Odontogenic tumors-2002-02-slides (1)

•ODONTOGENIC KERATOCYST SUKESH

KUMAR.V IV B.D.S

ODONTOGENIC KERATOCYST

DEVELOPMENTAL CYST OF UNKNOWN ORIGIN

FROM REMINANTS OF DENTAL LAMINA11% OF ALL JAW DERIVED CYSTS ARE

OKCALSO KNOWN AS PRIMORDIAL

CYST(BASED UPON PRIGIN)

CLINICAL FEATURES

AGE:-OCCURS OVER A WIDE RANGE,INTIATED IN EARLY LIFE,PEAK INCIDENCE IN 2nd & 3rd

DECADES. SEX:- MALES>FEMALES;BLAKS>WHITES

SITE:-MORE IN MANDIBLE;AT ANGLE MOSTLY SYMPTOMS:-ASYMPTOMATIC TILL 2ndrly

INFECTED

IF 2ndrly INFECTD PID COMPLAINTS OF PAIN,SWELLING,EXPANSION OF

BONE,PARASTHESIA OF LOWER LIP AND TEETH

TEETH:-MAY BE DISPLACED IF EXPANDS THROUGH CANCELLOUS BONE&BODY OF

MANDIBLE

SIGNS:-CAN LEAD TO PATHOLOGIC FRACTURE & AS THESE CYSTS GROW IN

ANTEROPOSTERIOR DIRECTION THERE IS NO BONY EXPANSION IN MOST CASES

ASPIRATION:-ON THIS GETS A ODORLESS,REAMY OR CASEOUS MATERIAL

SYNDROMES ASSOCIATED

GORLIN-GOLTZMARFANS

EHLERS-DANLOSNOONAN’S

MULTIPLE OKC’S ARE FOUND IN RELATION TO THESE

ROENTGENOGRAPHIC ROENTGENOGRAPHIC FEATURESFEATURES

1) SITE:- >90% SEEN POSTERIOR TO CANINE IN MANDIBLE;AMONG THEM

>50% AT ANGLE OF MANDIBLE.

2) CHARACTERISTIC:- 40%SUGGESTIVE DENTIGEROUS CYST

25% OF PRIMORDIAL CYST

25% OF LATERAL PERIODONTAL CYST

10% GLOBULO MAXILLARY CYST

Odontogenic Keratocyst

3)INTERNAL STRUCTURE:- UNDULATING BORDERS WITH CLOUDY INTERIOR

APPEARENCES SUGGESTIVE OF MULTILOCULARITY.

4)SIZE:- VARIES FROM 5Cm or MORE IN DIAMETER.

5)SHAPE:- USUALLY OVAL EXTENDING ALONG BODY OF MANDIBLE.

6)MARGINS ARE HYPEROSTOTIC

7)UNILOCULAR VARIETY:- MAJORITY OF LESIONS ARE UNILOCULAR WITH SMOOTH BORDERS OR

LARGE IRREGULAR BORDERS. RADIOLUCENCY IS HAZY DUE TO KERATIN FILLED

CAVITY& SURRONDED BY THIN SCLEROTIC RIM.

IN SOME CASES IT CAN PERFORATE BUCCAL &LINGUAL CORTICAL PLATES OF BONE,DUE TO WHICH DISPLACEMENT OF INFERIOR ALVEOLAR

CANAL OCCURS.

CT FEATURES WILL DEMONSTRATE EXACT DIMENSIONS OF RADIOLUCENCY.

RADIOLOGICAL TYPES OF KERATOCYST:-ENVELOPMENTAL TYPEREPLACEMENT TYPEEXTRANEOUS TYPECOLLATERAL TYPE

HISTOLOGICAL FEATURES

• LINING EPITHELIUM IS HIGHLY CHARACTERISTIC &COMPOSED OF

1)PARAKERATINISED SURFACE WHICH IS TYPICALLY CORRUGATED,RIPPLED.

2)6-10CELL THICKNESS OF EPITHELIUM3)PROMINENT PALISADED POLARISED

BASAL LAYER OF CELLS OFTEN DESCRIBE AS “PICKET FENCE” or

“TOMBSTONE” appearance.

Odontogenic Keratocyst

FORMED WITH STRATIFIED SQUAMOUS EPITHELIUM THAT PRODUCES

ORTHOKERATIN(10%) PARAKERATIN(83%).

NO RETERIDGES ARE PRESENT.LUMEN IS FILLED WITH STRAW COLOUR

FLUID WITH GR8 DEAL OF KERATIN.CHOLESTEROL,HYALINE BODIES ARE

PRESENT AT SITE OF INFLAMMATION.DYSPLASTIC &NEOPLASTIC FEATURES

OF LINING EPITHELIUM IS UNCOMMON.C.TISSUE HAS DAUGHTER or SATELLITE

CYSTS

DIAGNOSIS

CLINICAL DIAGNOSIS- Not so specific.RADIOLOGICAL- Radiolucency extending in anteroposterior direction with undulating borders

suggest OKC.LAB DIAGNOSIS-Biopsy reveals the related

histological features.DIFFERENTIAL DIAGNOSIS:

AMELOBLASTOMARESIDUAL CYST

TRAUMATIC CYSTFIBROMA

GAINT CELL GRANULOMATOOTH CRYPT

MANAGEMENT ENUCLEATION-WITH VIGOROUS CURETTAGE OF

CYSTIC WALL.

PERIPHERAL OSTEOTOMY-REDUCES CHANCES OF RECURRENCE.

CHEMICAL CAUTERIZATION-WITH INTRALUMINAL Inj .OF CARNOY’S Sol.

DECOMPOSITION-WITH HELP OF POLYETHYLENE DRIANAGE TUBE KEPT IN BONY CAVITY.

RECURRENCEVERY HIGH DUE TO--

SATELLITE CELLSNEW CYST FORMATION

DIFFICULTY IN ENUCLEATIONINTRINSIC GROWTH POTENTIALPROLIFERATION OF BASAL CELL.

REFERENCES

• ANIL GOVINDARAO GHOM

• SHAFFER-HINE-LEVY.

• BURKITT’S

• SCULLEY

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