EVALUATION OF KERATOCYSTIC ODONTOGENIC TUMORS USING CONE BEAM COMPUTED TOMOGRAPHY

Abstract

Purpose:  The aim of this retrospective study is to determine the radiological features of keratocystic odontogenic tumors (KCOT) using cone-beam computed tomography (CBCT).

Materials and methods: CBCT images of 28 patients who had histopathologically-confirmed KCOT were retrospectively reviewed from the archives of the Department of Dentomaxillofacial Radiology, Gazi University Faculty of Dentistry. The location and size of KCOT, cortical expansion, cortical perforation, relation with the impacted teeth, and the impact on the mandibular canal were evaluated.

Results: The mean age of patients at initial diagnosis was 34.5 years. Patients with an impacted tooth were significantly younger than those without an impacted tooth (p < 0.05). Among KCOTs, 21% were localized in the maxilla whereas 79% were found in the mandible. The lesions localized in the mandible were mostly found in the retromolar-ramus region. Of these patients, 93% had cortical expansion and 75% had bone perforation. Of the 22 mandibular lesions, 20 were in close proximity of the mandibular canal and 18 (90%) of these lesions had caused destruction in the mandibular canal.

Conclusion: KCOTs exhibit their aggressive nature in the jaw bone. CBCT is a useful radiological imaging method to examine the radiologic characteristics of KCOTs such as bone destruction and their spatial relations with the neighboring anatomic structures.

Keywords

• Keratocystic odontogenic tumor,cone beam computed tomography; impacted tooth; inferior alveolar canal; bone destruction

References

1. Philipsen HP. Om keratocyster (kolesteatomer) i kaeberne. Tandlaegebladet 1956;60:963-980.
2. Maurette PE, Jorge J, de Moraes M. Conservative treatment protocol of odontogenic keratocyst: A preliminary study. J Oral Maxillofac Surg 2006;64(3):379-383.
3. Agaram NP, Collins BM, Barnes L, Lomago D, Aldeeb D, Swalsky P, Finkelstein S, Hunt JL. Molecular analysis to demonstrate that odontogenic keratocysts are neoplastic. Arch Pathol Lab Med 2004;128(3):313-317.
4. Barnes L, Eveson JW, Reichart P, Sidransky D. Pathology and genetics of head and neck tumours. WHO classification of tumours series. Lyon: IARC Press; 2005.
5. Regezi JA, Sciubba JJ. Oral pathology: clinico-pathologic correlations. 4th ed., Philadelphia: WB Saunders, 2003, p. 250-254.
6. Barreto DC, Gomez RS, Bale AE, Boson WL, De Marco L. Ptch gene mutations in odontogenic keratocysts. J Dent Res 2000;79(6):1418-1422.
7. Kaneda T, Minami M, Kurabayashi T. Benign odontogenic tumors of the mandible and maxilla. Neuroimaging Clin N Am 2003;13(3):495-507.
8. Scarfe WC, Farman AG, Sukovic P. Clinical applications of cone-beam computed tomography in dental practice. J Can Dent Assoc 2006;72(1):75-80.

9. Kocak-Berberoglu H, Cakarer S, Brkic A, Gurkan-Koseoglu B, Altug-Aydil B, Keskin C. Three-dimensional cone-beam computed tomography for diagnosis of keratocystic odontogenic tumours; evaluation of four cases. Med Oral Patol Oral Cir Bucal 2012;17(6):e1000-1005.
10. Akay C, Tetik A, Zeytinoğlu M. Keratocystic odontogenic tumor: A retrospective study of 64 cases. Ege Journal of Medicine / Ege Tıp Dergisi 2015;54(2):59-64.
11. Blanchard SB. Odontogenic keratocysts: Review of the literature and report of a case. J Periodontol 1997;68(3):306-311.
12. Ba K, Li X, Wang H, Liu Y, Zheng G, Yang Z, Li M, Shimizutani K, Koseki T. Correlation between imaging features and epithelial cell proliferation in keratocystic odontogenic tumour. Dentomaxillofac Radiol 2010;39(6):368-374.
13. Zhao Y, Liu B, Cheng G, Wang SP, Wang YN. Recurrent keratocystic odontogenic tumours: Report of 19 cases. Dentomaxillofac Radiol 2012;41(2):96-102.
14. Madras J, Lapointe. Keratocystic odontogenic tumour: reclassification of the odontogenic keratocyst from cyst to tumour. J Can Dent Assoc 2008;74(2):165–165h.
15. Haring JI, Van Dis ML. Odontogenic keratocysts: A clinical, radiographic, and histopathologic study. Oral Surg Oral Med Oral Pathol 1988;66(1):145-153.
16. Macdonald-Jankowski DS, Li TK. Keratocystic odontogenic tumour in a hong kong community: The clinical and radiological features. Dentomaxillofac Radiol 2010;39(3):167-175.
17. Dammer R, Niederdellmann H, Dammer P, Nuebler-Moritz M. Conservative or radical treatment of keratocysts: A retrospective review. Br J Oral Maxillofac Surg 1997;35(1):46-48.
18. Neville BW, Damm DD, Allen CM. Oral and maxillofacial pathology. 2nd ed., Philadelphia: WB Saunders, 2002, p.594-597.
19. MacDonald-Jankowski DS. Keratocystic odontogenic tumour: Systematic review. Dentomaxillofac Radiol 2011;40(1):1-23.
20. Stoelinga PJ. Long-term follow-up on keratocysts treated according to a defined protocol. Int J Oral Maxillofac Surg 2001;30(1):14-25.
21. Myoung H, Hong SP, Hong SD, Lee JI, Lim CY, Choung PH, Lee JH, Choi JY, Seo BM, Kim MJ. Odontogenic keratocyst: Review of 256 cases for recurrence and clinicopathologic parameters. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001;91(3):328-333.
22. Brannon RB. The odontogenic keratocyst. A clinicopathologic study of 312 cases. Part I. Clinical features. Oral Surg Oral Med Oral Pathol 1976;42(1):54-72.
23. Brauer HU, Diaz C, Manegold-Brauer G. Radiographic assessment of a keratocystic odontogenic tumour using cone-beam computed tomography. Eur Arch Paediatr Dent 2013;14(3):173-177.
24. Philipsen HP. Keratocystic odontogenic tumour. In: Barnes L, Eveseon JW, Reichert P, Sidransky D, editors. Pathology and genetics of head and neck tumours. Lyon: World Health Organization IARC Press, 2005, p.305–307.
25. Monsour PA, Dudhia R. Implant radiography and radiology. Aust Dent J 2008;53 Suppl 1:S11-25.
26. Scarfe WC, Farman AG. What is cone-beam ct and how does it work? Dent Clin North Am 2008;52(4):707-730.