A residual cyst, as the name implies, is a radicular, lateral periodotal, dentigerous or any other cyst that has persisted after it's associated tooth has been lost. Residual cysts show more predilection in males and they commonly affect the maxillary region
Below see 2 examples :
Friday, January 27, 2017
Friday, August 5, 2016
Tuesday, August 2, 2016
Tuesday, July 12, 2016
Central Giant-Cell Granuloma
Central
Giant-Cell Granuloma
Giant
cell lesions of the jaws are more frequent in first two decade of life and are
more prevalent in female patients 2:1
Although other lesions containing giant cells do occur in other bones of the body, they are much less frequent and are generally felt to be variants of other tumors, most often a low-grade osteosarcoma.
Diagnosis of central giant cell
granuloma is made histologically from an incisional biopsy.
Similar histological appearances
are seen in the following lesions, which must often be differentiated:
- The brown tumor of
hyperparathyroidism.
- The aneurysmal bone cyst.
- Cherubism.
Conventional management is surgical
and consists of:
1. Enucleation and curettage.
Despite this, a recurrence rate of 15-20% is often quoted, and in these cases
treatment may need to be more aggressive and may need to consist of an “en
bloc” resection.
2. Intralesional steroid injections protocol is a 50/50 mixture of 2%
lidocaine with 1:100,000 epinephrine with triamcinolone (Kenalog®)
Experience
with this technique is limited. In the hands of those who use this technique on
a regular basis, it appears that it is successful in around 50% of cases
3. Calcitonin injections
In
the United States only salmon calcitonin is available, and although it is more
potent than human calcitonin, antibody formation can limit its effectiveness. Results
from the use of calcitonin have shown fairly high success rates.
Treatment with alpha interferon
Based
on the assumption that this lesion may be vascular in origin, subcutaneous
alpha interferon has been used in the treatment of this lesion. It is given for
its anti-angiogenic effects, though there is little evidence that the lesion is
vascular in origin. The treatment has shown some success, but its use is
limited by its side effects.
Below
see a case treated with both Intralesional
steroid injections and Calcitonin on a 12 year old with a 5 year follow up with
no recurrence.
At presentation
6 months post treatment
1 year post treatment
4 year post treatment
5 year post treatment
Friday, June 17, 2016
Mesiodentes
A mesiodent is an extra tooth in the maxillary anterior incisor
region. Mesiodentes are the most common supernumerary teeth,
occurring in 0.15% to 1.9% of the population. The etiology of mesiodens is unclear, but is twice prevalent in
males (possibly an autosomal recessive gene), and there is a familial trait. Proliferation
of the dental lamina and genetic factors have been implicated. Mesiodentes can
cause delayed or ectopic eruption of the permanent incisors, which can further
alter occlusion and appearance.
Mesiodens sometimes
interfere with eruption of permanent teeth and cause other alignment problems
with the existing teeth. Only a small portion of supernumerary teeth eventually
erupts.
To prevent additional
damage such as misalignment and delayed eruption of the permanent central
incisors early intervention is suggested. Usually it is preferred to wait until
the root of the central and the lateral teeth are completely formed before
mesiodents are removed.
Mesiodens have been
found in certain syndromes such as cleft lip and palate, cleidocranial
dysostosis, and Gardner's syndrome. Supernumerary teeth in general have
associations with Ehler-Danlos syndrome, Apert syndrome, and Down's syndrome as
well.
The concerns associated
with mesiodens are listed below and removal is often needed
1. Delayed eruption of
permanent teeth
2. Cyst formation
3. Crowding
4. Diastemas
5. Resorption of the
roots of adjacent teeth
6. Eruption of mesiodens in to the nasal cavity..
Below see two cases that show the mesiodents erupting in to the nasal cavity.
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.
Thursday, June 9, 2016
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