COM April 2010

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April 2010: Large unilocular radiolucency anterior maxilla

Dolphine Oda, BDS, MSc
doda@u.washington.edu

Contributed by
Dr. Stephen Knoff
Oral & Maxillofacial Surgery, Kirkland, WA

Case Summary and Diagnostic Information

This is a 37-year-old male with a large, asymptomatic, unilocular and well-demarcated radiolucency in the anterior midline maxilla involving the mid-root to apices of teeth #s 7-10 (Figure 1).

Diagnostic Information Available

History of present Illness

This is a 37-year-old male with a large, asymptomatic, unilocular and well-demarcated radiolucency in the anterior midline maxilla involving the mid-root to apices of teeth #s 7-10 (Figure 1). It is of unknown duration and is clinically described to be 2 x 2 x 1.8 cm in size. The patient complained of a swelling behind his front teeth. There was an eight mm divergence of the central incisors caused by this lesion. His past medical history is negative.

Figure 1 This radiograph was taken at the first clinical presentation; note the large, well-demarcated unilocular radiolucency associated with teeth #s 7, 8, 9 and 10.

Medical History

His past medical history is negative.

Clinical and Radiographic Findings

The patient was referred by his general dentist to an Oral & Maxillofacial Surgeon to evaluate a large unilocular radiolucency in the anterior maxilla involving teeth #s 7-10. It is not painful but a swelling was present in the anterior hard palate. There was an eight mm divergence of teeth #s 8 & 9. The associated teeth are vital and show no evidence of decay or periodontal disease (Figure 1). The lesion was described to be 2 x 2 x 1.8 cm in size.

Figure 1 This radiograph was taken at the first clinical presentation; note the large, well-demarcated unilocular radiolucency associated with teeth #s 7, 8, 9 and 10.

Excisional Biopsy

Treatment

Under IV general anesthesia a palatal flap was reflected where a large cystic lesion was identified. The lesion had perforated the palatal bone, the nasal floor and the labial cortical plate between teeth #’s 8 and 9. The area was curetted and irrigated. The patient healed with no complications.

Incisional Biopsy

Histologic examination reveals multiple pieces of soft tissue composed of a cystic structure lined by respiratory-type epithelium in most parts and focally by stratified squamous epithelium (Figure 2). The respiratory epithelium was focally ciliated with a few mucous-producing cells (Figure 3). The connective tissue wall comprised the bulk of the specimen and was cellular in some areas and fibrotic in others. It contained neurovascular bundles (Figure 4). Inflammatory cells were occasional to absent.

Figure 2 Low power (x100) H & E histology demonstrates multiple pieces of soft tissue composed of a cystic structure lined by epithelium and supported by fibrous connective tissue wall. The lining epithelium is mostly respiratory in type.

Figure 3 Higher power (x200) H & E histology demonstrates closer look at the lining epithelium which is ciliated psuedostratified squamous in type with occasional mucous producing cells.

Figure 4 Higher power (x200) H & E histology demonstrates closer look at the connective tissue wall with a peripheral nerve bundle and a cross section through a small artery.

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