MASSIVE RESIDUAL DENTAL CYST:

Case Report

George Dimitroulis & John CurtinPresented by Fitri Nursapti Arini

INTRODUCTION

A RESIDUAL CYST arises from epithelial remnants to proliferate by inflamatory process from non vital tooth that is no longer present.

Begins with a non vital tooth which developed radicular cyst.

Eventually the tooth is extracted without periapical pathosis removal

The cyst may regress, remain static or grow in size

This journal reported an individual with massive residual cyst that involve over half his edentulous mandible

Sub mental view

• A 53 year 0ld male-Had a painless golf-ball size swelling in the right parasymphyseal area of his edentulous mandible-(May, 1996)-CC: an ill fitting lower denture which he had tolerated for many years

CASE REPORT

HISTORY

Swellingin the lower right mandible had been present for many years

The last teeth in hiis mandible were extracted over 20 years ago

EKSTRA ORALSwelling in the right

mandibleBony hardPainlessGolf ball sizeParasthesia along

distribution of the right mental nerve area

INTRA ORALtotally edentulous mouthFirm, bucally expanded

alveolus in theright mandible extending anteriorly to the symphiysis

Overlying alveolar mucosa was normal, no signs of discharge or inflamation

PHYSICAL EXAMINATION

1. Panoramic radiograph

extensive but circumscribed radolucency extending from the right angle of the symphysis

involving the whole right body

DIAGNOSTIC IMAGING

2. CT scan

Corfirm the extent of the lesion

Lesion wasconfined to bone with mainly buccal expansion n little distortion of lingiual plate

Pathological fracture was evident in the prasymphysis

THE CYSTIC can be confirmed by aspirating fluid, which detected presence of cholesterol crystals

The fluid is usually watery n opalescent, sometimes more viscid, n yellowish

Sometimes a dark red colouured

The high soluble protein content of the cyst appeared to rule out an OKC

FLUID EXAMINATION

Patient was admitted to hospital in June 1996

Under GA , the right hemimandible was perform via EO

Incision & dissection : along the lower border of the right angle to symphysis and the soft tissue

TREATMENT

Having exposed all the involved right hemimandible, the expanded buccal cortical plate was osteomized and removed to reveal the cyst lining underneath

The cyst was enucleated without breaching the oral mucosa n leaving the lingual plate of mandibular cortical bone intact

The inferior alveolar neurovascular bundle was sacrificed

A bridging mandibular reconstruction plate with bicortical screws was fixed from the right angle to the symphysis to help fortify the weakened right hemimandible

An autogenous cortico cancellous bone graft was also procured from the iliac crest n placed to fill the bone defect

Post operative recovery was uneventful and patient discharged from hospital after 3 days

HISTOPATHOLOGY REPORT

- Inflamaed odontogenic cyst- -similar with radicular cyst- Less inflammed than radicular

cyst.- The epithelial lining may be thin n

regular and indistinguishable from developmental cyst : dentigerous or lateral priodontal cyst.

- No evidence of odontogenic keratocyst or neoplasia when examinned under light microscopic

CONCLUTION

Residual cyst : cyst that is retained in the jaw after removal or root filling of the associated tooth.

To prevent growth of residual cyst It is suggested to perform removal of periapiical patosis following the extraction of non vital tooth

Diagnosis Residual cyst is based on history, physical, dianostic imaging, fluid, histopathology examination

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