OKC Aspiration — ORE Part 1 MCQ

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ModerateOral PathologyOKC AspirationORE Part 1

A 60-year-old man presents with a well-defined radiolucency in the angle of the mandible. It has a characteristic scalloped or multilocular appearance. Aspiration reveals white, cheesy keratinaceous material. What is the most likely diagnosis?

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Correct answer: C — Odontogenic keratocyst

The diagnosis is odontogenic keratocyst (OKC). The key discriminating features are: (1) Location at the mandibular angle—a classical site for OKC; (2) Radiographic appearance of a scalloped or multilocular radiolucency—characteristic of OKC and distinguishes it from unilocular lesions; (3) White, cheesy keratinaceous aspirate—pathognomonic for OKC, reflecting its parakeratinised epithelial lining. Although ameloblastoma can mimic OKC radiographically and also occurs at the mandibular angle, aspiration typically yields serous or haemorrhagic fluid, not keratinaceous material. Dentigerous cyst is unilocular, pericoronal, and yields clear serous fluid. Traumatic bone cyst is unilocular and yields no fluid or blood. Aneurysmal bone cyst yields blood-tinged fluid and is non-odontogenic. The combination of location, radiographic features, and aspiration finding uniquely identifies OKC.

Reference: Multilocular Radiolucent Pathology in the Body and Ramus of the Mandible, PMC11296215, 2024; Management of the Odontogenic Keratocyst – Six Cases, PMC6937463; Comprehensive keratin profiling, PubMed 20801488, 2010. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11296215/