Mandibular Fracture Associated with a Dentigerous Cyst: Report of a Case and Literature Review

[Nasal obstruction: Odontogenic cysts in 4 brachycephalic dogs]

OBJECTIVE

Odontogenic cysts may be of developmental or inflammatory origin. They are frequently observed in brachycephalic dogs. Due to their expansive growth, cysts in the maxilla may extend into the nasal cavity, obstruct the nasal airway and cause nasal discharge. Epithelial cysts may lead to a comparable clinical picture. A new endonasal endoscopic intervention for the removal of these cysts is described.

MATERIAL AND METHODS

Four brachycephalic dogs (Boxer, Chihuahua, French bulldog, Pug) with unilateral cysts obstructing the nasal cavity were included in the study. The animals underwent clinical examination, computed tomography (CT) imaging and rhinoscopy examination. Histopathologic evaluation of the cyst wall was performed. In addition to dental surgery and conventional extraction of the involved tooth, the cyst wall was removed by endoscopic intervention via the physiologic nasal opening. Clinical course following treatment was assessed by rhinoscopy and CT.

RESULTS

The main clinical signs were unilateral or bilateral serous to hemorrhagic nasal discharge. Nasal airflow was restricted in all patients. Removal of the cysts and involved teeth did not lead to any intra- and postoperative complications. No recurrence of the cysts was observed. Histologic diagnosis consisted of an epidermoid cyst, a follicular cyst, a radicular cyst, and a canine odontogenic parakeratinized cyst (COPC). Neoplastic transformation was excluded in all cases.

CONCLUSIONS

Removal of the cyst wall may be performed by means of minimally invasive endoscopic intervention via the physiologic nasal entrance. The procedure is curative and carries the risk of only few complications. In cases in which treatment is restricted to extraction of the affected tooth, the nasal airway may remain obstructed due to a calcified cyst wall.

CLINICAL RELEVANCE

In brachycephalic dogs, oronasal defects due to dental pathology are the most common reason for chronic nasal discharge, whereas in normocephalic dogs nasal neoplasia are. Odontogenic cysts carry importance as differential diagnosis of nasal discharge.

[Clinical analysis of the treatment of maxillary odontogenic cyst by nasal endoscope fenestration through nasal base]

Objective:To investigate the feasibility and clinical effect of the surgical approach and method of transnasal fenestration under nasal endoscope for the treatment of maxillary odontogenic cyst. Methods:The clinical data of 23 cases with maxillary odontogenic cysts treated by nasal endoscopy through nasal fenestration were retrospectively analyzed. All cases underwent nasal endoscopy and CT examination before the operation. The mucosal membrane of the parietal wall of the cyst was excised through fenestration of the nasal base. The cyst fluid was removed by decompression, and the bony opening of the nasal base was trimmed and enlarged to the edge of the cyst. The intraoperative and postoperative effects were observed. Results:All cases were well exposed under the direct vision of nasal endoscope. The top wall of the cyst was removed to maximize the communication between the cyst cavity and the nasal floor. There were no complications such as nasolacrimal duct injury, turbinate atrophy, necrosis, and facial numbness. All patients were followed up for 6-12 months, and the clinical symptoms gradually disappeared after surgery. The inferior turbinate was in good shape, the cyst cavity was smooth, the cyst wall was determined, and no cyst recurrence was observed. Conclusion:The treatment of odontogenic cyst of maxilla under nasal endoscope through nasal fenestration is convenient. It has less trauma, fewer complications and a satisfactory curative effect, which is worthy of clinical promotion.

Vertical direction impaction of kissing molars: A case report

BACKGROUND

Kissing molars (KMs) are a scarcely reported form of molar impaction in which the occlusal surfaces contact each other within a single dental follicle and the roots point in opposite directions. The direction of KMs impaction is generally tilted. KMs with vertical direction impaction have not been reported in the literature.

CASE SUMMARY

A 25-year-old female visited a dentist for right maxillary wisdom teeth extraction and was diagnosed with two vertically impacted KMs in the left mandible on panoramic radiography. After cone-beam computed tomography examination confirmed no secondary complication, the patient chose to undergo observation and regular follow-up. A literature review of KMs revealed that vertical impacted KMs are rare; high-quality evidence regarding their prevalence is still lacking. At present, the causality of KMs is controversial. In this study, we have tried to provide a detailed definition of KMs to allow an accurate evaluation of their prevalence and classification based on their impaction direction which may be related to their pathogenesis. The treatment plan of KMs depends on the condition and location of the affected teeth and associated complications; they may be either directly extracted or treated using a multidisciplinary approach including maxillofacial surgeons and orthodontists.

CONCLUSION

KMs are a rare clinical condition of impacted teeth with unclear pathogenesis. Vertically impacted KMs were seldom reported. Reasonable definition and classification of KMs can help in the understanding of their causes and prevalence.

An Analysis of Dentigerous Cysts Developed around a Mandibular Third Molar by Panoramic Radiographs

Dentigerous cysts are one of the most prevalent types of odontogenic cysts and are associated with the crown of an unerupted tooth, especially of the mandibular third molar. In this study, the characteristics of a dentigerous cyst developed around a mandibular third molar on panoramic radiographs were investigated. The panoramic images of 257 consecutive dentigerous cyst cases associated with a mandibular third molar were analyzed. The mean age of the patients was 45.9 ± 13.3 years. The size of the cyst did not significantly correlate to the age of the patient. The unilocular type (89.1%) and the crown side type (68.5%) were significant. The associated mandibular third molars had a high frequency of class III (64.6%) and position B (48.3%) in Pell and Gregory classification and of horizontal position (36.3%) in angulation. Dentigerous cysts were thought to originate and grow commonly around deeply impacted third molars. The associated third molar with dentigerous cyst tends to have a mesial inclination. Dentigerous cysts do not appear to develop gradually after the crown formation has finished, but arise at various periods randomly.

Regeneration of Cystic Bone Cavities and Bone Defects With Bioactive Glass S53P4 in the Upper and Lower Jaws

Cysts and tumors are common lesions in the jaws. To be able to retain a good volume of the alveolar ridge during healing as well as strengthening the angle and body of the mandible and provide an instant improved support for adjacent teeth, reliable long-term bone regeneration is needed. The purpose of this prospective study was to promote bone regeneration by filling bony defects in the upper or lower jaw with granules of the bioactive glass S53P4 (BAG), which have osteostimulative and antimicrobial properties.The authors treated 20 patients (21 defects) surgically; benign tumors, cysts, or infection related to impacted teeth in the maxilla or mandible. The tumor or cyst was removed or enucleated and thorough cleaning of the infected area was performed. The bone cavity was filled with granules of the BAG S53P4 despite signs of chronic infection in the area at the time of surgery. The patients were followed up for an average of 34 months clinically and with cone beam computerized tomography for 28 months. In 20 defects the final outcome was successful. Despite infection at the time of surgery in 65% of the patients, no material associated infection was seen during the follow-up. The BAG S53P4 granules were radiologically remodeled into bone after 2 years follow-up. The use of granules of the BAG S53P4 in the treatment of large bone defects provides infection-free reliable bone regeneration despite chronic infection at the time of surgery, which improves the prognosis of adjacent teeth.

Coronectomy and dentigerous cysts: a review of 68 patients

OBJECTIVE

This large case series retrospectively reviewed the outcomes of coronectomy in conjunction with dentigerous cyst removal in 68 patients at the oral surgery department of Guy's Hospital.

STUDY DESIGN

A retrospective review of 68 patients was undertaken in a single department where 73 teeth with associated dentigerous cysts were treated by coronectomy to reduce the risk of inferior alveolar nerve injury or mandibular fracture.

RESULTS

One patient experienced permanent injury of the inferior alveolar nerve. There were no intraoperative mandibular fractures in this series. Four coronectomy roots required retrieval at 2, 4, and 20 months and 10 years after the initial surgery due to persistent surgical site infection and incomplete coronectomy with retained enamel and associated cystic tissue leading to symptoms. The longest follow-up in this series was 10 years for 2 patients, and 30 of 68 patients were reviewed between 1 and 3 years postoperatively.

CONCLUSION

Coronectomy in conjunction with dentigerous cysts is an effective treatment, with minimal morbidity seen in both short- and long-term periods.