Dentigerous cyst maxilla arising from unerupted tooth

Clinical details:

28 year old male patient came with complaints of:

1. Swelling left side of upper jaw - 3 months

2. Pain over the selling ++

No H/O loosening of teeth

On examination:

Globular mass seen arising from lateral wall of left maxilla measuring 5 cms x 4 cms.

It felt hard / firm on palpation.

Left nasolabial fold obliterated.

Same swelling could be palpated through bucco gingival sulcus. Hard in consistency.

Nose:

Lateral wall of nose could be seen bulging on the left side.

Oral cavity:

Mass could be seen involving the anterior portion of left side of hard palate.
On palpation hard to firm.
Dental formula normal and complete.

Imaging:

CT scan images:

denti_1.jpg

CT scan image showing cyst involving the anterolateral wall of left maxilla.

denti_5.jpg

CT scan showing cyst arising from left maxilla extending up to left nasal cavity

dnetige_2.jpg

CT scan image showing radio dense body within the cyst ? unerupted tooth

Diagnosis:

Dentigerous cyst left maxilla with unerupted supernumerary tooth

Management:

The cyst was accessed via left sublabial incision and was enucleated in toto.

Unerupted tooth could be seen within the maxillary sinus after removal of the cyst.

cyst.jpg

Image showing cyst being exposed via left sublabial incision

unerupted.jpg

Image showing unerupted tooth within left maxillary sinus after removal of cyst

Discussion:

Dentigerous cyst is an odontogenic developmental anomaly. This cyst usually surrounds the crown of impacted teeth, odontoma,
or supernumerary teeth. The cyst enlarges in size due to accumulation of fluid between reduced enamel epithelium and the crown.

Supernumerary teeth:

This is defined as teeth in excess of the regular configuration of 20 deciduous and 32 permanent teeth. Prevalence rate of supernumerary teeth
causing dentigerous cyst is about 0.8% in permanent dentition. It also constitutes about 5% of all dentigerous cysts.

These cysts are slow growing and may reach considerable size before causing symptoms. Needle aspiration reveals straw colored fluid.

Radiologically these cysts appear as well defined radiolucency, with sclerotic borders. The lesion per se appears to be associated with the crown
of unerupted teeth. Radiologically it may be difficult to differentiate cyst from normal dental follicle if the cyst is small. General rule of thumb
is that any follicular space greater than 4 mm should be suspected to be a dentigerous cyst unless proved otherwise.

Next to the radicular cyst dentigerous cyst appears to the frequently appearing cystic lesions involving jaw bones.

Complications of dentigerous cyst:

1. Displacement of normal dentition

2. Expansion into adjacent areas

3. Fracture of jaw bones

In children whom dentition is not complete, it is always better to be conservative in managing these cysts. Marsupialization is ideal in these
patients giving a chance for normal teeth to erupt.

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