Odontogenic keratocysts of the jaws in children: peculiarities of the clinical and X-ray picture

Abstract

The slow growth and asymptomatic course of odontogenic keratocysts of the jaws in children complicates diagnosing on the early stages of development, they have relatively aggressive course and a high rate of recurrence and only when the cyst is large enough the symptoms may appear in the form of jaw deformation, disruption of teeth eruption or changes in their positioning. The purpose of our study is to determine the characteristic features of the clinical and radiological manifestation of keratocysts in the jawbones of children in the period of temporary and permanent occlusion. Clinical material was based on the examination of 8 children aged from 8 to 18 years old suffering from keratocysts of the jaws, who addressed to the clinical base of the Department of Postgraduate Education of Dentists at Poltava State Medical University (Ukraine) lover six years. All children underwent standard X-ray examination: orthopantomogram, computed tomography. Keratocysts were most often detected at age of 12–14 years old. The lower jaw was damaged by the pathological process almost twice as often as the upper jaw. As a rule, the localization of the lesion was in the area of the angle and branch of the lower jaw. And, as for the frontal group of teeth - on the upper jaw. There is a characteristic feature in growth of odontogenic keratocysts - they spread along the length of the jaw and do not cause a pronounced deformation of the bone for a long time; in children, during the period of intensive growth of the jaws, they often have a large size of 3 cm or more. In the period of transitional dentition, we took into account the terms of permanent teeth eruption along with the degree of resorption of the roots of temporary teeth in accordance with the age of the child. We consider the fact that the size of the lesion depends on the age of the child to be a specific feature of the clinical course of keratocysts in children. In case when the process was localized on the upper jaw, we identified the area of destruction of bone tissue with clear rounded contours or of triangular shape in the form of one-chamber cavity in the area of incisors, canines or premolars. The permanent teeth buds were often situated horizontally or pushed distally, some of them were located in the cavity of the cyst. The roots of erupted permanent teeth were turned into the cyst cavity. When the lesion was localized on the lower jaw, the X-ray revealed areas of bone thinning with clear contours, which either spread to the frontal part, or to the body, angle and branch of the lower jaw, the 8th tooth's bud was more often pushed to the branch of the lower jaw. The contours of the periodontal cleft of the teeth, which were located in the area of keratocysts, were always preserved, pathological root resorption was not observed. The growth of the jawbones, anatomic and topographic features of the teeth and jaws in temporary occlusion, immature roots of permanent teeth contribute to the specific course of keratocysts in children. In order to make proper OKC diagnosis, a special place, in addition to anamnesis, should be given to the correct clinical and radiological diagnosing by the means of CT scanning.