Periapical Odontogenic Keratocyst

Document Type : Case Report


1 Assistant Professor of Oral & Maxillofacial Pathology.Dental Materials Research Center, Dental Faculty, Babol University of Medical Sciences, Babol, Iran.

2 Assistant Professor of Oral & Maxillofacial Surgery.Department of Oral & Maxillofacial Surgery, Babol University of Medical Sciences, Babol, Iran.


Background and Objective: Odontogenic keratocyst is a developmental odontogenic cyst. It is to be considered for histopathological features and clinical behavior. It has aggressive behavior and tendency to recurrence and it has been named benign cystic neoplasm. OKCs have different radiographic appearance such as unilocular to multilocular radiolucency. In some cases, they have been observed in the interradicular area but in rare cases they can be found in periapical radiolucency in apex of non-vital teeth that may be mistaken with lesions of endodontic origin and cause mistreatment.
Case Report: A 33 year old male patient came to clinic because of swelling in the anterior region of mandible that was repaired with endodontic treatment. In the histological diagnosis of radiolucent lesion, inflamed odontogenic keratocyst was reported.
Conclusion: Diagnosis based on clinical finding may risky because it can lead to inappropriate treatment. In most of the cases, microscopic examination of all material surgically removed is necessary for diagnosis. This is especially recommended when treatment of lesion is not successful with routine treatment.


1-Philipsen HP. On keratocysts in the jaws. Tandleagebladet 1956;60: 963-80.
2-Neville BW, Damm DD, Allen CM, Bouquot JE. Oral and maxillofacial pathology. 3rd ed. St. Louis, Mo: Saunders/Elsevier; 2009.
3-Forssell K. The primordial cyst. A clinical and radiographic study. Proc Finn Dent Soc 1980;76:129-74.
4-Madras J, Lapointe H. Keratocystic odontogenic tumour: reclassification of the odontogenic keratocyst from cyst to tumour. J Can Dent Assoc 2008;74:165-165h.
5-Brannon RB. The odontogenic keratocyst. A clinicopathologic study of 312 cases. Part I. Clinical features. Oral Surg Oral Med Oral Pathol. 1976;42:54-72.
6-Wood NK, Goaz PW. Differential diagnosis of oral and maxillofacial lesions. 5th ed . St Louis: Mosby; 1997.
7-Brannon RB. The odontogenic keratocyst. A clinicopathologic study of 312 cases. part II. Histologic feature. Oral Surg Oral Med Oral Pathol 1977;43:233-5.
8-Garlock JA, Pringle GA, Hicks ML. The odontogenic keratocyst: a Potential endodontic misdiagnosis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998;85:452-6.
9-Kuroyanagi N, Sakuma H, Miyabe S, Machida J, Kaetsu A, Yokoi M, et al. Prognostic factors for keratocystic odontogenic tumor (odontogenic keratocyst): analysis of clinico-pathologic and immunohistochemical findings in cysts treated by enucleation. J Oral Pathol Med 2009;38:386-92.
10-Nohl FS, Gulabivala K. Odontogenic keratocyst as periradicular radiolucency in the anterior mandible: two case reports. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996;81:103-9.
11-Wright BA, Wysocki GP, Larder TC. Odontogenic keratocysts presenting as periapical disease. Oral Surg Oral Med Oral Pathol 1983;56:425-9.
12-Blanas N, Freund B, Schwartz M, Furs IM. Systemic review of the treatment and prognosis of the odontogenic keratocyst. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;90:553-8.
13-Nary Filho H, Matsumoto MA, Fraga SC, Goncales ES, Servulo F. Periapical radiolucency mimicking an odontogenic cyst. Int Endod J 2004;37:337-44.
14-Ali M, Baughman RA. Maxillary odontogenic keratocyst: a common and serious clinical misdiagnosis. J Am Dent Assoc 2003;134:877-83.
15-Schulz M, von Arx T, Altermatt HJ, Bosshardt D. Histology of periapical lesions obtained during apical surgery. J Endod 2009;35:634-42.
16-Peters E, Lau M. Histopathologic examination to confirm diagnosis of periapical lesions: a review. J Can Dent Assoc 2003;69:598-600.
17-Ortega A, Farina V, Gallardo A, Espinoza I, Acosta S. Nonendodontic periapical lesions: a retrospective study in Chile. Int Endod J 2007;40:386-90.
18-Stajcińá Z, Paljm A. Keratinization of radicular cyst epithelial lining or occurrence of odontogenic keratocyst in the periapical region?. Int J Oral Maxillofac Surg 1987;16(5):593-5.
19-Kuc I, Peters E, Pan J. Comparison of clinical and histologic diagnoses in periapical lesions. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;89:333-7.
20-Vier FV, Figueiredo JAP. Prevalence regarding the type of periapical pathology in 102 human teeth extracted with associated periapical lesion. ECLER Endod 2000;2:1-15.
21-Ramachandran Nair PN,  Pajarola G,  Schroedera HE. Types and incidence of human periapical lesions obtained with extracted teeth. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996;81:93-102.
22-Pace R, Cairo F, Giulani V, Prato LP, Pagavino G. A diagnostic dilemma: endodontic lesion or odontogenic keratocyst? A case presentation. Int Endod J 2008;41:800-6.