INFLAMMATORY ODONTOGENIC CYST. A CASE REPORT

Abstract

The aim of this case report is therefore to highlight the management of inflammatory cysts of the maxilla in a 32 year-old female patient with previous history of root canal therapy on the upper anterior teeth, who presented with a bluish oval-shaped swelling measuring about 1.5cm x 1cm, located labially between #22 and #23, with no tenderness and little palatal extension. [...]the radicular cyst is one of the commonest types of inflammatory odontogenic formations that requires prompt and detailed treatment with regular monitoring, in order to prevent undue epithelial cells transformation. CASE REPORT A 32 year-old female patient presented to the intern clinic with 2 months history of jaw swelling, labially, on the upper left anterior region.

Headnote

Abstract

Inflammatory odontogenic cysts are pathological fluidfilled cavities lined by the epithelium, originating from the remnants of odontogenic epithelial cells - such as rests cells of Malassez [1]. They result from the infection of root canals caused by caries or trauma to the pulp tissue, with resulting pulpal changes [2]. Inflammatory odontogenic cysts could be classified into: radicular (apical/ lateral periodontal or apical cyst), residual and paradental cyst, each requiring treatment. The aim of this case report is therefore to highlight the management of inflammatory cysts of the maxilla in a 32 year-old female patient with previous history of root canal therapy on the upper anterior teeth, who presented with a bluish oval-shaped swelling measuring about 1.5cm x 1cm, located labially between #22 and #23, with no tenderness and little palatal extension. Medical history was non-contributory. Lateral periodontal cyst, odontogenic keratocyst, radicular cyst as well as globulomaxillary cyst were considered as possible provisional diagnosis. Cyst enucleation with bone sauceraization using acrylic burs performed under local anesthesia was uneventful. Histology came back as radicular cyst. In conclusion, the radicular cyst is one of the commonest types of inflammatory odontogenic formations that requires prompt and detailed treatment with regular monitoring, in order to prevent undue epithelial cells transformation.

Keywords: odontogenic cysts, inflammation,

1. INTRODUCTION

Inflammatory odontogenic cysts are pathological fluid-filled cavities lined by the epithelium, originating from the remnants of odontogenic epithelial cells - such as rests cells of Malassez [1]. They result from the infection of root canals caused by caries or trauma to the pulp tissue, with resulting pulpal changes [2]. Inflammatory odontogenic cysts could be classified into: radicular (apical/ lateral periodontal or apical), residual and paradental cyst, each requiring treatment. The aim of this study is to highlight the management of inflammatory cysts of the maxilla which can be performed under local anesthesia in a dental clinic setting.

2. CASE REPORT

A 32 year-old female patient presented to the intern clinic with 2 months history of jaw swelling, labially, on the upper left anterior region. There was a previous history of root canal therapy on #22 and #23, performed 2 months prior to presentation. Medical history was non-contributory. Examination revealed a bluish oval-shaped swelling measuring about 1.5cm x 1cm, located labially between #22 and #23, with no tenderness and little palatal extension. Radiological investigation noted a pear-shaped radiolucency between the left upper lateral incisor and the canine. Radiographically, the lesion measures about 2 x 2.7 cm in its widest part. The associated teeth were endodontically treated, the canine showing restorative defect. Lateral periodontal cyst, odontogenic keratocyst, radicular cyst as well as globulomaxillary cyst were considered as a possible provisional diagnosis. Patient was scheduled for surgery under local anesthesia 3 days post-presentation. A triangular mucoperiosteal flap was raised after achieving anesthesia of the area, using 2% mepivacaine containing 1:100,000 adrenalin, using a Moths number 9 periosteal elevator. The cyst was enucleated using the same periosteal elevator and the resulting cavity suacerized using a round vulcanized rose head bur under copious normal saline irrigation. Mucoperiosteal flap was sutured back in position using black silk sutures after achieving haemostasis. Patient received 500 mg of Amoxicillin 3x daily for 5 days, and Ibuprofen 400 mg 3x daily, for 3 days. The cystic tissue was placed in a formalin container, properly labeled and sent to the pathologist. Patient was consulted 24 hrs after surgery and the sutures were removed 7 days post operatively. Healing was satisfactory and the patient was grateful. The pathology report attested a radicular cyst, so that the patient was referred back to the endodontic department for reassessment of the endodontically treated #22 and #23. Patient was again examined 3 months post operatively and the healing was very satisfactory, with new bone formation filling the residual bone defects from the surgery, as radiographically observed.

3. DISCUSSION

The radicular cyst is a common inflammatory odontogenic slow growing formation, which affects the anterior maxilla more than the mandible, being more common between the third and fourth decades of life [3]. It accounts for about two-third of the odontogenic cysts of the maxilla, being usually associated with anterior teeth [3,4]. Radicular cysts occur less in females compared to males, in a ratio of 1: 1.6 even though some studies have reported a higher female preponderance - our case being of a female patient [3,5,6]. The treatment of these lesions is usually dependent on their location and size, and may include root canal therapy, enucleation and marsupialization [7,8]. Enucleation and saucerization was our treatment of choice in this case, considering cyst size and its localization on the anterior maxilla. Transformation within the cells of the radicular cyst epithelium has been reported in literature, with possible malignant transformation [3]. Also, squamous odontogenic tumors like proliferations within the lining of radicular cysts have also been reported, noted as commoner in maxillary radicular cysts [8,9]. These possible changes within the radicular cyst epithelium require a prompt treatment of these inflammatory cysts.

4. CONCLUSIONS

The radicular cyst is one of the commonest types of inflammatory odontogenic formations, requiring a prompt and detailed treatment with regular monitoring, in order to prevent undue epithelial cells transformation.

References

References

1. Nair PN. New perspectives on radicular cysts: Do they heal? Int Endod J 1998;31(3):155-60

2. Jamdade A, Nair GR, Kapoor M, Sharma N, Kundendu A. Localization of a peripheral residual cyst: diagnostic role of ct scan. Case Rep Dent. 2012;2012:760571. doi: 10.1155/2012/760571.

3. Koju S, Chaurasia NK, Marla V, Niroula D, Poudel P. Radicular cyst of the anterior maxilla: An insight into the most common inflammatory cyst of the jaws. J Dent Res Rev. 2019;6:26-9.

4. Regezi JÁ, Sciubba JJ. Patologia bucal, 3rd ed. Rio de Janeiro:Guanabara Koogan. 2000.

5. Shimita KR, Umadi HS, Priya NS. Clinicopathological study of 100 odontogenic cysts reported at v s dental college- a retrospective study. J Adv Dent Res. 2011;2(1):51-7.

6. Santos LCS, Ramos EAG, Meira TM, Figueiredo CRLV, Santos JN. Etiopatogenia do cisto radicular: parte I [article in Portuguese]. R Ci Méd Biol., Salvador. 2006; 5(1):69-74.

7. Joshi NS, Sujan SG, Rachappa MM. An unusual case report of bilateral mandibular radicular cysts. Contemp Clin Dent. 2011;2(1):59-62.

8. Bodner L. Cystic lesions of the jaws in children. Int J Pediatr Otorhinolaryngol 2002; 62(1):25-9.

9. Parmar RM, Brannon RB, Fowler CB. Squamous odontogenic tumor- like proliferations in radicular cysts: A clinicopathologic study of forty-two cases. J Endod. 2011;37(5):623-6.