Contribution of cone beam computed tomography to suggest a hypothesis of odontogenic keratocyst in the diagnosis of a bone lesion: a case report

In the literature, several studies have investigated cone beam computed tomography (CBCT) findings of microscopically confirmed odontogenic keratocysts (OK). Such data can be useful on clinical routine in the diagnosis of bone lesions to define a hypothesis of OK before surgical resection. Objective: To report a clinical case of an extensive bone lesion in the mandible, which tomographic and clinical findings suggested OK as the first hypothesis. Case report: A 14-year-old male underwent a CBCT scan of the mandible for investigating an asymptomatic radiolucent bone lesion detected in a panoramic radiography. Clinically no swelling was evident and the adjacent teeth presented positive response to pulpal sensitivity test. CBCT images revealed a hypodense and unilocular lesion extending from mandibular left central incisor region to mandibular left first molar site; from jaw base to periapical region of the adjacent teeth; from buccal to lingual bone cortical. At the site of the lesion, there was erosion of the buccal and lingual bone cortical, which presented a mild expansion. Additionally, sectional images showed scalloped edges of the lesion, slight external root resorption at the apex of mandibular left second premolar, subtle incomplete septa and mandibular canal involvement by the lesion. Conclusion: The relevant CBCT findings contributed to suggest a probable hypothesis of OK in the diagnosis of a mandibular bone lesion. However, final diagnosis depends on microscopic examination.