Recurrence of an odontogenic keratocyst in the zygomatic bone with orbital floor involvement: a case report
This case report describes the rare recurrence of an odontogenic keratocyst in the zygomatic bone and orbital floor of a 32-year-old woman with a history of multiple surgeries, which was successfully managed through cyst enucleation, peripheral ostectomy, chemical cauterization, and orbital reconstruction, resulting in no recurrence at seven-month follow-up.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
In the human face, beneath the skin and muscle, lies a complex landscape of bone that supports our eyes, cheeks, and teeth. Sometimes, a specific type of fluid-filled sac, known as an odontogenic keratocyst, can form within these bones. These sacs originate from tiny, leftover fragments of the tissue that once formed our teeth. While they are not cancerous, they behave with a stubborn persistence, often growing quietly until they cause swelling or pain. They have a notorious habit of returning after treatment, sometimes hiding in small pockets of tissue that surgeons miss during the initial removal. Because these cysts usually appear in the lower jaw, finding one in the cheekbone or near the eye socket is an unusual and challenging event for medical specialists.
This story follows the journey of a thirty-two-year-old woman who had been living with a recurring version of this condition for nearly two decades. Her medical history began in her teenage years when she first noticed her right eye shifting upward and felt constant congestion in her nose. Doctors at the time identified a cyst associated with an impacted tooth in her upper jaw and removed it. However, the problem did not stay gone. Over the next fifteen years, the cyst returned multiple times, leading to several more surgeries, including drainage procedures that treated the symptoms but failed to stop the underlying growth. By the time she arrived at the Amrita Institute of Medical Sciences, she was suffering from pain, swelling, and pus discharge beneath her right eye, accompanied by a visible scar from previous operations.
When the medical team examined her, they found that the cyst had grown far beyond its original location in the upper jaw. It had expanded into the zygomatic bone, which forms the prominence of the cheek, and had eroded the floor of the eye socket. Imaging scans revealed a clear, dark area in the bone where the cyst had dissolved the structure, pushing against the orbit and threatening the stability of the eye. The team realized that previous treatments had likely left behind tiny, invisible fragments of the cyst wall, which had slowly grown into this difficult-to-reach area over the years.
To address this, the surgeons performed a delicate operation designed to remove the entire cyst while protecting the eye. They made an incision just below the eyelid, carefully separating the tissues to reach the bone without disturbing the eye itself. Once the cyst was exposed, they removed it completely in one piece. To ensure no microscopic remnants were left behind, they trimmed the surrounding bone and applied a chemical solution to the area, a step intended to kill any remaining cyst cells that might cause the problem to return. Because the cyst had destroyed part of the bone supporting the eye, the surgeons rebuilt the floor of the orbit using a fine mesh made of titanium, creating a new, stable foundation.
The tissue removed during the surgery was examined under a microscope, confirming that it was indeed an odontogenic keratocyst. The pathologists noted the presence of small satellite cysts within the tissue, which explained why the condition had returned so many times in the past. These tiny pockets are often the reason standard removal techniques fail, as they can be left behind and grow again later. The patient's recovery was smooth, with her vision and eye movement remaining stable throughout the process.
Seven months after the surgery, follow-up scans showed no signs of the cyst returning, and the titanium mesh was holding the bone structure in place. Five years later, follow-up imaging continued to show the mesh in place with good bone formation and no evidence of recurrence; the patient's vision remained unchanged and eye movement was fully functional. This case highlights that while these cysts can be aggressive and difficult to manage, especially when they reach unusual locations like the cheekbone, a combination of careful removal, chemical treatment, and structural reconstruction can lead to a favorable outcome. The success of this approach depends on recognizing the potential for hidden remnants and taking extra steps to ensure the entire lesion is addressed, followed by long-term monitoring to catch any potential return early, as recurrence may still occur even years after treatment.
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