Wolf in sheep’s clothing—an odontogenic keratocyst clinically masquerading as a dentigerous cyst: a case report

Abstract

Background: Odontogenic keratocyst (OKC) is a developmental odontogenic cyst, infamous for its aggressive nature and high recurrence rate. Sometimes, an OKC may be misdiagnosed as any other maxillofacial cyst, based on the clinical and radiological presentation, especially when present in the toothbearing areas. A proper clinico-radiographico-pathological diagnostic workup is crucial for a definitive diagnosis and to reduce the chances of recurrence. Here, we report a case of an OKC closely associated with an impacted maxillary right third molar, clinically and radiographically resembling a dentigerous cyst.Case Description: A 28-year-old male patient complained of pain, swelling, and fluid discharge in the upper right back tooth region. The cone-beam computed tomogram revealed a well-defined, corticated cystic radiolucency that appeared to be attached to the cervical aspect of the impacted maxillary right third molar, suggestive of dentigerous cyst. Under general anaesthesia, the entire cystic lining and the impacted maxillary third molar were surgically removed using the Caldwell-Luc procedure. The histopathology was consistent with features of an OKC. There were no adverse or unanticipated events post-surgery. The patient has been kept under close follow-up and has not shown any clinical or radiographic evidence of recurrence after six months of surgery.Conclusions: A complete clinical, radiographic and histopathological correlation is imperative, along with advanced molecular analysis to arrive at the final diagnosis of an OKC which can help in understanding the pathogenesis and determining the treatment plan.