Non-syndromic odontogenic keratocysts: A rare case report
A 23-year-old male normally fit and well reported to the outpatient department of our hospital with a chief complaint of asymptomatic swelling and pus discharge from the left maxillary posterior region since 10 days.\nThere was no significant past medical history. A detailed examination of the maxillofacial region had no significant extra-oral findings. Intra-oral examination revealed a partially edentulous state; teeth 13, 14, 18, 27, 28, 37, and 47 were missing with slight expansion of the buccal cortical plate in the left maxillary posterior region. On exertion of pressure, a white creamy exudate expressed out of the area between 23 and 24, but there was no tenderness or bleeding on further palpation.\nA panoramic radiograph revealed multiple radiolucencies in all four quadrants []. Lesion in the left maxillary quadrant was associated with multiple impacted teeth and retained deciduous teeth. In the lower jaw, well-defined radiolucencies were associated with missing 37 and 47 which mimics dentigerous cysts. Diagnostic biopsy from the maxillary left quadrant was reported as OKC.\nThe patient's chest and skull radiographs were unremarkable. Dermatology consultation did not reveal any cutaneous abnormality. Hematological investigations were within normal limits. The patient was admitted to hospital, and enucleation of the cystic lesions was performed under general anesthesia and the surgical bed was treated with Carnoy's Solution. It was interesting to note that there were two separate entities in the right maxillary region with one of the lesion associated with the impacted canine and they were sent as two separate specimens. Four lesions (excluding the small lesion distal to tooth 36) were enucleated and sent for histopathological examination. The small cystic lesion distal to tooth 36 was kept under observation. The patient recovered uneventfully and was discharged the next day and is presently being kept under observation with regular follow ups at the interval of 3 months are being conducted.\nThe histopathologic report revealed that three out of four lesions were OKC and the other lesion which was associated with the impacted canine in the maxillary right quadrant was dentigerous cyst. Cystic lining of all three Keratocystic lesions was parakeratinized stratified squamous epithelium of uniform 6-8-cell thickness. The lining epithelium consisted of well-defined columnar basal cells in a palisade arrangement and with polarized nuclei. The height of the epithelial cells and the number of nuclei they contained were reduced. Satellite cysts and epithelial remnants were observed in the connective tissue capsule.