Diagnosis and treatment of keratocystic odontogenic tumor mimicking a dentigerous cyst in panaromic radiography

Öz

Keratocystic odontogenic tumor (KCOT) is a cystic lesion of odontogenic origin, which is classified as a developmental tumor derived from the dental lamina. KCOT may occur in any part of both maxillaries, most commonly in the angle and the ramus region of the mandible.  It has an aggressive behavior and high recurrence rate. Radiographically, lesions may appear as round or ovoid in shape, often with a scalloped, multilocular appearance that may involve an impacted tooth. In this case report, a unilocular radiolucent large lesion with relatively well-circumscribed margins involving the left mandibular impacted third molar was detected incidentally on panoramic radiographic examination. Cone beam computed tomography (CBCT) was used for advanced imaging. The radiographic appearance of the lesion resembled a dentigerous cyst. Patient was consulted to Oral and Maxillofacial Surgery Department for possible treatment options. Initially an intraoral surgical operation with marsupialization was made under local anesthesia.  After four months, the dimension of the lesion was reduced, previous marsupialization followed by surgical enucleation. The histopathological report revealed a parakeratinized epitel surrounding the lesion that means a KCOT.

Anahtar Kelimeler

• Keratocyst,dentigerous cyst,cone-beam computed tomography

Panaromik radyografide dentigeröz kiste benzeyen keratokistik odontojenik tümörün teşhis ve tedavisi

Öz

Keratokistik odontojenik tümör (KKOT) odontojenik kaynaklı, dental laminadan gelişen ve tümör olarak sınıflandırılan kistik bir lezyondur. KKOT orofasiyal bölgede maxilla ve mandibulada, sıklıkla da mandibulanın ramus ve angulus bölgelerinde görülür. Agresif davranış gösteren ve nüksetme oranı yüksek benign bir neoplazmdır. Radyografik olarak lezyonlar yuvarlak veya oval şekilli, bazen de tarak şeklinde multiloküler görüntü sergiler ve gömülü bir diş ile ilişkili olabilir. Bu vaka raporunda, sol alt gömülü üçüncü molar diş ile ilişkili, iyi sınırlı ve geniş uniloküler radyolüsent bir lezyon rutin panoramik radyografik incelemede tesadüfen tespit edildi. İleri görüntüleme amacıyla bölgeden konik ışınlı bilgisayarlı tomografi (KIBT) görüntüleri alındı. Lezyonun radyografik özelliklerine göre dentigeröz kist ön tanısı kondu. Hasta olası tedavi seçenekleri için Ağız Diş ve Çene Cerrahisi Anabilim Dalı’na konsülte edildi. Tedavide ilk olarak lokal anestezi altında marsupializasyon işlemi gerçekleştirildi. İlk operasyondan 4 ay sonra lezyon boyutları küçüldüğünde, cerrahi olarak enükleasyon yapıldı. Histopatolojik incelemede lezyonun parakeratinize epitel ile çevrili olmasından dolayı kesin teşhis olarak KKOT olduğu rapor edildi. 

Anahtar Kelimeler

• Keratokist,dentigeröz kist,konik ışınlı bilgisayarlı tomografi

Kaynakça

1. Singh M, Gupta KC. Surgical treatment of odontogenic keratocyst by enucleation. Contemp Clin Dent 2010; 1: 263-7.
2. Padaki P, Laverick S, Bounds G. Conservative management of a large keratocystic odontogenic tumour. J Surg Case Rep 2014; 2014. pii: rju091. doi: 10.1093/jscr/rju091.
3. Janardhan A, Prakash P, Prabhakar R. Odontogenic keratocyst associated with impacted maxillary third molar. Oral Surg 2013; 6: 50.
4. Chaudhary D, Bhargava M, Aggarwal S, Gill S. Keratocystic odontogenic tumor-A case report with review of literature. Indian J Stomatol 2012; 3: 66-9.
5. Deepankar M, Akansha M, Shalu R, Rohit M. Cone-beam computed tomographic illustration of an unusual position of keratocystic odontogenic tumor mimicking a dentigerous cyst: A case report. J Indian Acad Oral Med Radiol 2014; 26: 187.
6. K. Priya, P. Karthikeyan, V. Nirmal Coumare. Odontogenic keratocyst: A case series of five patients. Indian J Otolaryngol Head Neck Surg 2014; 66: 17–21.
7. de Lima JL, Dias-Ribeiro E, Honfi ES, de Araújo TN, de Góes KKH, do Socorro Aragão M. Odontogenic Keratocyst of mandible. Indian J Otolaryngol Head Neck Surg 2006; 58: 373-6.
8. Bland PS, Shiloah J, Rosebush MS. Odontogenic Keratocyst: A case report and review of an old lession with new classification. J Tenn Dent Assoc 2012; 92: 33-6.

9. Zhu L, Yang J, Zheng YW. Radiological and clinical features of peripheral keratocystic odontogenic tumor. Int J Clin Exp Med 2014; 7: 300-6.
10. Adisen MZ, Selmi Y, Misirlioglu M, Atil F. Evaluation of volumetric measurements on CBCT images using stafne bone cavities as an example. Med Oral Patol Oral Cir Bucal 2015; 20: e580-e6.
11. Mojsa I, Stypulkowska J, Kaczmarzyk T, Okon K, Zaleska M. Treatment of a patient with large keratocystic odontogenic tumour in the mandible: case report with literature review. Oral Surg 2012; 5: 1-6.
12. Chirapathomsakul D, Sastravaha P, Jansisyanont P. A review of odontogenic keratocyst and the behaviour of recurrences. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006; 101: 5.