The clinical and radiographic features of Keratocystic odontogenic tumors (KOT) are not pathognomonic. It is difficult to distinguish KOT from other lesions, however in most cases, the pattern of radiological destruction do not correlate with clinical examination, i.e radiologically KOT may be an extensive lesion,however clinically they might be minimum bone expansion especially when the lesion is in mandible.

Reliable pre-operative features for KCOT in particular. Nothing absolutely specific and reliable. A number of it's differential diagnoses (Odontogenic cysts and tumors) tend to share same features. The only exception which I would not tag absolutely reliable is KCOT's reluctance to cause bony expansion and facial asymmetry, but this tends to set in with time when left un-managed over a long time.