Odontogenic keratocyst

Case contributed by Dr Craig Hacking

Presentation

Numbness to lip and chin

Patient Data

Age: 40 years
Gender: Male
X-ray

There is a large well-defined lytic lesion present involving the body and angle of the mandible on the left. It measures approximately 19 x 38 mm. The lesion is very well defined and there is no break in the cortex identified.There is a retained molar tooth present in the lateral superior aspect of this cystic lesion. There is no soft tissue component identified.

DDx include a dentigerous cyst, keratocystic odontoid tumour or a unilocular ameloblastoma. CT is advised.

 

CT

There is a 29 x 13 x 27 mm unilocular cystic slightly expansile lesion involving the body and angle of the left mandible, adjacent to the roots of the tooth 36 and 37 and to a lesser extent the unerupted mesially angulated 38. The lesion is not centred o the crown of 38. No dental caries or root absorption. The cortex is severely thinned inferiorly and posteriorly and there is a small region posteriorly where there is cortical breach. No periosteal reaction or pathological fracture.

The lesion extends to involve the left inferior alveolar canal near its origin.

No enlarged cervical lymph nodes.

No other destructive osseous lesion.

Small amount of bilateral maxillary sinus mucosal disease. Imaged lung apices are clear.

Conclusion

Cystic lesion of the body and angle of the left mandible. Based on location, appearances and the patients age, keratocystic odontic tumour is the favoured provisional diagnosis with a differential including unilocular ameloblastoma.

Case Discussion

Histology = keratocystic odontic tumour

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Case information

rID: 41270
Case created: 24th Nov 2015
Last edited: 8th Sep 2017
System: Head & Neck
Inclusion in quiz mode: Included

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