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169:Radiographic Incidental Finding Of An Aggressive Dentigerous cyst[AAOM2021]
EP36064
Poster Title: 169:Radiographic Incidental Finding Of An Aggressive Dentigerous cyst[AAOM2021]
Submitted on 29 Mar 2021
Author(s): Farzad Nourollah-zadeh, Adeyinka Dayo
Affiliations: University of Pennsylvania, United states, Phyladelphia
This poster was presented at 2021 American Academy of Oral Medicine Virtual Conference
Poster Views: 228
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Poster Information
Abstract: Background:

Odontogenic cysts are epithelial-lined pathologic lesions surrounded by fibrous connective tissue of odontogenic origin in the maxilla and mandible. Dentigerous cysts are more commonly seen in the posterior mandible. Early detection of these lesions and referral for appropriate management will prevent excessive bone destruction and improved management outcomes. We describe a case of a radiographic incidental finding of an aggressive dentigerous cyst in the maxilla.

Case Summary:

A 71 year old male presented to the Oral Medicine Clinic at Penn for admissions fair with specific complaint of severe pain from area of #28 and #29. Medical history included Rheumatoid Arthritis, asthma and metastatic gastrointenstinal stromal tumor.

Clinical examination revealed a partially edentulous patient with carious teeth and retained roots. Grossly broken down #28 and #29 had pulpal necrosis with mild right side facial swelling. A panoramic radiograph obtained, confirmed the clinical findings. However, there was an incidental finding of impacted tooth in the right maxilla surrounded by a distinct, expansile, corticated radiolucency elevating the right maxillary sinus floor suggestive of a cystic lesion. A cone beam computed tomography was acquired. Findings revealed horizontal impaction of #6 in an antero-posterior orientation along the right lateral hard palate. The crown was surrounded by a well-defined, corticated, unilocular, expansile, ovoid, soft-tissue density lesion measuring approximately 3X2X2 cm. The crown of impacted #6 was the epi-center of the lesion with the root perforating the palatal cortex. There was associated expansion and erosion of the buccal cortex and anterolateral wall of the right maxillary sinus, with partial occlusion of the sinus cavity by the elevated sinus floor. Medially, the lesion displaced the floor of the right nasal fossa superiorly with associated severe erosion. Radiographically, heterogenous attenuation within this lesion is reflective of protein-rich fluid and soft tissue. Histologic findings was consistent with a diagnosis of squamous lined odontogenic cyst consistent with dentigerous cyst. The lesion was enucleated with extraction of impacted #6.

Conclusion:

The prevalence of incidental findings on panoramic radiographs is about 26%, and they could provide life-saving information. Dentigerous cysts are expansile lesions with propensity for bone destruction without overt clinical symptoms.
Summary: Odontogenic cysts are epithelial-lined pathologic lesions surrounded by fibrous connective tissue of odontogenic origin in the maxilla and mandible. Dentigerous cysts are more commonly seen in the posterior mandible. We describe a case of a radiographic incidental finding of an aggressive dentigerous cyst in the maxilla.

Ask the author questions about this poster:farzadnz@upenn.edu
References: 1. Parkar MI, Belgaumi UI, Suresh KV, et al Bilaterally symmetrical infected radicular cysts Case report and review of literature J Oral Maxillofac Surg Med Pathol 2017 29 5 458 62
2. Ferreres J, Sánchez A, Aguirre J, Escoda C Dentigerous cyst with parietal and intra cystic calcifications A case report and literature review Exp Dent 2018 e 296 9
3. Prockt AP, Schebela CR, Maito FD, Sant'Ana Filho M, Rados PV Odontogenic cysts analysis of 680 cases in Brazil Head Neck Pathol 2008 2 150 6
4. Macluskey M Nayyer Citation for published version, Odontogenic Cysts An Overview Dental Update, 42 6 548 555 42 N V Keys, W 2015
5. Monteiro L,Santiago C,Amaral B, Al Mossallami A,Albuquerque R,Lopes C Oral Medicine and Pathology Publication Types: Research
doi:10.4317/medoral.24337
6. Henien M, Sproat C, Kwok J, Beneng K, Patel V Coronectomy and dentigerous cysts a review of 68 patients Oral Surg Oral Med Oral Pathol Oral Radiol 2017 123 670 674
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