Page 32 - MDJ Volume 47 Number 2 ( Jul-Dec 2024)

Case Report

Odontogenic Keratocyst: Theory of Its Origin

Parmanand Dhanrajanijani
Strathfield Private Hospital, Strathfield, NSW, Australia

Abstract

Generally, it is believed odontogenic keratocyst (OKC) originates from remnants of the dental lamina. However, a tooth is generally
not missing and, therefore, they are believed to originate from additional remnants of the lamina not involved in tooth formation.
A case of an OKC arising in the mandible 4 years after the removal of a wisdom tooth is presented to discuss its likely origin. This
present case might be one in which the remnants of dental lamina might have stirred up in developing OKC post-removal of wisdom
tooth.
Keywords: Odontogenic keratocyst, origin, pathogenesis

IntroductIon as a day procedure in September 2020 [Figure 1]. The
In the past, odontogenic keratocysts (OKCs) were thought lower teeth #38 and #48 were impacted mesioangular,
and upper wisdom teeth were breaking through the
to originate from the primordium of tooth buds before gum and buccally inclined. Both bottom teeth #38 and
mineralisation and were called primordial cysts. Firstly, as #48 required bone removal and sectioning, whereas
[1,2]
knowledge of the pathogenesis of OKC improved, another upper teeth #18 and #28 were elevated after raising the
theory of origin from the remnants of dental lamina came buccal flap. The procedure was uneventful without any
to the limelight. Secondly, the frequent presentation of complications.
OKC involving the ascending ramus of the mandible was
explained by the hypothesis that the remnants of dental He was reviewed 1-week after treatment and a routine
lamina were also responsible in this region. Stoelinga and orthopantomogram (OPG) was performed, which was
others believe that these entities can arise from the down normal. His surgical recovery was uneventful [Figure 2].
growth of the oral epithelium and suggest that the overlying The patient was discharged with advice to return if
epithelium should be excised with the cyst lining. [3,4] any symptoms arose and to continue regular dental
check-ups.
The latest fifth edition of the World Health Organisation
(WHO) classification of head and neck tumours, OKC He re-presented in February 2024 as an emergency having
continues in the cyst classification and commonly pain on the right side of his mandible in the tooth #48
researched cyst due to its aggressive nature and high area. On examination, there was no extraoral swelling but
recurrence rate and association with the nevoid basal cell intraorally tooth #48 area was tender to palpate in the
carcinoma syndrome. [5,6] buccal sulcus. There was no discharge intraorally from
tooth #48 area or any altered sensation on the right lower
This present case might be one of these where the remnants lip.
of dental lamina might have stirred up in developing OKC
post removal of wisdom tooth.

Address for correspondence: Dr. Parmanand Dhanrajani,
case report Strathfield Private Hospital, Strathfield 2135, NSW, Australia.
A 16-year-old medically fit male presented for the E-mail: [email protected]
removal of four wisdom teeth under general anaesthesia
This is an open access journal, and articles are distributed under the terms of the
Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows
Access this article online others to remix, tweak, and build upon the work non-commercially, as long as
appropriate credit is given and the new creations are licensed under the identical terms.
Quick Response Code:
Website: For reprints contact: [email protected]
https://journals.lww.com/mdj
How to cite this article: Dhanrajani P. Odontogenic keratocyst: Theory
of its origin. Malaysian Dent J 2024;47:58-61.
DOI:
10.4103/MDJ.MDJ_18_24 Received: 22-Sep-2024 Revised: 10-Nov-2024
Accepted: 21-Nov-2024 Published: 30-Dec-2024

© 2024 Malaysian Dental Journal | Published by Wolters Kluwer - Medknow
26