Lingual Gingival Cyst of the Adult

Abstract

Introduction: Gingival cysts of the adult (GCAs) are rare developmental soft tissue cysts usually found on the facial attached gingiva. Documented cases on the lingual aspect are extremely uncommon. This report details a lingual GCA along with distinguishing characteristics of this lesion. Case Presentation: The patient, a 37‐year‐old female, presented with a firm, round‐shaped, bluish swelling on the lingual gingiva in the interproximal area between teeth #21 and #22. Radiographs revealed a circular radiolucency at the osseous crest. Surgical exploration showed cystic‐appearing tissue with accompanying bone resorption. Histologic examination, along with clinical presentation, confirmed a diagnosis of gingival cyst. Healing was uneventful with no evidence of recurrence at a 5‐month recall. Conclusions: A GCA is usually of odontogenic origin and occurs typically in the attached gingiva of the mandibular premolar region. Occasionally, it demonstrates radiographic evidence of bone loss from pressure resorption. Its more frequent intraosseous counterpart, the lateral periodontal cyst, shares histopathologic characteristics with the GCA. These findings underscore the importance in establishing a definitive diagnosis.

Gingival Cyst of the Adult: A Case Description with a Relevant Literature Analysis

“…The most common localization described in the literature is the vestibular attached gingiva in the mandibular canine and first premolar areas; the cysts mainly occur in women during the fifth and sixth decades of life and generally grow as a slow and painless swelling, usually solitary and small (measuring about 3-4 mm) nodules or vesicles varying in color from flesh-colored to bluish due to the presence of cystic fluid; multiple occurrences are poorly described [3][4][5][6][7]. GCAs usually lack bone involvement on radiograms, but bone resorption may be observable in relation to the cystic fluid pressure [8]. Upon histopathological examination, a GCA is characterized by a subepithelial connective tissue wall covered by a thin, squamous or cuboidal epithelium, where, in some points, glycogen-rich clear cells might be found [9,10].…”

“…Upon histopathological examination, a GCA is characterized by a subepithelial connective tissue wall covered by a thin, squamous or cuboidal epithelium, where, in some points, glycogen-rich clear cells might be found [9,10]. The differential diagnosis includes gingival inflammatory or non-inflammatory lesions such as a fibroma, epulis or lateral periodontal cysts, peripheral odontogenic tumors (e.g., peripheral ameloblastoma or peripheral odontogenic keratocysts), and vascular lesions [2][3][4][5][6][7][8][9][10][11][12]. The gold standard treatment for GCAs remains surgical excision, which is associated with a minimally invasive mucosal approach and very low recurrence rate [4][5][6][7][8][9][10][11][12][13].…”

“…Nikitakis et al described in their study a radiographic image of LPC associated with a well-circumcised intraosseous radiolucency at the level of the dental mid-root or lateral root surface. [14] GCAs are rarely evident on radiograms; however, when the cyst pressure determines bone involvement, they may appear as a crestal bone translucency, making it impossible to differentiate GCAs from LPCs [8].…”