356:
368:
380:
37:
500:
remnants of the dental epithelium. With current treatment techniques the recurrence rate is around 2-3% but can be as high as 50%. Recurrence can occur as early as 5 years and as late as 40 years after removal. Recurrence is usually seen within 5 years of treatment. Early findings of recurrence can be easily treated with minor surgery and curretage. Any fragment of the cyst that is left behind has the potential to survive and grow. Therefore, the success of enucleation depends on how well the cyst is removed. Larger cysts have a higher rate of recurrence after enucleation as they are more difficult to remove.
92:) from 2005 to 2017. In 2017 it reverted to the earlier name, as the new WHO/IARC classification reclassified OKC back into the cystic category. Under The WHO/IARC classification, Odontogenic Keratocyst underwent the reclassification as it is no longer considered a neoplasm due to a lack of quality evidence regarding this hypothesis, especially with respect to clonality. Within the Head and Neck pathology community there is still controversy surrounding the reclassification, with some pathologists still considering Odontogenic Keratocyst as a neoplasm in line with the previous classification.
396:
215:
117:
202:. Almost all individuals with NBCCS have odontogenic keratocysts which require numerous treatments. Consideration of the syndrome needs to be taken into account if found in children or if multiple OKCs are present; diagnosis of multiple OKCs in a child necessitates referral for genetic evaluation. Histologically, the cysts are indistinguishable to non-syndromic cysts and over 80% will have
226:. Aspirational biopsy of odontogenic keratocysts contains a greasy fluid which is pale in colour and contains keratotic squames. Protein content of cyst fluid below 4g% is diagnostic of odontogenic keratocysts. Smaller and unilocular lesions resembling other types of cysts may require a biopsy to confirm the diagnosis. On a
471:
Ostectomy or En – bloc resection: in addition to the above treatments, these may be required due to the issue of recurrence. Ostectomy is removal of peripheral bone. En – block resection is removal of the cyst with the surrounding tissue. Extensive cysts may require a bone graft after bone resection
105:
present they usually take the form of pain, swelling and discharge due to secondary infection. Odontogenic keratocysts are usually noted as incidental radiographic findings. Radiographically they can be seen as unilocular or multilocular radiolucencies. They can be mistaken for other cysts such as
445:. This allows the cavity to be in contact with the outside of the cyst for an extended period of time. Marsupialisation results in slow shrinkage of the cyst allowing later enucleation. However, resolution can take up to 20 months and patients are required to clean the open cavity and irrigate it.
426:
fixative (ethanol, chloroform and acetic acid) which is usually used in conjunction with excision and curretage. Cavity wall can be treated with the fixative either before enucleation to kill the lining of the wall or added after curretage to bony walls, killing any residual epithelial cells to a
104:
Early odontogenic keratocysts usually do not display symptoms. Typically, clinical signs and symptoms present with bony expansion, or infection. However, bony expansion is uncommon as odontogenic keratocysts grow due to increased epithelial turnover rather than osmotic pressure. When symptoms are
245:
Radiographs of odontogenic keratocysts show well-defined radiolucent areas with rounded or scalloped margins which are well demarcated. These areas can be multilocular or unilocular. The growth pattern of the lesion is very characteristic from which a diagnosis can be made as there is growth and
499:
Recurrence is likely when treated by simple enucleation. Contributing causes include thin and fragile epithelium leading to incomplete removal, cyst extensions extending into cancellous bone, satellite cysts found in the wall, experience of the surgeon, formation of further new cysts from other
403:
As the condition is quite rare, opinions among experts about how to treat OKCs differ. A 2015 Cochrane review found that there is currently no high quality evidence to suggest the effectiveness of specific treatments for the treatment of odontogenic keratocysts. Treatment depends on extent of
246:
spread both forward and backward along the medullary cavity with little expansion. No resorption of teeth or inferior dental canal and minimal displacement of teeth is seen. Due to lack of expansion of the odontogenic keratocyst, the lesion can be very large when radiographically discovered.
341:. The epithelium can separate from the wall, resulting in islands of epithelium. These can go on to form 'satellite' or 'daughter' cysts, leading to an overall multilocular cyst. Presence of daughter cysts is particularly seen in those with NBCCS. Inflamed cysts show
100:
Odontogenic keratocysts can occur at any age, however they are more common in the third to sixth decades. The male to female ratio is approximately 2:1. The majority are found in the mandible, with half occurring at the angle of the mandible.
404:
multilocularity and cyst. Small multilocular and unilocular cysts can be treated more conservatively through enucleation and curretage. Treatment options for KTOC may vary according to its size, extent, site, and adjacent structures.
1207:
de Castro MS, Caixeta CA, de Carli ML, Ribeiro Júnior NV, Miyazawa M, Pereira AA, et al. (June 2018). "Conservative surgical treatments for nonsyndromic odontogenic keratocysts: a systematic review and meta-analysis".
1402:
1382:
1319:
Slusarenko da Silva Y, Stoelinga PJ, Naclério-Homem MD (June 2019). "The presentation of odontogenic keratocysts in the jaws with an emphasis on the tooth-bearing area: a systematic review and meta-analysis".
190:, resulting in the cyst epithelium undergoing highly proliferative activity. This leads to growth of the cyst wall and when removed favours recurrence if following incomplete removal of the epithelium.
73:
and most commonly presents in the third decade of life. Odontogenic keratocysts make up around 19% of jaw cysts. Despite its more common appearance in the bone region, it can affect soft tissue.
355:
337:
in the basal layer which have focal reverse polarisation (nuclei are on the opposite pole of the cell). The basal cells are an indication of the odontogenic origin as they resemble
751:
518:
inactivation, some have classified OKCs as benign neoplasms. The best evidence to suggest that this type of cyst is not a neoplasm is that it responds very well to
218:
Classic look of an odontogenic keratocyst of the right mandible in the place of a former wisdom tooth. Well defined, unilocular, radiolucent lesion within the bone.
367:
481:
Annual radiographic review has been recommended. Long-term clinical follow-up is also recommended due to recurrences occurring many years after treatment.
379:
1558:
289:
881:
514:
nature of odontogenic keratocysts has been debated. Due to high recurrence rate, late detection when the cyst has grown very large and causation by
779:"Update from the 4th Edition of the World Health Organization Classification of Head and Neck Tumours: Odontogenic and Maxillofacial Bone Tumors"
678:
1084:
957:
84:
classification of head and neck pathology, this clinical entity had been known for years as the odontogenic keratocyst; it was reclassified as
1172:
Schmidt BL, Pogrel MA (July 2001). "The use of enucleation and liquid nitrogen cryotherapy in the management of odontogenic keratocysts".
507:. A substantial amount of odontogenic keratocysts also recur in the tooth-bearing area of the jaws, requiring attention from clinicians.
81:
333:
The fibrous wall of the cyst is usually thin and uninflamed. The epithelial lining is thin with even thickness and parakeratinised with
1100:"Imaging features contributing to the diagnosis of ameloblastomas and keratocystic odontogenic tumours: logistic regression analysis"
1449:
452:
after curettage and/or enucleation. Extensive cysts may require a bone graft after bone resection and reconstruction of the area.
933:
761:
691:
349:
instead. Due to areas of focal inflammation, a larger biopsy is required for correct diagnosis of odontogenic keratocysts.
199:
1156:
1060:
618:
1292:
Piloni MJ, Keszler A, Itoiz ME (2005). "Agnor as a marker of malignant transformation in odontogenic keratocysts".
1537:
1532:
273:
141:) in the alveolus left from tooth development stages. They are mainly thought to arise from rests of Serres.
268:
465:. Decompression followed by enucleation has been shown to be most successful with lowest recurrence rates.
1442:
642:
Stoelinga, P, et al. (January 2022). "The extra-osseous odontogenic keratocyst: An anachronism?".
167:
36:
721:"Keratocystic odontogenic tumour: reclassification of the odontogenic keratocyst from cyst to tumour"
697:
77:
680:
World Health
Organization Classification of Tumours: Pathology and Genetics of Head and Neck Tumours
489:
1053:
Master dentistry. Volume 1, Oral and maxillofacial surgery, radiology, pathology and oral medicine
414:
Marsupialisation followed by enucleation: this method is carried out by surgeons for larger cysts.
493:
1435:
175:
515:
458:
756:. WHO/IARC Classification of Tumours. Vol. 9 (4th ed.). Lyon, France: IARC Press.
1253:"Topical 5-Fluorouracil is a Novel Targeted Therapy for the Keratocystic Odontogenic Tumor"
423:
395:
214:
116:
8:
1406:
319:
1345:
1233:
1124:
1099:
1078:
1019:
992:
951:
857:
832:
803:
778:
577:
552:
258:
242:. However, ameloblastomas show more bone expansion and seldom show high density areas.
1415:
1411:
1098:
Ariji Y, Morita M, Katsumata A, Sugita Y, Naitoh M, Goto M, et al. (March 2011).
1458:
1337:
1301:
1274:
1225:
1189:
1152:
1129:
1066:
1056:
1024:
991:
Ren C, Amm HM, DeVilliers P, Wu Y, Deatherage JR, Liu Z, MacDougall M (August 2012).
939:
929:
862:
808:
757:
732:
720:
687:
659:
624:
614:
582:
531:
442:
327:
1349:
1237:
1329:
1264:
1217:
1181:
1119:
1111:
1014:
1004:
852:
848:
844:
798:
790:
651:
572:
564:
519:
434:
428:
411:
Surgical enucleation: surgical removal of the entire epithelial lining of the cyst.
278:
121:
110:
198:
Multiple odontogenic keratocysts are a feature, and major diagnostic criteria, of
1474:
971:
655:
345:
epithelium which is no longer characteristic of OKCs and can have resemblance to
235:
200:
nevoid basal cell carcinoma syndrome (NBCCS, also known as Gorlin-Goltz
Syndrome)
1333:
1269:
1252:
346:
294:
70:
1395:
1391:
1221:
794:
361:
Intermediate magnification of an odontogenic keratocyst showing a folded cyst.
1552:
1497:
1070:
943:
628:
399:
Large odontogenic keratocyst with impacted wisdom teeth superficial to lesion
311:
Odontogenic keratocysts have a diagnostic histological appearance. Under the
300:
263:
239:
138:
106:
1185:
1115:
1009:
882:"Odontogenic lesions of the jaw: a clinical-pathological study of 461 cases"
568:
222:
Diagnosis is usually radiological. However, definitive diagnosis is through
1466:
1341:
1305:
1278:
1229:
1193:
1133:
1028:
866:
812:
736:
663:
611:
Oral and maxillofacial medicine : the basis of diagnosis and treatment
586:
437:
which involves the surgical opening of the cyst cavity and a creation of a
231:
163:
48:
1318:
462:
342:
323:
316:
1374:
993:"Targeting the sonic hedgehog pathway in keratocystic odontogenic tumor"
1489:
750:
El-Naggar AK, Chan JK, Grandis JR, Takata T, Slootweg PJ, eds. (2017).
338:
334:
312:
183:
44:
1206:
1508:
1479:
1051:
Coulthard P, Heasman PA, Horner K, Sloan P, Theaker ED (2013-05-17).
833:"Interventions for the treatment of keratocystic odontogenic tumours"
449:
438:
417:
1516:
511:
504:
150:
137:
Odontogenic keratocysts originate from the odontogenic epithelium (
503:
Pronto genie keratocysts are well known to recur in the posterior
227:
1427:
1386:
223:
62:
1151:. Foundations in Diagnostic Pathology. Churchill Livingstone.
676:
158:
1251:
Ledderhof NJ, Caminiti MF, Bradley G, Lam DK (March 2017).
1250:
1050:
976:
880:
Borges LB, Fechine FV, Mota MR, Sousa FB, Alves AP (2012).
677:
Barnes L, Eveson JW, Reichart P, Sidransky D, eds. (2005).
154:
66:
1097:
749:
831:
Sharif FN, Oliver R, Sweet C, Sharif MO (November 2015).
926:
Cawson's
Essentials of Oral Pathology and Oral Medicine
830:
373:
Intermediate magnification of an odontogenic keratocyst
193:
879:
544:
743:
670:
644:
420:
involving simple excision and scraping-out of cavity.
1364:
553:"Keratocystic odontogenic tumour: systematic review"
326:
and often have an artifactual separation from their
550:
484:
1291:
990:
613:(2nd ed.). Edinburgh: Churchill Livingstone.
1046:
1044:
1042:
1040:
1038:
234:of a keratocystic odontogenic tumour is about 30
1550:
385:High magnification of an odontogenic keratocyst.
1091:
714:
712:
710:
604:
602:
600:
598:
596:
1035:
919:
718:
1443:
1171:
917:
915:
913:
911:
909:
907:
905:
903:
901:
899:
826:
824:
822:
1244:
707:
593:
468:Topical application of 5FU after enucleation
972:"PATCHED, DROSOPHILA, HOMOLOG OF, 1; PTCH1"
923:
837:The Cochrane Database of Systematic Reviews
776:
753:WHO Classification of Head and Neck Tumours
686:(2005 ed.). Lyon, France: IARC Press.
1559:Cysts of the oral and maxillofacial region
1450:
1436:
1083:: CS1 maint: location missing publisher (
964:
956:: CS1 maint: location missing publisher (
896:
819:
641:
297:(particularly if the OKC is very inflamed)
153:OKCs are associated with mutations in the
35:
1268:
1257:Journal of Oral and Maxillofacial Surgery
1174:Journal of Oral and Maxillofacial Surgery
1123:
1018:
1008:
873:
856:
802:
576:
249:
1146:
608:
394:
213:
115:
1147:Thompson LD (2006). Goldblum JR (ed.).
551:MacDonald-Jankowski DS (January 2011).
1551:
113:if they occur over an unerupted tooth.
69:. It most often affects the posterior
30:Keratocystic odontogenic tumour (KCOT)
1431:
95:
65:but locally aggressive developmental
431:and the neurovascular bundle within.
427:depth of 1-2mm. Used with care near
194:Nevoid basal-cell carcinoma syndrome
186:. A third of OKCs show mutations in
997:The Journal of Biological Chemistry
719:Madras J, Lapointe H (March 2008).
13:
14:
1570:
1457:
1360:
1294:Acta Odontologica Latinoamericana
777:Wright JM, Vered M (March 2017).
182:activity leads to a brake in the
485:Recurrence and neoplastic nature
378:
366:
354:
1538:Keratocystic odontogenic tumour
1312:
1285:
1200:
1165:
1140:
984:
472:and reconstruction of the area.
132:
86:keratocystic odontogenic tumour
1322:Oral and Maxillofacial Surgery
1180:(7): 720–5, discussion 726–7.
1104:Dento Maxillo Facial Radiology
849:10.1002/14651858.cd008464.pub3
770:
635:
557:Dento Maxillo Facial Radiology
47:of an odontogenic keratocyst.
1:
1533:Adenomatoid odontogenic tumor
1055:(Third ed.). Edinburgh.
928:(Ninth ed.). Edinburgh.
886:Revista Gaúcha de Odontologia
537:
274:Adenomatoid odontogenic tumor
238:, which is about the same as
149:Sporadic (non-syndromic) and
1210:Clinical Oral Investigations
924:Odell EW, Cawson RA (2017).
656:10.1016/j.jormas.2022.07.001
476:
390:
306:
269:Central giant-cell granuloma
209:
7:
525:
496:may occur, but is unusual.
144:
128:is labeled at bottom right.
10:
1575:
1334:10.1007/s10006-019-00754-5
1270:10.1016/j.joms.2016.09.039
168:Hedgehog signaling pathway
1525:
1506:
1488:
1465:
1368:
1222:10.1007/s00784-017-2315-8
795:10.1007/s12105-017-0794-1
43:
34:
26:
21:
490:Malignant transformation
315:, OKCs vaguely resemble
1186:10.1053/joms.2001.24278
1149:Head and Neck Pathology
1010:10.1074/jbc.M112.367680
783:Head and Neck Pathology
494:squamous cell carcinoma
166:, which is part of the
516:tumour suppressor gene
400:
250:Differential diagnosis
219:
176:tumour suppressor gene
129:
126:Odontogenic keratocyst
120:Relative incidence of
59:odontogenic keratocyst
22:Odontogenic keratocyst
1116:10.1259/dmfr/24726112
569:10.1259/dmfr/29949053
398:
322:; however, they lack
217:
119:
1003:(32): 27117–27125.
609:Crispian S (2008).
407:Treatment options:
320:squamous epithelium
401:
259:Odontogenic myxoma
220:
130:
96:Signs and symptoms
1546:
1545:
1425:
1424:
935:978-0-7020-4982-8
763:978-92-832-2438-9
693:978-92-832-2417-4
532:Cysts of the jaws
424:Carnoy's solution
328:basement membrane
281:(follicular cyst)
122:odontogenic cysts
55:
54:
16:Medical condition
1566:
1452:
1445:
1438:
1429:
1428:
1366:
1365:
1354:
1353:
1316:
1310:
1309:
1289:
1283:
1282:
1272:
1248:
1242:
1241:
1216:(5): 2089–2101.
1204:
1198:
1197:
1169:
1163:
1162:
1144:
1138:
1137:
1127:
1095:
1089:
1088:
1082:
1074:
1048:
1033:
1032:
1022:
1012:
988:
982:
981:
968:
962:
961:
955:
947:
921:
894:
893:
877:
871:
870:
860:
843:(11): CD008464.
828:
817:
816:
806:
774:
768:
767:
747:
741:
740:
716:
705:
704:
702:
696:. Archived from
685:
674:
668:
667:
650:(6): e790–e793.
639:
633:
632:
606:
591:
590:
580:
548:
520:marsupialisation
435:Marsupialization
429:mandibular canal
382:
370:
358:
279:Dentigerous cyst
236:Hounsfield units
111:dentigerous cyst
39:
19:
18:
1574:
1573:
1569:
1568:
1567:
1565:
1564:
1563:
1549:
1548:
1547:
1542:
1521:
1502:
1484:
1475:Cementoblastoma
1461:
1456:
1426:
1421:
1420:
1377:
1363:
1358:
1357:
1317:
1313:
1290:
1286:
1249:
1245:
1205:
1201:
1170:
1166:
1159:
1145:
1141:
1096:
1092:
1076:
1075:
1063:
1049:
1036:
989:
985:
970:
969:
965:
949:
948:
936:
922:
897:
878:
874:
829:
820:
775:
771:
764:
748:
744:
731:(2): 165–165h.
717:
708:
700:
694:
683:
675:
671:
640:
636:
621:
607:
594:
549:
545:
540:
528:
487:
479:
455:Simple excision
393:
386:
383:
374:
371:
362:
359:
347:radicular cysts
339:pre-ameloblasts
309:
290:Orthokeratocyst
285:Histologically
254:Radiologically
252:
212:
196:
147:
135:
98:
17:
12:
11:
5:
1572:
1562:
1561:
1544:
1543:
1541:
1540:
1535:
1529:
1527:
1523:
1522:
1520:
1519:
1513:
1511:
1504:
1503:
1501:
1500:
1494:
1492:
1486:
1485:
1483:
1482:
1477:
1471:
1469:
1463:
1462:
1455:
1454:
1447:
1440:
1432:
1423:
1422:
1419:
1418:
1399:
1378:
1373:
1372:
1370:
1369:Classification
1362:
1361:External links
1359:
1356:
1355:
1328:(2): 133–147.
1311:
1284:
1263:(3): 514–524.
1243:
1199:
1164:
1157:
1139:
1110:(3): 133–140.
1090:
1061:
1034:
983:
963:
934:
895:
872:
818:
769:
762:
742:
706:
703:on 2015-09-24.
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335:columnar cells
308:
305:
304:
303:
298:
295:Radicular cyst
292:
283:
282:
276:
271:
266:
261:
251:
248:
240:ameloblastomas
211:
208:
195:
192:
146:
143:
134:
131:
107:residual cysts
97:
94:
61:is a rare and
53:
52:
41:
40:
32:
31:
28:
24:
23:
15:
9:
6:
4:
3:
2:
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1531:
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1524:
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1515:
1514:
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1510:
1505:
1499:
1498:Ameloblastoma
1496:
1495:
1493:
1491:
1487:
1481:
1478:
1476:
1473:
1472:
1470:
1468:
1464:
1460:
1459:Dental tumors
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1187:
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1158:0-443-06960-3
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1062:9780702046001
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673:
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638:
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620:9780443068188
616:
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318:
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302:
301:Ameloblastoma
299:
296:
293:
291:
288:
287:
286:
280:
277:
275:
272:
270:
267:
265:
264:Ameloblastoma
262:
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164:chromosome 9q
161:
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139:dental lamina
127:
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93:
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68:
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49:H&E stain
46:
42:
38:
33:
29:
25:
20:
1467:Cementoblast
1401:
1381:
1325:
1321:
1314:
1300:(1): 37–42.
1297:
1293:
1287:
1260:
1256:
1246:
1213:
1209:
1202:
1177:
1173:
1167:
1148:
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1093:
1052:
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836:
789:(1): 68–77.
786:
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724:
698:the original
679:
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343:hyperplastic
332:
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244:
232:radiodensity
221:
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148:
136:
133:Pathogenesis
125:
103:
99:
89:
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75:
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56:
1394:(Maxilla);
563:(1): 1–23.
463:cryotherapy
459:Enucleation
448:Peripheral
324:rete ridges
317:keratinized
206:mutations.
27:Other names
1490:Ameloblast
1398:(mandible)
538:References
512:neoplastic
313:microscope
184:cell cycle
178:. Loss of
45:Micrograph
1509:hamartoma
1480:Cementoma
1079:cite book
1071:826658944
952:cite book
944:960030340
629:123962943
477:Follow-up
450:ostectomy
439:marsupial
418:Curettage
391:Treatment
307:Histology
210:Diagnosis
162:found on
151:syndromic
1553:Category
1517:Odontoma
1350:71145159
1342:30825057
1306:16302459
1279:27789270
1238:31083453
1230:29264656
1194:11429726
1134:21346078
1029:22679015
867:26545201
813:28247226
737:18353202
664:35798194
587:21159911
526:See also
505:mandible
145:Genetics
71:mandible
1125:3611454
1020:3411054
858:7173719
804:5340735
725:Journal
578:3611466
228:CT scan
76:In the
1507:Mixed/
1348:
1340:
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585:
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441:-like
230:, the
224:biopsy
63:benign
1526:Other
1416:213.1
1412:213.0
1396:D16.5
1392:D16.4
1346:S2CID
1234:S2CID
701:(PDF)
684:(PDF)
443:pouch
174:is a
109:or a
1407:9-CM
1338:PMID
1302:PMID
1275:PMID
1226:PMID
1190:PMID
1153:ISBN
1130:PMID
1085:link
1067:OCLC
1057:ISBN
1025:PMID
977:OMIM
958:link
940:OCLC
930:ISBN
892:(1).
863:PMID
841:2016
809:PMID
758:ISBN
733:PMID
688:ISBN
660:PMID
625:OCLC
615:ISBN
583:PMID
510:The
461:and
204:PTCH
188:PTCH
180:PTCH
172:PTCH
159:PTCH
155:gene
90:KCOT
82:IARC
67:cyst
1403:ICD
1383:ICD
1330:doi
1265:doi
1218:doi
1182:doi
1120:PMC
1112:doi
1015:PMC
1005:doi
1001:287
853:PMC
845:doi
799:PMC
791:doi
652:doi
648:123
573:PMC
565:doi
492:to
78:WHO
57:An
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