Odontogenic keratocyst

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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