Presentation
Painless swelling of the maxilla.
Patient Data
Age: 70 years
Gender: Male
From the case:
Odontogenic keratocyst
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Large expansile unilocular lucent lesion of the maxilla with scalloped well-corticated borders and areas of a cortical breach, extending into the right maxillary sinus. The cystic content is of heterogeneous density ranging from 20 to 30 HU with no enhancement on postcontrast images. No calcification, internal septation or enhanced soft tissue component.
Status of left globe enucleation with a prosthetic eye.
Case Discussion
CT features of a unilocular expansile lucent lesion of the maxilla with scalloped, well-corticated borders suggestive of odontogenic keratocyst (OKC)
On imaging, the main differential diagnosis should include:
-
ameloblastoma
- tend to be multilocular, more expansile, with a "soap-bubble" or "honeycomb" appearance
- tend to be more aggressive and cause more significant tooth resorption
- long-standing OKC may mimic ameloblastoma
-
dentigerous cyst
- tend to attach at the cementoenamel junction of teeth
-
radicular cyst
- centered at the apices of non-vital teeth
- does not scallop, does not exhibit septation, and is often more expansile
-
simple bone cyst
- exhibit minimal expansion, and spare the lamina dura as well as the periodontal ligament spaces
- OKC will tend to efface the lamina dura
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