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INFLAMMATORY ODONTOGENIC CYST. A CASE REPORT
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Radicular cyst is believed to be derived from the epithelial cell rests of Malassez. The associated tooth is nonvital, usually asymptomatic, and may result in swelling, tenderness, tooth mobility, or other problems with rare possibility of neoplastic transformation of its epithelial lining. The treatment options include endodontic procedure, extraction of offending tooth, enucleation with primary closure, and marsupialization. The present report describes the case of a radicular cyst of anterior maxillary region in a 31-year-old male patient, with a detailed description of clinical, radiographic, histopathologic features, pathogenesis, and its surgical management.
Resumo As lesões periapicais crônicas decorrem principalmente da infecção dos canais radiculares, devido à doença cárie. Sabe-se que o processo imuno-inflamatório é a base de formação dos granulomas dentários e cistos radiculares, favorecido pela defesa primária e mediado por células como macrófagos e neutrófilos, ou através de uma defesa específica, mediada por linfócitos e células apresentadoras de antígenos, como as Células de Langerhans. O presente trabalho se propõe a apresentar os aspectos gerais sobre a etiopatogenia dos cistos radiculares, cuja complementação a respeito destas lesões e a avaliação morfológica das mesmas serão objeto da segunda parte deste estudo. Palavras-chave: cisto radicular – etiopatogenia; lesões periapicais.
The term residual cyst is used most often for retained radicular cyst from teeth that has been removed. Residual cysts are among most common cysts of the jaws. The location of all odontogenic cysts is usually intraosseous. The peripheral (extraosseous) presentations are rare. The peripheral presentation of residual cyst has never been reported in the literature. In this article, the role of CT in diagnosing an unusual peripheral presentation of a residual cyst is discussed.
A radicular cyst is one of the most common odontogenic cysts of anterior maxilla, not commonly seen in adolescence. Here, we present a rare, atypical case, of bilateral radicular cysts of the mandibular posterior region in a 13-year-old girl. The patient management comprised surgical enucleation of cystic sac under general anesthesia followed by rehabilitation of the same area. The purpose of this article is to lay emphasis on the pedodontist's role in early diagnosis and treatment of such lesions.
Squamous odontogenic tumor-like epithelial islands occurring in the walls of odontogenic cysts are histologically identical to the squamous odontogenic tumor (SOT). Microscopically, the squamous odontogenic tumor-like proliferations (SOTLPs) share certain histologic features with SOT, acanthomatous and desmoplastic ameloblastoma, and well-differentiated squamous cell carcinoma. Little is known about the rarely reported SOTLPs occurring in radicular cysts. The purpose of this study was to define the clinical and histopathologic spectrum of SOTLP in radicular cysts and to investigate its histogenesis, prevalence, and biologic behavior.
A retrospective clinicopathologic study was conducted at the Louisiana State University School of Dentistry, and a total of 42 radicular cysts with SOTLPs were accepted. Clinical findings and detailed histopathologic features were documented, and follow-up information was solicited for the 42 cases.
Forty-two cases of radicular cysts with SOTLPs were found among 1241 radicular cysts. Two thirds of the cases revealed the SOTLPs were arising from budlike extensions of the epithelial lining of the cyst. The SOT-like epithelial islands were in areas free of inflammatory cells in 73.8% of the cases. No evidence of recurrence or unexpected clinical behavior was reported in 11 cases with adequate follow-up.
The prevalence of SOTLPs in radicular cysts at Louisiana State University School of Dentistry is 3.4%. The SOTLPs appear to originate from the epithelial lining of the cyst and do not appear to be directly associated with inflammation. The biologic behavior of the radicular cyst with SOTLP is innocuous, with no apparent potential for neoplastic transformation or recurrence.
During the past few decades several authors have perpetuated the notion that nearly half of all periapical lesions are radicular cysts. A few studies, based on meticulous serial sectioning of periapical lesions retrieved in toto, have shown that the actual incidence of radicular cyst is only about 15% of all periapical lesions. Equally significant was the discovery in 1980 and recent confirmation that radicular cysts exist in two structurally distinct classes namely, those containing cavities completely enclosed in epithelial lining (periapical true cysts) and those containing epithelium-lined cavities that are open to the root canals (periapical pocket cysts). From a clinical point of view a periapical pocket cyst may heal after conventional root canal therapy whereas an apical true cyst is less likely to be resolved without surgical intervention.
Sixty nine pediatric patients with cystic lesions of the jaws were successfully diagnosed and treated. Thirty one (45%) were dentigerous cysts (D.C.), 15 (22%) were eruption cysts (E.C.), 12 (17.3%) were traumatic bone cysts (T.B.C.), nine (13.3%) were radicular cysts (R.C.), one (1.5%) was primordial cyst (P.C.) and one (1.5%) globulomaxillary cyst (G.M.C.). The mean age for E.C., R.C., D.C., T.B.C. was 4.7, 9.2, 11.5, and 13.3 years, respectively. The mean age of E.C. is significantly (P<0.05) younger than D.C. and T.B.C. but not from R.C. No significant age differences were found between R.C., D.C. and T.B.C. The differences in mean cyst diameter were not significant. Male to female ratio was 1. The treatment modalities were: marsupialization, enucleation or enucleation with bone grafting. The findings demonstrate that the distribution and characteristics of jaw cysts in children is unique and is different from the distribution in adults. The relatively high rate of developmental cyst and the fact that they occur in an area with rapid developmental changes, suggest the need for more conservative surgical management in this selected patient population.
Clinicopathological study of 100 odontogenic cysts reported at v s dental college-a retrospective study
- K R Shimita
- H S Umadi
- N S Priya
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.