Radiographic Incidental Finding of an Aggressive Dentigerous Cyst

Farzad Nourollah-Zadeh

---

Nourollah-Zadeh, Farzad, Dayo, Adeyinka
University of Pennsylvania School of Dental Medicine, Department of Oral Medicine

Introduction

Early detection of odontogenic cysts 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.

Methods

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 gastrointestinal stromal tumor. Clinical examination revealed 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. Cone beam computed tomography (CBCT) and histopathologic evaluation confirmed the diagnosis of a Dentigerous cyst and CBCT was useful in lesion localization and surgical planning.

Results

Dentigerous cysts are well-defined, benign, developmental, odontogenic lesions that surround the crown of an unerupted tooth. As documented in literature, it is more commonly seen in the posterior mandible and less common in the anterior maxilla. A previously published retrospective study on 397 patients with odontogenic cysts and tumor, reported the posterior mandible as the most common site for Dentigerous cysts. In this case, the lesion presented in the maxilla, associated with impacted #6 and with no clinical symptoms or signs. These cysts are commonly asymptomatic and therefore noticed either by incidental radiographic finding, or by noticeable facial swelling/asymmetry from significant increase in size of cyst with bony expansion. As the cyst enlarges, it has the capacity to displace the tooth from which the cyst originated and adjacent vital structures. In this case, there was no obvious clinical sign, but the lesion originated around impacted #6 and expanded medially to perforate and destroy the right nasal floor and expand the facial aspect of the maxilla.

Conclusion

The prevalence of incidental findings on panoramic radiographs is about 26%, and they could provide life-saving information. As highlighted in this case, Dentigerous cysts are expansile lesions with propensity for bone destruction without overt clinical symptoms.