Calcifying OKC: an encounter and recollection
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This article, published in the Annals of Clinical Case Reports describes a case of a 20 year old male patient who was treated for odontogenic keratocyst in the right mandible.

A 20 year old male patient presented with a chief complaint of swelling on the right lower side of his jaw present since 6 months. The swelling was initially small in size which gradually increased. No complaints of pain discharge or paresthesia of inferior alveolar nerve was elicited. On examination, a diffuse swelling was seen on the right lower side of the face approximately 2 cm in greatest dimension extending anteroposteriorly about 3 cm posterior to the corner of the lip.

Skin over the swelling appeared uninvolved. Intra-oral examination revealed bony hard swelling indicative of buccal cortical expansion in relation to 45, 46 region, retained 85, 84 was present with missing 43, 44. The OPG revealed a well-defined multilocular radiolucent lesion extending from distal of 42 to distal of 48 anteroposteriorly and superoinferiorly extending from the height of the alveolar bone on the right quadrant to the base of the mandible with the displacement of the inferior alveolar canal towards the lower border of the mandible.

The border of the mandible was intact. Deep vertically impacted 43, 44 were present along with a supernumerary tooth (bucco-version) between the retained deciduous molars and impacted permanent teeth. No root resorption was evident. The OPG also confirmed the presence of a supernumerary tooth between the upper first and second premolars bilaterally.

CBCT confirmed the extensions of the radiolucent lesion along with the presence of vertically impacted 43, 44 and supernumerary tooth. Thinned out buccal and lingual cortex with associated expansion of the buccal cortical plate was present. With a well-defined breach in the buccal cortex noted at level distal to the tooth 45. This breach could be correlated to the site of biopsy which was done prior to the patient’s consultation with us. A breach was also evident on the lingual cortex of 47.

The lesion was provisionally diagnosed as odontogenic keratocyst of the right mandible; with the differential diagnosis of ameloblastoma, aneurysmal bone cyst and central giant cell granuloma. Aspiration cytology and incisional biopsy of the cystic lesion was performed at the thinned out buccal cortical region between 45 and 46. Aspiration fluid was smeared and revealed the presence of scattered abundant hematoxyphilic calcifications.

Incisional biopsy revealed cystic lining comprising of 5 layers to 7 layers thick parakeratinized stratified squamous epithelium with surface corrugations. Basal cells are prominent and show palisading arrangement of nuclei. The unique finding in the cystic wall was the presence of hematoxyphilic; dystrophic calcifications resembling calcospherites. The histopathological features confirmed the diagnosis of OKC.

Enucleation of the cyst along with extraction of impacted 43, 44 and the supernumerary tooth was done followed with treatment of bony cavity with carnoy’s solution and packing the same with BIPP (Bismuth Iodoform Paraffin Paste) soaked gauze. Microscopic examination of the excisional specimen revealed similar features as described in incisional biopsy and the histopathological diagnosis of OKC was consistent with the incisional biopsy diagnosis.

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