Huge keratocystic odontogenic tumour in medically compromised patient–a management dilemma
DOI:
https://doi.org/10.18203/issn.2454-2156.IntJSciRep20191435Keywords:
KCOT, OKC, CECT, HPR, Aspirate, Enucleation, ResectionAbstract
Keratocystic odontogenic tumour (KCOT) is a cystic lesion of the jaws with tumour behaviour. Its high prevalence rate makes it one of the commonest cystic lesions especially involving the lower jaw. The characteristic histologic features and aggressive nature corresponds to the high recurrence rate associated with KCOT. Lesion expands mostly in an anteroposterior direction and can cause extensive bone destruction before the appearance of any clinical symptoms. The characteristic radiological picture is that of a multilocular cystic lesion with the common differential diagnosis being dentigerous cyst and ameloblastoma. Here we are presenting a case of KCOT of the left lower jaw of size 10.9×7.86×8.54 cm. It is a huge multilocular cystic lesion extending from the right canine region to the left side involving the body, ramus, coronoid and condyle. Various management options are there ranging from enucleation and chemical cauterization to resection and reconstruction depending upon the size of the lesion. In this case we were not able to perform the ideal treatment option for the case because of the multiple drug allergy the patient was having, including most of the general anesthetic agents. Also the patient was not willing for any extensive procedure under general anesthesia. So we had to follow a compromised treatment plan aiming to reduce the size of the lesion, to improve the aesthetics and frequent follow up.
Metrics
References
Hauer A. Ein Cholesteatom im linken Unterkiefer unter einem retinierten Weisheitszahn. Zeitschrift fur Stomatologie. 1926;24:40–59.
Robinson HBG. Classification of cysts of the jaws. American J Orthodon Oral Surg. 1945;31:370–5.
Philipsen HP. Om keratocyster (kolestetomer) i kaeberne. Tandlaegebledet. 1956;60:963-7.
Pindborg JJ, Hansen J. Studies on odontogenic cyst epithelium. ACTA Pathol Microbial Scand. 1963;58:283-8.
Shear MM. The aggressive nature of the odontogenic kerato-cyst: Is it a benign cystic neoplasm? Part 1. Clinical and early experimental evidence of aggressive behavior. Oral Oncol. 2002;38:219-26.
Forssell K, Sainio P. Clinicopathological study of keratinized cysts of the jaws. Proc Finn Dent Soc. 1979;75:36-9.
Kuusela P, Hormia M, Tuompo H, Ylipaavalniemi P. Demonstration and partial characterization of a novel soluble antigen present in keratocysts. Oncodevelopmental Biol Med. 1982;3:283–90.
Borg G, Persson G, Thilander H. A study of odontogenic cysts with special reference to comparisons between keratinizing and nonkeratinizing cysts. Swedish Dental J. 1974;67:311–25.
Brannon RB. The odontogenic keratocyst—A clinicopathologic study of 312 cases (part I). Oral Surg Oral Med Oral Pathol. 1976;54.
Voorsmit RACA, Stoelinga PJW, van Haelst UJGM. The management of keratocysts. J Maxillofac Surg. 1981;9:228-34.
Dayan D, Buchner A, Gorsky M, Harel-Raviv M. The peripheral odontogenic keratocyst. Int J Oral Maxillofacial Surg. 1988;17:81–3.
Ghali GE, Connor MS. Surgical management of the odontogenic keratocyst. In: Pogrel MA, Schmidt BL, eds. Oral and Maxillofacial Clinics of North America. The Odontogenic Keratocyst. W.B. Saunders Co; 2003: 383–392.
Nakamura N, Mitsuyashu T, Mitsuyashu Y, Taketomi T, Higuchi Y, Orishi M. Marsupialisation for odontogenic keratocyst: long term follow-up analysis of the effects and changes in growth charakteristic. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002;94:543-53.
Bramley P. The odontogenic karatocyst—An approach to treatment. Int J Oral Surg. 1974;3:337.
Stoelinga PJW, Bronkhorst FB. The incidence, multiple presentation and recurrence of agressive cysts of the jaws. J Cranio Max Fac Surg. 1988;16:184-95.
Zhang L, Sun ZJ, Zhao YF, Bian Z, Fan MW, Chen Z. Inhibition of SHH signaling pathway: Molecular treatment stratergy of odontogenic keratocyst. Med Hypotheses. 2006;67:1242-4.