keratocystic

Keratocystic is a term often encountered in reference to the keratocystic odontogenic tumor (KCOT), a benign but locally aggressive lesion of the jaw that arises from odontogenic epithelium. KCOT was previously known as the odontogenic keratocyst (OKC) and has been reclassified to reflect its neoplastic characteristics. It can occur across a wide age range, with a slight predominance for adults in the third decade, and shows a male-to-female ratio near unity.

Clinically, KCOTs are typically asymptomatic and may be discovered incidentally on radiographs. When symptomatic, they present with swelling, loosening of teeth, or discomfort. They most commonly affect the mandible, especially the posterior body and ramus, but can occur in the maxilla. Radiographs show well-defined radiolucencies that can be uni- or multilocular, with scalloped margins and potential cortical expansion or tooth displacement. The cyst may grow along bone and occasionally cause root resorption.

Histologically, KCOTs feature a thin to thick parakeratinized stratified squamous epithelium with a uniform, hyperchromatic, palisaded basal layer and a corrugated surface. The cyst wall often contains satellite or daughter cysts, which contribute to a high recurrence rate after treatment. Keratin debris fills the lumen.

Management depends on size and location and ranges from conservative enucleation with adjunctive therapy (e.g., Carnoy’s solution, cryotherapy) or marsupialization/decompression to more extensive resection. Long-term follow-up is essential due to the risk of recurrence, which can persist for many years. KCOT is also associated with Gorlin-Goltz syndrome in a subset of cases.