Odontogenic Keratocyst: A Case Series of five Patients

During the time period of August 2009 to August 2010, five cases of odontogenic keratocyst were admitted and treated under the care of Department of Otorhinolaryngology, MGMC and RI, Puducherry. Patients came to the ENT OPD with history of swelling in the cheek region, nasal obstruction, numbness in the upper alveolar region. On examination diffuse swelling of size 7 × 3 cm in one patient and size of 5 × 3 cm in two patients, and other two patients size of 6 × 3 cm present in the maxillary region with ill defined borders, the swelling was firm in consistency, no warmth, non tender. Anterior rhinoscopy reveals mass pushing the lateral wall medially, septum pushed to opposite side, mucopus present in nasal cavity, airway reduced on the side of swelling. On examination of oral cavity, a small granulation of size 1.0 × 0.5 cm present in two patient and swelling of size 1.5 × 1.0 cm seen in two patients in vestibule, no swelling in one patient and swelling of size 3 × 2 cm seen in hard palate of two patients and no swelling in three patients, no loosening of tooth seen in all patients. X-ray PNS reveals maxillary hazziness, diagnostic nasal endoscopy reveals lateral wall of nose pushed medially and septum pushed to opposite side. FNAC reveals resolving inflammatory aspirate in one patient, few macrophages seen in two of patients, few keratinocytes seen in two of the patients. CT nose and PNS revealed a large cystic lesion with erosion of anterior and medial wall and floor of maxilla in relation to the root of the last molar tooth in two patients and there is erosion of anterior and medial wall in other three patients. A combined endonasal and external sublabial (Caldwell-luc) approach was performed in four patients and the cystic lesion was removed and in other one patient only endonasal approach was done and cystic lesion was removed and sent for biopsy. Biopsy sent for HPE revealed odontogenic keratocyst.