Keratinizing Dentigerous Cyst - An Unusual Entity-A Rare Case Report

Abstract

Background: A dentigerous cyst or follicular cyst is one of the forms of odontogenic cysts. It encloses the crown of an un-erupted tooth by the expansion of its follicle within the follicular space. It is normally painlessly discovered during the routine radiographic examination. Importance of keratinization in odontogenic cysts is still a mystery as it is a very rare entity. This article reports a case of keratinizing dentigerous cyst associated with a mandible. Case Presentation: A 50-year-old male patient with a chief complaint of swelling and pain in the right side of the lower jaw for 4 months. The lesion was provisionally diagnosed as OKC or dentigerous cyst after the clinical and radiographic examination. Treatment consisted of surgical excision and the excised specimen was sent for histopathological examination which confirmed the findings of a keratinizing dentigerous cyst. Conclusions: Only a few cases of keratinizing dentigerous cyst has been reported in the literature so far to the best of our knowledge. Early recognition and intervention play a key role in its management due to its malignant transformation and potential for recurrence.

Management of extensive dentigerous cystic lesions in adult patient

“…In agreement with several studies 10,15,[20][21][22] , most of the patients included in this study were in the third decade of life. Most of the lesions were associated with third molars, with the mandible more affected than the maxilla.…”

“…Half of the present study lesions were associated with impacted third molars (50%) ), and only one case related to mandibular first molar Fig ( 7). The lesions-related teeth association is shown in figure (8).…”

“…Considering the unfavourable damaging sequelae of untreated dentigerous cysts, surgery is always indicated. Described treatment modalities include decompression, marsupialization, and enucleation [15][16][17][18][19] . There are no definite guidelines regarding which treatment is to be used.…”

“…Despite this theory may explain the cases where the cyst is related to a tooth that has a predecessor, it is unlikely to be a solid explanation of cysts related to third molar teeth, since cyst can form around completely bony impacted teeth. The histopathological features of inflammatory dentigerous cysts are characterized by presence of diffuse chronic inflammatory cells within the cyst lining and at the odontogenic epithelium forming small groups within the cyst wall 15 . The exact presentation was encountered in two of the cases involved in this study.…”

“…When the fluid accumulates between the reduced enamel epithelium and the enamel or within the enamel organ itself the cyst is considered intra-follicular. Extra-follicular cysts are associated with foci of enamel hypoplasia within the crown of the involved tooth 8 . The highest incidence of dentigerous cysts is usually seen during the second and third decades of life.…”