An odontogenic keratocyst is lined by a keratinizing, stratified squamous epithelium and may have adjacent "daughter" cysts. These lesions tend to recur after simple enucleation and can be locally destructive. These cysts also can be one manifestation of the nevoid basal cell carcinoma syndrome.


The recurrence rate after simple enucleation ranges from 17-56% (Blanas et al). Some form of adjunctive therapy can markedly reduce the recurrence rate, without the need for extensive resections.


Questions for determining management:

(1) Is the patient likely to be lost to followup?

(2) Is the cyst very large?


Size of the Cyst

Management (after Blanas et al)


small or medium

enucleate followed by instillation of Carnoy's solution for 3 minutes



decompression followed by enucleation and instillation of Carnoy's solution



resection of the lesion



• Carnoy's solution is described as a mixture of glacial acetic acid, ferric chloride, chloroform and 100% (200 proof) ethanol.


If a patient presents with an odontogenic keratocyst, s/he should be evaluated for the Nevoid Basal Cell Carcinoma Syndrome, which features:

(1) odontogenic keratocysts in the mandible and/or maxilla, which may be multiple

(2) skeletal anomalies (ribs, vertebra, shortened metacarpals, ocular hypertelorism)

(3) ectopic calcifications in soft tissue

(4) multiple basal cell carcinomas of the skin

(5) dyskeratotic pitting involving the skin of the hands and feet

(6) risk of medulloblastoma


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