Maxillary dentigerous odontogenic cyst: the sinusitis simulator – case report

Abstract

Cell degeneration of the enamel’s starry reticulum gives rise to the primary cyst before the mineralized tissue is formed. This cyst appears in place of a normal, un-erupted or supra-numerous teeth and is frequently observed among young people in middle age. A 17-year-old boy, born and resident in Portugal, 2 months before hospitalization starts complaints of nasal obstruction on the right, and later the left, with progressive worsening and pain located in the dental arch and gums and appearance of swelling gingival pain with chewing in the last two weeks. On clinical examination there was a painful swelling of the right cheek, without any other inflammatory signs. Attached to the upper right maxillary dental arch there was a soft, vascularized and painful mass of 3 cm in diameter. Blood tests found hemoglobin 15.3 g/dL (reference: 10.3-13.5 g/dL), leukocytes 9110/uL (reference: 6-16/uL) and c-reactive protein 0.05mg/ dL (reference: < 0.5 mg/dL). Computed tomography and magnetic resonance imaging described a 49x45x44 mm right maxillary odontogenic cyst, with an erosion and thinning of the external, posterior, and anterior wall of the maxillary sinus and left deviation of the nasal septum. The diagnosis of odontogenic cyst was made and the cyst was making an orbital compression and involving almost all maxillary sinuses. He was submitted to a videoendoscopic technique associated a Caldwell-Luc technique. This combined technique promotes a better view and control all borders of the lesion. The surgery completely removed the lesion and the supernumerary tooth. The follow up was done without complications. It is important, to bear in mind that in the presence of complaints associated with the sinuses and oral cavity, the need to exclude non-surgical pathology requires the performance of a detailed objective examination.

Keywords

• Dentigerous cyst. Mouth. Sinusitis.