PMC9924817_01
Mandibular odontogenic keratocysts (OKCs): a. Cropped panoramic radiograph shows a multilocular lesion in the posterior mandible and ramus ( ) that determines basilar displacement of the mandibular canal ( ), small and incomplete internal septum and root resorption. b. Para-axial reconstruction image of CT scan: perforation of the lingual cortex ( ), reduction in the thickness of the buccal cortex, and the basilar position of the mandibular canal. c. Incisional biopsy of the lesion. d. Histological image shows the typical parakeratinised stratified squamous epithelial lining (HE 40 X). e. Immediate post-operative cropped panoramic radiograph with the arch bars placed in the mandible and maxilla with inter-maxillary fixation. f. One-year cropped panoramic radiograph.
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Root resorption of the molars is noted as well as a displacement of the mandibular canal to the basilar bone (Figure 1a). Small and incomplete septa were also noticed (Figure 1b). After discussion and written approval from the patient, an incisional biopsy was performed under local analgesia (Figure 1c). The histopathological examination showed the typical parakeratinized stratified squamous epithelial lining and the diagnosis of OKC was confirmed (Figure 1d). The patient was followed monthly to observe the healing process and then yearly (Figure 1f).
a. Two-years (2004) cropped panoramic radiograph showing a mono-locular radiolucency ( ) and the mandibular canal still in a basilar position ( ). b. Enucleation of the lesion, the mental nerve was intact. c. The bony cavity after enucleation and note the small inside bony cavity. d. One-year (2005) cropped panoramic radiograph showing the bone healing of the lesion after second surgery.
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Two years later, the panoramic radiograph showed a mono-locular radiolucency located around the extracted molars area (Figure 2a). The new lesion was enucleated under local analgesia and histopathological examination confirmed the OKC recurrence diagnosis (Figure 2b and 2c).
a. Two-years (2007) cropped panoramic radiograph showing the new lesion in the ramus ( ). b. Enucleation of the lesion. c. Diode laser application. d. 5-FU application. e. Cavity after cleaning. f. One-year (2008) after third intervention and 6 years after first surgery cropped panoramic radiograph revealing a remission of the cystic lesion.
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a. Eight-years (2015), after the third surgery: cropped panoramic radiograph showing complete remission of the mandibular bone. b. Para-axial reconstruction image of CT scan: complete bone formation and the new position of the mandibular canal ( ). c. Sagittal reconstruction image of CT scan showing bone healing in the body, angle and ramus of the mandible. d. Panoramic radiograph, 18 years after (2020), showing complete remission of the mandibular bone with two-implant placed to restore the extracted molars.
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Two dental implants were then placed to substitute the extracted first and second molars (Figures 4a, 4b, and 4c).