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33 yo, F

Mild swelling on the left mandible


Gross Findings

The specimen consisted of multiple small strips of sac-like tissue. The specimen was entirely submitted.


Microscopic Findings

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Final Diagnosis:


  • 10–20% of odontogenic cysts 
  • The third most common cyst of the jawsa peak incidence in the second to third decades of life and a second, smaller peak among patients aged 50–70 years
  • A slight male predilection 
  • As many as 5% of all OKCs occur as part of Gorlin syndrome: tend to be multiple and effect younger patients 
  • 80% of cases in the mandible, ramus-angle



  • Most often by enucleation, or by surgical resection for large lesions 
  • Prior to definitive cystectomy, many cysts are decompressed/marsupialized.


Take-Home Message

  • The histopathology of odontogenic keratocyst is pathognomonic and the diagnosis is easy.
  • With significant inflammation in the cyst or if marsupialization has been attempted, the typical features are lost, and the diagnosis may be impossible.
  • Multiple lesions can be associated with nevoid basal cell carcinoma syndrome.
  • It has a relatively higher recurrence rate than other odontogenic cysts.