Page 35 - MDJ Volume 47 Number 2 ( Jul-Dec 2024)

Dhanrajani: Odontogenic keratocyst
this organ has served its purpose. OKCs that occur in the given his/her/their consent for his/her/their images and
dentate areas of both the maxilla and mandible probably other clinical information to be reported in the journal.
derive from those remnants found in the gingiva and The patients understand that their names and initials will
probably in the periodontal ligament. It is not known why not be published and due efforts will be made to conceal
keratocysts develop from such epithelial residues, whereas their identity, but anonymity cannot be guaranteed.
others remain dormant. [7-10]
Financial support and sponsorship
18]
Stoelinga and Peters and Stoelinga first mentioned
[17]
the unlikeliness of possible remnants or offshoots of this Nil.
part of the dental lamina to be located in the mucosa
posterior to the last molar. Yet, there is plenty of evidence Conflicts of interest
that the majority of epithelial islands, as found in the wall There are no conflicts of interest.
of OKCs, are located in the mucosa that is, overlying the
OKC and attached to it. This is the reason why it is thought references
that offshoots of the basal layer of the epithelium of the 1. Robinson HBG. Classification of cysts of jaws. Am J Orthod Oral
oral mucosa may also be involved in the pathogenesis and Surg 1945;31:370-5.
recurrence of OKCs. Whatever the causative epithelial 2. Philipsen HP, Reichart P. Classification of odontogenic tumours. A
historical review. J Oral Pathol Med 2006;35:525-9.
source may be, epithelial islands and/or microcysts are 3. Shear M. Primordial cysts. J Dent Ass S Afr 1960;15:211-7.
found in approximately 50% of the cases in the overlying, 4. Toller PE. Origin and growth of cysts of jaws. Ann R Coll Surg Engl
attached mucosa. [18] 1967;40:306-36.
5. Pogrel MA. The keratocystic odontogenic tumor. Oral Maxillofac
Surg Clin North Am 2013;25:21-30, v.
Theory of origin 6. Stoelinga PJW. Etiology and pathogenesis of keratocysts. Oral
The patient reported having no post-operative Maxillofac Surg Clin North Am 2003;15:317-24.
complications following his wisdom teeth extractions. Pre- 7. Stoelinga PJW. The treatment of odontogenic keratocysts by
and post-operative OPG does not show any associated excision of overlying, attached mucosa, enucleation, and treatment
of the bony defects with Carnoy solution. J Oral Maxillofac Surg
pathological findings suggestive of any pre-existing 2005;63:1662-6.
condition. This raises the question of what is the origin of 8. Stoelinga PJW. Long-term follow-up on keratocysts treated
the cystic radiolucency. However, the clinical implication according to a defined protocol. Int J Oral Maxillofac Surg
2001;30:14-25.
may be that some of these dental lamina remnants got 9. Stoelinga PJ. Excision of the overlying, attached mucosa, in
stirred up following surgical removal of the wisdom tooth conjunction with cyst enucleation and treatment of the bony
and later gave rise to a new keratocyst. defect with Carnoy solution. Oral Maxillofac Surg Clin North Am
2003;15:407-14.
Alternative theories may be that it arose from the 10. Pindborg JJ, Clausen F. Classification of odontogenic tumours. A
epithelium of some daughter cyst that existed pre- suggestion. Acta Odont Scand 1958;16:293-301.
operatively but was too small to be identified either 11. Gorlin RJ, Chaudhry AP, Pindborg JJ. The odontogenic tumours:
Their classification, histopathology and clinical behaviour in man
directly or on the OPG. and domesticated animals. Cancer 1961;14:73-101.
Stoelinga also postulated in 2003 that OKC can 12. Pindborg JJ, Kramer JR, Torloni H. Histological Typing of
[9]
Odontogenic Tumours, Jaw Cysts and Allied Lesions. Geneva:
arise from the down growth of the oral epithelium and World Health Organization; 1971.
recommended the overlying epithelium should be excised 13. Kramer IR, Pindborg JJ, Shear M. WHO International Histological
with the cyst lining. This case reported may support this Classification of Tumours: Histological Typing of Odontogenic
Tumours. 2nd ed. Heidelberg: Springer-Verlag; 1992
theory. Therefore, it is of paramount importance to locate 14. Barnes L, Eveson JW, Reichart P, Sidransky D. WHO Classification
the area where the cyst is attached to the mucosa and to of Tumours: Pathology and Genetics, Head and Neck Tumours.
excise that part of the mucosa. In failing to do so, one will Lyon: IARC Press; 2005
leave behind possible sources of recurrent OKC, or better 15. Speight P, Devilliers P, Li TJ, Odell EW, Wright JM. Odontogenic
to say newly formed cysts. keratocyst. In: El-Naggar AK, Chan JK, Grandis JR, Takata T,
Slootweg PJ, editors. World Health Organization Classification of
Head and Neck Tumours. 4th ed. Lyon: IARC; 2017. p. 235–6.
I present this case to stimulate discussion about the 16. Soluk-Tekkeşin M, Wright JM. The World Health Organization
possibility of its origin. Classification of odontogenic lesions: A summary of the changes of
the 2022 (5th) edition. Turk Patoloji Derg 2022;38:168-84.
Declaration of patient consent 17. Stoelinga PJW, Peters JH. A note on origin of odontogenic
keratocyst. Int J Oral Surg 1973;2:37-44.
The authors certify that they have obtained all appropriate 18. Stoelinga PJW. The odontogenic keratocyst revisited. Int J Oral
patient consent forms. In the form, the patient(s) has/have Maxillofac Surg 2022;51:1420-3.

Malaysian Dental Journal ¦ Volume 47 ¦ Issue 2 ¦ July-December 2024 29