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Odontogenic keratocyst (OKC) is a benign but locally aggressive developmental cyst of odontogenic origin, arising from the rests of the dental lamina. It is known for its tendency to recur and potential syndromic association.

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Epidemiology

• Represents ~10–15% of all jaw cysts
• Mandible affected in ~70–80% (esp. posterior body and ramus)
• Peak incidence: 10–40 years
• Slight male predominance

Pathogenesis

• Arises from epithelial remnants of the dental lamina
• Characterized histologically by:
  • Parakeratinized stratified squamous epithelium
  • Palisaded basal layer
• High recurrence due to:
  • Satellite cysts
  • Thin, friable wall
  • Daughter cysts

Syndromic Association: Gorlin syndrome

• Multiple OKCs
• Early onset
• Associated findings: basal cell carcinomas, falx cerebri calcification, bifid ribs

Clinical Features

• Often asymptomatic, discovered incidentally on dental imaging
• May present with:
  • Jaw swelling
  • Tooth displacement
  • Pain (if infected or large)
  • Pathologic fractures (rare)