The clinicopathological features and treatments of odontogenic keratocysts

Abstract

An odontogenic keratocyst (OKC) is a benign but aggressive intraosseous tumor derived from the remains of the original tooth germ or dental lamina. It has a marked ability to recur and become cancerous. However, patients with early-stage OKC often have no symptoms and manifestations. The common clinical manifestation is swelling. Hence, it is critical to precisely diagnose the disease, to use differential diagnosis in combination with auxiliary examination methods, and to select the most appropriate treatment option to reduce the loss of bone tissue and the related damage to patients. In recent years, with the advancement in understanding the molecular basis of this disease and the development of early detection and targeted therapy, the diagnosis and the prognosis of OKC have been improved. The aim of this study was to provide an overview on the clinical features, diagnosis, and treatment of OKC. The molecular and genetic basis of this disease and the characteristics of malignant transformation of OKC were also discussed. Finally, we presented patient cases from our clinical practice to provide some advice on the diagnosis and treatment of OKC.

Keywords: Odontogenic cysts; keratocystic odontogenic tumor; odontogenic keratocyst; odontogenic tumors.

Figure 1

CT imaging examination of patients. A. Before the second operation, bony destruction of the ascending ramus of the mandible was seen. B. Before the second operation, in the coronal view, the bone destruction of the ascending ramus of the mandible was seen. C. Before the third operation, on this preoperative CT scan, bony structures could be seen in the temporal mass. D. Before the third operation, CT scan showed possible tumor mass in the coracoid region: the shadow of a cyst in the temporal part of the deep zygomatic arch.

Figure 2

Histopathologic features indicate a keratocystic odontogenic tumor. Images were taken at magnification of Х40 (A), Х100 (B), Х200 (C), and Х400 (D). The outer layer is fibrous tissue, and the inner layer is stratified squamous epithelium with keratosis or incomplete keratosis. There are ascocyst or epithelial island in the fibrous capsule.