In the recent World Health Organization classification of tumours of the head and neck1, the name keratocystic odontogenic tumour (KCOT) has been changed again to odontogenic keratocyst (OKC). This decision has caused some confusion and has undoubtedly lessened alertness regarding this potentially very aggressive lesion. Apart from the known tendency of OKCs to recur, their potential aggressiveness has been well documented by Emerson et al.2, who described the extension of two recurrent OKCs in the mediastinum, extended via the neck.
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