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Friday, June 10, 2016

Glubomaxillary cyst or Periapical cyst?

Globulomaxillary cyst has been considered to be a developmental cyst that arises from entrapped nonodontogenic epithelium in the globulomaxillary suture. In recent years existence and histogenesis of this lesion has been disputed. It had been argued that the anterior maxilla was formed by merging of growth centers rather than fusion of facial processes and therefore,  ectodermal entrapment was ruled out. Recent embryologic studies have demonstrated that Fusion of facial processes does occur, and epithelium is entrapped in areas that later will lie between the maxillary lateral incisors and canines. At the present Globumaxillary cyst has been removed from WHO classification of non odontogenic cyst and some argue that it needs to be reinstated as a developmental non odontogenic cyst.

 Below see a case which could potentially be argued both ways. 40 year old male presented with swelling of the space between maxillary left canine and lateral incisor. Patient had been treated with a root canal treatment years go on teeth #8, 9, and 10 and does not recall why. He denies history of trauma to the anterior maxilla.   Panoramic x ray disclosed  potentially an endodontic lesion in apex of #10 and cystic lesion that has resulted in root divergence in the area of tooth #10 and 11. Tooth #11 has tested vital and has been ruled out as a potential source of the lesion.   Pathology was consistent with both periapical lesion arising from tooth#10 and a non odontogenic cyst.

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