Figure 1
Figure 1
Orthopantogram showing a well defined radiolucency around the crown of an ectopic upper third molar tooth.
Ectopic third molar tooth with left maxillary dentigerous cyst
SectionHead & neck imaging
Case TypeClinical Cases
AuthorsDR.SUNITHA LINGA REDDY DNB ELBIT MEDICAL DIAGNOSTICS LTD. Padmaja Palace , Flat No.401, Plot No.14, Hyderabad . DR.SANDEEP J MD ELBIT MEDICAL DIAGNOSTICS LTD. 1-2-593/40 Gagan Mahal Colony Hyderabad . DR.C.JOGA RAO MD,DMRD,DNB. ELBIT MEDICAL DIAGNOSTICS LTD. Naimisam Apartments, Flat No.401, Plot No.22, Hyderabad .
Connected authors
19 years, male
Clinical History
Left maxillary swelling of 4 months duration in a 19 year old male
Imaging Findings
19-year-old-male patient presented with left maxillary swelling of about 4 months duration. An OPG study revealed a well defined radiolucency around the crown of an ectopic upper third molar
tooth.Caldwell view taken subsequently showed a soft tissue density mass with the ectopic tooth.Axial and coronal CT sections demonstrated a soft tissue density mass (30 HU) with thin rim of
calcification and embedded upper 3rd molar tooth.
Discussion
Cysts of the jaws are basically of two types1 ,developmental and inflammatory.Developmental cysts can be odontogenic and non odontogenic.Dentigerous cyst is a type of odontogenic cyst
which is nearly twice as common in men as in women. In Shear`s series2 they were the most frequent type of odontogenic cyst in the first decade, but the majority of cases were seen in the
second to fourth decades. These cysts are frequently symptomless and discovered initially during routine radiography. They develop most commonly around the crown of third mandibular molar
tooth3. In our case the unerupted 3rd upper molar was in an ectopic location probably secondary to the cyst formation which has displaced the tooth superiorly, a rather rare
entity especially taking into consideration the age and location. The occurrence of ectopic teeth at sites other than the immediate dental environment is rare. A few reports of tooth displacement
into the maxillary sinus, nasal cavity, orbit, chin and mandibular ramus, condyle and coronoid process have been published4,5,6,7. Etiology of ectopic teeth can be due to developmental
abnormalities, over crowding, trauma and sepsis4,6. Impaction of tooth in the maxillary sinus can be asymptomatic7. Such teeth are often discovered serendipitously on inspection
of X-Rays of skull or teeth. In other cases symptoms such as nasal obstruction, facial fullness, head ache, hyposmia, anosmia, epistaxis, fever, rhinorrhea, deviation of naso maxillary anatomy can be
observed4,6,7,8.It is seen as a well-demarcated unilocular radiolucency around the crown of an unerupted tooth relatively small (less than 2.0 cm in diameter).They can become large and
multilocular which suggests their transformation into more serious lesions.Following enucleation of the cyst and extraction of the unerupted tooth, the prognosis is excellent. Recurrence is seldom
observed after complete removal.Rare complications include transformation to an ameloblastoma, squamous cell carcinoma and intraosseous mucoepidermoid carcinomas1.
Differential Diagnosis List
Ectopic third molar tooth with left maxillary dentigerous cyst
Final Diagnosis
Ectopic third molar tooth with left maxillary dentigerous cyst
References
[1] Gervasio AM, Silva DA, Taketomi EA, Souza CJ, Sung SS, Loyola AM. Levels of GM-CSF, IL-3, and IL-6 in fluid and tissue from human radicular cysts. J Dent Res 2002;81(1):64-8. (PMID: 11824415)
[2] Shear M. Cysts of the oral regions, 3rd edition, 1992, Bristol:Wright.
[3] Issar DK, Das S. Indian Journal of Otolaryngology and Head and Neck Surgery,2002; Vol.54.No.1.January-March,2002.
[4] Bodner L, Tovi F, Bar-Ziv J. Teeth in the maxillary sinus - imaging and management.J Laryngol Otol 1997;111:820-4. (PMID: 9373546)
[5] Elango S, Palaniappan SP. Ectopic tooth in the roof of the maxillary sinus. Ear Nose Throat J 1991;70:365-6. (PMID: 1893885)
[6] Pracy JP, Williams HO, Montgomery PQ. Nasal teeth. J Laryngol Otol 1992;106: 366-7. (PMID: 1613354)
[7] Jude R, Horowitz J, Loree T. A case report. Ectopic molars that cause osteomeatal complex obstruction. J Am Dent Assoc 1995: 126:1655-7. (PMID: 7499667)
[8] Alexandrakis G, Hubbell RN, Aitken PA. Nasolacrimal duct obstruction secondary to ectopic teeth. Ophthalmology 2000; 107:189-92. (PMID: 10647741)
Case information
| URL: | https://www.eurorad.org/case/4418 |
| DOI: | 10.1594/EURORAD/CASE.4418 |
| ISSN: | 1563-4086 |
Figure 2
Figure 2
Caldwell view demonstrating soft tissue density mass in the region of left maxillary antrum with a molar tooth adjacent to the medial wall.
Figure 3
Figure 3
Axial CT section showing a large well circumscribed soft tissue density mass scalloping the superior wall of the left maxillary sinus with thin rim of calcification.Notice embedded third molar tooth.
Figure 4
Figure 4
Coronal CT section showing a soft tissue density mass with a fluid level and a molar tooth projecting from the superior wall.
Figure 1
Orthopantogram showing a well defined radiolucency around the crown of an ectopic upper third molar tooth.
Figure 2
Caldwell view demonstrating soft tissue density mass in the region of left maxillary antrum with a molar tooth adjacent to the medial wall.
Figure 3
Axial CT section showing a large well circumscribed soft tissue density mass scalloping the superior wall of the left maxillary sinus with thin rim of calcification.Notice embedded third molar tooth.
Figure 4
Coronal CT section showing a soft tissue density mass with a fluid level and a molar tooth projecting from the superior wall.