenic keratocysts were included. Patients with history of basal cell nervous syndrome, Orthokeratinized variant and treated cases were excluded. Clinical features and radio graphical appearance of odontogenic keratocyst was collected as per operational definition. Clinical features were noted under the supervision of a consultant with 3 years’ post fellowship experience. Data was collected and noted. Results: Age range in this study was from 20 to 40 years with mean age of 29.629±3.87 years, mean weight 72.675±12.99 kg, mean height 1.556±0.10 meters, mean BMI 30.087±5.03 Kg/m2, mean duration of complain 8.555±2.49 months and mean pain score was 5.291±1.85. Majority of the patients (61.1%) belongs to 20-30 years age groups. While males were 56.9% as compare to females 43.1%. Pain was seen in 52.8% patients, facial asymmetry 69.4% and root resorption was 9.3%. Conclusion: It is recommended to the general dental practitioners to have an overview of whole of the stomatognathic system, even if a patient comes for a single tooth problem.

Particularities of the treatment of odontogenic keratocyst by cystectomy. Clinical case

Odontogenic keratocysts (KO) are benign uni- or multichystic, intraosseous lesions of development located in the oro-maxillo-facial region. They appear as a result of the disruption of odontogenesis, the main sources being the dental lamina with its remains and the extensions of the basal layer of the oral covering epithelium. It is characterized by a potential aggressive, infiltrative or diffuse behavior. Due to the fact that the condition is associated with an asymptomatic clinical picture, it is diagnosed late, when the formation is in a phase of chronic evolution, reaching considerable dimensions. Thus, there is a dilemma among specialists regarding the choice of the optimal treatment method, addressing the need to combine surgical-conservative methods with surgical methods that have a radical character, such as mandibular resection. The aim of the study is the early diagnosis of odontogenic keratocyst and the treatment of the disease in a minimally invasive way. The study examined a patient who was diagnosed with odontogenic keratocyst and treated by the cystectomy method. Analyzing the data of the literature and the aspects of the treatment of odontogenic keratocysts, it was found that the surgical management of patients with KO is individually being influenced by the high recurrence rate and its morphopathological peculiarities.

Clinicopathological analysis of 847 odontogenic cysts in North Indian population examined over 10 years' period: A retrospective study

Aims and Objectives: The purpose of this study is to analyze and report the prevalence, frequency, sex distribution, site distribution, and clinicopathological features of odontogenic cysts in an institutional academic dental hospital by studying the biopsy specimens and clinical records obtained from the archives of the Department of Oral and Maxillofacial Surgery and Department of Pathology, AMU, Aligarh, India, during the past 10 years. Materials and Methods: Data on odontogenic jaw cysts treated between 2009 and 2018 were retrieved from clinical files; imaging and histopathology reports and a total of 847 patients were included. In each case, we analyzed age, gender, type and number of cysts, and cyst location. Imaging characteristics and pathologies associated with cystic lesions were also determined. Results: Diagnosis of odontogenic cyst was made in 847 cases and accounted for 10.9% of all lesions biopsied (7748) throughout the period. Mean age of the patient was 28.2 years, and 57.3% were males. The overall male to female ratio was 1.34:1. Radicular cyst was most prevalent histological type (54.54%) followed by dentigerous cyst, odontogenic keratocyst, lateral periodontal cyst, residual cyst, botyroid odontogenic cyst, gingival cyst. The distribution of cysts was nearly equal in the mandible (51.6%) and maxilla (48.4%) with the cysts most commonly located in anterior maxilla and posterior mandible. The most prevalent radiological feature of these lesions was unilocular cyst (88.78%). Associated pathologies with cystic lesions such as displacement and resorption of teeth occurred in 14.7%. Conclusions: This study revealed that prevalence, distribution, and characteristics of odontogenic cysts of oral cavity and jaws in the North Indian population, have some differences as well as similarities with the findings of studies in different populations.

Clinicopathological analysis of 844 cases of odontogenic keratocysts

To investigate the clinicopathologic features and prognostic factors in odontogenic keratocyst (OKC), and to provide new reference for clinic treatment and management of these patients. Clinicopathological data of 844 cases initially diagnosed as or associated with OKC at Department of Oral Pathology, Peking University Hospital of Stomatology from 2000 to 2018 were collected. The cases were divided into 4 groups: sporadic OKCs (intraosseous, cystic lesion irrelevant to nevoid basal cell carcinoma syndrome), syndromic OKCs, solid OKCs and peripheral OKCs. The patients were follow-up for 6 to 216 months and the factors that might relate to recurrence were analyzed. There were 805 cases (95.4%) of sporadic OKCs, 32 cases (3.8%) of syndromic OKCs, 3 cases of solid OKCs and 4 cases of peripheral OKCs. The main age of sporadic OKCs was 36.03 years with the peak at the second and third decades. Ratio of male and female was 1.27:1. The predilection site was the molar and ramus area of mandibular (56.2%). In the study, 428 cases (71.2%) were unilocular in radiography while 28.8% were multilocular. The recurrent rate of enucleation with the follow-up was 20.1% (118/588) while most of them occurred in 1-3 years after surgery. The recurrent rate of multilocular patients (39.0%) was significantly higher than that of the unilocular. Enucleation after marsupialization (43 cases) or enucleation only (545 cases) showed no difference in recurrence (P>0.05). The syndromic OKCs was younger (main 20.97) and preferred to be multiple compared with sporadic OKCs (30/32, 93.7%). The predilection site was also molar and ramus area of mandibular (41.7%). Age and gender distribution of multiple cases had no significant difference with those in sporadic OKCs. More daughter cysts and epithelial islands were seen (56.3% and 17.9%). Furthermore, the recurrent rate was significantly higher than that of the sporadic OKCs (13/29, 44.9%). But there was no evidence of recurrent-related factors. The age of solid and peripheral OKCs, averaged at 45.00 and 65.75 years, were older than others. Four of peripheral OKCs showed no recurrence after enucleation. The recurrence rate of sporadic OKCs after enucleation is 20.1%. The multilocular lesions prefer to be recurrent. There is no significant difference of recurrence with enucleation only or enucleation after marsupialization. Compared with sporadic OKCs, the syndromic patients are younger and easier to be multiple. It tends to be recurrent frequently and rapidly. There are no related factors about recurrence of syndromic patients. The clinicians should considerate comprehensively and make an individual management of therapy and follow-up. Solid and peripheral OKCs are rare and older.

Case study – Rehabilitation after removal of an extensive odontogenic keratocyst: Treatment in big bone defects

Odontogenic keratocysts are not uncommon in dental practice. Besides the removal of the cyst, regular follow-up checks are also important, as they facilitate early diagnosis and treatment of recurrent cysts. The successful removal of the cyst is followed by prosthetic rehabilitation. The focus should be on the objectives of restoring the patient's ability to chew and on resolving any issues affecting speech. Using templates for the implantation procedure ensures the correct positioning of the implants. If a template is used, any additional augmentation that may be required can be performed precisely at the site of the planned implantation, thus preventing over-augmentation.

Decompression or Marsupialization; Which Conservative Treatment is Associated with Low Recurrence Rate in Keratocystic Odontogenic Tumors? A Systematic Review.

Various treatment modalities have been reported for keratocystic odontogenic tumors (KOT), with different recurrence rates. Marsupialization and decompression are two different conservative surgical techniques for the treatment of KOTs. This study aimed at comparing the recurrence rate between marsupialization and decompression in the treatment of KOTs with or without adjunctive treatments. This is a systematic review study. The research sources utilized were PubMed (MEDLINE), Google scholar, Ovid MEDLINE and Cochrane Library. The keywords which were selected based on Medical Subject Heading (MeSH) terms and PICOS criteria were odontogenic keratocyst, keratocyst odontogenic tumor AND marsupialization OR decompression OR cystectomy OR enucleation OR curettage. Statistical analyses were performed to compare the recurrence rate between marsupialization and decompression with or without adjunctive treatments, regarding various follow-up times. The number of subjects that underwent marsupialization was 182. There was a significant difference for the recurrence rate between the marsupialization and decompression groups without considering adjunctive treatments (p= 0.001). However, considering adjunctive treatments, there was no difference between marsupialization and the decompression groups (p= 0.18). It appears that decompression without any adjuvant treatment may have a lower recurrence rate than marsupialization. The recurrence rate was not different when enucleation or cystectomy was performed after decompression and marsupialization.

Cutaneous keratocyst with D2-40 immunoreactivity in basal cell nevus syndrome (BCNS)

Cutaneous keratocyst with D2-40 immunoreactivity in basal cell nevus syndrome (BCNS)

Controversies Regarding the Management of Teeth Associated with Cystic Lesions of the Jaws.

The continual growth of cystic lesions of the jaws can cause bone expansion, facial deformity, impacted teeth, occlusal disorder and displacement and loosening of the originating tooth or adjacent teeth. The management of teeth associated with cystic lesions of the jaws has been widely debated. When standing teeth with vital pulp are associated with cystic lesions, especially when tooth roots protrude into the cyst cavity, different treatment options have been recommended to support tooth preservation. However, there is no consensus about the extraction of the affected tooth in cases of root involvement by odontogenic keratocyst (OKC). In addition, there is controversy around whether root canal therapy should be considered a necessary treatment to be carried out prior to or after enucleation when standing teeth are associated with cystic lesions. An impacted tooth enclosed in the cavity of a developmental cyst may be treated by various approaches such as marsupialisation or decompression, or enucleation in combination with extraction or coronectomy, depending on the patient's age, root development and the angle and depth of the tooth in the jaw. Successful results obtained in pulp revascularisation after autotransplantation or endodontic regeneration treatments have been reported and pulp tissue functionality after cyst enucleation or apicetomy is a serious concern. In this article, we present an overview of the management of teeth associated with cystic lesions of the jaws.

Cone-beam computed tomographic findings of odontogenic keratocyst resembling dentigerous cyst: A diagnostic dilemma

Odontogenic keratocysts (OKCs) are locally aggressive, the developmental cysts arising from the remnants of the dental lamina. They may be associated occasionally with an impacted or unerupted tooth and may thus resemble a dentigerous cyst. Formerly considered as an odontogenic tumor by the WHO in 2005, it is currently reclassified under cysts and has retained its former name of OKC. It has radiographic features ranging from unilocular, lucent lesions to multilocular variants. Management of OKC is through surgical enucleation followed by surgical enucleation due to the high possibility of recurrence. We present a case which was diagnosed based on cone-beam computed tomographic findings as a dentigerous cyst and treated accordingly. Histopathological features were suggestive of an OKC. The patient reported back with a recurrence which was then managed with treatment protocol for OKC.

1375 Cutaneous adnexal cysts revisited: A novel classification based on morphological and molecular features

Cutaneous cysts have been classified by many dermatopathologists in different ways. We propose a novel classification of cutaneous adnexal cysts according to their origin in the folliculo-sebaceous unit and sweat glands. By examining the lining of the cystic structure, its origin can be easily identified. Epidermal cysts have an epithelial wall containing a granular layer and the keratinization through the lumen is lamellar, indicating an infundibular origin Tricholemmal cysts have an undulating epithelial wall with no granular layer and a compact keratinization, showing an isthmic origin. In steatocystoma, dermoid cyst and folliculosebaceous hamartoma, the epithelial lining shows a crenulated appearance which is seen in the sebaceous duct. Hidrocystoma shows the characteristic cuboidal epithelial lining of sweat glands with decapitation secretion in its apocrine forms. Metabolizing acquired dioxin-induced skin hamartoma (MADISH) is a cystic lesion with no sebaceous glands showing lamellar keratinization. Cytokeratin expression pattern is also consistent with the origin of the cysts. For example, the sebaceous duct keratin CK17 is expressed in steatocystoma, dermoid cyst and folliculo-sebaceous hamartoma. Epidermal cyst expresses CK10 as tricholemmal cyst, which also expresses CK17. Eccrine and apocrine hidrocystoma shows a broader expression of cytokeratins (CK1, CK5, CK7, CK8, CK10, CK14, CK18, CK19). CK16 is only expressed by folliculo-sebaceous hamartoma. In MADISH, as in folliculo-sebaceous hamartoma, CK15 is expressed. Follicular stem cell marker Lrig1 is expressed at the isthmic region of human folliculosebaceous and the activation of β-catenin in Lrig1-positive stem cells gives rise cystic proliferations reminiscent of MADISH in mice. Recently, cutaneous keratocyst and steatocystoma unified as sebaceous duct cyst has been proposed to be a hamartoma resembling the sebaceous duct. The classification proposed here aims to simplify the complexity of cutaneous adnexal cysts and to have a better understanding of the origin of the cystic lesions of the skin.

Comparison of Mast Cells Count in Odontogenic Cysts Using Histochemical Staining.

Odontogenic cysts are among the most frequent destructive lesions of jaws which their pathogenesis and growth mechanism are not cleared. With respect to different roles of mast cells, they may play a role in the pathogenesis and growth of odontogenic cysts. The aim of present study was to evaluate mast cells in the most common odontogenic cyst. Thirty paraffin-embedded tissue blocks including 10 radicular cysts, 10 dentigerous cysts and 10 odontogenic keratocysts were used and 5 micron sections stained with toluidine blue and observed by light microscope under ×400 magnification to evaluate mast cells within these cysts. For each case, 5 high-power field areas, selected from hot-spot areas, were considered and each area divided into 3 zones: intra-epithelial zone, sub-epithelial zone and deep zone. Most of the studied cyst showed presence of mast cells. There was not any significant difference in mast cell count between studied cysts ( P -values > 0.05).With respect to intra-epithelial, sub-epithelial and deep zones, there was not any significant difference between three studied cysts. There was not any significant difference between sub-epithelial zone and deep zone within each of these cysts. There was only significant difference between intra-epithelial zone and sub-epithelial zone within dentigerous cysts and odontogenic keratocysts ( P -value < 0.05). Prevalence of mast cells in fibrous wall of odontogenic cysts suggests their activity in these cysts. Mast cells may not be directly involved in the pathogenesis of odontogenic keratocysts.

A rare case of calcifying cystic odontogenic tumor

Calcifying odontogenic cyst is a rare odontogenic cyst. It was described by Gorlin in 1962 and is also called as Gorlin’s cyst. Ghost cells in the epithelium are the hallmark of Gorlin’s cyst. A 25 year old male patient complained of a painless swelling in his lower anterior teeth region which was present for the past 3 years. It was slow growing with absence of infiltration, soft in its center and bony hard in its periphery, radiograph showing multilocular radiolucency, with associated root resorption, tooth displacement. Histopathological examination revealed a cystic lesion, lined by odontogenic epithelium and amorphous eosinophilic round or oval structures suggestive of ghost cells were seen within the epithelium. A long standing multilocular radiolucent lesion in the mandible crossing the midline with clinical features imitating anameloblastoma and odontogenic keratocyst was later diagnosed as a Gorlin’s cyst with histological evidence. Keywords: Calcifying cystic odontogenic tumor, Ghost cells, Multilocular radiolucency

Gorlin-goltz syndrome: a rare case.

Gorlin-Goltz syndrome or nevoid basal cell carcinoma syndrome is characterized by multiple basocellular epitheliomas, keratocysts in the jaws, bifid ribs, palmar and/or plantar pits and ectopic calcifications of the falx cerebri. We describe a case of Gorlin-Goltz syndrome illustrating the importance of a thorough examination including the examination of palms and soles and detailed investigations in a patient having lesions suggestive of basal cell carcinoma and multiple naevi.

Odontogenic Keratocyst Tumor: Report of Two Cases

El ano 2005 quiste odontogenico fue clasificado como un tumor queratoquiste odontogenico (TQO) debido a su agresividad y recurrencia. El TQO tiene las caracteristicas del tumor: crecimiento lento, no causa metastasis y proporciona una gran destruccion osea. El objetivo de este estudio fue examinar los aspectos relacionados con el diagnostico, pronostico y tratamiento del TQO mediante la presentacion de dos casos. Ambos casos fueron inicialmente sometidos a descompresion debido al gran tamano de la lesion y la proximidad de esta con estructuras anatomicas importantes, con el objetivo de prevenir las fracturas patologicas. Se llevo a cabo un seguimiento clinico-radiografico y despues de tener una regresion de la lesion postdescompresion, los pacientes fueron sometidos la enucleacion total.

Sporadic Cutaneous Keratocyst without Nevoid Basal Cell Carcinoma Syndrome - Report of 1 Case -

Sporadic Cutaneous Keratocyst without Nevoid Basal Cell Carcinoma Syndrome - Report of 1 Case -

Keratocyst of the buccal mucosa: is it odontogenic?

Odontogenic keratocyst (OKC) of the buccal mucosa, the diagnosis of which is based on subjective histologic evaluation, is a controversial entity of questionable existence. This report describes 2 rare cases of parakeratinized cyst arising from the buccal mucosa. Case 1 was a 60-year-old man with a 3-cm cyst and case 2 was a 16-year-old boy with a microcyst incidentally discovered on histology. Both lesions were essentially identical in histologic appearance and immunophenotype to intraosseous and gingival OKC, but they were clearly different from orthokeratinized odontogenic cysts and buccal mucosal epidermoid cysts. Step sections failed to reveal any kind of odontogenic tissue or skin adnexa in the cyst wall. These microscopic characteristics reflexively lead to the diagnosis of OKC, if the extragingival occurrence in the buccal mucosa cannot be considered. An alternative nonodontogenic origin includes a keratocyst of the skin, ie, an unusual mucosal presentation of cutaneous keratocyst. Because its true nature, either odontogenic or epidermal, cannot be conclusively proven at this time, we propose a more descriptive and noncommittal term, "mucosal keratocyst," for a particular cyst in a buccal location that is morphologically indistinguishable from OKC.

Cutaneous Keratocyst: A Renaming as Isthmic-Anagenic Cyst Proposal

Cutaneous Keratocyst: A Renaming as Isthmic-Anagenic Cyst Proposal

Cutaneous Keratocyst Not Associated to Gorlin Syndrome: An Incidental Finding in a Healthy Male

Peñaranda, Jose Manuel Suarez MD, PhD; Aliste, Carlos MD; Forteza, Jerónimo MD, PhD Author Information

PTCH gene mutations in odontogenic keratocysts

To investigate the frequency, type and distribution of PTCH mutations in odontogenic keratocysts (OKC) and to analyze the molecular pathological relationship between sporadic OKC and OKC associated with nevoid basal cell carcinoma syndrome (NBCCS). Genomic DNA was extracted from 8 cases of OKC lesions (4 sporadic OKCs and 4 NBCCS-related OKCs). PTCH gene mutations were detected by PCR-direct sequencing. Six novel PTCH mutations were identified in 6 out of 8 cases (2 sporadic and 4 NBCCS-related OKCs). Two of these were missense mutations leading to substitution of an amino acid residue respectively. The other 4 mutations were identified as insertion or deletion ranging from one single base to 7 bases, three of which caused frame-shift leading to premature truncation of PTCH protein and one resulted in an insertion of 2 amino acid residues. All these identified mutations were novel and have not been previously described. PTCH gene mutation is a common event in NBCCS-related OKCs and could also be detected in some sporadic OKCs. Abnormalities of PTCH gene may be involved in the pathogenesis of OKC.

Orthodontic treatment of a patient with an impacted maxillary second premolar and odontogenic keratocyst in the maxillary sinus.

An eight-year-, four-month-old girl was brought to the orthodontic clinic of Okayama University Medical and Dental Hospital. The patient had an impacted upper left second premolar because of an odontogenic keratocyst and showed a skeletal Class II jaw base relationship. At the age of six years four months, marsupialization of a cyst was performed at the Okayama University Medical and Dental Hospital because the patient had shown a swelling of the left cheek because of the cyst. The upper left second premolar was located in the roof of the maxillary sinus. The cyst was histopathologically diagnosed as an odontogenic keratocyst. At the age of nine years 10 months and after regaining the space for eruption of the premolar, the impacted premolar erupted without traction. At the age of 12 years five months, edgewise treatment was initiated, which continued for three years. After removing the edgewise appliance, an optimum occlusion was achieved. The occlusion was maintained without recurrence of the keratocyst after a retention period of five years.