Keratocyst is the medical term for a keratocystic odontogenic tumor. It refers to an aggressively growing, but in most cases benign, tumor.
What is a keratocyst?
A keratocyst refers to a keratocystic odontogenic tumor (KOT). In medicine, it is also known as an odontogenic primordial cyst. This is a cavity within the jawbone that is equipped with keratinizing squamous epithelium. However, the term keratocyst is now considered obsolete and has been replaced by the term keratocystic odontogenic tumor because it does not correspond to the characteristics of a cyst. Thus, it is a unicystic or multicystic intraosseous neoplasia that is usually benign in nature. Instead of a normal tooth, a keratocystic odontogenic tumor forms instead. Since 2005, the WHO (World Health Organization) has classified developmental keratocysts as head and neck tumors. From a fine tissue point of view, the keratocyst belongs to the odontogenic epithelial tumors, in which hard substance formation may also be present. In most cases, a keratocystic odontogenic tumor presents in the mandible. Thus, the percentage is 50 to 80 percent. The keratocyst is mostly located on the ascending mandibular branch or on the posterior molars. The male sex is particularly affected. Among odontogenic tumors, the keratocyst ranks 2nd. In most cases, a keratocyst occurs between the ages of 10 and 40 years or between 50 and 70 years.
Causes
Keratocyst belongs to the odontogenic tumors. These arise in the original tissues of tooth formation. However, the cause of the keratocystic odontogenic tumor could not be clearly determined so far. There is a presumption that its formation occurs from the remnants of the dental ridge. Multiple keratocystic odontogenic tumors also occur in Gorlin-Goltz syndrome. In addition, basal cell carcinomas are formed. However, this disease is an exceptional case. As a rule, the occurrence of the keratocyst is solitary.
Symptoms, complaints and signs
The growth of a keratocystic odontogenic tumor usually occurs unnoticed, so it is often diagnosed only by chance during dental radiographic examinations. The keratocyst presents as a multilayered keratinizing squamous epithelium in the form of a cavity within the jawbone. Parakeratinization of the epithelium is often present. The growth pattern of the keratocystic odontogenic tumor is very aggressive, usually resulting in the formation of satellite cysts. The cortical bone is destroyed by the keratocyst. This can also affect the adjacent soft tissue. Signs of a keratocystic odontogenic tumor include local swelling of the jawbone and loosening and shifting of teeth. Pain, on the other hand, is seen only in rare cases.
Diagnosis and course of the disease
As mentioned above, the keratocyst can usually only be detected by chance during a dental X-ray examination. However, demarcation from an ameloblastoma cannot be made by radiographs. Therefore, a histological examination of the tumor or a sample following its removal is required for an exact diagnosis. While smaller keratocystic odontogenic tumors have an oval or round shape, larger keratocysts have an arcuate margin. It is not uncommon for marginal sclerosis to be present. Even after successful surgical removal of the keratocystic odontogenic tumor, a reappearance of the keratocyst must often be expected. Thus, the recurrence rate is 40 to 60 percent. Even years later, the further appearance of a keratocyst is possible. In rare cases, the keratocystic odontogenic tumor may degenerate and transform into a malignant squamous cell carcinoma. Occasionally, ameloblastoma also occurs.
Complications
In keratocyst, a tumor usually develops. This spreads extremely, but is benign in most cases. In most cases, treatment is delayed because the tumor is diagnosed only by chance during checkups. The affected person does not suffer from any particular discomfort or symptoms. However, restrictions and discomfort in the oral cavity may occur. The teeth are often loose and can shift.However, pain does not occur. It is not uncommon for inflammation to occur in the oral cavity, which considerably restricts the daily life of the person affected. It is not uncommon for this tumor to reoccur after treatment and must therefore be removed again or treated differently. The treatment involves surgical removal of the tumor. There are no particular complications. However, the course of the disease is not positive every time, so that the affected person may develop this tumor again. In the case of successful removal, life expectancy is usually not limited. Certain defects on the bones can be filled with a replacement material in the process.
When should you see a doctor?
Periodically, children and adults should attend checkups with a doctor. Because the keratocyst is often asymptomatic and therefore can go largely unnoticed by the affected person over a long period of time, there is a possibility that it may be diagnosed in the event of an incidental finding within a dental examination. If there are irregularities in the chewing process, difficult conditions when crushing food in the mouth or a feeling of tightness, a doctor should be consulted. Disorders in wearing braces or inconsistencies in a denture that has been inserted should be examined and corrected dentally. Pain, spontaneous bleeding or inflammation of the gums indicate an existing disease that should be treated medically. If there are deformities of the face, changes in the position of the jaw, restrictions in phonation or problems with the flow of saliva, a doctor should be consulted. Discoloration of the mouth, abnormalities of the mucous membranes and hypersensitivity to the intake of food as well as liquids should be discussed with a doctor. If teeth become loose or displaced, if unusual spaces form between teeth, or if an adult experiences sudden tooth loss, a visit to the doctor is necessary. Swelling or growths in the jawbone area are considered unusual and indicate irregularities. A doctor should be consulted to prevent deterioration of the health condition.
Treatment and therapy
Treatment of a keratocystic odontogenic tumor consists of its surgical removal. However, this is not always easy because it often has satellite or daughter cysts. Thus, small strands of cells originating from the keratocyst grow into the adjacent bone, resulting in the formation of small daughter tumors (metastases). These daughter tumors cannot be seen with the naked eye. Therefore, they may be missed even when the tumor is carefully removed surgically, making the procedure incomplete. For this reason, recurrences show up repeatedly later. To ensure the removal of the small microcysts, the surgeon mills out the bone cavity. This results in a defect that can be refilled with autologous bone or bone substitute material. In some patients, the findings are so extensive that this necessitates an interruption of the bone continuity. This means that the surgeon removes not only the keratocystic odontogenic tumor but also the remaining thin bone. This procedure is the only way to avoid recurrence of the keratocyst. The use of osteosynthesis plates allows the continuity of the bone to be restored. Alternatively, the insertion of a bone graft is also within the realm of possibility. The additional use of Carnoy solution to fix the cyst bellows intraoperatively is also recommended. In this way, it is possible to reduce the recurrence rate. Aftercare following surgical removal of the keratocystic odontogenic tumor also plays an important role in therapy. This includes an annual X-ray control in a period of at least five years. However, even beyond that time, a keratocyst may recur.
Outlook and prognosis
The prognosis of the keratocyst is favorable once the affected person has sought treatment. The characteristic of the cyst is characterized by a strong growth. If it is not stopped by surgical removal, there is a risk of secondary damage and complications. The teeth or an existing denture are gradually displaced by the growths.Unwanted changes of the jaw are the consequences. This results in disturbances of the speech function as well as the chewing process. With medical treatment, the unwanted tissue is completely removed. Although it is a routine procedure, the surgical intervention is associated with the usual risks and side effects. If the removal remains free of complications, recovery of the patient is usually documented within a few weeks after the removal. Consequential symptoms are not normally to be expected. In the course of life, a new keratocyst can develop at any time. Men belong to the risk group. The prognosis remains favorable even in the case of repeated growth of a cyst as soon as it is medically removed. The prospect of an optimal course of the disease worsens if treatment is delayed. If tooth misalignments are already present, they must subsequently be corrected in a long-term therapy. This has a negative impact on further development and may be associated with impairments.
Prevention
Measures to prevent keratocystic odontogenic tumor are not known. Thus, the exact causes of keratocyst development could not yet be determined.
Follow-up
In most cases, the measures of aftercare for a keratocyst are very limited, so the person affected by this disease should see a doctor at a very early stage to avoid further complications or other complaints. In the worst case, the cancer can continue to spread in the body due to this disease and thus also lead to the death of the affected person. Therefore, a doctor should be consulted at the first signs and symptoms of the disease to prevent this spread. In the case of a keratocyst, the affected person usually has to undergo a surgical intervention in which the tumor is removed. As a rule, bed rest should be observed after such an operation, and strenuous or physical activities should be avoided. At the same time, the support and help of the affected person by his or her own family has a positive effect on the further course of the disease and can also prevent depression and other psychological upsets. Regular check-ups by a doctor should be performed even after the successful surgery. Universally, no prediction can be made about the further course of the disease, although in many cases the life expectancy of the patient is significantly reduced by the keratocyst.
What you can do yourself
Patients suffering from a keratocyst should definitely talk to a doctor. The benign tumor must be diagnosed by a doctor and then surgically removed. Prior to surgery, the diet may need to be adjusted, depending on where the cyst is located and its size. Patients who regularly take medication or suffer from circulatory system complaints that have not yet been clarified should inform the doctor in charge. After the operation, rest and bed rest are initially required. In addition, the surgical wound must be carefully cared for in order to exclude wound healing disorders, infections and other problems. If a cyst forms again, another visit to the doctor is indicated. In general, regular examinations must be performed after tumor surgery, as there is an increased risk of complications. Accompanying these measures, the cause of the development of the keratocyst must also be determined, if possible. In addition, logopedic treatment is indicated to alleviate any speech disorders. If there are permanent problems with speech, as can occur especially after the removal of larger tumors, further dental treatment measures should be taken.
