Osteolytic lesions of the jaws: focus on keratocysts and ameloblastomas

OBJECTIVES The objective of this Module is to pro-vide the clinician with a thorough un-derstanding of the aspects of odonto-genic keratocysts and ameloblasto-mas from a radiographic stand point. The topic of discussion is the compar-ison between a conservative versus a surgical approach. Similarities and dif-ferences among the lesions have been highlighted and the elements of radio-graphic as well as clinical diversity an-alyzed, allowing proper differential di-agnosis. MATERIALS AND METHODS The most recent available international literature about keratocysts and amelo-blastomas has been reviewed. Considering that the lesion to date known as keratocyst has changed name over time, the terms dermoid cyst, cholesteoma, primordial cyst and keratocystic tumor were also consid-ered in the literature search. In line with the latest classification of the World Health Organization, only the cases presenting paracheratinized histology were considered. With regards to ameloblastomas, the five variants by which it is classified as: unicystic, conventional, adenomatoid, metastasizing, and peripheral were ex-amined. The adenomatoid variant has only recently been introduced, so there is not much supporting literature yet. The literature was found through the major databases (PubMed, Medline, Scopus, Google Scholar, and Cochrane Library), in addition to decades of aca-demic clinical practice of the authors. RESULTS The datas reported in the literature re-garding keratocysts are extremely het-erogeneous with regards to both the type of treatment and the lesions, fea-tures in terms of location, extent, in-volvement of dental and/or mucosal el-ements and association with syn-dromes. With regards to ameloblasto-mas there is a broader classification and thus a more focused literature. In both keratocysts and ameloblastomas, unicystic forms are often misinterpret-ed and diagnosed retrospectively be-cause they are less known. On the oth-er hand, clinicians often draw their at-tention towards multilocular lesions that are put into differential diagnosis (including the lesser known ones such as glandular odontogenic cyst). DISCUSSION After an initial skimming, a number of lesions still remains in differential diag-nosis. Literature agrees, that these le-sions require a biopsy examination in order to diagnose their nature with cer-tainty. The goal is to implement the most appropriate treatment plan that aims not only to minimize the recur-rence rate but also to ensure a good standard of quality of life for patients. CONCLUSIONS In cases of keratocysts and ameloblas-tomas, correct identification with re-spect to other lesions turns out to be crucial, as a failure to recognize them may give clinical implications such as more invasive surgeries for the patient. CLINICAL SIGNIFICANCE To focus on the often underestimated unicystic forms of keratocysts and am-eloblastomas. The professional should follow a diagnostic flowchart to make a correct diagnosis by clinical, radio-graphic and biopsy examination wich will guided the management of the le-sions in a conservative or intervention-al approach. In addition, the funda-mental differential diagnosis aspects that allow intercepting these types of lesions are highlighted.