COM August 2008

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Large unilocular radiolucency associated with impacted tooth # 32

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

Contributed by
Dr. Adam Fettig
Knoff & Fettig Oral & Maxillofacial Surgery, Kirkland-Washington

Case Summary and Diagnostic Information

This is a 62-year-old white male referred by his general dentist for a deeply impacted tooth # 32 associated with a large unilocular radiolucency. This lesion was discovered on routine dental examination. There was no evidence of a swelling and the patient denied any pain or parasthesia.

Diagnostic Information Available

History of present Illness

This is a 62-year-old white male referred by his general dentist for a deeply impacted tooth # 32 associated with a large unilocular radiolucency.  This lesion was discovered on routine dental examination.  There was no evidence of a swelling and the patient denied any pain or parasthesia. 

Figure 1 This is a panoramic view taken at the first clinical presentation.  The radiograph demonstrates a well-defined to corticated unilocular radiolucency around impacted tooth #32 with the tooth displaced inferiorly.    

Medical History

His past medical history is significant for cardiac stents in 2000 and 2002 and kidney stones in 2004.  His medications include Vytorin, Lisinopril and Aspirin.

Clinical and Radiographic Findings

Radiographic findings included multiple missing teeth, multiple teeth with large cavities and a well-defined large and unilocular radiolucency around the crown of impacted tooth # 32.  Clinical examination revealed no evidence of swelling and the patient denied any pain or parasthesia. 

Excisional Biopsy

Treatment

Under IV sedation, tooth # 32 was removed and the cavity curetted and thoroughly irrigated.  The soft tissue was in form of a sac surrounding the crown of tooth #32.  The area healed without any events. 

Incisional and excisional biopsy

The biopsy specimen was read by Dr. Thomas Morton at the Oral Pathology Biopsy Service, University of Washington.  Histological examination revealed a cystic structure lined by epithelium and supported by fibrous connective tissue wall (Figures 2 & 3).  The lining epithelium is non-keratinized stratified squamous in type (Figure 3).  The connective tissue wall comprises the bulk of the specimen is cellular in some areas and fibrotic in others.  It contains a few lymphocytes, plasma cells and neutrophils.  It also contains small aggregates of hemosiderin pigment.    

Figure 2 Low power (x100) histology shows a cystic structure lined by non-keratinized stratified squamous epithelium and supported by a thick connective tissue wall infiltrated by a few acute and chronic inflammatory cells. It also contains clusters of hemosiderin pigment.

Figure 3 Higher power (200) histology shows the lining epithelium, connective tissue wall, inflammatory cells and hemosiderin pigment at a closer magnification.

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