The diagnostic challenges and two-step surgical approach to an infected dentigerous cyst resembling a unicystic ameloblastoma: A case report
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Background: A dentigerous cyst is the second-most frequently observed odontogenic cyst, and an ameloblastoma is one of the most frequently observed odontogenic tumors. Both are mostly associated with an impacted mandibular third molar and have similar characteristics. Diagnostic difficulties often result in misdiagnosis and remain a challenge to overcome. Comprehensive clinical, radiographic, and histopathological views are essential to correctly diagnose the problem and formulate the most suitable treatment plan. Purpose: This case report aims to present a thorough approach to the diagnostic and surgical procedures involved in treating a dentigerous cyst that resembles an ameloblastoma by using marsupialization followed by enucleation. Case: This article presents the case report of a 27-year-old male patient with an infected dentigerous cyst resembling a unicystic ameloblastoma associated with a totally impacted lower mandibular left third molar. The patient had a history of swelling, pain, and pus drainage in the retromolar area. Symptoms subsided after antibiotic and analgesic prescriptions, but the lesion remained and was slowly progressing. The diagnostic approach began with a fine-needle aspiration biopsy, and the result confirmed a benign cystic lesion that was suspected to be an odontogenic tumor. Then an incisional biopsy was conducted under local anesthesia, diagnosing an infected dentigerous cyst. Case Management: Marsupialization and decompression using an obturator was preferred, followed by enucleation. Nine months later, a radiographic examination revealed satisfactory bone regeneration without recurrence. Conclusion: An incisional biopsy plays a vital role in establishing a definitive diagnosis. Marsupialization followed by enucleation offers an excellent combination of treatments achieving complete cyst removal, anatomical structure preservation, and bone regeneration with minimal complications.
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Caruso D, Lee C, Peacock ZS. What factors differentiate dentigerous cysts from other pathologic entities in pericoronal radiolucent lesions? J Oral Maxillofac Surg. 2021; 79(10): e57–8. doi: https://doi.org/10.1016/j.joms.2021.08.081
Soluk-tekkesin M, Wright JM. The world health organization classification of odontogenic lesions: a summary of the changes of the 2017 (4th) edition. Turkish J Pathol. 2018; 34(1). doi: https://doi.org/10.5146/tjpath.2017.01410
Thompson LDR. Dentigerous cyst. Ear, Nose Throat J. 2018; 97(3): 57. doi: https://doi.org/10.1177/014556131809700304
Rajendra Santosh AB. Odontogenic cysts. Dent Clin North Am. 2020; 64(1): 105–19. doi: https://doi.org/10.1016/j.cden.2019.08.002
Abu-Mostafa N, Abbasi A. Marsupialization of a large dentigerous cyst in the mandible with orthodontic extrusion of three impacted teeth. A case report. J Clin Exp Dent. 2017; 9(9): e1162–6. doi: https://doi.org/10.4317/jced.53890
Mortazavi H, Baharvand M. Jaw lesions associated with impacted tooth: A radiographic diagnostic guide. Imaging Sci Dent. 2016; 46(3): 147–57. doi:10.5624/isd.2016.46.3.147
Martin LHC, Speight PM. Odontogenic cysts: an update. Diagnostic Histopathol. 2017; 23(6): 260–5. doi: https://doi.org/10.1016/j.mpdhp.2017.04.006
Rioux-Forker D, Deziel AC, Williams LS, Muzaffar AR. Odontogenic cysts and tumors. Ann Plast Surg. 2019; 82(4): 469–77. doi: https://doi.org/10.1097/SAP.0000000000001738
Hallikeri K, Babu B, Sudhakaran A, Monteiro R. Cell block and its impact in the diagnosis of jaw lesions over fine needle aspiration cytology. Acta Cytol. 2021; 65(5): 361–7. doi: https://doi.org/10.1159/000517166
Riachi F, Khairallah CM, Ghosn N, Berberi AN. Cyst volume changes measured with a 3D reconstruction after decompression of a mandibular dentigerous cyst with an impacted third molar. Clin Pract. 2019; 9(1): 1132. doi: https://doi.org/10.4081/cp.2019.1132
Patil M, Patil RU, Panse AM, Patil AS, Jathar PN, Bahutule SR. Infected dentigerous cyst and its conservative management: A report of two cases. Int J Clin Pediatr Dent. 2019; 12(1): 68–72. doi: https://doi.org/10.5005/jp-journals-10005-1578
Salama AA, Abou-ElFetouh A. Marsupialization and functional obturator placement for treatment of dentigerous cyst in child: A successful blend. Oral Maxillofac Surg Cases. 2020; 6(4): 100200. doi: https://doi.org/10.1016/j.omsc.2020.100200
Chouchene F, Ameur W Ben, Hamdi H, Bouenba M, Masmoudi F, Baaziz A, Maatouk F, Ghedira H. Conservative approach of a dentigerous cyst. Radnai M, editor. Case Rep Dent. 2021; 2021: 5514923. doi: https://doi.org/10.1155/2021/5514923
Robinson RA. Diagnosing the most common odontogenic cystic and osseous lesions of the jaws for the practicing pathologist. Mod Pathol. 2017; 30: S96–103. doi: https://doi.org/10.1038/modpathol.2016.191
Kamadjaja DB, Satriyo H, Setyawan A, Lesmaya YD, Safril JW, Sumarta NPM, Rizqiawan A, Danudiningrat CP, Tran TT. Analyses of bone regeneration capacity of freeze-dried bovine bone and combined deproteinized–demineralized bovine bone particles in mandibular defects: The potential application of biological forms of bovine-bone filler. Eur J Dent. 2022; 16(02): 403–13. doi: https://doi.org/10.1055/s-0041-1736291
Emamverdizadeh P, Arta SA, Ghanizadeh M, Negahdari R, Ghavimi MA, Ghoreishizadeh A, Tojih MR. Compatibility of clinical and histopathological diagnosis of oral lesions in Iranian patients. Pesqui Bras Odontopediatria Clin Integr. 2019; 19(1): 1–7. doi: https://doi.org/10.4034/PBOCI.2019.191.01
Siregar M, Sitam S, Lita YA, Hadikrishna I. Analysis of dentigerous cyst, ameloblastoma, and odontogenic keratocyst panoramic radiograph and CBCT: a scoping review. ODONTO Dent J. 2022; 9: 115–30. doi: https://doi.org/10.30659/odj.9.0.115-130
Wulandari P, Widkaja D, Nasution AH, Syahputra A, Gabrina G. Association between age, gender and education level with the severity of periodontitis in pre-elderly and elderly patients. Dent J. 2022; 55(1): 16–20. doi: https://doi.org/10.20473/j.djmkg.v55.i1.p16-20
Vyas T. Biopsy of oral lesion -a review article. J Adv Med Dent Sci Res. 2018; 6(1): 27–35. web: http://jamdsr.com/htmlissue.php?id=1874
Nugraha AP, Kamadjaja DB, Sumarta NPM, Rizqiawan A, Pramono C, Yuliati A, Hendrianto E, Rahman MZ. Osteoinductive and osteogenic capacity of freeze-dried bovine bone compared to deproteinized bovine bone mineral scaffold in human umbilical cord mesenchymal stem cell culture: an in vitro study. Eur J Dent. 2023; . doi: https://doi.org/10.1055/s-0042-1758786
Bose DS, Sur DJ, Khan DF, Dewangan DD, Roul DA. Diagnostic dilemma of dentigerous cyst mimicking a radicular cyst: a case report. Saudi J Oral Dent Res. 2021; 6(3): 112–5. doi: https://doi.org/10.36348/sjodr.2021.v06i03.001
Rajae EG, Karima EH. Dentigerous cyst: enucleation or marsupialization? (a case report). Pan Afr Med J. 2021; 40: 149. doi: https://doi.org/10.11604/pamj.2021.40.149.28645
Soesilawati P, Rachmat EA, Arundina I, Naomi N. The possibility of polymorphonuclear leukocyte activation in dental socket healing by freeze-dried Aloe vera induction. Dent J. 2021; 54(3): 124–7. doi: https://doi.org/10.20473/j.djmkg.v54.i3.p124-127
Abu-Mostafa N. Marsupialization of dentigerous cysts followed by enucleation and extraction of deeply impacted third molars: two case reports. Cureus. 2022; 14(4): e23772. doi: https://doi.org/10.7759/cureus.23772
de Moraes ATL, Soares HA, Viana Pinheiro J de J, Ribeiro Ribeiro AL. Marsupialization before enucleation as a treatment strategy for a large calcifying odontogenic cyst: Case report. Int J Surg Case Rep. 2020; 67: 239–44. doi: https://doi.org/10.1016/j.ijscr.2020.01.031
Marin S, Kirnbauer B, Rugani P, Mellacher A, Payer M, Jakse N. The effectiveness of decompression as initial treatment for jaw cysts: A 10-year retrospective study. Med Oral Patol Oral y Cir Bucal. 2018; 24(1): e47–52. doi: https://doi.org/10.4317/medoral.22526
Consolo U, Bellini P, Melini GM, Ferri A, Lizio G. Analysis of marsupialization of mandibular cysts in improving the healing of related bone defects. J Oral Maxillofac Surg. 2020; 78(8): 1355.e1-1355.e11. doi: https://doi.org/10.1016/j.joms.2020.02.034
Kivovics M, Pénzes D, Moldvai J, Mijiritsky E, Németh O. A custom-made removable appliance for the decompression of odontogenic cysts fabricated using a digital workflow. J Dent. 2022; 126: 104295. doi: https://doi.org/10.1016/j.jdent.2022.104295
Fathi AL-Omar A, A. Elmorsy K. Treatment of a large maxillary cyst with marsupialization (case report). Oral Heal Care. 2017; 3(1): 1–4. doi: https://doi.org/10.15761/OHC.1000132
Oliveros-Lopez L, Fernandez-Olavarria A, Torres-Lagares D, Serrera-Figallo M, Castillo-Oyague R, Segura-Egea J, Gutierrez-Perez J. Reduction rate by decompression as a treatment of odontogenic cysts. Med Oral Patol Oral y Cir Bucal. 2017; 22(5): e643–50. doi: https://doi.org/10.4317/medoral.21916
AboulHosn M, Noujeim Z, Nader N, Berberi A. Decompression and enucleation of a mandibular radicular cyst, followed by bone regeneration and implant-supported dental restoration. Case Rep Dent. 2019; 2019: 9584235. doi: https://doi.org/10.1155/2019/9584235
Brookes ZLS, Bescos R, Belfield LA, Ali K, Roberts A. Current uses of chlorhexidine for management of oral disease: a narrative review. J Dent. 2020; 103: 103497. doi: https://doi.org/10.1016/j.jdent.2020.103497
Demir E, Günhan Ö. Treatment results of dentigerous cysts managed by marsupialisation, enucleation or enucleation with platelet rich plasma-a retrospective study. Meandros Med Dent J. 2021; 22(2): 116–24. doi: https://doi.org/10.4274/meandros.galenos.2021.86094
Irimia A, Moraru L, Ciubotaru DA, Caruntu C, Farcasiu A-T, Caruntu A. Minimally invasive two-staged surgery in the treatment of large cystic lesions of the jaw. Healthcare. 2021; 9(11): 1531. doi: https://doi.org/10.3390/healthcare9111531
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