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Introduction: The incidence of recurrence of OKC varied from 2.5 to 62%. Studies have linked recurrence to treatment methods and also clinical and pathological features. The aim of this study was to evaluate the 5-year recurrence and the factors associated with recurrence in odontogenic keratocysts of the jaws. Methods: A retrospective review of records was done from the Institute's Medical Records Directory from 2010 to 2021. The following data were obtained of the lesion; age at presentation, gender, site, subsite, radiographic presentation (locularity), radiographic borders, presence or absence of satellite cysts, inflammatory infiltrate, and treatment rendered presence or absence of cortical perforation and soft-tissue extension and presence or absence of recurrence. Kaplan Meir estimator was used to evaluate recurrence rate and log rank test was used to compare the survival amongst groups. Cox regression analysis was used to evaluate the odds ratio to find out the possible factors influencing risk of recurrence. A p value of < 0.05 was considered statistically significant at 95% confidence interval. Results: In our study cohort, 27.2% of patients had recurrence. Posterior maxillary lesions, multilocular lesions, lesions with scalloped borders, presence of soft-tissue extension and cortical perforation, presence of satellite cysts and inflammatory infiltrate and enucleation with peripheral ostectomy were significantly associated with recurrence. However, soft-tissue extension, cortical perforation, multilocular lesions and presence of satellite cysts were independent risk factors. Conclusion: There is still debate on the best treatment modality for the management of OKCs. More studies are required to quantify the results. [ABSTRACT FROM AUTHOR]

Background: Odontogenic keratocyst (OKC) has high recurrence rate. We sometimes extract the teeth in contact with the lesion to prevent recurrence. Case presentation: A 14‐year‐old male was referred to our hospital by his family dentist for the evaluation of a posterior left mandible lesion. We extracted the mandibular left second and third molar and performed enucleation and curettage of the OKC. After the operation, we performed intertemporal autotransplantation. Conclusion: The postoperative course has been good with no mobility and less than 3 mm periodontal pockets of the donor and with no recurrence of OKC. [ABSTRACT FROM AUTHOR]

Gorlin–Goltz syndrome (GGS) is a rare hereditary disease characterized by multiple basal cell carcinomas, odontogenic keratocyst (OKCs) and musculoskeletal malformations. Pathogenesis of the syndrome is attributed to abnormalities in the long arm of chromosome 9 (q22.3–q31) and mutations in the human patched gene (PTCH1 gene). Here, we report a rare case of an incidental finding of GGS in an 18-year-old male patient presenting multiple OKCs, calcification of the falx cerebri, and bifid rib. [ABSTRACT FROM AUTHOR]

Background: Keratoameloblastoma is a poorly characterized and rarely reported odontogenic neoplasm that can exhibit overlapping histopathologic features with conventional ameloblastoma and keratocystic odontogenic tumor (KCOT), with an ambiguous relationship to the so-called solid KCOT. Methods: A peripheral maxillary tumor causing bone saucerization in a 54-year-old male is described and investigated with immunohistochemistry and Next-Generation Sequencing (NGS). Results: Microscopically, the tumor comprised of a predominantly plexiform proliferation of odontogenic epithelium with central keratinization and evidence of surface origin. Peripheral cells exhibited nuclear palisading with variable reverse polarization, while stellate reticulum-like areas were observed internally. A few follicles and a few foci in the lining of cystic spaces revealed increased cellularity with cells exhibiting small but conspicuous nucleoli, focal nuclear hyperchromatism, and a few mitoses mostly seen in the peripheral outer cell layer. Nuclear staining for ki-67 was increased in those areas when compared with the other cystic, follicular, and plexiform areas. These features were interpreted as cytologic atypia suggesting also the possibility of a malignant process. Immunohistochemically, the tumor was positive for CK19 and negative for BRAF VE1, calretinin, and CD56. Ber-Ep4 was only focally positive. By sequencing, an ARID1A c.6527_6538delAG frameshift mutation (VAF: 5.8%), classified as likely oncogenic, and an FBXW7 c.1627 A > G missense mutation (VAF: 8.0%), classified as a variant of uncertain significance, were detected. Two mutations, probably germline (VAF ~ 50%), were recorded for RNF43 and FBXW7. No pathogenic variants were identified in PTCH1, BRAF, NRAS, HRAS, KRAS, FGFR2, or SMO genes. Conclusion: The significance of an ARID1A variant in keratoameloblastoma is uncertain since this variant has not been reported in ameloblastoma or KCOT, to date. Alternatively, it may characterize malignant transformation in the present case since ARID1A mutations have been encountered in various cancers. Sequencing of additional cases is necessary to determine whether this may represent a recurrent genomic event. [ABSTRACT FROM AUTHOR]

The effective management of odontogenic keratocyst (OKC) remains a subject of interest and confusion in the oral and maxillofacial surgery literature. Currently, there is a lack of consensus regarding the most appropriate treatment for patients with OKC. Of the various treatment options available, no modality to date has been shown to demonstrate a zero or near-zero recurrence rates except wide resection with clear margins. With the prevailing dearth of evidence based surgical protocols for the management of patients with OKC in the literature, this study aims to present a surgical algorithm, based on meta-analysis results, that hopefully will be beneficial in enhancing treatment of patients with this condition. Also, new meta-analysis was done to compare between modified Carnoy's solution (MCS) and 5-fluorouracil (5-FU) in respect of recurrence rate of OKC. Using parameters like size, lesion type (primary or secondary), syndromic or solitary nature of the lesion, presence of cortical perforations, and locularity; we present a decision tree, to aid treatment planning and help attain the least chance of recurrence in the management of the OKC. There was very low-quality evidence indicating that application of 5-FU, after enucleation and peripheral ostectomy of OKCs, significantly lowered recurrence rate when compared to MCS (RR = 0.087, CI: 0.017 to 0.436, P value = 0.003). [ABSTRACT FROM AUTHOR]

Purpose The purpose of this article is to present a case report of a periapical lesion found in a 24-yearold female who presented to a university dental hygiene clinic with a chief complaint of vestibular pain around tooth #22. Radiographically, the lesion appeared radiolucent and unilocular with well-defined borders and significant bone resorption. The area of radiolucency increased in size over a period of five weeks indicating an aggressive pathosis. Given the clinical and radiographic presentations, the differential diagnosis included an odontogenic keratocystic tumor (odontogenic keratocyst), central giant cell granuloma, periapical cyst, and squamous cell carcinoma. Biopsy revealed the diagnosis of a focal abscess. The patient's presenting signs and symptoms are reviewed. Management and contributing factors are discussed. [ABSTRACT FROM AUTHOR]

Background: Aggressive benign odontogenic neoplasms are a group of lesions that have the potential to grow to an enormous size resulting in bony deformities, locally aggressive behavior and have high recurrence rate. Ameloblastomas, keratocystic odontogenic tumors, etc., are included under this group of lesions. Treatment of these lesions is challenging owing to their particular characteristics including high recurrence rate, locally aggressive behavior, etc. Materials and Methods: A retrospective study was conducted in 40 patients who had undergone enucleation and open packing as treatment for benign aggressive neoplasms in the department of oral and maxillofacial surgery. Results: In the study, all the cases were followed up for a minimum of 5 years clinically and radiographically. Satisfactory bone healing was noted with no evidence of recurrence in all cases. Conclusion: Enucleation followed by open packing with iodoform is an excellent conservative modality with proven minimal rate of recurrences in 5-year period. [ABSTRACT FROM AUTHOR]

Background. Current evidence suggests that nevoid basal cell carcinoma syndrome (NBCCS)-associated odontogenic keratocysts (OKCs) exhibit more aggressive clinical behavior and a higher tendency to relapse. The prognostic efficacy of various markers in sporadic and syndromic OKCs is unclear, and so are the results of studies on the usefulness of immunohistochemistry in distinguishing syndromic from sporadic OKCs. Objectives. This retrospective study aimed to compare the prognostic relevance of various clinicoradiological and histopathological features, as well as the immunoexpression of COX-2, Bcl-2, proliferating cell nuclear antigen (PCNA), p53, Ki-67, osteoprotegerin (OPG), receptor activator of nuclear factor B (RANK) and receptor activator of nuclear factor B ligand (RANKL), as well as RANKL/OPG balance between sporadic and syndromic OKCs, and to test their utility in distinguishing the 2 types of OKC. Materials and methods. We compared the immunoexpression of the aforementioned markers between 31 sporadic and 12 syndromic OKCs, and tested clinicopathological findings and levels of immunostaining against recurrence. Results. We found a significant association between NBCCS and OKC recurrence. There were significant differences in PCNA, p53 and OPG immunoexpression between sporadic and syndromic OKCs. We also found that recurrent sporadic OKCs were significantly larger and markedly more often associated with cortical perforation. Recurrent sporadic OKCs exhibited COX-2 upregulation, but we failed to demonstrate its prognostic relevance. Recurrent syndromic OKCs showed a markedly higher RANKL > OPG ratio. Conclusions. The NBCCS-associated OKCs are significantly more prone to recur than their sporadic counterparts. Larger size and radiological signs of cortical perforation in sporadic OKCs may indicate a higher risk of recurrence. The COX-2 is upregulated in recurrent sporadic OKCs, whereas recurrent syndromic OKCs exhibit higher RANKL and lower OPG expression; however, these findings have no prognostic relevance. The immunoexpression of p53, PCNA and OPG may help to distinguish syndromic from sporadic OKCs. [ABSTRACT FROM AUTHOR]

Odontogenic keratocysts (OKC) are benign but aggressive lesions. As there is a lack of well randomized clinical studies assessing the effectiveness of the different treatment options for OKC, a network meta-analysis (NMA) was performed to identify the best treatment option with the lowest recurrence rate. An electronic search was performed following the PRISMA guidelines to identify all clinical studies comparing treatment options against enucleation alone. The outcome variable was recurrence. The predictor variables were treatments. The eight included treatments were: enucleation with peripheral ostectomy/curettage (E + PO/curettage); enucleation with cryotherapy (E + CRYO); enucleation with/without PO followed by modified Carnoy's solution (E ± PO+MCS); enucleation with PO and with topical 5-fluorouracil (E + PO+5FU); enucleation with/without PO followed by original Carnoy's solution (E ± PO+CS); marsupialization alone (MARS); marsupialization followed by secondary enucleation with/without PO (MARS+2°E ± PO); and resection. The odds ratio was used to estimate the recurrence rate. A frequentist NMA was performed using Stata software. A total of 2989 patients in 40 studies were included. Both direct pairwise meta-analysis and NMA showed that E + 5FU+PO was significantly superior to E ± PO+MCS. However, no statistically significant difference was found between E ± PO+CS vs E + 5FU+PO, E ± PO+MCS, and resection, respectively (all very low quality evidence). The three most effective treatments in reducing the recurrence rate were E + PO+ 5FU (98.1%; very low quality evidence), resection (83.5%; very low quality evidence), and E ± PO+CS (63.8%; moderate quality evidence). The findings from this study suggest that CS remains the most effective fixative agent after enucleation and PO until proven otherwise. Additionally, 5FU appears to be an effective method with promising results that needs further research. Finally, the efficacy of MCS remains controversial; further in vivo and in vitro studies are required to determine new protocols. As this NMA included retrospective studies, the results should be interpreted with great caution (level of evidence: type III). [ABSTRACT FROM AUTHOR]

Large benign odontogenic neoplasms of mandible are not rare in developing countries such as India. Treatment of choice depends not only on extent and size of the lesion but also the socio-economic status, resources and available armamentarium. Whenever resection of segment mandible is planned for these patients, goal of the treatment should not be to restore function of the mandible alone but also to give esthetic visual appearance of the face. The present study was performed to determine postoperative functional and esthetic outcome in such patients. A total of 18 patients (20–35 years) with benign odontogenic neoplasm of mandible were enrolled for the study. After surgical intervention i.e., resection and reconstruction of mandible with mandibular reconstruction plate, all the patients were evaluated post-operatively for functional and esthetic outcome at the end of 1st and 4th week. Functional outcome were assessed based on Quality of life questionnaire and esthetic outcome based on vancouver scar assessment scale, clinical and radiological assessment. The mean scores of all the functional outcomes was improved significantly like pain, drooling of saliva, eating solid and liquid and speech except deglutition. The mean score of scar was recorded as 4.67. Occlusion was achieved in 100% and lips competency in 89% of patients. It is advised to immediately reconstruct the mandible after segmental mandibulectomy which eventually helps to improve the quality of life post-operatively of patients being treated for benign odontogenic neoplasm of mandible [ABSTRACT FROM AUTHOR]

Objectives: The aim of this systematic review was to critically analyze available data on gene polymorphisms in odontogenic keratocysts (OKC) and ameloblastomas, including their possible relationship with clinical and histological features of these lesions. Materials and Methods: A comprehensive search of Web of Science Scopus, PubMed, Cochrane Central Register of Controlled Trials and EMBASE was conducted using relevant key terms and supplemented by a gray literature search. Quality assessment of included studies was performed using criteria from the Strengthening the Reporting of Genetic Association (STREGA) statement. Results: Ten studies were included in the final review. Survivin ‐31G/C, interleukin IL‐1α ‐889 C/T, p53 codon 72 G/C, tumor necrosis factor TNF‐α (−308G>A) and its receptor TNF‐R1 (36A>G), glioma‐associated oncogene homolog 1 rs2228224 and matrix metalloproteinase 2 rs243865 gene polymorphisms were reported to be associated with OKC. For ameloblastomas, p53 codon 72 G/C, X‐ray repair cross‐complementing protein 1—codons 194 and 399 and matrix metalloproteinase 9 rs3918242 gene polymorphisms were identified as risk factors. It was not possible to establish a relationship between specific polymorphisms and clinical and histological features of investigated lesions. Conclusions: Several gene polymorphisms might be considered as a risk factor for the development of these lesions. Future studies should investigate whether these polymorphisms might be used to identify patients with increased risk of recurrence or aggressive disease. [ABSTRACT FROM AUTHOR]

Purpose: to review in detail various aspects of odontogenic keratocyst, emphasizing recent nomenclature, clinical, histopathological, recurrence, and management of odontogenic keratocyst. Methods: To achieve the objective of this review, a manual search was done in hard copy books of oral and maxillofacial pathology, and an electronic search was done in the google website, oral and maxillofacial pathology E-books, virtual database sites, such as PubMed, Research Gate, Academia, and Google scholar using the descriptors: odontogenic cyst, kerato odontogenic tumor, odontogenic keratocyst, and jaws cystic lesion. The eligibility criteria for selecting articles were: to be in the English language, studies published in journals, or indexed in these databases until 2021. Exclusion criteria were: articles in any languages other than English, studies presented in duplicate between the bases, whose theme did not contemplate the objective proposed in this review, or those not available in the digital environment. Data collection occurred from October to December 2020, followed by a thorough evaluation of the studies found, including an exploratory, selective, analytical, and interpretative reading. Summary and conclusions: the odontogenic keratocyst is noteworthy because of its unusual growth pattern, the tendency to recur, and association with an inherited syndrome. The renaming of odontogenic keratocysts as keratocystic odontogenic tumors has been one of the most debatable changes in the terminology of odontogenic lesions in recent years. Early diagnose of this lesion is important to perform the more conservative treatment. A wait-and-see policy, with yearly follow-up for the first five years and every two years after that, is strongly advocated.

Amongst odontogenic cysts, keratocystic odontogenic tumor (KOT) is a benign intra-osseous lesion, characterized by corrugated parakeratinized uniform stratified squamous epithelium, with potential for aggressive behavior and high tendency to recur. There are multiple treatment modalities for this cyst. Some surgeons prefer the conservative treatments such as marsupialization while the others prefer invasive treatments such as radical resection. The aim of this study was to present a case of KOT involving the right mandibular premolar area with an impacted tooth in a 9-year-old boy treated by marsupialization. The treatment resulted in eruption of the mandibular first premolar, and no signs of recurrence were observed after two years. Marsupialization was found to be an effective treatment in inducing the eruption of mandibular premolar associated with KOT in preadolescents and can be a reliable procedure to reduce recurrence tendency of KOT.

Abstract Purpose The aim of this study was to conduct epidemiologic investigations on the pattern of the lesion and differences between treatment modalities in terms of recurrence by reviewing follow-up records to form a basis for planning patient follow-up visits. Materials and methods In this retrospective, single-center cohort study, 266 patients diagnosed with odontogenic keratocyst between 1993 and 2013 were included. Medical records and radiographic images were analyzed for age distribution, occurrence site and size, treatment modalities, and recurrence. Results The average age at first diagnosis was 33.1 years, and the male to female ratio was 1.33:1.00. The highest rate of incidence was in the third decade followed by the fourth, second, and fifth decades. The incidence in the maxilla was 34%, and 66% in the mandible. Mandibular ramus was most commonly involved. Lesions between 3 and 6 crowns were the most common, and the rate of recurrence increased with size. Enucleation after decompression had higher rate of recurrence (35.8%) than enucleation (27.1%), but there was no statistical significance. Conclusion The recurrence of odontogenic kerotocyst (OKC) was significantly associated with large size, multilocular form, and surgical procedure. A 10-year follow-up period is recommended to determine any recurrence of OKC.

Background: Odontogenic lesions can bring about diagnostic challenges due to overlapping histology among pathologists. Thus, there are few tumor markers that provide accurate diagnosis. Syndecan-1 (CD-138) and podoplanin (PDPN) are proteoglycans that have been described as substantial diagnostic and prognostic markers in various odontogenic lesions. Aim: This study aims to evaluate and compare the immunohistochemical expression of syndecan-1 (CD-138) and podoplanin in keratocystic odontogenic tumor, orthokeratinized odontogenic cyst (OOC), and dentigerous cyst (DC). Materials and Methods: The formalin-fixed paraffin-embedded tissue blocks of KCOT, OOC, and DCs were retrieved form the archives of department. Three sections each of 3 μm thickness were made using a rotary microtome and they were stained with syndecan-1 (CD-138) and podoplanin (PDPN) using immunohistochemical methods and standard hematoxylin and eosin stain. Results: Immunohistochemical expression of syndecan-1in KCOT was found to be weakly to moderately positive in 6 cases with 2 cases exhibiting positive expression. In OOC, 3 cases displayed negative expression-1 whereas 7 cases were weakly to moderately positive. Immunohistochemical expression of podoplanin in KCOT was observed to be weakly to moderately positive in 4 cases with 5 cases exhibiting strongly positive expression. In OOC, 3 cases displayed negative immunohistochemical expression for podoplanin and 4 cases were strongly positive. Immunoreactivity for podoplanin in DC was negative in 3 cases whereas 5 cases were weakly to moderately positive. Conclusion: The absence of significant correlation between expression of syndecan-1 and podoplanin reinforces the exact role of these proteins in the differentiation of odontogenic lesions which need to be elucidated further.

Nevoid basal cell carcinoma syndrome (NBCCS) or Gorlin syndrome is a multi system disease exhibiting varied developmental abnormalities and a predisposition to neoplasms.A dentist may play a key role in early diagnosis of this disorder considering multiple & recurrent Odntogenic Keratocysts (OKC) are one of the first manifestations and are evident on routine X-rays.Present case report presents a patient diagnosed as NBCCS by clinical, radiographic and histological findings in a 13-year-old patient. We highlights the importance of early diagnosis of NBCCS which can help in preventive multidisciplinary approach to provide a better prognosis for the patient.

Odontogenic keratocyst (OKC) is a developmental cyst of the jaw which arises from odontogenic epithelium. OKCs have been considered to be cystic neoplasms and called keratocystic odontogenic tumors in WHO classification in 2005. Although reclassified as cysts by WHO in 2007, OKCs are characterized by clinically aggressive behavior and a high risk of recurrence.This report presents a clinical case of a male 22 years old patient, presenting an intraosseous lesion in the mandible (left side), asymptomatic, with a slight increase in intraoral buccal volume. The patient was submitted to the surgical decompression treatment, with a cystic fluid puncture, biopsy of the lesion, and anatomopathological examination. Enucleation of the tumor was then performed, after performing endodontic treatment on the necrotic tooth.It is a benign intraosseous cyst of the odontogenic origin, characterized by an aggressive behavior with a relatively high recurrence rate. OKC is mostly presented in the 2nd and 3rd decades and predominantly affects males. It affects the mandible more than the maxilla and is frequently found at the angle of the mandible. OKC can radiographically clinically and mimic other benign and less aggressive lesions. It is therefore important to differentiate them from other cysts and tumors, for proper treatment and reduction of recurrences.

Background: Odontogenic lesions can bring about diagnostic challenges due to overlapping histology among pathologists. Thus, there are few tumor markers that provide accurate diagnosis. Syndecan-1 (CD-138) and podoplanin (PDPN) are proteoglycans that have been described as substantial diagnostic and prognostic markers in various odontogenic lesions. Aim: This study aims to evaluate and compare the immunohistochemical expression of syndecan-1 (CD-138) and podoplanin in keratocystic odontogenic tumor, orthokeratinized odontogenic cyst (OOC), and dentigerous cyst (DC). Materials and Methods: The formalin-fixed paraffin-embedded tissue blocks of KCOT, OOC, and DCs were retrieved form the archives of department. Three sections each of 3 μm thickness were made using a rotary microtome and they were stained with syndecan-1 (CD-138) and podoplanin (PDPN) using immunohistochemical methods and standard hematoxylin and eosin stain. Results: Immunohistochemical expression of syndecan-1in KCOT was found to be weakly to moderately positive in 6 cases with 2 cases exhibiting positive expression. In OOC, 3 cases displayed negative expression-1 whereas 7 cases were weakly to moderately positive. Immunohistochemical expression of podoplanin in KCOT was observed to be weakly to moderately positive in 4 cases with 5 cases exhibiting strongly positive expression. In OOC, 3 cases displayed negative immunohistochemical expression for podoplanin and 4 cases were strongly positive. Immunoreactivity for podoplanin in DC was negative in 3 cases whereas 5 cases were weakly to moderately positive. Conclusion: The absence of significant correlation between expression of syndecan-1 and podoplanin reinforces the exact role of these proteins in the differentiation of odontogenic lesions which need to be elucidated further. [ABSTRACT FROM AUTHOR]

Reconstruction of mandibular surgical defects often poses a great challenge to maxillofacial surgeons. Mandibular segmental defects majorly disrupt the occlusion, mastication, and the facial esthetics. Free autografts such as iliac crest and rib; allografts such as three-dimensional, bendable reconstruction plate; and patient-specific implant are some of the techniques that had been employed for the reconstruction of such defects. Nevertheless, in recent times, the most dependable modes of reconstruction are the microvascular fibula reconstruction and transport distraction techniques. Transport distraction osteogenesis (TDO) is a reliable technique without donor-site morbidity especially in the dentate region of the mandible as it provides native bone for rehabilitation. The aim of this article is to report a successful case of TDO to fill the defect in the left body of the mandible secondary to segmental resection of the mandible for keratocystic odontogenic tumor. The technique was successful with a 2-year follow-up period without any potential esthetic compromise.

Background: The clinical feature and radiographic appearance of orthokeratinized odontogenic keratocyst (OKC) are not characteristic, which may lead to the misdiagnosis. The radiographic appearance of OKC may range from a small unilocular radiolucency to a large multilocular radiolucency, resembling other odontogenic cysts and tumors. Aim: The aim was to illustrate the characteristic feature of OKC presented on the digital panoramic radiograph and cone-beam computed tomography (CBCT), which may provide great value for the differential diagnosis and the treatment planning and also to compare the various radiographic features of OKC in CBCT and digital panoramic radiograph. Materials and Methods: Digital panoramic and CBCT records of seven cases, with 11 lesions of OKC were analyzed retrospectively from the patients' database from our institute (2014 to 2016), which was histopathologically diagnosed as OKC. Results: The mean age of the patients was 24.1 years, and the female-to-male ratio was 3: 4. Six of 11 lesions were localized within the mandible, and five lesions were in the maxilla. Conclusion: The presurgical assessment with radiological information is extremely important for treatment planning, and CBCT provides us with an accurate and faster three-dimensional representation of a lesion at a lower dose and cost, but the role of panoramic radiograph cannot be refuted.

Abstract Background Orthokeratinized Odontogenic Cyst (OOC) is a rare, developmental odontogenic cyst which was considered in the past to be a variant of Odontogenic keratocyst (OKC) later renamed as keratocystic odontogenic tumor (KCOT). The treatment of OOC is by enucleation and the prognosis, following enucleation is excellent with a recurrence rate of less than 2%. On the other hand, OKC has a recurrence rate between 8 and 25% after enucleation. Thus it is important to differentiate between the two entities. Methods All cases reported in our section as OOC during the period 2013 to 2018 were retrieved from the surgical pathology files and slides were reviewed by the authors. All cases which met the histological criteria for OOC were included. Results A total of 10 cases were included. 70% patients were males, ages ranged from 23 to 60 years, with mean age of 38.9 years. 70% of cases were located in the mandible and 90% patients presented with swelling. Radiologically, 90% cases were unilocular, all were radiolucent lesions. Mean size was 4.0 cm. Histologically, all cases demonstrated the classic microscopic features. Follow-up was available in 8 patients. All were treated by enucleation. All 8 were alive with no recurrences over a follow-up period ranging from 7 to 62 months. Conclusions OOC has a better prognosis than OKC and needs to be differentiated from OKC due to differences in treatment and prognosis. Large majority of our cases presented with swelling and occurred in the mandibles of young males. All were radiolucent and most were unilocular. All were treated by enucleation and no recurrences occurred over follow up period ranging up to 62 months. Our findings were similar to those described in other published series.

Purpose: The aim of this study was to conduct epidemiologic investigations on the pattern of the lesion and differences between treatment modalities in terms of recurrence by reviewing follow-up records to form a basis for planning patient follow-up visits. Materials and methods: In this retrospective, single-center cohort study, 266 patients diagnosed with odontogenic keratocyst between 1993 and 2013 were included. Medical records and radiographic images were analyzed for age distribution, occurrence site and size, treatment modalities, and recurrence. Results: The average age at first diagnosis was 33.1 years, and the male to female ratio was 1.33:1.00. The highest rate of incidence was in the third decade followed by the fourth, second, and fifth decades. The incidence in the maxilla was 34%, and 66% in the mandible. Mandibular ramus was most commonly involved. Lesions between 3 and 6 crowns were the most common, and the rate of recurrence increased with size. Enucleation after decompression had higher rate of recurrence (35.8%) than enucleation (27.1%), but there was no statistical significance. Conclusion: The recurrence of odontogenic kerotocyst (OKC) was significantly associated with large size, multilocular form, and surgical procedure. A 10-year follow-up period is recommended to determine any recurrence of OKC. [ABSTRACT FROM AUTHOR]

Amongst odontogenic cysts, keratocystic odontogenic tumor (KOT) is a benign intraosseous lesion, characterized by corrugated parakeratinized uniform stratified squamous epithelium, with potential for aggressive behavior and high tendency to recur. There are multiple treatment modalities for this cyst. Some surgeons prefer the conservative treatments such as marsupialization while the others prefer invasive treatments such as radical resection. The aim of this study was to present a case of KOT involving the right mandibular premolar area with an impacted tooth in a 9-year-old boy treated by marsupialization. The treatment resulted in eruption of the mandibular first premolar, and no signs of recurrence were observed after two years. Marsupialization was found to be an effective treatment in inducing the eruption of mandibular premolar associated with KOT in preadolescents and can be a reliable procedure to reduce recurrence tendency of KOT. [ABSTRACT FROM AUTHOR]

Background: Keratocystic odontogenic tumor (KCOT) is an odontogenic lesion which manifests distinct biological behavior. Predominant studies in KCOT attribute this behavior to high epithelial proliferative capacity. Besides, a few studies facet loosely arranged collagen can contribute to the behavior of KCOT. Matrix metalloproteinases (MMP) are enzymes that degrade extracellular matrix components under both physiologic and pathologic conditions. The loosely arranged collagen in connective tissue wall of KCOT could be related to the degree of MMP-9 expression. Aim: To evaluate the arrangement of collagen fibers along with immunoexpression of MMP-9 and to relate to its neoplastic biologic behavior in sporadic cases of KCOT. Materials and Methods: KCOT (n = 23) and dentigerous cyst (DC) (n = 15) samples were processed for the following techniques: Masson's trichrome stain for light microscopy, PMA-PSR stain for confocal microscopy, and MMP-9 for immunohistochemistry. Results: In Masson's trichrome analysis, correlation of collagen fiber arrangement in the deeper regions with color intensity for KCOT was found to be statistically significant (P =.033). In confocal microscopy, there was no difference between intensities in KCOT (P =.990) and DC (P =.233), respectively. The immunoexpression of MMP-9 in the connective tissue wall of DC (73.3%) was relatively higher than that of KCOT (60.8%). However, on comparison between KCOT and DC in the presence of inflammation, the immunoexpression of MMP-9 was higher in DC (100%) than KCOT (69.9%) and was statistically significant (P =.028). Conclusion: It was concluded that the loose connective tissue wall in KCOT is because of the inherent nature of the lesion that could facilitate its biologic behavior. If inflammation is present, this could further aggravate the tumorigenic behavior. [ABSTRACT FROM AUTHOR]

Background. Odontogenic keratocysts (OKCs) are clinically aggressive lesions with relatively high recurrence rates. Dysregulation of functional equilibrium in the RANK/RANKL/OPG system is responsible for osteolysis associated with the development of OKCs. Previously published findings imply that immunoexpression of these 3 proteins may correlate with bone resorption activity in OKCs. Objectives. The rationale behind this study was to assess the potential for receptor activator of nuclear factor kappa-B (RANK), receptor activator of nuclear factor kappa-B ligand (RANKL) and osteoprotegerin (OPG) expression, as well as RANKL/OPG expression ratio, to serve as prognostic indicators for OKC recurrence. Materials and methods. We investigated the immunoexpression patterns of RANK, RANKL and OPG, and their correlation with recurrence rates, in 41 patients with OKCs treated with enucleation. Results. We found no statistically significant differences between recurrent and non-recurrent cysts in terms of either: epithelial (p = 0.404) and stromal (p = 0.469) immunoreactivity of RANK; epithelial (p = 0.649) and stromal (p = 0.198) immunoreactivity of RANKL; or epithelial (p = 1) and stromal (p = 0.604) immunoreactivity of OPG. We also did not find significant differences in the distribution of cases with respect to ratios of RANKL/OPG immunostaining scores between recurrent and non-recurrent OKCs, both in the epithelium and in the connective tissue (p = 1 and p = 0.237, respectively). Conclusions. Our results suggest that immunoexpression levels of RANK, RANKL and OPG at the time of pathological diagnosis, as well as the RANKL/OPG ratio, are not useful as prognostic markers for OKC recurrence. [ABSTRACT FROM AUTHOR]

A 37-year-old woman consulted for a slow-growing mass of one-year duration on the left side of the mandible with associated tooth mobility. Clinical examination showed buccal expansion along the left hemi-mandible from the mid-body to the molar-ramus region with associated mobility and displacement of the pre-molar and molar teeth. Radiographs showed a well-defined unilocular radiolucency with root resorption of the overlying teeth. Decompression and unroofing of the cystic lesion was performed. Received in the surgical pathology laboratory were several gray-white rubbery to focally gritty tissue fragments with an aggregate diameter of 1 cm. Histopathologic examination shows a fibrocollagenous cyst wall lined by a fairly thin and flat stratified squamous epithelium without rete ridges. (Figure 1) The epithelium is parakeratinized with a wavy, corrugated surface while the basal layer is cuboidal and quite distinct with hyperchromatic nuclei. (Figure 2) Based on these features, we signed the case out as odontogenic keratocyst (OKC). Odontogenic keratocysts are the third most common cysts of the gnathic bones, comprising up to 11% of all odontogenic cysts, and most frequently occurring in the second to third decades of life.1,2 The vast majority of cases occur in the mandible particularly in the posterior segments of the body and the ramus. They typically present as fairly large unilocular radiolucencies with displacement of adjacent or overlying teeth.1 If associated with an impacted tooth the radiograph may mimic that of a dentigerous cyst.2 Microscopically, the parakeratinized epithelium without rete ridges, and with a corrugated luminal surface and a prominent cuboidal basal layer are distinctive features that enable recognition and diagnosis.1,2,3 Occasionally, smaller “satellite” or “daughter” cysts may be seen within the underlying supporting stroma, sometimes budding off from the basal layer. Most are unilocular although multilocular examples are encountered occasionally.1 Secondary inflammation may render these diagnostic features unrecognizable and non-specific.2 Morphologic differential diagnoses include other odontogenic cysts and unicystic ameloblastoma. The corrugated and parakeratinized epithelial surface is sufficiently consistent to allow recognition of an OKC over other odontogenic cysts, while the absence of a stellate reticulum and reverse nuclear polarization will not favor the latter diagnosis.2,3 Odontogenic keratocysts are developmental in origin arising from remnants of the dental lamina. Mutations in the PTCH1 gene have been identified in cases associated with the naevoid basal cell carcinoma syndrome as well as in non-syndromic or sporadic cases.1,3 These genetic alterations were once the basis for proposing a neoplastic nature for OKCs and thus the nomenclature “keratocystic odontogenic tumor” was for a time adopted as the preferred name for the lesion.3,4 Presently, it is felt there is not yet enough evidence to support a neoplastic origin and hence the latest WHO classification reverts back to OKC as the appropriate term.1 Sekhar et al. gives a good review of the evolution of the nomenclature for this lesion.3 Treatments range from conservative enucleation to surgical resection via peripheral osteotomy.5 Reported recurrences vary in the literature ranging from less than 2% of resected cases up to 28% for conservatively managed cases.1,5 These are either ascribed to incomplete removal or to the previously mentioned satellite cysts - the latter being a feature associated with OKCs that are in the setting of the naevoid basal cell carcinoma syndrome.1,2,3 Thus, long term follow-up is recommended.5 Malignant transformation, though reported, is distinctly rare.2

Abstract Background The Gorlin-Goltz syndrome is an autosomal dominant disorder characterized by keratocystic odontogenic tumors in the jaws, multiple basal cell carcinomas and skeletal abnormities. Frequently, the manifestation of the syndrome occurs in the adolescent years. Case presentation An 11-year-old boy was referred to our clinic due to the persistence of the lower deciduous molars. The further diagnosis revealed bilateral keratocystic odontogenic tumors in the region of teeth 33 and 45 representing a symptom of a Gorlin-Goltz syndrome. This case of the oral rehabilitation of an adolescent with bilateral keratocystic odontogenic tumors shows the approach of a multidisciplinary treatment concept including the following elements: Enucleation and bone defect augmentation using a prefabricated bone graft; distraction osteogenesis to extend the graft-block vertically after cessation of growth; accompanying orthodontic treatment, guided implant placement and prosthetic rehabilitation. Six months after implant insertion, a new keratocystic odontogenic tumor in the basal part of the left sinus maxillaris had to be removed combined with the closure of the oroantral fistula. During the follow-up period of 18 months in semi-annual intervals, the patient showed no sign of pathology. Conclusion In the presented case could be shown that distraction osteogenesis of prefabricated bone blocks is possible. With a multidisciplinary approach in a long-term treatment a sufficient oral rehabilitation of the patient suffering from extended keratocystic odontogenic tumors was possible.

Abstract Objectives This study was aimed to analyze the reducing pattern of decompression on mandibular odontogenic keratocyst and to determine the proper time for secondary enucleation. Materials and methods Seventeen patients with OKC of the mandible were treated by decompression. Forty-five series of CT data were taken during decompression and measured by using InVivo software (Anatomage, San Jose, Calif) and were analyzed. Results The expected relative volume during decompression is calculated using the following formula: V(t) = V initial × exp.(at + 1/2bt 2) (t = duration after decompression (day)). There was no significant directional indicator in the rate of reduction between buccolingual and mesiodistal widths. Conclusion The volume reduction rate gradually decreased, and 270 days were required for 50% volume reduction following decompression of OKC. The surgeon should be aware of this pattern to determine the timing for definitive enucleation. Clinical relevance The volume reduction rate and pattern of decompression of the OKC can be predicted and clinicians should be considered when treating OKC via decompression.

Introduction: Collagen forms an integral part of connective tissue and maintains its structural integrity. It has natural birefringence which is attributed to the arrangement of its fibers and is enhanced by special stains such as picrosirius red through polarizing microscopy. The polarization colors differ according to the fiber thickness and pattern of arrangement which in turn related to aggressiveness. Hence, the present study was conducted to evaluate collagen fibers in keratocystic odontogenic tumor (KCOT) and ameloblastoma using polarizing microscopy. Aim: This study aims to compare and correlate different types and patterns of collagen fibers in KCOT and ameloblastoma using picrosirius red stain under polarizing microscopy to delineate their aggressiveness. Materials and Methods: The color, thickness, and orientation of collagen fibers in the KCOTs (n = 15) and ameloblastomas (n = 15) were studied histochemically by staining the sections with picrosirius red and examined under polarizing microscope using image analyzer software. Results: When collagen fiber bundles in KCOT and ameloblastoma were compared, significant difference was noted between yellowish-orange collagen fiber bundles, but no significant difference was observed between greenish-yellow and orange-red collagen bundles. With respect to orientation and organization, the results are statistically significant (P < 0.05). Conclusion: The connective tissue stroma of KCOT could be regarded not just as a structural support but as a functional part of the lesion. In KCOT, the thin, parallel, and loosely arranged greenish-yellow collagen fibers may be attributed to its high recurrence rate and biological aggressiveness.

Aim: The present study was conducted to determine the podoplanin expression in odontogenic tumors and cysts. Materials and Methods: It consisted of 12 cases of the keratocystic odontogenic tumor (KCOT), 10 cases of ameloblastoma, 8 cases of dentigerous cysts (DC), 8 cases of radicular cysts (RC) and 8 dental follicles (DF) as controls which were immunohistochemically evaluated using an antibody against podoplanin. Results: Immunostaining intensity, % of PPC and total score of ameloblastoma was higher than DC and DF but less than KCOT (t- 1.48). When DC was compared with KCOT and RC, the podoplanin expression was significantly higher with DC (P < 0.05). The podoplanin expression was comparatively higher with KCOT as compared to RC and DC. OT (t-4.40) revealed higher podoplanin expression as compared to OC and DF (t-5.54). Conclusion: There was significantly higher expression of podoplanin in cases of ameloblastoma and KCOT as compared to the RC, DC and DF. Podoplanin may be considered as a useful marker to delineate the aggressiveness of ameloblastoma and KCOT.

Keratocystic odontogenic tumor (KCOT) is a rare, bening intraosseous tumor of odontogenic origin with a potential of aggressive and infiltrative behavior. It shows specific histopathological features, and has a high recurrence rate. In this report, we present a case of 17 year old female patient with large-sized KCOT associated with impacted third molar in the mandibular ramus region and its decompression treatment. Decompression was applied by a customized removable appliance to prevent the closing of the cyst cavity. On the 3rd and 6th months of the control radiography, it was seen that the calcification foci began to be seen and erupting the impacted teeth as a result of shrinkage of the lesion volume. After 18 months, there was a normal contrast image on the tomography and the intraoral healing was uneventfully.Keywords: Customized removable aparey, decompression treatment, keratocystic odontogenic tumor.

Reconstruction of mandibular surgical defects often poses a great challenge to maxillofacial surgeons. Mandibular segmental defects majorly disrupt the occlusion, mastication, and the facial esthetics. Free autografts such as iliac crest and rib; allografts such as three-dimensional, bendable reconstruction plate; and patient-specific implant are some of the techniques that had been employed for the reconstruction of such defects. Nevertheless, in recent times, the most dependable modes of reconstruction are the microvascular fibula reconstruction and transport distraction techniques. Transport distraction osteogenesis (TDO) is a reliable technique without donor-site morbidity especially in the dentate region of the mandible as it provides native bone for rehabilitation. The aim of this article is to report a successful case of TDO to fill the defect in the left body of the mandible secondary to segmental resection of the mandible for keratocystic odontogenic tumor. The technique was successful with a 2-year follow-up period without any potential esthetic compromise. [ABSTRACT FROM AUTHOR]

Abstract Background The term “primary intraosseous squamous cell carcinoma” was introduced in 2005 by the World Health Organization with three subcategories. Squamous cell carcinoma arising from the lining of an odontogenic cyst is one important rare subcategory of such lesions with an incidence of 0.01 to 0.02%. Furthermore, the appearance of such malignancy in an odontogenic tumor such as keratocystic odontogenic tumor is considered extremely rare. Case presentation In this case report we report a case of a 50-year-old Sri Lankan woman who complained of pain and increase in the size of a swelling at the anterior mandible, which had been present for over 1 year. The increase was significant for 1 month with accompanying numbness of the left half of her lip. Cone beam computed tomography results revealed an irregular radiolucent lesion involving most of her mandible and, except in the anterior part, very little buccolingual expansion was seen that suggested a keratocystic odontogenic tumor. An excision biopsy of the cyst lining confirmed a squamous cell carcinoma arising from a preexisting keratocystic odontogenic tumor. Conclusions Even though primary intraosseous squamous cell carcinoma arising from a keratocystic odontogenic tumor is considered to be very rare, the present case is comparable to most of the aspects cited in the literature. The current case emphasizes the importance of careful investigation of swellings present in the mandible. Clinicians as well as patients should be aware and detect these changes to avoid being clinically negligent.

Background: The clinical feature and radiographic appearance of orthokeratinized odontogenic keratocyst (OKC) are not characteristic, which may lead to the misdiagnosis. The radiographic appearance of OKC may range from a small unilocular radiolucency to a large multilocular radiolucency, resembling other odontogenic cysts and tumors. Aim: The aim was to illustrate the characteristic feature of OKC presented on the digital panoramic radiograph and cone-beam computed tomography (CBCT), which may provide great value for the differential diagnosis and the treatment planning and also to compare the various radiographic features of OKC in CBCT and digital panoramic radiograph. Materials and Methods: Digital panoramic and CBCT records of seven cases, with 11 lesions of OKC were analyzed retrospectively from the patients' database from our institute (2014 to 2016), which was histopathologically diagnosed as OKC. Results: The mean age of the patients was 24.1 years, and the female-to-male ratio was 3: 4. Six of 11 lesions were localized within the mandible, and five lesions were in the maxilla. Conclusion: The presurgical assessment with radiological information is extremely important for treatment planning, and CBCT provides us with an accurate and faster three-dimensional representation of a lesion at a lower dose and cost, but the role of panoramic radiograph cannot be refuted. [ABSTRACT FROM AUTHOR]

Introduction: Collagen forms an integral part of connective tissue and maintains its structural integrity. It has natural birefringence which is attributed to the arrangement of its fibers and is enhanced by special stains such as picrosirius red through polarizing microscopy. The polarization colors differ according to the fiber thickness and pattern of arrangement which in turn related to aggressiveness. Hence, the present study was conducted to evaluate collagen fibers in keratocystic odontogenic tumor (KCOT) and ameloblastoma using polarizing microscopy.Aim: This study aims to compare and correlate different types and patterns of collagen fibers in KCOT and ameloblastoma using picrosirius red stain under polarizing microscopy to delineate their aggressiveness.Materials and Methods: The color, thickness, and orientation of collagen fibers in the KCOTs (n = 15) and ameloblastomas (n = 15) were studied histochemically by staining the sections with picrosirius red and examined under polarizing microscope using image analyzer software.Results: When collagen fiber bundles in KCOT and ameloblastoma were compared, significant difference was noted between yellowish-orange collagen fiber bundles, but no significant difference was observed between greenish-yellow and orange-red collagen bundles. With respect to orientation and organization, the results are statistically significant (P < 0.05).Conclusion: The connective tissue stroma of KCOT could be regarded not just as a structural support but as a functional part of the lesion. In KCOT, the thin, parallel, and loosely arranged greenish-yellow collagen fibers may be attributed to its high recurrence rate and biological aggressiveness. [ABSTRACT FROM AUTHOR]

Odontogenic keratocyst (OKC) originates from the dental lamina and is more commonly seen in the posterior mandible than in the maxilla. OKC is the most aggressive cyst of the oral cavity and is known for its rapid growth and its tendency to invade bone of the adjacent tissues. The recurrence rate of OKC is very high due to various reasons debated upon. Cases of OKC have shown the presence of calcifications, dentinoid formation and ossification. Here, we report the first case of OKC in a 27-year-old male showing granular cell changes. [ABSTRACT FROM AUTHOR]

Tumors that originate from the epithelium of the odontogenic apparatus are classified as benign or malignant. The proliferative activity could provide a basis for differences in the biologic behavior among the histological variants of ameloblastoma (AM) and keratocystic odontogenic tumor (KCOT). We examined 32 solid AM and 18 KCOT cases. The AM sample comprised 16 cases of follicular AM, six cases of unicystic AM, eight cases of plexiform AM and two cases of acanthomatous AM. Sections were stained with the Ki-67 antibody. Ten representative fields were selected randomly in each section. For AM, peripheral tall columnar cells of tumor islands/nests/cords were selected. For KCOT, fields were selected in the basal and the suprabasal region of the epithelial lining. We counted the average number of Ki-67 positive cells/field for AM and KCOT. AM exhibited Ki-67 expression in peripheral tall columnar cells, whereas KCOT exhibited Ki-67 expression in the basal and suprabasal layer. No significant difference between AM and KCOT was observed; the cellular proliferative activity varied among the subtypes. No significant difference in Ki-67 expression in acanthomatous, cystic and follicular types of AM was observed, although the plexiform type exhibited significantly higher levels than the other three types. High expression of Ki-67 could be a useful prognostic marker for proliferative activity and a prognostic indicator for recurrence rate of AM and KCOT. [ABSTRACT FROM AUTHOR]

Purpose: This study was conducted in order to gain insight in the actual ratio of odontogenic keratocysts occurring in the tooth-bearing area as compared to the posterior region of the jaws in order to come up with reliable data to base upon a rational treatment policy. Methods: We searched MEDLINE, Web of Science, Scopus, and Cochrane databases for studies reporting on the location of mandibular and maxillary odontogenic keratocysts. All records were independently assessed and a meta-analysis was performed. Risk difference with a confidence interval of 95% of having the lesion in the posterior region versus the tooth-bearing area was the effect measure. P value for the summary effect of < 0.05 was considered statistically significant. Results: The 2615 records retrieved were reduced to 34 studies to be qualitatively/quantitatively assessed. The pooled values showed that the difference in the clinical risk of having keratocysts in the posterior region of the mandible and in the tooth-bearing area of the maxilla is 21 and 43%, respectively (P < 0.02 and P < 0.00001). Conclusions: A substantial amount of keratocysts occur in the tooth-bearing area of the jaws, requiring attention. [ABSTRACT FROM AUTHOR]

The paper is a systematic review of using the pharmaceutical substance, Carnoy's solution, to reduce the number of recurrences of such tumors as keratocystic odontogenic tumor and ameloblastoma. These are benign yet aggressive jaw tumors with a high percentage of recurrences (up to 60–80%). Surgical treatment of the above-described lesions can be performed using: (1) marsupialization (recurrence rate up to 24.8%); (2) enucleation with or without adjunct therapy; therapy may include cryotherapy with liquid nitrogen (recurrence rate up to 23.1%), peripheral ostectomy (recurrence rate up to 20%), and bone cavity treatment with Carnoy's solution (recurrence rate up to 6.6%); (3) marginal/segmental resection of the jaw (recurrence rate up to 2.5%). Despite the low percentage of recurrences when using marginal/segmental resection, this method requires a longer and more expensive anesthetic and surgical intervention as well as longer postoperative and rehabilitation periods. With the use of Carnoy's solution, it became possible to reduce the risks of recurrence of keratocystic odontogenic tumors and ameloblastomas from 60–80 to 6.6‒11.5%. Worldwide today, not only Carnoy's solution recommended by Cutler and Zollinger in 1933 is applied but also its modifications that are not inferior to the original substance in terms of removal efficiency of the remaining cystic cells. The safety of the use of the solution near the vessels and nerves is confirmed by works of a number of authors. It is concluded that, despite the large number of surgical treatments of both keratocystic odontogenic tumors and ameloblastomas, enucleation with the use of Carnoy's solution is the optimal method of choice for these diseases. [ABSTRACT FROM AUTHOR]

Aims and Objectives: A keratocystic odontogenic tumour (KCOT) is a benign uni- or multicystic, intraosseous tumour of odontogenic origin, with a characteristic lining of parakeratinized stratified squamous epithelium and potential for aggressive, infiltrative behaviour. Various studies in hamsters showed that, alpha-Tocopherol, which is an active biological form of Vitamin E, is a potent antioxidant known to inhibit tumour formation and also regression of established tumours. So, the aim of the present pilot study was to assess the levels of Alpha-Tocopherol(Vitamin E) in Patients with KCOT and compare them with Vitamin E levels in normal healthy individuals. Materials and Methods: A sample of 20 individuals were taken and Alpha Tocopherol levels in serum were assessed. Independent sample t test was used to analyse the data. Serum Vitamin-E levels were found to be decreased in KCOT cases. Results: Mean Vitamin-E level was found to be decreased (mean + S.D. = 10,549.34 +/- 2494.21 ng/mL) as compared to healthy controls (mean + S.D. = 13,982.42 +/- 2178.02 ng/mL). The reduction in serum vitamin E level was statistically significant (P < 0.05). Conclusion: The reduction in Vitamin E levels in KCOT patients might be suggestive of the possible interrelation between Vitamin E and KCOT invivo. Also, increase in intake of Vitamin E might help in reducing the risk of recurrence in KCOT by reducing the dysregulation of Cyclin D1 and Down-Regulation of mutant p53.

Purpose: The aim of this retrospective study is to determine the radiological features of keratocystic odontogenic tumors (KCOT) using cone-beam computed tomography (CBCT).Materials and Methods: CBCT images of 28 patients who had histopathologically-confirmed KCOT were retrospectively reviewed from the archives of the Department of Dentomaxillofacial Radiology, Gazi University Faculty of Dentistry. The location and size of KCOT, cortical expansion, cortical perforation, relation with the impacted teeth, and the impact on the mandibular canal were evaluated. Results: The mean age of patients at initial diagnosis was 34.5 years. Patients with an impacted tooth were significantly younger than those without an impacted tooth (p

Background. The inferior alveolar canal should be examined as a significant anatomical landmark, particularly in the posterior body and ramus of the mandible, for dental and surgical procedures. In the present study, the effects of two pathological lesions, ameloblastoma and keratocystic odontogenic tumor, on canal displacement were investigated. Methods. This study had a single-blinded design. Twenty-six patients with lesions in the mandible referred to Imam Reza Hospital, Tabriz, Iran, were studied in two equal groups (13 patients with a histopathological diagnosis of ameloblastoma and 13 with a histopathological diagnosis of odontogenic keratocyst). After confirming the initial incisional biopsy and pathological report, cone beam computed tomography (CBCT) of lesions larger than 3 cm mesiodistaly and those involving the mandibular posterior body and ramus were included in the study. Two maxillofacial surgeons in association with an oral and maxillofacial radiologist examined three points on CBCT images to determine the mandibular canal position relative to the lesions from the lingual and buccal aspects. Results. The results of statistical analyses showed that in ameloblastoma, the inferior alveolar canal had been displaced more buccally in the ramus area (point A) (84.6%) but in the distal region (point C), the displacement was less buccal (41.6%). The canal was displaced buccally in 53.8% of cases at point A and in 46.2% of cases at point C in KOT lesions. Finally chi-squared test did not show any statistically significant differences between these two lesions. Conclusion. The results of this study showed no relationship between these lesions and the displacement of the mandibular canal.

Background: Assess clinicopathological features of patients with keratocystic odontogenic tumor (KCOT) associated with Gorlin–Goltz syndrome in our institution from 2004 to 2015. Method: After histopathological analyses of KCOT related to Gorlin–Goltz syndrome, 7 patients were assessed. These patients presented a total of 15 primary and 2 recurrent KCOT. Results: All patients presented a multiple KCOT, and 13 lesions were located in mandible (77%) and 4 (23%) in maxilla. Most of the tumors presented a unilocular pattern (71%) and had tooth association (88%). Four patients (57%) were in the age group of 10–19 years and three patients (43%) were in the age group of 20–29 years. There were four male and three female patients. Conclusion: KCOT is a frequent manifestation of Gorlin–Goltz syndrome and can be its first sign, mainly in young patients. The four patients presented with two lesions (57%) and three lesions in three patients (43%).

Keratocystic odontogenic tumor (KCOT) is an odontogenic tumor which has the highest rate of recurrence. This report describes a rare case of bilateral ciliated epithelium-lined odontogenic keratocyst in the maxilla of a 15-year-old male. Panoramic radiography showed two lytic lesions on both sides of the maxilla associated with impacted third molars. Computerized tomography image revealed the involvement of both maxillary sinuses by the lesion which was destroying both sinuses’ floors and posterior walls. Histopathologically, the keratinized epithelial-lined cyst of OKC was changed to a ciliated columnar hyperchromatic epithelium, suggesting the fusion of both these epithelia rather than a metaplastic transformation. The patient was treated by surgical enucleation of the cyst and was followed for one year. In this case report the biological behaviour of odontogenic keratocysts and its treatment options are discussed.