Odontogenic Keratocyst in the Mandible with Bone Swelling and Cortex Perforation: A Case Report

One of the most common odontogenic cysts is odontogenic keratocyst (OKC), which originates from the cell rests of the dental lamina. The peak incidence of this cyst is in the second and third decades of life. It tends to occur more in males and is often seen in the mandible, especially the posterior area. One of the important features of this lesion is its high expansion without clinical swelling. In cases where the lesion is small, it is usually asymptomatic; however, in larger cases, it may be accompanied by pain, swelling, or drainage.

A 42-year-old woman referred with a complaint of mandibular swelling. The patient described pain in some cases with low to moderate intensity without any specific pattern. An external oral examination showed face asymmetry with right mandibular swelling in the chin area. Intraoral examination revealed buccal expansion in the right mandible from dental mesial 32 to 46 mesial. All teeth involved in the lesion (32-46) responded positively to the cold test and pulp electrical test. In panoramic radiography, a unilocular radiolucent lesion with well-demarcated and corticated borders was observed in the mandible anterior from 32 to 46 mesial, and in the cone beam computed tomography radiographic view, the perforation of the buccal and lingual cortex was observed. The patient underwent incisional biopsy and marsupialization, and the sample was referred to the pathologist for histopathological examination. In the microscopic examination, histopathological characteristics of OKC were observed.

Although the usual feature of OKC is a lesion without bone swelling, according to this case report, in the differential diagnosis of this lesion, lesions with expansion and perforation of the cortex should also be considered.