Gingival odontogenic keratocyst presenting as pseudoinfection: Inclusion of demonstrative case report and review.

Abstract

Background: The peripheral odontogenic keratocyst (POKC) is a rare developmental odontogenic cyst and represents the soft tissue counterpart of the more common intraosseous variant. Although the majority of POKCs have been discovered on the gingiva, scant information is available in the periodontal literature.

Methods: A 69-year-old man presented with a painless, red fluctuant-like papular lesion on the maxillary anterior labial gingiva. The adjacent teeth had vital pulpal responses and normal gingival probing depths. A subtle radiolucency with corticated borders was evident overlying the apical third of the roots. The patient recalled receiving local anesthesia in this site 3 months ago in conjunction with dental restorative treatment.

Results: An excisional biopsy was performed and pus-like material extruded from the surgical specimen. The histopathologic diagnosis was POKC.

Conclusion: With the inclusion of this report, at least 31% (14/45) of cases of gingival OKC have mimicked infection by exhibition of a fluctuant consistency and/or extrusion of thick luminal fluid that contains keratin and resembles purulence. Due to the high recurrence rate, affected patients should be followed for at least 5-7 years.

Plain language summary: This article features a rare example of the peripheral odontogenic keratocyst (POKC) on the gingiva. The lesion was initially suspected to be an infection and appeared as a painless, red compressible growth on the maxillary anterior labial gingiva of an older adult male. A dental radiograph revealed a subtle radiolucency with corticated borders. A biopsy was performed to determine the diagnosis. Affected patients must continue to be monitored for lesional recurrence.

Key points: The gingival odontogenic keratocysts may be adherent to the overlying mucosa and warrant supraperiosteal dissection during excisional biopsy to reduce lesional recurrence. At least 31% of published cases of gingival odontogenic keratocysts have featured an infection-like clinical presentation. Due to the high rate of lesional recurrence, affected patients should undergo yearly follow-up clinical assessments for at least 5 years, as informed by the current evidence.