A rare case of odontogenic keratocyst extending into the sphenoid bone from the maxilla. (2020)

• Record Type: Journal Article
• Authors: Goto, Mitsuo; Ueda, Sei; Miyabe, Satoru; Watanabe, Satoshi; Sugita, Yoshihiko; Nagao, Toru
• Is Part Of: International journal of surgery case reports. Volume 71(2020)
• Page Start: 132
• Page End: 138
• Publication Date: 2020
• Subjects: Odontogenic keratocyst -- Maxillary sinus -- Sphenoid bone -- Skull base -- Recurrence -- Case report; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2020.05.003
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: Odontogenic keratocyst (OKC) is the third most common odontogenic cyst which arises from cell rests of dental lamina. Because of high rate of recurrence, there are various treatment strategies. OKC is usually observed in the jaws. We report on a rare case of OKC which involved the maxillary sinus extending into the sphenoid bone nearly to the skull base. Abstract: Background: Odontogenic keratocyst (OKC) is the third most common odontogenic cyst which arises from cell rests of dental lamina, and usually observed in the jaws. Because OKC is noted for its high rate of recurrence, there are various treatment strategies. Here, we present a rare case of OKC which occupied the entire maxillary sinus and pterygoid process of the sphenoid bone extending nearly to the skull base. Case presentation: The patient was a 21-year-old male and underwent surgical removal of the cyst using the Caldwell-Luc procedure which in this case extended the surgical approach to the pterygoid process of the sphenoid bone via the pterygomaxillary junction. However, we found a recurrent lesion in the posterior wall of the maxillary sinus 20 months after the surgery and subsequently performed a secondary cystectomy. Surgical specimens showed positive bcl-2 staining of OKC and negative cytokeratin-10 on immunohistochemistry for both primary and recurrent lesions. Conclusion: OKC rarely occurs in the maxillary sinus and extends to the deep maxillary structure and the skull base. In order to prevent recurrence, it is necessary to recognize the exact location of the entire lesion. Careful examination of preoperative CT images is needed to make a complete surgical planning and to perform a reliable surgical procedure.