A case of odontogenic keratocyst in the buccal space: characterization by multimodality imaging including computed tomography, diffusion-weighted magnetic resonance imaging, and ultrasonography

Odontogenic keratocyst (OKC) is a relatively common non-inflammatory jaw lesion. OKC is known to occur most often in the mandibular angle and mandibular ramus, but rarely outside the bone. In this report, we describe characteristic multimodality imaging of OKC in the buccal space, especially diffusi...

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Bibliographic Details
Published in:Oral radiology 2024-04, Vol.40 (2), p.304-309
Main Authors: Tezuka, Yasuhito, Oneyama, Takahiro, Kanri, Yoriaki, Toya, Shuji, Okada, Yasuo, Ogura, Ichiro
Format: Article
Language:English
Subjects:
Bone imaging
Case Report
Computed tomography
Dentistry
Diffusion coefficient
Diffusion Magnetic Resonance Imaging - methods
Doppler effect
Humans
Imaging
Inflammation
Jaw
Lesions
Magnetic resonance imaging
Magnetic Resonance Imaging - methods
Mandible
Medicine
Odontogenic Cysts - diagnostic imaging
Odontogenic Tumors
Oral and Maxillofacial Surgery
Radiology
Tomography, X-Ray Computed
Tumors
Ultrasonic imaging
Ultrasonography
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Summary:Odontogenic keratocyst (OKC) is a relatively common non-inflammatory jaw lesion. OKC is known to occur most often in the mandibular angle and mandibular ramus, but rarely outside the bone. In this report, we describe characteristic multimodality imaging of OKC in the buccal space, especially diffusion-weighted MR imaging (DWI) with apparent diffusion coefficient (ADC) mapping, extra-oral and intra-oral ultrasonography. On clinical examination, an approximately 20 mm in diameter mass with elastic hardness was found the left side of the buccal area. Contrast-enhanced CT showed areas of internal non-contrast lesions in the left buccal space. On T1-weighted image, the mass showed multilocular high signal intensity, and homogeneous internal. T2-weighted images revealed high signal at the marginal part and slightly median signal in the internal part. STIR images revealed a heterogeneous high signal in the interior. Furthermore, DWI and ADC map showed high signal and moderate-to-low signal intensity, respectively. ADC value of the lesion was 1.55 × 10 –3  mm 2  s −1 . On extra-oral ultrasonography, the tumor showed clear boundary, hypoechoic, homogeneous internal architecture and vascular signals, and heterogeneous hard of the lesion. On intra-oral ultrasonography also showed clear boundary, hypoechoic, homogeneous internal architecture, heterogeneous hard of the tumor, and back echo enhance. The histopathologic diagnosis based on a full excisional specimen was odontogenic keratocyst. This case suggests that multimodality imaging, especially MR imaging with ADC and DWI, and extra and intra-oral ultrasonography with color Doppler imaging and elastography, could be effective for evaluating buccal lesions.
ISSN:0911-6028
1613-9674
DOI:10.1007/s11282-023-00712-8