Orthokeratinised Odontogenic Cyst: A Diagnostic Havoc

This case report presents a 27 year old male patient who reported with pain in his anterior mandible since a week. History revealed an incidence of trauma on his chin when he was young for which he didn't undergo any treatment. On examination buccal cortical expansion was clinically evident and tenderness was elicited on percussing over the lower anterior teeth. Aspiration was negative initially while it showed serous blood the second time. Radiograph featured an unilocular radiolucency extending from distal of left mandibular first premolar to mesial of right mandibular first molar with an impacted right mandibular canine was seen. Displacement of teeth and inter-radicular scalloping were also evident. With all these clinical and radiographic features we could arrive at a provisional diagnosis of odontogenic keratocyst. A differential diagnosis of traumatic bone cyst and ameloblastoma were also considered. A Complete surgical excision with curettage of the cystic cavity was performed following which histopathological evaluation confirmed the lesion to be an orthokeratinised odontogenic cyst.