www.ijcmr.com International Journal of Contemporary Medical Research Volume 3 | Issue 5 | May 2016 | ICV: 50.43 | ISSN (Online): 2393-915X; (Print): 2454-7379 1258 Comprehensive Management of Keratocystic Odontogenic Tumor of the Mandible: A Case Report Ashwini Samant 1 , Kumar Nilesh 2 , M I Parkar 3 , Shivsagar Tewary 4 , Pronob Sanyal 5 CASE REPORT ABSTRACT Introduction: Keratocystic Odontogenic tumor (KCOT) is a odontogenic neoplasm of jaw which has high recurrence po- tential. Case Report: This paper reports a case of KCOT in left hem- imandible with buccal and lingual cortical perforations. The case was treated by segmental resection with disarticulation and reconstructed with avascular ibula graft. Postoperative prosthetic rehabilitation was done with cast partial denture. Conclusion: For complete management of KCOT involving hemimandible, a treatment plan of resection and reconstruc- tion with long term follow up should be carried out. Also the patient’s deformity should be prosthetically rehabilitated to give him a functionally and esthetically acceptable dentition. Keywords: Odontogenic Tumor, Surgical treatment, Recon- struction, Fibula graft, Hemimandibulectomy. INTRODUCTION Keratocystic odontogenic tumor (KCOT), previously known as a cystic lesion was renamed as an odontogenic jaw tumor in 2005 by WHO. 1,2 KCOT is clinically benign but locally aggressive lesion with a slight male predilection and commonly occurs in the sec- ond and third decades of life. KCOTs can occur in any part of the jaw, but majority of the lesions are seen in the man- dible, most commonly in the posterior body and ascending ramus. It is considered to be an aggressive odontogenic tu- mor, owing to its high recurrence rate and tendency to in- vade adjacent tissue. The treatment modalities of KCOT’s, vary from conservative procedure like marsupilization and enucleation, with or without adjuvant physicochemical ther- apy (such as cryotherapy, application of cornoy’s solution) to more aggressive marginal or segmental resection of jaw. The recurrence rates are signiicantly high and differ in various published articles, varying from 0% to 62%, depending on the site of involvement, type of surgical procedure used, and length of follow-up. Most recurrences are seen in the irst 5 years after surgery. 1,3 In the present report, we describe a case of large KCOT originating in the left mandibular body and ramus region with buccal and lingual cortical perforations. The tumor was managed by segmental resection of mandible. Reconstruc- tion was done using autogenous avascular ibula graft and prosthetic rehabilitation was done using cast partial denture. CASE REPORT A 34-year-old male patient reported to the Department of Oral and Maxillofacial Surgery, School of dental sciences, Krishna Hospital, Karad, in September 2014 with a chief complaint of swelling over lower left jaw for the past 3 months. The swelling was initially small and gradually in- creased to the present size. There was no associated pain, paresthesia or discomfort. Extraoral examination revealed mild swelling in the mandibular left angle-ramus region (igure 1a). The swelling was non tender and the overlying skin appeared normal with no local rise of temperature. The temporomandibular joint showed normal movements and absence of tenderness and clicking. Intraoral examination showed expansion of left buccal cortical plate and oblitera- tion of vestibule in region of 34-37 with thinning and ‘Egg Shell Crackling’ over the cortical plates (igure 1b). The as- sociated teeth were non-carious and did not show mobility. Electric pulp vitality test revealed positive vitality for all the left mandibular posterior teeth. Orthopantamogram showed a well deined, corticated multilocular radiolucent lesion in the left posterior mandible, extending anterio-posteriorily from the apical region of 35 to posterior border of ramus of mandible and superior-inferiorily from coronoid and condy- lar processes to lower border of mandible (igure 1c). Based on the clinical presentation and the radiographic indings provisional diagnosis of keratocystic odontogenic tumor was made. Differential diagnosis included ameloblastomna, od- ontogenic myxoma, central odontogenic ibroma and central giant cell granuloma. Aspiration of the lesion as done under local anesthesia, which revealed thick white cheesy viscoid luid with keratin lakes. Cytochemical evaluation of the as- pirate showed soluble protein content of 3.4md/dl. Incision biopsy was performed and a portion of the lesion was sub- mitted for histopathological examination. Hematoxylin and eosin (H and E) stained section showed 6 to 8 cells thick parakeratinized stratiied squamous epithelium with surface cell keratinization, hyperchomatic tall columnar basal cells with palisading and reversal of nuclear polarity. Separation of basement membrane from connective tissue at some plac- es was appreciated. Based on the histological indings diag- nosis of keratocystic odontogenic tumor was made (igure 2a, b). Computed tomography (CT) was done to study exact extent of the lesion for pre-surgical planning. CT revealed intraosseous expansile lesion involving left mandibular body and ramus with buccal cortical perforation distal to the men- 1 Post-Graduate Student, 2 Reader, 3 Professor and H.O.D., Depart- ment of Oral and Maxillofacial Surgery, 4 Reader, 5 Professor and H.O.D., Department of Prosthodontics, School of Dental Sciences, KIMSDU, Karad, India Corresponding author: Dr. Ashwini Samant, Department of Oral and Maxillofacial Surgery, School of Dental Sciences, Krishna Hospital, Karad, Satara 415110, Maharashtra, India How to cite this article: Ashwini Samant, Kumar Nilesh, M I Parkar, Shivsagar Tewary, Pronob Sanyal. Comprehensive manage- ment of keratocystic odontogenic tumor of the mandible: a case report. International Journal of Contemporary Medical Research 2016;3(5):1258-1261.