- Dr Hemant Baonerkar
Introduction
A cyst can be defined as a benign pathologic cavity within bone or in soft tissues, generally formed by a connective tissue wall. The cavity, within the oral regions, is almost always lined by dental epithelium. Some cyst-like lesions, without epithelial lining, also can be seen in the maxillo-facial regions. The cyst's lumen usually contains fluids, keratin or cellular debris (pus) or gas. Treatment of cysts varies from curettage, excision, enucleation, marsupalization depending on nature and size of the cyst.
Dentigerous cyst is a developmental odontogenic cyst. It is the second most common cyst in jaws, accounting for 20% of all jaw cysts cases. Generally it is more common in males than females, and most common site is body of mandible and posterior mandible. It usually presents between 10 and 30 years of age and is mostly associated with deep seated impacted wisdom tooth. Dentigerous cysts are usually non aggressive and asymptomatic, unless infected. The objective of this article is to present a case of a dentigerous cyst with its clinical, radiological features, and its treatment plan.
Case Report
A 55 year old female patient reported to the hospital with chief complaint of pain and swelling in mandibular left posterior region from last 6 months. Patient reported that initially the swelling was asymptomatic but gradually increased in size, causing pain and discomfort. She did not have any relevant medical history.
On intraoral examination, swelling in mandibular wisdom tooth region and anterior ramus was present. Buccal cortical expansion from mandibular left second molar to ramus area was found. Small intraoral draining sinus was also present. Same area had moderate inflammation. Extraoral tenderness on palpation was present at left angle of mandible and ramous region. Patient was advised to do radiographic evaluation.
Radiographic evaluation
CBCT (cone beam computerized tomography) scans showed a well defined radiolucency present with impacted mandibular left wisdom tooth, extending from the periapical region of second molar to distal to third molar. A well defined radiolucency surrounded by radio opaque boundaries is the classical radiological presentation of cystic pathology.
Osteolytic activity was diagnosed on both, the buccal and lingual cortex. Thinning of buccal bone cortex and resorption with perforation on lingual cortex was suggestive of chronic cystic pathology. Crown of wisdom tooth encircled in radiolucency was suggestive of dentigerous cyst. Size of pathology anterio posteriorly was approximately 29 mm and superio inferior was approximately 22.1 mm. Moderate buccal cortical expansion was present. Due to pathologic expansion, inferior alveolar nerve was pushed downward and wisdom tooth was pushed distally in ramus, suggestingpathology is benign but locally aggressive. (Image no. 1)
Differential diagnosis
Based on the above findings differential diagnosis for this case was
- benign odontogenic cyst
- dentigerous cyst
- unicystic ameloblastoma
- keratocyst etc.
Lab investigations
Lab investigations such as
- complete blood count (CBC)
- blood sugar levels and
- viral markers
were done and they were in normal reference limits.
Surgical procedure
Surgical procedure was planned under general anesthesia. Local infiltration of lignocaine and adrenalin was administered at surgical site to achieve hemostasis and local effect. An intraoral incision was places with no. 15 surgical blade. Intraoral full thickness mucoperiosteal flap was raised from first molar up to distal and buccal to ramus region. Then, enucleation of cyst was done with Lucas curette. (Image no.2)
The extraction of impacted wisdom tooth was completed. Complete cystic lining was removed. (Image no 3)
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