CASE PRESENTATION

D r. K . Vi s h n u p r i y a t h a m
Pg lst year
Dept. of OMFS
Patient details:

Name Ms. T.Ramadevi

Age 48 years

Gender Female

Address Mohan nagar, kothapet

Chief complaint
Patient complains of pain
in upper right back tooth
region since one month.
HISTORY OF PRESENT ILLNESS
• Patient was apparently asymptomatic 1 month back and
gradually noticed pain which is gradual in onset and
intermittent in nature, aggrevated on taking hot and cold
food and relieved on taking medication.
Pain Gradual in onset, intermittent in nature.

Swelling Mild diffused swelling seen in the labial vestibule

in the region of 13, 12, 11, 21, 22 and solitary
swelling seen palatally in the premaxillary region.
Vestibular tenderness present.

Patient gives a history of antibiotic and painkiller for 3 days.

Past History
PAST DENTAL HISTORY
No relevant history.

PERSONAL HISTORY
• Appetite: Normal
• Diet: Mixed
• Bowel and Micturition: Regular
• Sleep: Undisturbed
HABIT HISTORY
• Oral hygiene: brushes once daily in the morning
• Parafunctional habits: no abnormality detected
• Deleterious habits :no abnormality detected

FAMILY HISTORY
• No relevant history reported
Clinical Examination
Patient :

• conscious, coherent, cooperative

GENERAL EXAMINATION

• Gait: Unaltered

• Posture: Upright

• Built: Moderate

• Nourishment: Moderate

• No signs of pallor, icterus, cyanosis, clubbing and edema

• HEIGHT: 155Cm

• WEIGHT: 50Kg

Vitals recorded as on

• BP: 130/80 mm of Hg

• Pulse: 74 beats per minute

• Respiratory rate: 16/minute

 extra-oral examination.

TMJ: no clicking sounds.

LOCAL FACE: no facial asymmetry
EXAMINATION seen.
LYMPH NODES: not palpable.
INTRA-ORAL
EXAMINATION
HARD TISSUE:

Deep dentinal caries irt 32,33.

Top positive irt 16.

Soft Tissue Examination:

Inspection:
• Mild diffused swelling seen in the labial
vestibule in the region of 13, 12, 11, 21, 22 and
round, solitary swelling seen palatally in the
premaxillary region.
Palpation:

• all inspectory findings are confirmed

Swelling

• localized rise in temperature.

• Tender on palpation.

• Size: approximately measuring 2 cm x1.5 cm.

PROVISIONAL DIAGNOSIS

• Peri apical cyst irt 31,32,33.

DIFFERENTIAL DIAGNOSIS
• Radicular cyst.
• Traumatic bone cyst.
 INVESTIGATION
S
• Advised OPG
opg
FINAL DIAGNOSIS

• RADICULAR CYST irt 31,32,33,41,42.

TREATMENT-PLAN

Advised for rct of 31,,33,41,42

Followed by extraction of 32

Cyst enucleation and currattage

under LA.
Operative procedure done
1) Root canal treatment off 31,33,41,42.
2) cyst enucleation and currattage. Under 2 % LA With
1:80,000 dilution of Adrenaline given as mental nerve
blocks bilaterally and local infilterations.
suturing done 1 week post op
 MEDICATION

1. Patient was given on Analgesics and Antibiotics

AUGMENTIN 625 mg TID for 5 days

METROGYL 400 mg TID for 5 days
2.
KETOROL DT 10 mg BID for 5 days
PANTOPRAZOLE 40 mg BID for 5 days

3. Patient was recalled for suture removal after 1 week.

 DISCUSSION
RADICULAR CYST
Radicular cyst is the most common Odontogenic cyst that occurs at
the apex or lateral to the root of a non-vital tooth. It comprises 70%
of all jaw cysts. It is most common between the ages of 20 to 60
years. It can arise at any age after tooth eruption but is rare in the
deciduous dentition. It can occur in relation to any tooth in the arch,
although 60% are found in the maxilla, where there is a particularly
high incidence in anterior teeth. It is included in inflammatory cysts
because inflammation in the periodontal ligament is the inciting
factor in its formation. Previous untreated dental trauma and caries
result in pulpal necrosis and devitality of the tooth.
The leakage of the irritant products from the pulp to the
periodontal ligament result in granuloma formation.
Granuloma is the defensive response of the periapical
tissue to the leaking pulpal-irritants.
Various inflammatory mediators stimulate the proliferation
of epithelial rests of Malassez, which are the embryonic
remnants of the Hertwig’s sheath lying dormant in the
periodontal ligament.
The epithelial cells proliferate within granuloma and form a
mass of epithelial cells. The central cells of the mass get
degenerated because of lack of nutrient supply and
undergo necrosis.
Thus a cavity is formed, lined by epithelium, having fluid
and is called Radicular cyst.
Classification:-
It is classified as follows---
1) Periapical Cyst:- These are the radicular cysts
      

which are present at root apex.

2) Lateral Radicular Cyst:- These are the radicular
      

cysts which are present at the opening of lateral

accessory root canals of offending tooth.
3) Residual Cyst:- These are the radicular cysts
      

which remains even after extraction of offending tooth.

 INCIDENCE
MORE COMMON IN MAXILLA THAN MANDIBLE
Bhaskar (1966) in his study of 2308 lesions found that the
incidence of cyst in maxilla is 10 times more common than the
mandible. This was explained by stating that the maxilla
contains far more epithelial debris than mandible.
MALES ARE MORE COMMOMLY EFFECTED THAN FEMALES,
probably due to:
• 1) Males are more actively involved in sports than females and
thus more vulnerable to receive sports dental injury in our
region.
• 2) Males are aggressive and there is increased interpersonal
violence in males than females.
• Incidence of cyst related to AGE of patients.
• Mostly commonly effected in the 4th decade.
• TREATMENT
1) ENDODONTIC TREATMENT
2) SURGICAL TREATMENT by
ENUCLEATION and CURRETTAGE
EXPECTED COMPLICATIONS
1)      Carcinomatous/Neoplastic Changes:-                 
      Squamous Cell Carcinoma or Epidermoid Carcinoma
may occasionally arise from epithelial lining of Radicular
Cyst.
2)      Pathologic Jaw Fracture:-                                                     
      If Cyst have completely eroded the bone specially if it is
present in posterior region which is very rare in case of
Radicular Cyst it may cause pathologic jaw bone fracture.
3)      Secondary Infection:-                                                            
      Cyst may get secondarily infected and create further
complications.