Journal of Oral and Maxillofacial Pathology

CASE REPORT
Year
: 2005  |  Volume : 9  |  Issue : 1  |  Page : 41--42

Odontogenic keratocyst of anterior mandible crossing the midline


Mukul Kumar, Bandtopadhyay, GK Thapliyal 
 Division of Oral and Maxillo Facial Surgery, Department of Dental Surgery, Armed Forces Medical College, Pune 411 040, India

Correspondence Address:
G K Thapliyal
Department of Dental Surgery, Armed Forces Medical College, Pune 411 040
India




How to cite this article:
Kumar M, Bandtopadhyay, Thapliyal G K. Odontogenic keratocyst of anterior mandible crossing the midline.J Oral Maxillofac Pathol 2005;9:41-42


How to cite this URL:
Kumar M, Bandtopadhyay, Thapliyal G K. Odontogenic keratocyst of anterior mandible crossing the midline. J Oral Maxillofac Pathol [serial online] 2005 [cited 2020 May 26 ];9:41-42
Available from: http://www.jomfp.in/text.asp?2005/9/1/41/39061


Full Text

 Introduction



Odontogenic keratocyst (OKC) as defined by WHO are known for their peculiar behaviour, varied origin, debated development, unique tendency to recur, and disputed treatment modalities. Thus, it has been the subject of much research over the last 40 years. 'The term was introduced by Philipsen in 1956 and much work subsequently on research of this intriguing category on mitotic activity, origin, growth, histological features, clinicopathology, and recurrence have been carried out by many researchers [1]

Although there is considerable predilection for mandibular 3rd molar region and ramus, they may also occur in maxilla. Anterior mandible is an uncommon site with the lesion crossing the midline being an unique occurrence. Typical radiographic features such as scalloped margins or multilobular and multilocular appearance are indicative but are not unequivocal. The diagnostic problems are mainly related to the relative lack of specific clinical and radiographic features that unequivocally point to the diagnosis. Hence aspiration biopsies and histopathological findings are an adjunct to diagnosis [2] .

 Case Report



This 26-year-old male reported to us with pain and swelling in lower jaw along with pus discharge from the intraoral wound since last tour months, Biopsy was done by a civil practitioner 4 months back, which developed into an unhealed site with pus discharge but the histopathological finding was of OKC.

On clinical and radiological evaluation, there was a healed scar extraorally over the left parasymphyseal region with tenderness over the lower symphyseal region. Both lower canines were missing with pus drainage in the lower right canine region. Tender, diffuse, bilateral, single swelling was observed extending from lower left first molar to lower right first molar region with expansion of buccal cortex. Lower anterior teeth were mobile.

After complete investigation, haemogram, blood grouping, LFT, ELISA. Urine RE, Radiographs, biopsy was taken along with fluid aspiration for protein estimation. Radiograph showed unilocular radiolucency from first molar to first molar on either side with sclerotic borders and buccal cortex expansion with impacted lower canines [Figure 1]. Histopathological finding again was confirmed as OKC.

Patient was taken up for enucleation and curettage under GA after proper preparation. Submandibular degloving incision was placed bilaterally and blunt dissection was carried out to expose the site [Figure 2]. Buttonholes were made over the buccal cortex, later joined by bur, and the hone removed using Rongeur forceps. Cyst was enucleated through this bony window, all teeth from molar to molar were removed, and rough margins were rounded off using vulcanite bur [Figure 3]. After achieving haemostasis. Carnoy's solution was applied and the area was irrigated. Suction drain was placed and wound was closed in layers. Postoperative antibiotics rued analgesics were prescribed. Presently, the patient wears prosthesis and there is no functional disability even after two years of surgery [Figure 4].

 Discussion



Though OKC is a well recognized entity, the current views on its origin vary. Some regard it as a development abnormality. Others consider it as a primordial cyst of a normal or supernumerary tooth before hard tissue formation. Another theory advocates the extension of basal cells from the overlying oral epithelium.

Etiopathogenesis attributed are increased mitotic activity, hydrostatic pressure, raised osmolalities, mural growth, enzymatic mechanism, bone resorting factor, and dental lamia/proliferating basal cells.

The histological features of OKCs are characteristic. The most intriguing and renowned feature is its high propensity to recur. It is said that they tend to grow more in antero-postern direction along the cancellous component without producing much expansion of the cortical plates especially the lingual plate, for a long period of time [3] .

The treatment of OKC is controversial: some authors reported low recurrence rate after enucleation, excision of overlying mucosa, curettage, and use of Carnoy's solution [4] . Most researches have advocated a strict follow-up protocol, which allows early surgical intervention in case of recurrence, limits the extent of second surgery, and thus giving rise to less morbidity [2].

References

1Shear M: Cysts of the Oral Region. Bristol: John Wright & Sons Ltd, Chapter 2, pg 4-25,1976.
2Paul J. W, Stoelings: Long term follow up on keratocysts treated according to defined protocol. Int J Oral Maxillofac Surg 2001, 30: 14- 25
3Andras Ezsias: Longitudinal in vivo observations on odontogenic keratocyst over a period of 4 years. Int J Oral Maxillofac Surg 2001; 30: 80-82.
4Voorsmith, stoelinga and Van Haelst: The Management of Keratocsts. J Max Fac Surg 1981;9: 228-236.