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Odontogenic keratocyst and ameloblastoma: radiographic evaluation



To describe the radiographic features of odontogenic keratocysts (OKCs) and ameloblastomas and to compare the radiographic findings between these 2 lesions.


Radiographs of OKCs and ameloblastomas were retrospectively reviewed. Location, border, shape, association with impacted tooth, tooth displacement, root resorption, and bone expansion were evaluated. Chi-squared or Fisher’s exact tests were used for statistical analysis. A p value < 0.05 was considered to indicate statistical significance.


One hundred OKCs and 101 ameloblastomas were reviewed. The ratios of maxilla to mandible were 1:1.4 and 1:9.1 in OKCs and ameloblastomas, respectively. All evaluated features significantly differed between OKCs and ameloblastomas (p ≤ 0.001). Most OKCs showed smooth border (60%) and unilocular shape (82%), while most ameloblastomas showed scalloped border (77.2%) and multilocular shape (68.3%). Association with impacted tooth was found in 47% of OKCs and 18.8% of ameloblastomas. Adjacent tooth displacement was found in 33.7% of OKCs and 55.8% of ameloblastomas. Root resorption was more common in ameloblastomas (66.7%) than in OKCs (7%). Bone expansion was also more common in ameloblastomas (96.3%) than in OKCs (63.6%).


A unilocular radiolucent lesion with smooth border, no adjacent tooth displacement, no root resorption and causing mild or no bone expansion is suggestive of an OKC rather than an ameloblastoma.

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  1. 1.

    Philipsen HP. Keratocystic odontogenic tumour. In: Barnes L, Eveson JW, Reichart P, Sidransky D, editors. World Health Organization classification of tumours. Pathology and genetics: head and neck tumours. Lyon: IARC Press; 2005. p. 306–307.

  2. 2.

    El-Naggar AK, Chan John KC, Grandis JR, Takata T, Slootweg PJ. World Health Organization classification of head and neck tumours. Lyon: IARC Press; 2017.

  3. 3.

    Manor E, Kachko L, Puterman MB, Szabo G, Bodner L. Cystic lesions of the jaws—a clinicopathological study of 322 cases and review of the literature. Int J Med Sci. 2012;99(1):20–6.

  4. 4.

    Tamiolakis P, Thermos G, Tosios KI, Sklavounou-Andrikopoulou A. Demographic and clinical characteristics of 5294 jaw cysts: a retrospective study of 38 years. Head Neck Pathol. 2019;13(4):587–96.

  5. 5.

    Reichart PA, Philipsen HP, Sonner S. Ameloblastoma: biological profile of 3677 cases. Eur J Cancer B Oral Oncol. 1995;31B(2):86–99.

  6. 6.

    Siriwardena BSMS, Crane H, O'Neill N, Abdelkarim R, Brierley DJ, Franklin CD, et al. Odontogenic tumors and lesions treated in a single specialist oral and maxillofacial pathology unit in the United Kingdom in 1992–2016. Oral Surg Oral Med Oral Pathol Oral Radiol. 2019;127(2):151–66.

  7. 7.

    Ahire MS, Tupkari JV, Chettiankandy TJ, Thakur A, Agrawal RR. Odontogenic tumors: a 35-year retrospective study of 250 cases in an Indian (Maharashtra) teaching institute. Indian J Cancer. 2018;55(3):265–72.

  8. 8.

    Worawongwasu R, Tiensuwan M. Odontogenic tumors in Thailand: a study of 590 Thai patients. J Oral Maxillofac Surg Med Pathol. 2015;27(4):567–76.

  9. 9.

    Lam EWN. Cysts. In: Mallya SM, Lam EWN, editors. White and Pharoah's oral radiology: principles and interpretation. 8th ed. St. Louis: Elsevier; 2019. p. 391–395.

  10. 10.

    Chrcanovic BR, Gomez RS. Idiopathic bone cavity of the jaws: an updated analysis of the cases reported in the literature. Int J Oral Maxillofac Surg. 2019;48(7):886–94.

  11. 11.

    Chrcanovic BR, Gomez RS. Glandular odontogenic cyst: an updated analysis of 169 cases reported in the literature. Oral Dis. 2018;24(5):717–24.

  12. 12.

    Neville BW, Damm DD, Allen CM, Chi AC. Oral and maxillofacial pathology. 4th ed. St. Louis: Elsevier; 2016.

  13. 13.

    Kakimoto N, Chindasombatjaroen J, Tomita S, Shimamoto H, Uchiyama Y, Hasegawa Y, et al. Contrast-enhanced multidetector computerized tomography for odontogenic cysts and cystic-appearing tumors of the jaws: is it useful? Oral Surg Oral Med Oral Pathol Oral Radiol. 2013;115(1):104–13.

  14. 14.

    Minami M, Kaneda T, Ozawa K, Yamamoto H, Itai Y, Ozawa M, et al. Cystic lesions of the maxillomandibular region: MR imaging distinction of odontogenic keratocysts and ameloblastomas from other cysts. AJR Am J Roentgenol. 1996;166(4):943–9.

  15. 15.

    Sumi M, Ichikawa Y, Katayama I, Tashiro S, Nakamura T. Diffusion-weighted MR imaging of ameloblastomas and keratocystic odontogenic tumors: differentiation by apparent diffusion coefficients of cystic lesions. AJNR Am J Neuroradiol. 2008;29(10):1897–901.

  16. 16.

    Crusoe-Rebello I, Oliveira C, Campos PS, Azevedo RA, dos Santos JN. Assessment of computerized tomography density patterns of ameloblastomas and keratocystic odontogenic tumors. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;108(4):604–8.

  17. 17.

    Alves DBM, Tuji FM, Alves FA, Rocha AC, Santos-Silva ARD, Vargas PA, et al. Evaluation of mandibular odontogenic keratocyst and ameloblastoma by panoramic radiograph and computed tomography. Dentomaxillofac Radiol. 2018;47(7):20170288.

  18. 18.

    Borghesi A, Nardi C, Giannitto C, Tironi A, Maroldi R, Di Bartolomeo F, et al. Odontogenic keratocyst: imaging features of a benign lesion with an aggressive behaviour. Insights Imaging. 2018;9(5):883–97.

  19. 19.

    Ariji Y, Morita M, Katsumata A, Sugita Y, Naitoh M, Goto M, et al. Imaging features contributing to the diagnosis of ameloblastomas and keratocystic odontogenic tumours: logistic regression analysis. Dentomaxillofac Radiol. 2011;40(3):133–40.

  20. 20.

    Wakoh M, Okawa Y, Otonari-Yamamoto M, Kamio T, Sakamoto J, Yamamoto A, et al. Reliance on diagnostic elements in panoramic imaging with focus on ameloblastoma and keratocystic odontogenic tumor: psychometric study. Bull Tokyo Dent Coll. 2011;52(1):1–12.

  21. 21.

    Chirapathomsakul D, Sastravaha P, Jansisyanont P. A review of odontogenic keratocysts and the behavior of recurrences. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;101(1):5–9.

  22. 22.

    Apajalahti S, Hagstrom J, Lindqvist C, Suomalainen A. Computerized tomography findings and recurrence of keratocystic odontogenic tumor of the mandible and maxillofacial region in a series of 46 patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011;111(3):e29–37.

  23. 23.

    Boffano P, Ruga E, Gallesio C. Keratocystic odontogenic tumor (odontogenic keratocyst): preliminary retrospective review of epidemiologic, clinical, and radiologic features of 261 lesions from University of Turin. J Oral Maxillofac Surg. 2010;68(12):2994–9.

  24. 24.

    Buckley PC, Seldin EB, Dodson TB, August M. Multilocularity as a radiographic marker of the keratocystic odontogenic tumor. J Oral Maxillofac Surg. 2012;70(2):320–4.

  25. 25.

    Chow HT. Odontogenic keratocyst: a clinical experience in Singapore. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998;86(5):573–7.

  26. 26.

    Dhanuthai K, Chantarangsu S, Rojanawatsirivej S, Phattarataratip E, Darling M, Jackson-Boeters L, et al. Ameloblastoma: a multicentric study. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012;113(6):782–8.

  27. 27.

    Gumusok M, Toraman Alkurt M, Museyibov F, Ucok O. Evaluation of keratocystic odontogenic tumors using cone beam computed tomography. J Istanb Univ Fac Dent. 2016;50(3):32–7.

  28. 28.

    Habibi A, Saghravanian N, Habibi M, Mellati E, Habibi M. Keratocystic odontogenic tumor: a 10-year retrospective study of 83 cases in an Iranian population. J Oral Sci. 2017;49(3):229–35.

  29. 29.

    Kim SG, Jang HS. Ameloblastoma: a clinical, radiographic, and histopathologic analysis of 71 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001;91(6):649–53.

  30. 30.

    Macdonald-Jankowski DS, Li TK. Keratocystic odontogenic tumour in a Hong Kong community: the clinical and radiological features. Dentomaxillofac Radiol. 2010;39(4):167–75.

  31. 31.

    MacDonald-Jankowski DS, Yeung R, Lee KM, Li TK. Ameloblastoma in the Hong Kong Chinese. Part 1: systematic review and clinical presentation. Dentomaxillofac Radiol. 2004;33(2):71–82.

  32. 32.

    Philipsen HP, Reichart PA. Unicystic ameloblastoma. A review of 193 cases from the literature. Oral Oncol. 1998;34(5):317–25.

  33. 33.

    Sansare K, Raghav M, Mupparapu M, Mundada N, Karjodkar FR, Bansal S, et al. Keratocystic odontogenic tumor: systematic review with analysis of 72 additional cases from Mumbai, India. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013;115(1):128–39.

  34. 34.

    Siar CH, Lau SH, Ng KH. Ameloblastoma of the jaws: a retrospective analysis of 340 cases in a Malaysian population. J Oral Maxillofac Surg. 2012;70(3):608–15.

  35. 35.

    Hasan A, Akintola D. An update of Gorlin–Goltz syndrome. Prim Dent J. 2018;7(3):38–41.

  36. 36.

    Myoung H, Hong SP, Hong SD, Lee JI, Lim CY, Choung PH, et al. Odontogenic keratocyst: review of 256 cases for recurrence and clinicopathologic parameters. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001;91(3):328–33.

  37. 37.

    Simiyu BN, Butt F, Dimba EA, Wagaiyu EG, Awange DO, Guthua SW, et al. Keratocystic odontogenic tumours of the jaws and associated pathologies: a 10-year clinicopathologic audit in a referral teaching hospital in Kenya. J Craniomaxillofac Surg. 2013;41(3):230–4.

  38. 38.

    Titinchi F, Nortje CJ. Keratocystic odontogenic tumor: a recurrence analysis of clinical and radiographic parameters. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012;114(1):136–42.

  39. 39.

    Regezi JA, Scuibba JJ, Jordan RCK. Oral pathology clinical pathologic correlations. 7th ed. St. Louis: Elsevier; 2017. p. 253–257.

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Correspondence to Jira Kitisubkanchana.

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Conflict of interest

Jira Kitisubkanchana, Nor Hidayah Reduwan, Sopee Poomsawat, Suchaya Pornprasertsuk-Damrongsri, and Chanchai Wongchuensoontorn declare that they have no conflict of interest.

Ethical approval

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (the Institutional Review Board of the Faculty of Dentistry/Faculty of Pharmacy, Mahidol University, COA No. MU-DT/PY-IRB 2017/007.0902) and with the Helsinki Declaration of 1975, as revised in 2008. According to the Institutional Review Board of our university, for this retrospective study, formal consent is not required.

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Kitisubkanchana, J., Reduwan, N.H., Poomsawat, S. et al. Odontogenic keratocyst and ameloblastoma: radiographic evaluation. Oral Radiol (2020).

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  • Ameloblastoma
  • Differential diagnosis
  • Odontogenic keratocyst