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Odontogenic Keratocyst (OKC) / Keratocystic Odontogenic Tumour

What is an Odontogenic Keratocyst (OKC)?

The odontogenic keratocyst (OKC) is the most important of the tooth-derived cysts.

This cyst may have any clinical appearance; it is a great mimic and the diagnosis is made after microscopic analysis.

This is the third most common tooth-derived cyst.

These cysts also are found as part of the Basal Cell Nevus Syndrome, also known as Gorlin syndrome.

What are the causes of Odontogenic Keratocysts?

Their cause is controversial.

One theory is that the cyst develops instead of a tooth. Presumably, the cells that would form the tooth undergo cystic degeneration without ever completing tooth formation and develop into the OKC.

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Jaw_Xray_showing_an_odontogenic_keratocyst_areas_of_darkness_in_the_lower_jaw_-533x344-1015x673

The OKC has a number of ‘compartments’ and has connecting smaller cysts that extend into the surrounding bone. Because of this, there is frequent tendency for the condition to recur, particularly if the original surgical treatment did not result in complete removal of the cyst.

Removal of the cyst with removal of surrounding bone and / or cryosurgery (intense cold is applied to the cyst and bone) are the most common forms of treatment.

Long-term follow-up with monitoring by X-ray is important, as if these cysts are left untreated, they can become quite large and locally destructive.

Odontogenic_Keratocyst_Patient_had_Gorlin-Goltz_Syndrome_-883x1029
Radiograph of the above patient, 1 year post-op
Radiograph of the above patient, 1 year post-op
Radiograph of the above patient, 2 years post-op
Radiograph of the above patient, 2 years post-op
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5_Odontogenic_Keratocyst_4_years_post-op-896x593

Odontogenic Keratocysts – Key Features

  • Usually, multi-locular (many compartments)
  • Form intra-osseously (within bone), most frequently in the posterior (back) alveolar ridge or angle of the mandible (lower jaw)
  • May grow around a tooth
  • Spreads extensively along marrow spaces before expanding into the jaw
  • Frequently recurs after enucleation
  • Does not respond to marsupialisation
  • Definitive diagnosis only by histo-pathology, although clinical & radiographic features may allow fairly accurate pre-operative diagnosis
  • May be easily confused with ameloblastoma or, less likely, with dentigerouscysts
  • May be part of the jaw cyst / basal cell naevus syndrome

Useful Articles & Websites

J Oral Maxillofac Surg 2005. Treatment of Keratocysts. The Case for Decompression and Marsupialization

JOMS 2005. The Treatment of Odontogenic Keratocysts by Excision of the Overlying, Attached Mucosa, Enucleation & Treatment of the Bony Defect With Carnoy Solution

JOMS 2006. A Retrospective Review of Treatment of the Odontogenic Keratocyst

JOMS 2006. Conservative Treatment Protocol of Odontogenic Keratocyst – A Preliminary Study

JOMS 2006. Conservative Management of a Large Odontogenic Keratocyst – Report of a Case & Review of the Literature

JCDA 2008. Clinical Practice. Keratocystic Odontogenic Tumour – Reclassification of the Odontogenic Keratocyst from Cyst to Tumour

JCDA 2008. Keratocystic Odontogenic Tumour – Reclassification of the Odontogenic Keratocyst from Cyst to Tumour

JOMS 2009. Keratocystic Odontogenic Tumor – A Review

Head & Neck Pathol 2010. Keratocystic Odontogenic Tumor

JOMS 2010. Keratocystic Odontogenic Tumor vs Odontogenic Keratocyst – The Issue Of Adequate Nomenclature

Contemporary Clin Dent 2010. Surgical Treatment of Odontogenic Keratocyst by Enucleation

J Oral & Maxillofacial Res 2010. Conservative Treatment Protocol for Keratocystic Odontogenic Tumour – A Follow-up Study of 3 Cases

The Saudi Dental Journal 2011. Surgical Treatment of Keratocystic Odontogenic Tumour – A Review Article

BJOMS 2011. Technical Note. Use of Methylene Blue for Precise Peripheral Ostectomy of Keratocystic Odontogenic Tumour

Oral Surgery 2012. Treatment of a Patient with Large Keratocystic Odontogenic Tumour in the Mandible. Case Report with Literature Review

Stomatos 2012. Diagnostic & treatment features of keratocystic odontogenic tumors

J Nat Sci Bio Med 2013. Odontogenic Keratocyst – What is in the name?

JOMS 2013. Keratocystic Odontogenic Tumor Recurrence Rates With Enucleation & Curettage Using Carnoy’s Versus Modified Carnoy’s Solution

JOMS 2013. How Well Do We Manage the Odontogenic Keratocyst

Biomed & Pharmacol J 2014. Surgical Treatment of Odontogenic Keratocyst Tumour – A Review Article

Cochrane Database of Systematic Reviews 2015. Interventions for the Treatment of Keratocystic Odontogenic Tumours (Review)

Dental Update 2015. Odontogenic Cysts – An Overview

JOMS 2015. Keratocystic Odontogenic Tumours – Etiology, Pathogenesis & Treatment Revisited

Braz Oral Res 2017. Reclassification & Treatment of Odontogenic Keratocysts – A Cohort Study

Int J Curr Res 2017. Odontogenic Keratocyst (OKC) or Journey of OKC from Cyst To Tumor To Cyst Again – Comprehensive Review with Recent Updates on WHO Classification (2017)

J Med Case Reports 2018. Multidisciplinary Approach for Treatment of a Dentigerous Cyst – Marsupialization, Orthodontic Treatment & Implant Placement. A Case Report

J Adv Med & Med Res 2019. A Review of the Odontogenic Keratocyst & Report of a Case

Case Reports Dent 2019. Nonsyndromic Examples of Odontogenic Keratocysts – Presentation of Interesting Cases with a Literature Review

Dent Oral Bio Craniofac Res 2019. Decompression of Mandibular Odontogenic Keratocyst using a Custom Drain – A Technical Note

Dental Update 2019. The Bigger Picture – a Gorlin-Goltz Case Report

Dental Update 2019. Surgical / Orthodontic Management of a Large Mandibular Odontogenic Keratocyst (OKC)

Cysts & Cystic Lesions of the Mandible

Chapter 12. Cysts of the Jaws

Power Point Presentation about the Origin of Odontogenic Cysts & Tumours