Essay Example on Infected Dentigerous Cyst Associated with Maxillary

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Infected Dentigerous Cyst Associated with Maxillary Third Molar Displaced at Orbital floor within a Maxillary Sinus Abstract Dentigerous cysts are the most common type of developmental odontogenic cysts arising from crowns of impacted embedded or unerupted teeth Such cyst remains initially completely asymptomatic unless infected and can be discovered only on routine radiographic examination They constitute about 20 of all epithelium lined cysts of the jaws The teeth involved most often are mandibular third molar and maxillary canines About 70 of Dentigerous cysts occur in the mandible and 30 in the maxilla Dentigerous cyst associated with maxillary third molar displaced in the maxillary sinus at orbital floor is fairly rare we are reporting a case in the present paper KEY WORDS Dentigerious cyst impacted tooth Third molar maxillary sinus Orbital floor INTRODUCTION Dentigerous cyst is the second most common odontogenic cyst developed by the accumulation of fluid within the follicular space of an un erupted or impacted tooth after its crown has fully formed 1

The teeth most commonly involved are the third molars the canines and the second premolars 1 2 Usually no symptoms are associated with Dentigerous cysts unless there is an infection it is followed by a painful swelling A Dentigerious cyst can expand cortical plates and may cause destruction of the tissues and facial asymmetry 2 Radiographically the Dentigerous cysts typically show a unilocular radiolucent shadow with a well defined sclerotic border associated with the crown of an unerupted tooth but an infected cyst will show ill defined borders 3 Dentigerous cysts associated with unerupted teeth within the maxillary sinus displaced at infra orbital border is very rare Case report A 17 year old male patient reported to dental department of Grant medical college sir J J group of hospitals Mumbai with chief complaint of asymptomatic swelling gradually increasing in size on left side of maxilla since four months No h o sinusitis and no pain in the tooth Medically the patient was fit with all vitals within normal limits personal and family history was unremarkable Extra oral examination Showed 3 3 cm non inflammatory palpable swelling present on left side of maxilla Lymph nodes were not palpable Mouth opening and T M J movements were within normal limits Intraorally on clinical examination patients oral hygiene was good 3 3cm non inflammatory palpable swelling was present from upper left canine to left second molar tooth No pain on percussion in any of maxillary left posterior teeth Egg shell crackling was present No abnormality was detected in the buccal mucosa tongue floor of the mouth palatal and tonsillar area 



On palpation there was thinning of the buccal cortical bone in region of left upper canine to second molar Blood and urine examination were within normal limit Radiographic examination included a P A waters O P G x ray showed presence of radiolucent area with haziness of maxillary sinus with destruction of the antrum wall Radiological findings revealed that the presence of tooth in the roof of the sinus at infra orbital border with well defined margins Although a CT scan was required to confirm the extent of destruction of the antrum walls but because of financial constraints patient could not afford it Aspiration biopsy was performed intra orally through the perforation of the left buccal cortex through wide bone needle 20 gauges 10 ml white pus like fluid substance was aspirated After aspiration swelling was reduced the specimen was sent for pathological test On the basis of history clinical examination radiographic examination and aspiration a provisional diagnosis of an infected Dentigerous cyst associated with an un erupted left maxillary third molar was done Differential Diagnosis Infected Dentigerous cyst Dentigerous keratocyst Treatment Caldwelluc procedure was planned to enucleate Dentigerious cyst Surgical procedure Since a provisional diagnosis of based on clinical radiological aspiration biopsy findings Dentigerous cyst was made treatment was planned as in enucleation of cyst 



The fluid was aspirated from the cyst and incision was made in the buccal vestibule from canine to second molar region in the mucosa above the attachment gingiva The window was made in the sinus after elevation of the full thickness mucoperiosteal flap Sinus was approached from that wall it was observed that the third molar was visible at the infraorbital region The cystic lining was separated from the sinus lining tooth was located with the help of endoscope and was elevated and extracted The lesion along with the lining was completely enucleated without remnants to avoid multiplicity Drain was put in the sinus and the mucosal closure done with 3 0 vicryl sutures The specimen obtained was sent for histopathological examination and was found to be infected Dentigerious cyst Discussion References 1 Szerlip L Displaced third molar with dentigerous cyst An unusual case J Oral Surg 1978 36 551 2 PubMed 2 Elango S Palaniappan SP Ectopic tooth in the roof of the maxillary sinus Ear Nose Throat J 1991 70 365 6 PubMed 3 Goh YH Ectopic eruption of maxillary molar tooth an unusual cause of recurrent sinusitis Singapore Med J 2001 42 80 1 PubMed 4 Amin ZA Amran M Khairudin Removal of extensive maxillary dentigerous cyst via a Caldwell Luc procedure Arch Orofac Sci 2008 3 48 51 5 Srinivasa Prasad T Sujatha G Niazi TM Rajesh P Dentigerous cyst associated with an ectopic third molar in the maxillary sinus A rare entity Indian J Dent Res 2007 18 141 3 PubMed 6 Wang Chih Jen Huang Po Hsien Wang Yin Lai Shyng Yih Chung Kao Wen Bin Dentigerous cyst over maxillary sinus A case report and literature review Taiwan J Maxillofac Surg 2009 20 116 24


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