Editor's note: Originally published May 2016. Updated September 2023.
Case presentation
A healthy 37-year-old male presents with pain on the lower-left and lower-right sides of his mouth. He states that he drinks a lot of soda, and he knows his teeth are bad. He feels like the area is swelling, and the associated pain is keeping him from sleeping.
A limited exam reveals rampant decay. The panoramic radiograph shows badly decayed teeth on the lower right side, with an apical radiolucency and associated swelling in the buccal vestibule. Also noted is a well-defined radiolucency above the apexes of tooth nos. 5–9. There is some expansion around the bone; the lesion is not fluctuant or mobile. Nos. 5–9 are severely decayed.
Differential diagnoses
- Traumatic bone cyst
- Periapical granuloma
Definitive diagnosis
Odontogenic/periapical (radicular) cyst
Treatment and discussion
Radicular cysts are primarily found in the maxilla (60%) and are the most common of odontogenic cysts (52%).1 Clinically, they are typically asymptomatic and found via radiographic examinations. If there is pain, it is due to a slow growth and subsequent swelling.
Radiographically, these lesions have well-defined borders with an oval/round radiolucency.1 If the lesion is large enough, the roots of adjacent teeth can be displaced; jaw fracture is a possibility if the lesion is large enough and in the right location.
Other complications include “squamous cell carcinoma and epidermoid carcinoma arising from the epithelial lining.”1
Treatment is complete enucleation of the cyst and surrounding lining.
The patient presented to the oral surgeon’s office, and all remaining maxillary teeth except nos. 6–11 were removed. Prognosis is good. A partial is in the patient’s definitive treatment plan.
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Reference
- Morrison A, Magliocca KR. Mandible-maxilla cysts of the jaw: radicular (periapical) cyst. PathologyOutlines. Updated March 25, 2014. https://www.pathologyoutlines.com/topic/mandiblemaxillaperiapicalcyst.html
