JCDA - Canadian Dental Association

Figure 1: Panoramic radiograph reveals a
large, multilocular, radiolucent lesion of the
right posterior mandible with extensive
involvement of the ramus. Histologic
examination revealed an odontogenic
keratocyst. Radiograph courtesy of
Dr. Henry Falk.
Figure 4: This odontogenic keratocyst has a
polarized, hyperchromatic basal cell layer.
Hematoxylin and eosin stain. Original
magnification ×40.
mucosa. Some surgeons advocate treating the cavity wall
with a fixative (Carnoy’s solution), with the goal of easier
tissue removal, to reduce the likelihood of recurrence.
Resection is reserved for more aggressive lesions.
Decompression is employed when the lesion encroaches on
a nerve or when primary resection would result in significant
morbidity. This method involves placing an
indwelling catheter into the cyst and following the patient
clinically and radiographically until the size of the lesion is
significantly reduced, at which time definitive surgery is
performed. The effectiveness of decompression may be
related to the observation that chronic inflammation alters
the characteristic histologic features of the OKC, such that
the cyst lining is more reminiscent of that of an inflamed
dentigerous cyst (Fig. 6).
When the dentist receives a histopathologic diagnosis of
OKC after removal of a presumed dentigerous cyst, consultation
with an oral and maxillofacial surgeon is recommended.
Factors influencing the need for re-excision include the location
of the tumour and the ease and completeness of cyst
Journal of the Canadian Dental Association
Figure 2: Close-up view of an odontogenic
keratocyst (right side).
Figure 5: A satellite cyst is apparent in the
connective tissue lining of this odontogenic
keratocyst. Hematoxylin and eosin stain.
Original magnification ×40.
Point of Care
Figure 3: The lining of this odontogenic
keratocyst is composed of corrugated
parakeratinized stratified squamous
epithelial lining. The connective tissue wall
is devoid of inflammation. Hematoxylin
and eosin stain. Original magnification ×20.
Figure 6: Inflamed odontogenic keratocyst.
On the left side of this photomicrograph,
the characteristic features of the lesion are
absent as a result of the chronic inflammation.
Hematoxylin and eosin stain.
Original magnification ×20.
removal at the time of initial surgery. Patients must be placed
on long-term clinical and radiographic recall. In the case of
maxillary lesions, in which recurrence can be difficult to
diagnose by plain film and panoramic radiography, computed
tomography is recommended. C
Further Reading
Blanas N, Freund B, Schwartz M, Furst IM. Systematic review of the
treatment and prognosis of the odontogenic keratocyst. Oral Surg Oral
Med Oral Pathol Radiol Endod 2000; 90(5):553–8.
Kimonis VE, Goldstein AM, Pastakia B, Yang ML, Kase R, DiGiovanna
JJ, and others. Clinical manifestations of 105 persons with nevoid basal
cell carcinoma syndrome. Amer J Med Genet 1997; 69(3):299–308.
LoMuzio L, Staibano S, Pannone G, Bucci P, Nocini PF, Bucci E, and
other. Expression of cell cycle and apoptosis-related proteins in sporadic
odontogenic keratocysts and odontogenic keratocysts associated with
the nevoid basal cell carcinoma syndrome. J Dent Res 1999;
78(7):1345–53.
Myoung H, Hong SY, Hong SD, Lee JI, Lim CY, Choung PH and
others. Odontogenic keratocyst: review of 256 cases for recurrence and
clinicopathologic parameters. Oral Surg Oral Med Oral Pathol Radiol
Endod 2001; 91(3):328–33.
Sciubba JJ, Fantasia JE, Kahn LB. Tumors and cysts of the jaws. Atlas of
tumor pathology. Rosai J and Sobin LH, editors. Washington, DC:
Armed Forces Institute of Pathology (3rd series, fascicle 29); 2001.
November 2003, Vol. 69, No. 10 679