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Case Study of aggressiveness of lesions in odontogenic keratocyst by Dr Shetty

Posted On: 25 Jan, 2017 Others में

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The world odontogenic keratocyst found its origin back in 1956 by philipsen which is now designated by WHO(World Health Organisation) as Keratocystic odontogenic tumor and is known as”“ a benign uni- or multicystic, intraosseous tumour of odontogenic origin, with a characteristic lining of para keratinized stratified squamous epithelium and potential for aggressive, infiltrative behaviour.”2 WHO “recommends the term keratocystic odontogenic tumour as it better reflects its neoplastic nature.” The case study by Dr DC Shetty explains it well as it compromises of 11% approximate of all cyst of jaws which mainly occur in ramus region and posterior body. These originate inside the bones but some cases of peripheral KCOT can also be found. Back in 1976, the 3 mechanisms for recurrence of KCOT was proposed by Brannon: the cyst lining removal is not complete, origin of new KCOT from odontogenic rests which are left after the surgery is also known as satellite cyst and recurrence i.e a new KCOT is developed in the nearby area.

Dr Devicharan Shetty performed a research which laid its basis on evaluating the expression of p53 in KCOT and Ameloblastoma. A surgical method for KCOT can be categorised as aggressive or conservative.The cyst oriented treatments also known as conservative treatment and it includes enucleation. In this type of treatment, the anatomical structure which includes teeth is preserved and is recommended as it is usually found in younger patients.This treatment is applicable to all age groups and is also recommended to patients with NBCCS

In the cases of NBCCS , recurrent lesions or large KCOT the aggressive treatment is recommended which includes chemical curettage with carney’s solution, peripheral mastectomy and en bloc resection sometimes. Some suggest that ““small keratocytes near the alveolar process a maximum of 1 cm in diameter should be treated by simple excision, but large keratocytes near the base of the skull which have invaded soft tissue should be treated by radical excision.” It is explained by its potential for local invasion of skull base that can presumably have dangerous consequences.According to the research by Dr Shetty, the positivity of p53 was observed in all the cases of OKCs and ameloblastomas. The total p53 count was much higher in ameloblastoma as compared to KCOT.The interest in this field of odontogenic Keratocyst is all because of its tendency to recur even after a surgical treatment and their continuous growth from small size to a very large size before clinical manifestation. It occurs due to the presence of keratin in jaws in very large amount.

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