Odontogenic keratocyst
Updates to Article Attributes
Keratocystic odontic tumours (KCOT), previously know as odontogenic keratocysts, are cystic benign tumours involving the mandible or maxilla and believed to arise from dental lamina.
Epidemiology
Present in younger patients (2nd-3rd decades) 1,7, are often multiple, and may be seen in either the body or ramus of the mandible (approximately 70% of all KCOT), or maxilla. There may be male predilection.
Pathology
They originate from epithelial cell rests (stratified squamous keratinizing epithelium) found along the dental lamina and periodontal margin of the alveolus of the mandible 7.
Associations
- basal cell naevus syndrome (or Gorlin-Goltz syndrome): strong association
- Marfan syndrome
- Noonan syndrome
Radiographic features
Plain film (OPG)
Typically seen as a solitary, lucent, unilocular lesion with smooth, corticated borders 5. When in the mandible, they typically grow along the length of the bone. In the maxilla, they expand into the maxillary sinus (as in Case 2).
They are often associated with an impacted tooth, mimicking a dentigerous cyst. KCOT may occasionally appear septated, making the distinction from ameloblastoma difficult. The presence of multiple KCOTs is associated with Gorlin-Goltz syndrome.
MRI
An KCOT will typically demonstrate 3:
- T1: low signal
- T2: high signal
Treatment and prognosis
They are locally aggressive. Treatment is often with enucleation / excision +/-aggressive curettage. They however However, they can have a very high recurrence rate (30-60%)
Differential diagnosis
Imaging differential considerations include:
- dentigerous cyst if pericoronal
- ameloblastoma
- calcifying odontogenic cyst (Gorlin cyst) and other odontogenic cysts and tumours
See also
-<a href="/articles/basal-cell-nevus-syndrome">basal cell naevus syndrome</a> (or <a href="/articles/gorlin-syndrome">Gorlin-Goltz syndrome</a>) : strong association</li>- +<a href="/articles/basal-cell-nevus-syndrome">basal cell naevus syndrome</a> (or <a href="/articles/gorlin-syndrome">Gorlin-Goltz syndrome</a>): strong association</li>
-</ul><h4>Radiographic features</h4><h5>Plain film (OPG)</h5><p>Typically seen as a solitary, lucent, unilocular lesion with smooth, corticated borders <sup>5</sup>. When in the mandible, they typically grow along the length of the bone. In the maxilla, they expand into the maxillary sinus (as in Case 2).</p><p>They are often associated with an impacted tooth, mimicking a dentigerous cyst. KCOT may occasionally appear septated, making the distinction from ameloblastoma difficult. The presence of multiple KCOTs is associated with Gorlin-Goltz syndrome.</p><h5>MRI</h5><p>An KCOT will typically demonstrate <sup>3</sup></p><ul>- +</ul><h4>Radiographic features</h4><h5>Plain film (OPG)</h5><p>Typically seen as a solitary, lucent, unilocular lesion with smooth, corticated borders <sup>5</sup>. When in the mandible, they typically grow along the length of the bone. In the maxilla, they expand into the maxillary sinus (as in Case 2).</p><p>They are often associated with an impacted tooth, mimicking a dentigerous cyst. KCOT may occasionally appear septated, making the distinction from ameloblastoma difficult. The presence of multiple KCOTs is associated with Gorlin-Goltz syndrome.</p><h5>MRI</h5><p>An KCOT will typically demonstrate <sup>3</sup>:</p><ul>
-</ul><h4>Treatment and prognosis</h4><p>They are locally aggressive. Treatment is often with enucleation / excision + / -aggressive curettage. They however can have a very high recurrence rate (30-60%)</p><h4>Differential diagnosis</h4><p>Imaging differential considerations include</p><ul>- +</ul><h4>Treatment and prognosis</h4><p>They are locally aggressive. Treatment is often with enucleation / excision +/-aggressive curettage. However, they can have a very high recurrence rate (30-60%)</p><h4>Differential diagnosis</h4><p>Imaging differential considerations include:</p><ul>
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