Clinical and radiological features of a large radicular cyst involving the entire maxillary sinus

Year 2012, Volume: 2 Issue: 1, 31 - 36, 31.01.2014

Filiz Namdar Pekiner , Oğuz Borahan Faysal Uğurlu Sinan Horasan B. Cem Şener Vakur Olgaç

Abstract

Objectives: Epithelium at the apex of a nonvital tooth can be presumably stimulated by inflammation to form a true epithelium-lined cyst, or radicular cyst. The source of the epithelium is usually a rest of Malassez but also may be traced to sinus lining or epithelial lining of fistulous tracts. Cyst development is common; the reported frequency varies from 7% to 54% of periapical radiolucencies. The incidence of radicular cysts is greater in the third to sixth decades and shows a slight male predominance. Most of the radicular cysts are found in the maxilla, especially around incisors and canines.
Methods: A 38-year-old male patient was referred to the Department of Oral Diagnosis and Radiology, Faculty of Dentistry, Marmara University, with a complaint of bilateral painless swelling on the anterior of hard palate. The swelling was smooth-surfaced and measured roughly 6 cm. in size. There were no filled teeth, but right maxillary canine was nonvital. Panoramic radiography showed radiolucency with partially sclerotic border from right premolar to left canine in alveolar process. The area was examined with conventional computed tomography to evaluate bone involvement. Coronal and axial computed tomography images showed expansive process occupying most of right maxillary sinus with a very thin sclerotic border. Cone-beam computed tomography image reconstructions showed aggressive destruction and extension into the maxillary sinus. The patient’s operation was carried out under general anesthesia. Enucleation after incision and mucoperiosteal flap elevation was performed for both cysts in bilateral locations. In order to avoid postoperative hemorrhage and edema antrotomy was performed. Operation side was sutured primarily. 
Conclusion: This presentation describes a relatively rare case of giant radicular cyst occurrence in maxillary sinus and its treatment. Radiological examinations provided valuable information.

Key words: Computed tomography, dental volumetric tomography, radicular cyst

Keywords

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Tüm maksiller sinüsü kaplayan büyük bir kistin klinik ve radyolojik özellikleri

Abstract

Amaç: Devital bir dişin apeksindeki epitel olası bir enflamasyon ile uyarılarak radiküler kist oluşturabilir. Epitelin kaynağı Malassez artıklarıdır; ancak sinüs sınırı veya fistül yollarının epitelinden de kaynaklanabilir. Radyografik olarak saptanan radyolusent alanların %7-%54’ünü kistler oluşturmaktadır. Radiküler kistler; 30-60’lı dekatta ve erkeklerde daha fazla görülmektedir.
Metodlar: 38 yaşında erkek hasta Marmara Üniversitesi Diş Hekimliği Fakültesi Oral Diagnoz ve Radyoloji Anabilim Dalı’na palatinal anterior bölgede çift taraflı ağrısız şişlik şikayeti ile başvurmuştur. Şişlik yüzeyi pürüzsüz ve boyutu yaklaşık 6 cm olarak ölçüldü.. Vitalometrik muayenede sağ maksiller kaninin devital olduğu belirlenmiştir. Panoramik radyografide sağ 1. Premolardan sol kanine doğru kısmen sklerotik sınır ile çevrili radyolusent alan izlenen olgunun koronel ve aksiyel bilgisayarlı tomografi görüntülerinde de çevresi ince bir sklerotik sınır ile çevrili sağ maksiller sinüsün büyük bölümünü kaplayan ekspansif proçes izlenmiştir. Volumetrik Bilgisayarlı Tomografi rekonstrüksiyonunda agresif tarzda destrüksiyon ve maksiller sinüse doğru geniş yayılım saptanmıştır. Hasta genel anestezi altında opere edilmiş, insizyon ve mukoperiostal flap kaldırıldıktan sonra kist bilateral olarak enükle edilmiştir. Post-operatif kanama veya ödemi engellemek için antrotomi yapılarak, operasyon sahası primer olarak suture edilmiştir. 
Sonuç: Bu çalışmada maksiller sinüse doğru geniş yayılım gösteren nadir bir radiküler kist olgusunun klinik-radyolojik değerlendirilmesi ve tedavisi sunulmuştur.

Anahtar Kelimeler : Bilgisayarlı tomografi, dental volumetrik tomografi, radiküker kist

Keywords

Bilgisayarlı tomografi, dental volumetrik tomografi, radiküker kist

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