Huge keratocystic odontogenic tumour in medically compromised patient–a management dilemma

ABSTRACT

Keratocystic odontogenic tumour (KCOT) is a cystic lesion of the jaws with tumourbehaviour. Its high prevalence rate makes it one of the commonest cystic lesions especially involving the lower jaw. The characteristic histologic features and aggressive nature corresponds to the high recurrence rate associated with KCOT. Lesion expands mostly in an anteroposterior direction and can cause extensive bone destruction before the appearance of any clinical symptoms. The characteristic radiological picture is that of a multilocular cystic lesion with the common differential diagnosis being dentigerous cyst and ameloblastoma. Here we are presenting a case of KCOT of the left lower jaw of size 10.9×7.86×8.54 cm. It is a huge multilocular cystic lesion extending from the right canine region to the left side involving the body, ramus, coronoid and condyle. Various management options are there ranging from enucleation and chemical cauterization to resection and reconstruction depending upon the size of the lesion. In this case we were not able to perform the ideal treatment option for the case because of the multiple drug allergy the patient was having, including most of the general anesthetic agents. Also the patient was not willing for any extensive procedure under general anesthesia. So we had to follow a compromised treatment plan aiming to reducethe size of the lesion, to improve the aesthetics and frequent follow up