CASE HISTORY-2

OPD no. 688331/18 Date: 13-06-2018

Name: Pankaj Singh Occupation: Student
Age: 12years Sex: Male
Address: Kakori, Lucknow

Chief complaint Patient complaint of swelling in left lower back tooth region of the jaw since 6 months.

History of present illness: Pt gave history of swelling in his lower left back tooth region of the jaw since
6 months. It was sudden in onset and gradually progressed to present size. Swelling was preceded with
pain which was initially mild to moderate, intermittent, dull, nonradiating which became painless since 3
months. There was no aggravating and relieving factors. No history of previous swelling and pus
discharge. No relative history of any medication. No other associated symptoms.

Past dental history: Nothing significant

Past medical history: Nothing significant

Family history: Nothing significant

Personal history:
Habit – Nothing significant
Oral hygiene- brushes daily once in a day
Diet- Mixed

GENERAL CLINICAL EXAMINATION:

Built – Moderately built
Nourishment- Moderately nourished
Gait -No Abnormality detected
Skin-No Abnormality detected
Nails-No Abnormality detected
Sclera-No Abnormality detected
Conjunctiva-No Abnormality detected
 Pallor -No Abnormality detected
Cyanosis -No Abnormality detected
Edema -No Abnormality detected
Vital sign:
Temperature; Afebrile
Pulse Rate: 72 beats /min
Respiratory Rate: 14 cycles/ min
Blood Pressure: 130/90 mm of Hg.

EXTRA ORAL EXAMINATION

Face –Symmetry- Symmetrical
Profile – Straight
Head:-No Abnormality detected
Hair-No Abnormality detected
Nose-No Abnormality detected
Eyes-No Abnormality detected
Ears-No Abnormality detected
TMJ-No Abnormality detected
Paranasal sinuses-No Abnormality detected
Salivary glands-No Abnormality detected
Lymph Nodes- Solitary left Submandibular lymph node was palpable oval, firm, mobile and
nontender.
Mouth opening- 40 mm

INTRA ORAL EXAMINATION

Soft tissue:
Buccal mucosa-No Abnormality detected
Labial mucosa-No Abnormality detected
Palate-No Abnormality detected
Tongue-No Abnormality detected
Floor of mouth-No Abnormality detected
Vestibule-No Abnormality detected
Tonsils-No Abnormality detected
Oropharynx-No Abnormality detected
Duct orifices- Patent
Gingiva-swelling present in lingual side wrt 31, 72,73
Hard tissue:
Teeth present-

Teeth Missing- 32,33,34,35

Caries- Absent
Tenderness on percussion- Absent
Non vital teeth- Absent
Fractured teeth- Absent
Discolored tooth- 51
Mobility- Pre-shadding mobility- 73, 74,75
Retained -51,61
Restored teeth- Absent
Wasting disease- Absent
Root stump- Absent
Occlusion- Angle class I relation
Deposits- Extrinsic stains

Saliva-
• Flow- Normal
• Viscosity- Normal

EXAMINATION OF THE LESION PROPER

1) Extra Oral examination- NAD
2) Intra Oral examination (buccal vestibule wrt 36)

a) Soft tissue examination

Inspection:
Presence of Solitary circumscribed dome shaped swelling in the left lingual gingival region
wrt 32, 73, 74, measuring about 1.5x1.5cm extending medio-laterally from mesial aspect of
32 to distal aspect of 74, supero-inferiorly from marginal gingiva to mucogingival junction.
Mucosa over swelling was smooth with normal color.

Palpation: On palpation swelling was slightly tender. All Inspectory findings were confirmed.
It was hard in periphery and firm to soft in center with cortical expansion, nonfluctuant, nonmobile,
noncompressible, and nonreducible .
b) Hard tissue examination
Inspection: Slight distal displacement of 31
Palpation: On palpation Inspectory findings was confirmed. Pre-shadding mobility wrt 73, 74,75
Percussion; On vertical and horizontal percussion it was nontender wrt 73, 74,75

ON ASPIRATION
Straw Colored Fluid Aspirated

PROVISIONAL DIAGNOSIS
 Cystic lesion irt 32,33,34,35
 Chronic marginal gingivitis

DIFFERENTIAL DIAGNOSIS
Dentigerous cyst
Ameloblastic fibroma
Ameloblastic fibro-odontoma
CEOT
AOT
Unicystic Ameloblastoma
INVESTIGATION
 IOPAR wrt 31,72,73,74,75, & Mandibular Occlusal View (Topographic)
 Orthopantomogram
 Hematologic examination

Intra-Oral periapical radiograph

Presence of well defined radiolucency in the apical region of 72, 73, 74, 75 measuring about 2x3 cm,
extending medio-laterally from the apex of 31 to apex of 75. Superoinferiorly inferior extent cannot be
determine.. Internal structure is completely radiolucent with scanty trabeculae

Mandibular Occlusal
Presence of well defined radiolucency in the apical region of 72, 73, 74, 75 measuring about 2x3 cm,
extending medio-laterally from the apex of 31 to apex of 75. Superoinferiorly from apex of 72, 73, 74 to
0.5 cm superior to lower border of mandible. Internal structure is completely radiolucent with scanty
trabeculae.
Orthopantomogram

Presence of well defined radiolucency with sclerotic border in the apical region of 72, 73, 74, 75
extending antero-posteriorly from the apex of 31 to apex of 75. Superoinferiorly from apex of 72, 73, 74
to 0.5 cm superior to lower border of mandible. Inferior border of radiolucency is attached to CEJ of
impacted 33 on mesial and distal side. Internal structure is completely radiolucent. Impacted 33, 34 also
seen.

RADIOLOGICAL DIAGNOSIS
Dentigerous cyst wrt impacted 33

RADIOLOGICAL DIFFERENTIAL DIAGNOSIS

Unicystic Ameloblastoma
OKC
AOT
CEOT
Ameloblastic fibro-odontoma
Ameloblastic fibroma
HISTOLOGICAL FINDINGS
The H & E stained sections shows nonkeratinized stratified squamous epithelium lining of varying
thickness. Underlying connective tissue shows abundant chronic inflammatory cells with loose
fibrous tissue

HISTOLOGIC DIAGNOSIS-
Infected Dentigerous cyst

FINAL DIAGNOSIS
Infected Dentigerous cyst wrt impacted 33

TREATMENT PLANNING
 Enucleation of cyst
CLINICAL PICTURES
EXTRA-ORAL

TRA-ORAL
 ADIOGRAPHS
IOPAR

OCCLUSAL VIEW
 OPG

INTRA- AND POST O.P.

HISTOPATOLOGICAL PICTURE