Orthodontic treatment of a patient with an impacted maxillary second premolar and odontogenic keratocyst in the maxillary sinus

An eight-year-, four-month-old girl was brought to the orthodontic clinic of Okayama University Medical and Dental Hospital. The patient had an impacted upper left second premolar because of an odontogenic keratocyst and showed a skeletal Class II jaw base relationship. At the age of six years four months, marsupialization of a cyst was performed at the Okayama University Medical and Dental Hospital because the patient had shown a swelling of the left cheek because of the cyst. The upper left second premolar was located in the roof of the maxillary sinus. The cyst was histopathologically diagnosed as an odontogenic keratocyst. At the age of nine years 10 months and after regaining the space for eruption of the premolar, the impacted premolar erupted without traction. At the age of 12 years five months, edgewise treatment was initiated, which continued for three years. After removing the edgewise appliance, an optimum occlusion was achieved. The occlusion was maintained without recurrence of the keratocyst after a retention period of five years.     

Odontogenic keratocyst in maxillary sinus with invasive behaviour

Odontogenic keratocyst is a cystic lesion characterized by a high rate of recurrence. This report describes a rare case of ciliated epithelium-lined odontogenic keratocyst in the maxilla of a 27-year-old female. Panoramic radiography showed a lytic lesion on the right maxilla associated with an impacted molar tooth. Computerized tomography image revealed the involvement of the lesion with the right maxillary sinus, destroying the sinus floor. Histopathologically, the typical keratinized epithelial-lined cyst of odontogenic keratocyst abruptly changed into a ciliated epithelium, suggesting the fusion of both these epithelia rather a metaplastic transformation. The biological behaviour of odontogenic keratocysts is discussed.     

Peripheral odontogenic keratocyst

The gingival cyst of the adult exhibits an epithelial lining that is essentially the same as the lateral periodontal cyst. Although the gingival cyst of the adult exhibits some morphologic variability, its lining is generally considered to be nonkeratinized. Nonetheless, rare cases of gingival cyst of the adult that exhibit a keratinized epithelial lining have been reported in the literature. There is now a growing tendency to consider this variant as a separate entity. This article describes six cases of gingival cysts that exhibit the histologic features of the odontogenic keratocyst. Evidence from this series suggests that the biologic behavior of this subset of gingival cysts is different from that of the generic gingival cyst of the adult and that the termperipheral odontogenic keratocyst more accurately describes this entity.     

Peripheral odontogenic keratocyst

BACKGROUND: An odontogenic keratocyst can develop at virtually any site in the jaws and is of concern because of its aggressive clinical behavior. It represents 3% to 12% of all odontogenic cysts. This paper describes the rare peripheral presentation of an odontogenic keratocyst localized to the maxillary anterior gingiva and its differential diagnosis. METHODS: A patient presented with a round yellow nodule on the maxillary gingiva between the left canine and first premolar. Clinical examination ruled out periapical abscess, periodontal abscess, and lateral periodontal cyst. A differential diagnosis included a gingival cyst, neuroma, neurilemoma, and mesenchymoma. The cyst ruptured during excisional biopsy revealing contents typical of an odontogenic keratocyst (OKC). Histology confirmed the peripheral OKC diagnosis. A conservative surgical treatment was performed assuming a less aggressive clinical course for the peripheral odontogenic keratocyst. Close follow-up was planned. RESULTS: To our knowledge, only 13 cases of peripheral OKC have been reported in the literature. Presently it is unknown if the peripheral variant shares the aggressive clinical behavior and recurrence rate of intraosseous OKC. CONCLUSION: This paper may contribute to the limited clinical knowledge base for the peripheral odontogenic keratocyst and assist clinicians in the identification and management of such lesions.     

Recurrent calcifying odontogenic cyst involving the maxillary sinus

The calcifying odontogenic cyst is an uncommon lesion that occurs in both jaws, however involvement of the maxillary sinus is rare. The accepted mode of treatment is enucleation with curettage since it is generally believed that recurrence following such treatment is extremely rare. Of the reported cases of recurrent calcifying odontogenic cysts, none have involved the maxillary sinus. This report is of a large recurrent calcifying odontogenic cyst involving the maxillary sinus, eroding the orbital floor as well as anterior and medial walls of the maxillary sinus and displacing an impacted upper canine into the nasal cavity, in a 45-year-old male patient, 8 years after the initial enucleation.     

The odontogenic keratocyst revisited

The treatment of odontogenic keratocysts is reviewed in light of the aetiology and pathogenesis of these lesions. The role of the dental lamina and submucosal hamartias, as frequently seen in nevoid basal cell carcinoma syndrome, is discussed, and the implications for treatment are emphasized.     

A pigmented odontogenic keratocyst

A pigmented odontogenic keratocyst arising in a white Caucasian female is reported. Melanocytes in the basal cell layer were identified by light and electron microscopy.     

The peripheral odontogenic keratocyst

A case with a firm asymptomatic nodule of 1 cm diameter on the gingiva between the left upper cuspid and first bicuspid is presented. Radiographic examination did not reveal any pathology of the bone in that region. Histologic examination revealed a cyst wall lined by squamous stratified epithelium, characteristic to the lining of an odontogenic keratocyst. It is suggested that the term peripheral odontogenic keratocyst be used for the diagnosis of this lesion.     

Clinicopathological study of odontogenic keratocyst

Fifty-five cases of odontogenic keratocyst in the mandible were classified into two subtypes according to the histopathologic characteristics of the epithelium (Group-1; the epithelium was parakeratotic with cuboidal or columnar, accentuated and palisadelike arranged basal cells, Group-2; the epithelium was orthokeratotic with a distinct stratum granulosum.) and were examined for the following four factors; 1) age distribution, 2) size of bone destruction, 3) degree of lateral bone expansion, and 4) features of the cyst contents. Most cases of Group-1 indicated radiographically lateral bone expansion and large cystic bone destruction and had fluid cyst content. On the contrary, the majority of Group-2 cases indicated no lateral bone expansion, were relatively small lesions, and their cystic cavities were filled with caseous materials.     

开窗减压术治疗大型上颌窦牙源性囊性病变疗效评价

目的：评价开窗减压术治疗大型上颌窦牙源性囊性病变的疗效,为临床治疗提供参考。方法：回顾2011年1月—2020年12月于上海交通大学医学院附属第九人民医院口腔外科就诊的大型牙源性上颌窦囊性病变病例,采用开窗减压后二期刮治手术治疗,开窗后配戴塞治器,分为负压及非负压引流2种。应用Mimics定量测量病变体积变化,观察新骨改建、上颌窦炎症情况。采用SPSS 17.0软件包,通过配对t检验比较术前囊性病变和最终二期手术前囊性病变体积是否存在差异,通过成组t检验和卡方检验比较不同塞治器治疗效果。结果：20例患者纳入研究,负压及非负压引流各10例。开窗前囊性病变体积为(25 993.81±13 611.78)mm³,减压后最终体积为(5 386.30±3 546.30)mm³,体积缩小率为(77.54±13.01)%,缩小显著(P<0.001)。11例病变体积缩小>80%,9例介于50%～80%之间。非负压吸引组体积缩小率为(72.75±14.16)%,疗效优秀率40%;负压吸引组体积缩小率为(82.33±10.29)%,疗效优秀率70%,...     

Solid variant of odontogenic keratocyst

A case of an unusual lesion from the maxilla is presented. Macroscopically, the lesion was solid and histologically consisted of 'multiple separate keratocysts' of varying size that infiltrated into the surrounding bone and soft tissues. Panoramic image and CT scans showed a multilocular honeycomb ill-defined radiolucency with infiltration into the maxillary sinus and floor of orbit. This lesion should be differentiated from similar odontogenic lesions, such as keratoameloblastoma and papilliferous keratoameloblastoma. As there was no evidence of follicles, islands of ameloblastoma, or papilliferous structures in the entire specimen, the lesion could not be diagnosed as either a keratoameloblastoma or a papilliferous keratoameloblastoma. The invasive and destructive growth behavior, the histopathological features, and the histochemical pattern of the collagen stroma imply that this solid lesion is a neoplasia. It is suggested that the proper term for this lesion is solid variant of odontogenic keratocyst.