Teaching Case

Left maxillary swelling of 4 months duration in a 19 year old male

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.

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 3^rd 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 published^4,5,6,7. Etiology of ectopic teeth can be due to developmental abnormalities, over crowding, trauma and sepsis^4,6. 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 observed^4,6,7,8.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.