There were no significant histological differences except for a greater amount never of inflammation in the non-recurrent cysts. It is suggested that operative factors have a major influence on the likelihood of recurrence. Woolgar et al.[47] have indicated that 164 OKC from 60 patients with the basal cell nevus syndrome were compared with a similar number of single keratocysts matched for age and site. Significant differences between the two groups were found in the numbers of satellite cysts, solid islands of epithelial proliferation and odontogenic rests within the capsule and in the numbers of mitotic figures in the epithelium lining the main cavity. An index of activity derived from these parameters suggests a greater growth potential in syndrome cysts; in addition, the patterns of association of the features support the theory that the odontogenic rests give rise to satellite cysts.

They found no association to support the theory that satellite cysts arose by basal budding of the epithelium lining the parent cyst from histological point view. Their results did, however, support the view that satellite cysts are formed when islands of proliferating epithelial cells derived from small epithelial rests reach a size where cystic breakdown occurs. They found no evidence that the ameloblastomatoid proliferations develop into true ameloblastomas. They suggested that there was some inherent genetic potential for proliferation of odontogenic epithelium in the syndrome patients. Dominguez and Keszler[48] reported that keratocysts of the solitary type were histologically and histometrically compared with those associated with the NBCCS.

It was observed that parakeratinization, intramural epithelial remnants and satellite cysts were a more frequent finding among NBCCS keratocysts than among solitary keratocysts. Conversely, it was also found that the total nuclear density was greater in non-associated cysts and that the total number of nuclei, the number of basal nuclei and the epithelial height values were also higher in solitary keratocysts. Nevoid BCC-keratocysts and solitary keratocysts are considered to be two morphologically distinct populations of the same entity. Some authors have referred to the occurrence of multiple OKC in patients without obvious signs of other features of the syndrome or of a familial trend.

Brannon[49] reported a frequency of 3% with multiple cysts in his sample, Kinard et al.[50] 4%, Ahlfors et al.[28] 6%, Voorsmit et al.[36] 2% and Stoelinga and Bronkhorst[51] 4.5%. As oral surgeons have become increasingly aware of the need to treat OKC more aggressively than other jaw cysts or by the use of special protocols, it is likely that future studies will show a declining frequency of recurrences. It is difficult to ignore the possibility that the variability in reported recurrence rates Anacetrapib may at least partly be attributable to differences in the surgical techniques used and in the experience of the surgeons.