Orthokeratinizing odontogenic cyst of maxilla with complex odontoma
A 26-year-old male reported to the Dental Department, with the chief complaint of swelling and difficulty in breathing for about 5 months. The extraoral clinical examination revealed a diffuse swelling on the left side of the face obliterating the nasolabial fold. The swelling was associated with slight pain and continuous headache. Patient also complained of continuous tear discharge from the left eye. Computed tomography scan revealed a soft tissue lesion completely obliterating the left maxillary sinus and extending up to the nasal cavity; right maxillary sinus was normal. The swelling extended anteriorly up to external nasal orifices and posteriorly to the nasopharynx. The nasal septum showed deviation to the right side. Left ethmoid sinus was also found to be involved. The (orthopantomogram) showed similar radiolucency of the lesion which was interrupted by some flecks of radiopacitites [Figures and ]. Also, both the maxillary canines were impacted with the left maxillary permanent canine involved with the lesion and were closely associated with the small flecks of radioopacity.\nThe presence of keratin and cholesterol crystals in the fine needle aspiration cytology report directed toward the cystic lesion having keratin in the lumen. A provisional diagnosis of OKC was arrived upon. Complete enucleation of the lesion was carried out under general anesthesia, which was followed by extraction of all the left maxillary teeth. Along with the lesion frontoethmoid sinus was also excised as the lesion had involved the same. After completion of the surgical procedure the entire cavity was completely cleaned and was packed with Gel foam. Prosthesis (obturator) was made from the presurgical records and was delivered to the patient after surgery. Following the surgery, the healing of the surgical wound was uneventful and the patient was kept under observation to check for recurrence.\nThe histopathological examination revealed the cystic space which was lined by a continuous layer of stratified epithelium of 6-8 cell layer thickness with prominent basal cell layer and the absence of rete ridges. The stratified epithelium was orthokeratinized in nature with prominent stratum granulosum layer. Abundance of orthokeratin was present in the cystic lumen. The connective tissue showed minimal or no inflammatory response. One portion of the lesion was hard and solid which was processed by decalcification. The decalcified section showed presence of dentine and pulp like tissue arranged in an irregular pattern. Enamel spaces were seen in some areas. On the basis of thorough histopathological examination, the final diagnosis of orthokeratinizing odontogenic cyst associated with complex odontoma was given [Figures and ].