|
 
 |
| CASE REPORT |
|
| Year : 2018 | Volume
: 9
| Issue : 1 | Page : 37-39 |
|
Bilateral radicular cyst of the mandible: A rare case report
P Venkatalakshmi Aparna1, S Ramasamy2, S Leena Sankari3, F Massillamani1, A Priyadharshini1
1 Department of Oral Medicine and Radiology, Ragas Dental College and Hospital, Chennai, India
2 Department of Oral Medicine and Radiology, Rajah Muthaih Dental College and Hospital, Chidambaram, Tamil Nadu, India
3 Department of Oral Pathology and Microbiology, Sree Balaji Dental College and Hospital, Chennai, India
| Date of Web Publication | 16-Mar-2018 |
Correspondence Address:
Dr. P Venkatalakshmi Aparna
No. 12, Nagarathinam Nagar, Thiruneermalai Road, Kadaperi, West Tambaram, Chennai - 600 045, Tamil Nadu
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/srmjrds.srmjrds_62_17
Radicular cysts are the most common inflammatory cysts and arise from the epithelial residues in the periodontal ligament as a result of periapical periodontitis following death and necrosis of the pulp. Cysts arising in this way are found most commonly at the apices of the involved teeth, but may also be found on the lateral aspects of the roots in relation to lateral accessory root canals. Many radicular cysts are symptomless and are discovered when periapical radiographs are taken of teeth with nonvital pulps. The classic description of the radiological appearance of radicular cysts is that they are round or ovoid radiolucencies surrounded by a narrow radiopaque margin which extends from the lamina dura of the involved tooth. This case report presents a rare case of bilateral radicular cysts of the mandibular posterior region.
Keywords: Bilateral mandibular radicular cyst, multilocular radiolucency, odontogenic cyst, periapical cyst, surgical enucleation
How to cite this article:
Aparna P V, Ramasamy S, Sankari S L, Massillamani F, Priyadharshini A. Bilateral radicular cyst of the mandible: A rare case report. SRM J Res Dent Sci 2018;9:37-9 |
How to cite this URL:
Aparna P V, Ramasamy S, Sankari S L, Massillamani F, Priyadharshini A. Bilateral radicular cyst of the mandible: A rare case report. SRM J Res Dent Sci [serial online] 2018 [cited 2023 May 30];9:37-9. Available from: https://www.srmjrds.in/text.asp?2018/9/1/37/227766 |
| Introduction | |  |
Radicular cyst is the most common odontogenic cyst. These cysts comprise about 52% to 68% of all the cysts affecting the human jaw. Radicular cyst involves the apex of erupted tooth and sequel of periapical granuloma originating as a result of bacterial infection and necrosis of the dental pulp, nearly always following carious involvement of tooth. The epithelium is derived from epithelial rests of Malassez in the periodontal ligament, which proliferate as a result of inflammatory stimulus in a pre-existing granuloma. Epithelium may be derived in some case from 1) Respiratory epithelium from maxillary sinus when the periapical communicates with the maxillary sinus 2) Oral epithelium from a fistulous tract 3) Oral epithelium proliferating apically from a periodontal pocket. Their incidence is highest in third and fourth decade of lifespan with male dominance. We present a rare case with bilateral radicular cyst in relation to mandibular posteriors.
| Case Report | | |
A 28-year-old female patient reported to the Department of Oral Medicine and Radiology with a chief complaint of dull pain followed by swelling on the lower right side of the face for 15 days. Presenting illness revealed that the patient had similar pain associated with swelling in the same region 6 months before and had taken medication prescribed by dentist. The pain was gradual in onset, continuous, dull aching, nonradiating, aggravated during chewing, and relived on medication. The patient developed swelling, 3 days before which was sudden in onset and gradually progressed to attain the present size.
On extra oral examination, there was a single diffuse smooth swelling noted on the right lower 3rd region of the face measuring about 3 cm × 3 cm in size extending superiorly 1 cm from the zygomatic bone, inferiorly till the lower border of the mandible, medially 1.5 cm from the commissure of the lip, and laterally 1 cm in front of tragus of the ear. The surface over the swelling was normal. On palpation, it was smooth, firm with egg shell crackling, nontender, and fluctuant. The inferior border of the mandible is intact [Figure 1]a. The right submandibular lymph nodes were palpable, mobile, and tender. On intraoral examination, there was a swelling obliterating the vestibule on the right mandibular posterior region in relation to 46, 47, and 48 which measured about 2 cm × 2 cm in size. On palpation, the swelling was mildly tender and firm in consistency [Figure 1]b. | Figure 1: (a) Swelling of the face. (b) Swelling and obliteration of the buccal vestibule
Click here to view |
Fine-needle aspiration cytology was performed which revealed straw-coloured fluid. Based on the above clinical findings, the provisional diagnosis of radicular cysts of the right mandibular region was made.
The intraoral periapical radiograph showed diffuse periapical radiolucency with sclerotic border in relation to 47, 48 [Figure 2]a. The orthopantomograph showed a large, well-defined unilocular radiolucency with a sclerotic border in the periapical region of the second molar on the right side of the mandible extending from the mesial root of the second molar to the ramus of the mandible leaving 2 mm of sound bone at the inferior border of mandible. Root resorption was evident in relation to 47 and 48 region. The mandibular canal was obliterated inferiorly. Similar findings were coincidentally noted on the left side of the mandible in relation to the grossly decayed of 36 [Figure 2]b. The computed tomography (CT) scan axial section shows expansile lesion of buccal and lingual cortical plate in relation to 47, 48, and 36 regions [Figure 3]a. Three-dimensional reconstruction of CT scan revealed destruction of the buccal cortical plate in relation to 47, 48 [Figure 3]b. Incisional biopsy was done and sent for histological examination [Figure 4]a. Histopathological examination revealed nonkeratinized stratified squamous epithelial lining with inflammatory cell infiltration in the connective tissue stroma suggestive of radicular cyst [Figure 4]b. Based on history, clinical, radiographic, and histopathologic examination, the final diagnosis was made as bilateral radicular cyst in relation to 47, 48, and 36. The patient was referred to the Department of Oral and Maxillofacial Surgery where enucleation of the cyst was done under local anesthesia. The patient was followed up for 1 year, and no recurrence was observed. | Figure 2: (a) Multilocular radiolucency along with root resorption. (b) Bilateral multilocular radiolucency of the mandible
Click here to view |
 | Figure 3: (a) Expansion of the buccal cortical plate. (b) Buccal cortical plate destruction
Click here to view |
 | Figure 4: (a) Gross specimen. (b) Nonkeratinized stratified squamous epithelial lining and underlying inflammatory cell infiltration
Click here to view |
| Discussion | | |
A periapical cyst also known as radicular cyst is usually associated with carious, nonvital, discolored, or fractured tooth.[1],[2] Stimulation of cell rests of Malassez, which are found in the periodontal membrane due to trauma or pulp necrosis, also contribute to the epithelial formation of these cysts.[3] They are most common of all the jaw cysts and comprise about 52%–68% of all the cysts which affect the human jaw.[4],[5] Radicular cyst commonly occurs in the maxillary anterior region in between 30th and 50th year of age frequently in men. They may be a slow-growing bony swelling and asymptomatic. In our case, it was in mandible and bilateral presentation.
The pathogenesis of radicular cyst has three definite phases; phase of initiation, cyst formation and the enlargement.[6] Radicular cysts are generally asymptomatic and are detected by radiography, but long-standing cases may show an acute exacerbation of the cystic lesion and develop signs and symptoms such as swelling, tooth mobility, and displacement of unerupted tooth, root resorption of the affected tooth. With advanced bone resorption, the enlargement exhibit egg shell crackling.
In this present case, there was cortical perforation and adjacent teeth in relation to the cyst were nonvital.[7] It has been stated that as the cyst enlarges, adjacent teeth can become nonvital.[8]
The treatment option depends on several factors, size and location of the cyst, integrity of the wall, and proximity of the cyst with vital structures.[9] Several treatment modalities are available for radicular cysts such as surgical endodontic management, extraction of the aberrant tooth, enucleation with initial resolution, and marsupialization followed by enucleation.[10] In this case, surgical enucleation was done on both sides along with the removal of the offending teeth.
| Conclusion | | |
A radicular cyst is common condition found in oral cavity. The significance of this case report is to illustrate a rare and dramatic example of bilateral symmetric representation which shows the importance of radiographic examination before the removal of teeth.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Scholl RJ, Kellett HM, Neumann DP, Lurie AG. Cysts and cystic lesions of the mandible: Clinical and radiologic-histopathologic review. Radiographics 1999;19:1107-24.  [ PUBMED] |
| 2. | Shafer HL. Textbook of Oral Pathology. 6 th ed. Amsterdam: Elsevier; 2006. |
| 3. | Lin LM, Huang GT, Rosenberg PA. Proliferation of epithelial cell rests, formation of apical cysts, and regression of apical cysts after periapical wound healing. J Endod 2007;33:908-16. [ PUBMED] |
| 4. | Latoo S, Shah AA, Jan MS, Quadir S, Ahmed I, Purra AR, et al. Radicular cyst. JK Sci 2009;11:187-9. |
| 5. | Riachi F, Tabarani C. Effective management of large radicular cysts using surgical enucleation vs. marsupialisation. IAJD 2010;1:44-51. |
| 6. | Jansson L, Ehnevid H, Lindskog S, Blomlöf L. Development of periapical lesions. Swed Dent J 1993;17:85-93. |
| 7. | Weber AL, Kaneda T, Scrivani SJ, Aziz S. Jaw: Cysts, tumors and nontumorous lesions. In: Som PM, Curtin HD, editors. Head and Neck Imaging. 4 th ed. St. Louis, MO: Mosby; 2003. p. 930-94. |
| 8. | Andersson L, Kahnberg KE, Pogrel MA. Oral and Maxillofacial Surgery. ed. 1 st: Wiley Blackwell; 2010. |
| 9. | Uloopi KS, Shivaji RU, Vinay C, Pavitra, Shrutha SP, Chandrasekhar R, et al. Conservative management of large radicular cysts associated with non-vital primary teeth: A case series and literature review. J Indian Soc Pedod Prev Dent 2015;33:53-6. [ PUBMED] [Full text] |
| 10. | Mihailova H, Nikolov VL, Slavkov SV. Diagnostic imaging dentigerous cyst of mandible. JIMAB Ann Proc (Sci Pap) 2008;book 2. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4]
|
Search Pubmed for