Odontogenic keratocyst (OKC) was first identified and described in 1876. Phillipsen further classified it in 1956. It is one of the rare odontogenic cysts, and clinicians become extremely cautious once they come across this lesion as it has a high recurrence rate. It originates from the cell rests of Serre of odontogenic apparatus. Another source of origin is from the basal cells of the overlying epithelium.[2,3]
It has a high recurrence rate; therefore, the clinician should be very careful as far as its diagnosis and surgical procedure is concerned. Hence, it is very important for the clinicians to understand the key events of its pathogenesis in a lifelike manner, i.e., in third dimension, which has never been explained in the literature yet. There are good two-dimensional (2D) histopathological images, but lifelike three-dimensional (3D) architecture in vivo images are not available so far.[4–6] Therefore, the author herself has designed histopathological images using various 3D animation software for educational purpose so that it is better understood not only by students but also by patients and clinicians.
Teaching methods in oral histopathology have always been through 2D static images, which, in this era of digitization, cannot be correlated with the 3D terms mentioned in the textbooks such as ”pathological pouch,” “basal offshoots,” corrugations etc.[7,8]
Thus, understanding would be better if, in addition to 2D images, 3D images and 3D animated videos are also made available to explain the step-by-step process of pathogenesis in a lifelike manner.
There have been only a few lesions, which have been explained in 3D aspect of histopathology, but there are not any data on OKC yet.[9–12] Therefore, this article presents preliminary effort on 3D of basic histopathological features of OKC using 3D animation software.
Preliminary 3D images and videos [Video 1] on histopathological aspect of OKC were designed using 3ds Max (Autodesk Media and Entertainment) and Adobe Premiere Pro 5.5 software, which is a video editing software (Adobe Systems).
Ethical approval was not considered as there are no patient-related data.
Key events of histopathological aspect of OKC have been explained in 2D and 3D both as follows.
Histopathology of odontogenic keratocyst (two dimensional)
Microscopically, a cystic lining has 6–10 cells thick layer of epithelium, with little or no evidence of rete ridges it has well-defined palisading columnar basal cell layer. Characteristic corrugated epithelial lining with keratin flakes in the cystic lumen is present. Epithelial proliferations are seen in the form of papillary projections into the cystic lumen as well as satellite cysts in the connective tissue wall.
Histopathological aspect of odontogenic keratocyst (three-dimensional)
OKC has been shown as small pouch-like swelling arising from conical rete pegs. The overlying epithelium has been shown as thin sheet covering the bone. Rete pegs have been shown as extended downward conical projections from the overlying epithelium [Figure 1].
The internal view of bone marrow shows cysts proliferating through marrow spaces in between the roots of the teeth. The whole cystic sac has been shown as a corrugated luminal surface shown as multiple folding [Figure 2]. The inner view of the sac has been opened up to show various parts such as lumen, epithelial lining, and connective tissue capsule. The keratin flakes have been shown as floating particles within the fluid [Figure 3]. Incisional biopsy has been shown as detachment of small pieces of the cyst containing all parts of cystic sac [Figure 4]. The basal layer has been shown as columnar cells arranged on the basement membrane in tombstone manner with overlying spinous cell layers. Keratin layer covers the epithelium. The depression, which is a part of a lumen, is filled with floating keratin fluid [Figure 5].
This is a preliminary attempt to show key events in the pathogenesis of OKC. All the oral lesions should have such videos and images for a better understanding of a lesion by clinicians, academicians, students, and patients.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
We would like to thank Mr. Harishankar Agnihotri and late Mr. Bhavesh, faculties of “Maya Academy of Advanced Cinematics (MAAC)” Mulund West, Mumbai Maharashtra, for teaching various softwares to the author (Dr. Sandhya Tamgadge), to create 3D images and videos.
1. Nayak MT, Singh A, Singhvi A, Sharma R. Odontogenic keratocyst
:What is in the name?. J Nat Sci Biol Med 2013;4:282–5.
2. Neville DW, Damm DD, Allen CM, Bouquot JE Oral and Maxillofacial Pathology 3rd ed Philadelphia W. B. Saunders 2009 528–9.
3. Hill WJ. Odontogenic keratocyst
. Miss Dent Assoc J 1989;45:13.
4. Cawson RA, Evenson JW. New York:Saunders;Cawson's Essentials of Oral Pathology and Oral Medicine 2008 108–9.
5. Regezi J, S J. Clinical Pathologic Correlations Oral pathology (5th
ed). Saunders company 2009 242–3.
6. Sapp JP, Eversole LR, Wysocki GP 2nd ed St Louis:Mosby Contemporary Oral and Maxillofacial Pathology 2004.
7. Shafer WG, Hine L Rajendran R, Sivapathasundharam BE Shafer's Textbook of Oral Pathology 5th ed New Delhi Elsevier Ltd 2006 404–7.
8. Kramer IR, Pindborg JJ, Shear M. The World Health Organization histological typing of odontogenic tumours. Introducing the second edition. Eur J Cancer B Oral Oncol 1993;29 B 169–71.
9. Tamgadge S, Tamgadge A. Histopathology
of oral submucous fibrosis in third dimension with an additional note on hypothesis of epithelial atrophy. J Microsc Ultrastruct 2020;8:31–4.
10. Tamgadge S, Tamgadge A. Histology of tooth development in 3D animation video
and images –
A preliminary report. J Microsc Ultrastruct 2021;9:141–4.
11. Tamgadge S, Tamgadge A. Third dimension on histopathological aspect of oral lichen planus:An innovation in teaching oral pathology. J Oral Maxillofac Pathol 2019;23:310.
12. Tamgadge S, Malathi N. From the Author's desk. J Oral Maxillofac Pathol 2015;19:273–4.