Date post: | 11-May-2015 |
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•ODONTOGENIC KERATOCYST SUKESH
KUMAR.V IV B.D.S
ODONTOGENIC KERATOCYST
DEVELOPMENTAL CYST OF UNKNOWN ORIGIN
FROM REMINANTS OF DENTAL LAMINA11% OF ALL JAW DERIVED CYSTS ARE
OKCALSO KNOWN AS PRIMORDIAL
CYST(BASED UPON PRIGIN)
CLINICAL FEATURES
AGE:-OCCURS OVER A WIDE RANGE,INTIATED IN EARLY LIFE,PEAK INCIDENCE IN 2nd & 3rd
DECADES. SEX:- MALES>FEMALES;BLAKS>WHITES
SITE:-MORE IN MANDIBLE;AT ANGLE MOSTLY SYMPTOMS:-ASYMPTOMATIC TILL 2ndrly
INFECTED
IF 2ndrly INFECTD PID COMPLAINTS OF PAIN,SWELLING,EXPANSION OF
BONE,PARASTHESIA OF LOWER LIP AND TEETH
TEETH:-MAY BE DISPLACED IF EXPANDS THROUGH CANCELLOUS BONE&BODY OF
MANDIBLE
SIGNS:-CAN LEAD TO PATHOLOGIC FRACTURE & AS THESE CYSTS GROW IN
ANTEROPOSTERIOR DIRECTION THERE IS NO BONY EXPANSION IN MOST CASES
ASPIRATION:-ON THIS GETS A ODORLESS,REAMY OR CASEOUS MATERIAL
SYNDROMES ASSOCIATED
GORLIN-GOLTZMARFANS
EHLERS-DANLOSNOONAN’S
MULTIPLE OKC’S ARE FOUND IN RELATION TO THESE
ROENTGENOGRAPHIC ROENTGENOGRAPHIC FEATURESFEATURES
1) SITE:- >90% SEEN POSTERIOR TO CANINE IN MANDIBLE;AMONG THEM
>50% AT ANGLE OF MANDIBLE.
2) CHARACTERISTIC:- 40%SUGGESTIVE DENTIGEROUS CYST
25% OF PRIMORDIAL CYST
25% OF LATERAL PERIODONTAL CYST
10% GLOBULO MAXILLARY CYST
Odontogenic Keratocyst
3)INTERNAL STRUCTURE:- UNDULATING BORDERS WITH CLOUDY INTERIOR
APPEARENCES SUGGESTIVE OF MULTILOCULARITY.
4)SIZE:- VARIES FROM 5Cm or MORE IN DIAMETER.
5)SHAPE:- USUALLY OVAL EXTENDING ALONG BODY OF MANDIBLE.
6)MARGINS ARE HYPEROSTOTIC
7)UNILOCULAR VARIETY:- MAJORITY OF LESIONS ARE UNILOCULAR WITH SMOOTH BORDERS OR
LARGE IRREGULAR BORDERS. RADIOLUCENCY IS HAZY DUE TO KERATIN FILLED
CAVITY& SURRONDED BY THIN SCLEROTIC RIM.
IN SOME CASES IT CAN PERFORATE BUCCAL &LINGUAL CORTICAL PLATES OF BONE,DUE TO WHICH DISPLACEMENT OF INFERIOR ALVEOLAR
CANAL OCCURS.
CT FEATURES WILL DEMONSTRATE EXACT DIMENSIONS OF RADIOLUCENCY.
RADIOLOGICAL TYPES OF KERATOCYST:-ENVELOPMENTAL TYPEREPLACEMENT TYPEEXTRANEOUS TYPECOLLATERAL TYPE
HISTOLOGICAL FEATURES
• LINING EPITHELIUM IS HIGHLY CHARACTERISTIC &COMPOSED OF
1)PARAKERATINISED SURFACE WHICH IS TYPICALLY CORRUGATED,RIPPLED.
2)6-10CELL THICKNESS OF EPITHELIUM3)PROMINENT PALISADED POLARISED
BASAL LAYER OF CELLS OFTEN DESCRIBE AS “PICKET FENCE” or
“TOMBSTONE” appearance.
Odontogenic Keratocyst
FORMED WITH STRATIFIED SQUAMOUS EPITHELIUM THAT PRODUCES
ORTHOKERATIN(10%) PARAKERATIN(83%).
NO RETERIDGES ARE PRESENT.LUMEN IS FILLED WITH STRAW COLOUR
FLUID WITH GR8 DEAL OF KERATIN.CHOLESTEROL,HYALINE BODIES ARE
PRESENT AT SITE OF INFLAMMATION.DYSPLASTIC &NEOPLASTIC FEATURES
OF LINING EPITHELIUM IS UNCOMMON.C.TISSUE HAS DAUGHTER or SATELLITE
CYSTS
DIAGNOSIS
CLINICAL DIAGNOSIS- Not so specific.RADIOLOGICAL- Radiolucency extending in anteroposterior direction with undulating borders
suggest OKC.LAB DIAGNOSIS-Biopsy reveals the related
histological features.DIFFERENTIAL DIAGNOSIS:
AMELOBLASTOMARESIDUAL CYST
TRAUMATIC CYSTFIBROMA
GAINT CELL GRANULOMATOOTH CRYPT
MANAGEMENT ENUCLEATION-WITH VIGOROUS CURETTAGE OF
CYSTIC WALL.
PERIPHERAL OSTEOTOMY-REDUCES CHANCES OF RECURRENCE.
CHEMICAL CAUTERIZATION-WITH INTRALUMINAL Inj .OF CARNOY’S Sol.
DECOMPOSITION-WITH HELP OF POLYETHYLENE DRIANAGE TUBE KEPT IN BONY CAVITY.
RECURRENCEVERY HIGH DUE TO--
SATELLITE CELLSNEW CYST FORMATION
DIFFICULTY IN ENUCLEATIONINTRINSIC GROWTH POTENTIALPROLIFERATION OF BASAL CELL.
REFERENCES
• ANIL GOVINDARAO GHOM
• SHAFFER-HINE-LEVY.
• BURKITT’S
• SCULLEY
THANKYOU