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Case Reports
. 2024 Mar 22;16(3):e56702.
doi: 10.7759/cureus.56702. eCollection 2024 Mar.

Odontogenic Keratocyst With Moderate Epithelial Dysplasia: A Rare Entity

Vimalasubhashini Vivekbalamithran  1 , Karthikeyan Ramalingam  1 , Pratibha Ramani  1 , Mahathi Neralla  2 , Alden S Jason  3
Affiliations
Case Reports

Odontogenic Keratocyst With Moderate Epithelial Dysplasia: A Rare Entity

Vimalasubhashini Vivekbalamithran et al. Cureus. .

Abstract

We present a rare case of odontogenic keratocyst (OKC) with moderate epithelial dysplasia in a 47-year-old male patient. He presented with a history of pain and swelling on the right side of his face for the past three months. The radiograph revealed multi-locular radiolucency involving the ramus, coronoid process, and condylar process of the right mandible. We have discussed the cytology, incisional biopsy, radiological investigations, surgical management, reconstruction, excisional biopsy report, and follow-up of this rare entity.

Keywords: biopsy; condyle; dysplasia; fibula graft; follow-up; mandible; odontogenic keratocyst; ramus; reconstruction; surgery.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Clinical pictures showing the diffuse extra-oral swelling on the right side of the mandible (A) and diffuse intraoral swelling in the molar-ramus region (B)
Green arrows indicate the swelling noted in the picture.
Figure 2
Figure 2. Radiograph revealing diffuse radiolucency involving the right mandibular ramus extending into the condyle along with perforation of cortical plates as seen in the orthopantomogram (A) and cone beam computed tomography (CBCT) (B)
Green arrows indicate the osteolytic lesion of the right mandible.
Figure 3
Figure 3. Aspirated sample (A), cytopathology (B), and histopathology (C)
A - Syringe containing cream-like fluid aspirated from the lesion as indicated by a green arrow B - Photomicrograph of cytopathology showing few nucleated and anucleated squames in an eosinophilic background (H&E, 20x) as indicated by a green arrow C - Photomicrograph of incisional biopsy showing classic keratinized odontogenic epithelial lining with palisaded basal cells (H&E, 20x) as indicated by a green arrow
Figure 4
Figure 4. Intraoperative pictures
A - Lesion involving the right mandibular ramus region before resection B - Reconstruction with free fibula graft and reconstruction plate
Figure 5
Figure 5. Photomicrograph of excisional biopsy showing odontogenic keratocyst with moderate epithelial dysplasia (H & E 20x, 40x)
Green arrows indicating keratinization, keratin flakes, and cellular pleomorphism of the odontogenic epithelial lining.
Figure 6
Figure 6. Follow-up images: clinical (A) and orthopantomogram (B)
A - Clinical picture showing the surgical wound closed with sutures B - Orthopantomogram showing the fibula graft along with the reconstruction plate
See this image and copyright information in PMC

References

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