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Surgical/orthodontic management of a large mandibular odontogenic keratocyst (OKC) Amarpreet Atwal Hannah Cottom Peter Doyle Jonathan Sandler Dental Update 2024 46:5, 707-709.
Authors
AmarpreetAtwal
BDS (Hons), MJDF, MOrth RCS
Post CCST Orthodontics, University of Sheffield and Royal Derby Hospital
The odontogenic keratocyst (OKC) is the third most common cyst of the jaw. OKCs are benign developmental cysts that are often locally destructive and large at presentation. They are usually identified during radiographic examination and require appropriate treatment planning to ensure optimal care. We present a very challenging case of a 12-year-old boy with a large mandibular OKC. The roots of several teeth were displaced, with both LR3 and LR5 unerupted and severely malpositioned. A multidisciplinary approach was therefore essential in view of the complexity, with joint planning and close liaison of treatment between the surgeon, orthodontist and general dental practitioner (GDP). This was fundamental to ensure the best possible outcome was achieved for the patient.
CPD/Clinical Relevance: This case report aims to increase awareness of OKCs to GDPs and outlines the surgical, orthodontic and restorative challenges faced in the management of such cases.
Article
Odontogenic keratocysts (OKCs) are benign developmental odontogenic cysts, which comprise approximately 10%–20% of all odontogenic cysts of the jaw.1 There is a peak in incidence in the second to third decade, with a greater prevalence reported in men compared to women (2:1).1 They occur most commonly in the mandible, especially the posterior body and angle regions, and almost always occur within bone, although a small number of peripheral OKCs have been reported.1 OKCs may initially appear small and unilocular, but early detection can be difficult, as they are often asymptomatic and growth is preferentially within the marrow spaces of the bone, with little cortical expansion. Therefore, OKCs are often detected later, when they are of a sufficiently large enough size to cause cortical expansion, perforation and affect adjacent structures.
In approximately 5%, OKCs may occur as part of Naevoid Basal Cell Carcinoma syndrome or Gorlin-Goltz syndrome.1 These syndromic cases tend to develop in younger patients, with greater tendency for multifocality and localization to the posterior maxilla.1 The OKC was renamed the Keratocystic Odontogenic Tumour (KCOT) in 2005 by the World Health Organization (WHO).2 At that time it was considered that this nomenclature more appropriately reflected its behaviour and proposed neoplastic nature. This was based on the knowledge that syndromic OKCs show mutation and inactivation of the PTCH1 gene, with a suggestion that the PTCH1 gene could also be important in the development of sporadic OKCs.2, 3 Similar genetic alterations have now been detected in other developmental cysts. Therefore, there is currently insufficient evidence to support a neoplastic nature of OKCs, which have now been reinstated as developmental in the current edition of the WHO Classification of Head and Neck tumours.1
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