International Journal of Clinical Case Reports 2015, Vol.5, No. 42, 1-6
6
that microcysts are present in the connective tissue
of the cyst wall and that these are left behind after
enucleation. Some keratocysts show active budding of
the basal layer of the epithelial lining that may reach
to the periphery of the connective tissue wall and,
therefore, may also be the source of a true recurrent
cyst. The third reason for a recurrent OKC is the
development of a new keratocyst from an epithelial
island or microcyst left behind in the mucosa
(Stoelinga, 2005). A recent study suggests that
PTCH1 mutations, particularly those causing
protein truncations, are associated with OKCs showing
increased proliferative activity and thus related to a
phenotype of higher recurrent tendency. When taking
into consideration removal of a keratocyst, however, it
is important to keep in mind the 3 possible reasons
why an OKC could recur as stated above. Therefore,
treatment should aim at complete elimination of
possible vital cells left behind in the defect. In
Browne’s series, three different treatment methods
were evaluated, which were marsupialization,
enucleation and primary closure, and enucleation and
open dressing (Rajkumar et al., 2011). There was no
correlation between treatment method and the rate of
recurrence. Morgan and colleagues categorize surgical
treatment methods for KCOT as conservative or
aggressive. Conservative treatment of OKC is
“cyst-oriented” and, thus, includes enucleation, with
or without curettage, or marsupialization. Aggressive
treatment addresses the “neoplastic nature” of the
KCOT and includes peripheral ostectomy, chemical
curettage with Carnoy’s solution or en bloc resection
(Avinash et al., 2010; Rajkumar et al., 2011). Enucleation
has a benefit over marsupialization as complete
specimen can be sent for histopathologic examination
(Rajkumar et al., 2011). The purpose of using
Carnoy’s solution is to provide a total elimination of
epithelial remnants from the cyst walls, which may
cause recurrences (Scartezini et al., 2012). Researchers
have suggested that the recurrence rate is relatively
low with aggressive treatment, whereas more conservative
methods tend to result in more recurrences and after
the combined therapy of enucleation and Carnoy’s
solution, the recurrence rate was found to be 9%
(Ozkan et al., 2012). Recurrence is documented in
many cases even after 10 years of follow up and
treatment.
Conclusion
In conclusion, benign uni- or multicystic intraosseous
tumors of odontogenic origin should be considered in the
differential diagnosis of jaw lesions. Due to variation of
its clinical and radiological appearances diagnosis,
becomes confusing and tricky. In spite of, even in the
incidence of clinical and radiological features suggestive
of KCOT, a definitive diagnosis cannot be made without
microscopic investigation. Only thorough investigation
will allow to arrive at the most effective treatment and
thus to pass up the recurrences.
References
Sulabha A.N., Sameer C., Umesh K., and Shrishal T., 2013, Massive keratocystic
odontogenic tumor of mandible crossing the midline in 11-year child: An
unusual case report and its management, Dental Hypotheses, 4: 28-32
MacDonald-Jankowski D.S., 2011, Keratocystic odontogenic tumour: A
systematic review, Dentomaxillofacial Radiology, 40: 1-23
Çakur B., Milog˘lu Ö., Yolcu Ü., Göregen M., and Gürsan N., 2008,
Keratocystic odontogenic tumor invading the right maxillary sinus: A
case report, Journal of Oral Science, 50: 345-349
Neville B.W., Damm D.D., Allen C.M., and Bouquot J.E., 2002, Oral and
maxillofacial pathology, 2
nd
Edition, United States of America,
Saunders Company, Elsevier, pp.594-601
Avinash T.M.L., Balaji B.B, and Malik A.M., 2010, Keratocystic
odontogenic tumor mimicking Radicular cyst: A Clinical dilemma,
IJDA, 2: 387-390
Scartezini G.R., Oliveira G.C., Guedes O.A., Decurcio D.A., and de
Carvalhosa Carlos Estrela A.A., 2012, Diagnostic treatment features of
keratocystic odontogenic tumors, Stomatos, 18: 9-15
Hiremath S.K.S., Deshpande A.M., Byakodi S., and Magdum D.B., 2011,
Diagnostic dilemma: A case report of odontogenic keratocyst in lateral
periodontal position, International Journal of Oral & Maxillofacial
Pathology, 2: 23-26
Nagraja A., Anigol P.S., Kamath V.V., and Setlur K.P., 2012, Keratocystic
odontogenic tumor of the maxilla: Report of a rare case and review of
literature, World Journal of Dentistry, 3: 100-108
Jyothi M., Kokila D., and Laxmidevi B.L., 2010, Odontogenic keratocyst of
maxillainvolving the sinus- OKC to be a cyst or a tumour? Journal of
Dental Sciences and Research, 1: 83-90
Rajkumar G.C., Hemalatha M., Shashikala R., and Sonal P., 2011, Massive
keratocystic odontogenic tumor of mandible: A case report and review
of literature, Indian Journal of Dental Research, 22: 205-209
Devenney-Cakir B., Subramaniam R.M., Reddy S.M., Imsande H., Gohel A.,
and Sakai O., 2011, Cystic and cystic-appearing lesions of the
mandible: Review, AJR, 196: 66-77
Silvaa G.C.C., Silvab E.C., Gomezb R.S., and Vieirac T.C., 2006,
Odontogenic keratocyst in the maxillary sinus: Report of two cases,
42: 231-234
Stoelinga P.J.W., 2005, The treatment of odontogenic keratocysts by excision of
the overlying, attached mucosa, enucleation, and treatment of the bony
defect with carnoy solution, J. Oral Maxillofac Surg., 63: 1662-1666
Ozkan A., Bayar G.R., Altug H.A., Sencimen M., and Senel B., 2012, Management
of keratocystic odontogenic tumour with marsupialisation, enucleation and
carnoy’s solution application: A case report, OHDM, 11: 69-73
