Pathologic jaw lesions associated with impacted teeth.

The aim of this study was to evaluate the histopathologic diagnoses and radiographic characteristics of lesions associated with impacted teeth. In this retrospective study, 2624 biopsy reports were assessed. If the report was a record of a pericoronal lesion, the age and sex of the patient and the location, microscopic diagnosis, radiographic features, and size of the lesion were recorded. The Pearson chi-square, Kruskal-Wallis, and Fisher exact tests were used for statistical analysis. In total, 189 patients (7.2%) had lesions associated with impacted teeth. The mean (SD) age of affected patients was 25.91 (14.38) years, and 51.9% of patients with pericoronal lesions were male. The most common lesion sites were the posterior region of the maxilla (43.3%) and the posterior region of the mandible (38.0%). Dentigerous cysts (DCs) constituted 64.6% of the lesions, and odontogenic keratocysts (OKCs) represented 18.5%. Radiographs were available in 153 cases, and most lesions were radiolucent (96.1%), had well-defined outlines (99.3%), and were unilocular (87.6%). Lesions larger than 2.0 cm were 5.5 times more likely than smaller lesions to be diagnosed as non-DC lesions (P = 0.001; Kruskal-Wallis test). Although most of the lesions associated with impacted teeth were DCs, there were other lesions with aggressive behavior, such as OKCs, ameloblastomas, and glandular odontogenic cysts, which require more extensive treatment. Lesions that were 2.0 cm or greater showed a higher probability of being non-DC lesions.

Report of intraosseous intravascular papillary endothelial hyperplasia associated with an odontogenic cyst in the maxilla and literature review.

Intravascular papillary endothelial hyperplasia (IPEH) represents an uncommon reactive endothelial hyperplastic proliferation. A 46-year-old man experienced increased volume in the right maxilla, elevation of the nasal ala, and swelling of the hard palate with a reddish hue for 3 months. Computed tomography revealed an expansive hypodense region and cortical bone destruction associated with an impacted supernumerary tooth and an endodontically treated tooth. Under the differential diagnoses of a radicular cyst, dentigerous cyst, and ameloblastoma, an exploratory aspiration and incisional biopsy were performed. This revealed the formation of blood vessels of various diameters lined by endothelium, forming intravascular papillae positive for CD-34. The definitive diagnosis was IPEH, and the patient was treated by embolization and surgery. Histological analysis confirmed the presence of IPEH associated with an odontogenic cyst. After 12 months of follow-up, no recurrence was observed. Also, we reviewed case reports of IPEH affecting the maxilla and mandible. Fourteen intraosseous cases were reported in the maxilla and mandible, with a preference for males and affecting a wide age range. Complete surgical excision was the treatment of choice, and recurrences were not reported. The pathogenesis of IPEH is controversial and may originate from trauma or inflammatory processes. To the best of our knowledge, this is the first report of an association of IPEH with an odontogenic cyst. The importance of IPEH in the differential diagnosis of intraosseous lesions in the jaws is emphasized, and preoperative semiotic maneuvers are needed to prevent surgical complications.

Appearance and recurrence of odontogenic keratocysts.

OBJECTIVE: The purpose of this study was to evaluate the appearance, histopathological features, and recurrence of odontogenic keratocysts (OKCs) from a large single institute registry over a 36-year period. MATERIALS AND METHODS: A total of 226 cases of OKC were identified in 174 patients over a 36-year period in a single institute in Southwestern Finland. Histological specimens were re-evaluated. The patient's age, sex, location, recurrence, and histopathological features of the OKC were the study variables. RESULTS: OKCs occurred more frequently in men, the mean age was 46 years, and the most frequent site was the lower jaw. Recurrence rate was 21%. Histopathologically, inflammation was present in 95% and satellite cysts in 10% of cases. In patients diagnosed with satellite cysts, OKC recurred in 50% of cases, while the corresponding figure for patients without satellite cysts was 17%. CONCLUSIONS: Compared with the literature, patients were older and inflamed cysts were found more frequently. Satellite cysts occurred only in association with chronic inflammation. Based on the results, regular radiographic evaluation is important among patients aged 10-29 years to detect OKCs and to treat them before enlargement, infection, and inflammation. Satellite cysts should be reported and may be a sign of increased risk of OKC recurrence.

[Treatment tactics for patients with retention cysts, odontogenic cysts, mucocele and other pathologies of the maxillary sinuses as preparation for a sinus lift]. / Lechebnaya taktika v otnoshenii retentsionnykh kist, odontogennykh kist, mukotsele i drugikh zabolevanii verkhnechelyustnoi pazukhi pri podgotovke k sinus-liftingu.

OBJECTIVE: The aim the studi. Differential diagnosis of retention cysts of the maxillary sinus with odontogenic cysts, acute and chronic sinusitis, aspergillosis, and mucocele in preparation for sinus-lifting surgery. MATERIAL AND METHODS: The analysis of the case histories of 265 patients aged 18-65 years of both sexes who were treated at the dental clinic «Rudenta Family¼ from 2016 to 2021 was carried out. On the basis of clinical symptoms and data of cone-beam computed tomography (CBCT), a description of the pathologies of HPV is given for the purpose of differential diagnosis and correct interdisciplinary interaction with ENT doctors for the purpose of dental implantation in the lateral parts of the upper jaw. RESULTS: In 90 (out of 265) patients (34%), a change in the condition of the maxillary sinus mucosa was detected. 18 patients (7%) for preoperative preparation were sent to the ENT department of the FSBI «CCB with polyclinic¼ of the UDP of the Russian Federation with diagnoses: chronic maxillary sinusitis of various etiologies and mucocele. In this group of patients, sinus lifting followed by dental implantation was performed 6 months after endoscopic maxillofacial surgery under the control of CBCT. Retention cyst Retention cysts of the maxillary sinus were of different sizes in 62 (23.4%) patients and, depending on the size and localization of the sinus-lifting was performed with simultaneous removal of the cyst, or without removal of the cyst. CONCLUSION: Retention cysts do not need to be removed as a preoperative preparation for sinus lifting. In the case of large sizes and difficulty in peeling the Schneider membrane, retention cysts are removed by a dental surgeon during antral augmentation as one of the stages of the operation. In such pathologies as odontogenic cyst, acute and chronic sinusitis, aspergillosis, mucocele, interdisciplinary interaction of ENT doctor and dentist is necessary. Differential diagnosis of maxillary snus pathology is carried out on the basis of clinical data and a picture of cone-beam computed tomography.

Management of radicular cyst associated with primary teeth using decompression: a retrospective study.

BACKGROUND: Radicular cysts arising from primary teeth are rare. Enucleation and marsupialization or decompression are treatment approach to odontogenic cysts. Decompression known to achieve good results in various cysts is widely used in clinic. This study aims to evaluate the efficiency of decompression in reducing radicular cysts associated with primary teeth in children. METHODS: Cases of radicular cysts associated with primary teeth treated by decompression were reviewed in the present study. Clinical information and radiologic data of pre and post decompression were measured and analyzed. RESULTS: Twenty-three patients treated for 25 cysts were included. All lesions with mean initial area 3.66 ± 2.00 cm2 were reduced after decompression time ranging 2 to 10 months. Mean rate of reduction was 0.77 ± 0.44 cm2/mo and large lesions (> 3.5 cm2) had a significantly higher reduction rate compared to smaller ones (< 3.5 cm2) (P < 0.00). All effected succedaneous teeth erupted after treatment at follow-up while 12 (46%) of them had root development problems. CONCLUSIONS: Decompression represents superiority as an effective and less invasive treatment in radicular cysts associated with primary teeth. TRIAL REGISTRATION: This study was retrospectively registered in the Ethics Committee of Ninth People's Hospital Affiliated with Shanghai JiaoTong University School of Medicine (No.SH9H-2022-T158-1).

Florid Cemento-Osseous Dysplasia with a Concurrent Glandular Odontogenic Cyst.

The presence of non-odontogenic cysts associated with benign fibro-osseous lesions of the jaws has been well documented. However, literature is scant when describing benign fibro-osseous lesions with associated odontogenic cysts. This case report highlights the presence of a concurrent developmental odontogenic cyst, glandular odontogenic cyst with extensive squamous metaplasia, in a patient with florid cemento-osseous dysplasia (COD). The postulated pathogenesis of these synchronous lesions is discussed along with a review of current literature. Surgical treatment is discouraged for florid COD, however, radiological follow-up is recommended, especially in lesions with associated cysts.

Endoscopic Removal of Huge Cholesterol Granuloma in the Maxillary Sinus Confused With Odontogenic Keratocyst.

Cholesterol granuloma is a foreign body reaction to the deposition of cholesterol crystals, usually found in association to chronic middle ear diseases, being highly uncommon in the paranasal sinuses. Furthermore, a huge and aggressive cholesterol granuloma involving the maxillary sinus, hard palate, buccal space, and maxillary alveolus is extremely rare and has not been reported previously. This article reports a case of huge cholesterol granuloma in the maxillary sinus confused with an expansile odontogenic keratocyst, which was treated successfully via transnasal endoscopic approach.

Oral pulse granuloma and oral pulse granuloma associated with odontogenic keratocyst: Two clinical cases and a review of the literature.

Two cases of oral pulse granuloma (OPG) or vegetable granuloma (VG) are presented, one of which was concomitant with an odontogenic keratocyst (OKC), which is an unusual finding. OKC is characterized by the presence of hyaline rings which include vessels, giant cells, other inflammatory cells and collagen fibres. There are two hypotheses as to its histogenesis: firstly, as a reaction to vegetable matter, such as legumes (thus the nomenclature "pulse" or edible seed) and secondly as a degenerative change in the vessel walls as a result of localized vasculitis. Due to the deceptive appearance of OPG, diagnosis can be challenging.

Elevated ATF4 Expression in Odontogenic Keratocysts Epithelia: Potential Involvement in Tissue Hypoxia and Stromal M2 Macrophage Infiltration.

The aim of this study was to investigate the expression of the activating transcription factor 4 (ATF4) in odontogenic keratocysts (OKC), its association with hypoxia and M2-polarized macrophages infiltration, and its potential relationships with angiogenesis in OKC. The expression of ATF4, hypoxia-inducible factor 1α (HIF-1α), macrophage colony-stimulating factor (M-CSF), and receptor activator of nuclear factor κ-B ligand (RANKL) in OKC samples and normal oral mucosa (OM) was detected by immunohistochemistry. Meanwhile, microvessel density (MVD) was measured using antibody against CD31. M2-polarized macrophages were identified using double-staining for CD68+ and CD163+. The correlations of ATF4 with HIF-1α, M-CSF, and M2-polarized macrophages infiltration were determined by Spearman's rank correlation test and hierarchical clustering. Human immortalized oral epithelial cells (HIOECs) were used in in vitro experiments. Our data showed that the expression of HIF-1α, ATF4, and M-CSF was significantly upregulated in the epithelium of OKC when compared with the OM. The expression of ATF4 was positively correlated with that of HIF-1α, M-CSF, MVD, and M2-polarized macrophages infiltration. Elevated expression of ATF4 in the epithelial lining of OKC may facilitate the M2 macrophages infiltration in response to hypoxia, leading to the development of OKC.

[Methods of diagnosis of non-specific and specific lymphideniates of the jaw-facial part in children (literature review)].

OBJECTIVE: Introduction: Insufficient basic knowledge on the mechanisms of the multifactoral etiology and pathogenesis of various forms of maxillofacial lymphadenitis of odontogenic and non-odontogenic nature in children causes difficulties in making differential diagnosis. The algorithm of their examination involves a large number of methods, each of which has its own advantages and disadvantages with variable informativeness, depending on the particular situation. The aim: The paper is aimed atfamiliarization of broad medical public with informativeness of diagnostic measures in the nonspecific and specific affection of lymph nodes of the maxillofacial area in children. PATIENTS AND METHODS: Materials and methods: A thorough comprehensive analysis and generalization of scientific achievements elucidated in the fundamental and periodical publications, relating to diseases of the lymphatic system, has been carried out. RESULTS: Results: It has been establishedthat, despite a large variety of diseases accompanied by the reaction of the lymph nodes of different anatomic localization, current diagnostic possibilities are potent to establish a clinical diagnosis in most cases. In this way, the current diagnostic model requires the interaction of clinicians, infectiologists, molecular biologists, geneticists and morphologists. In this regard, the issues of efficient organization of the diagnostic process, detailing all stages of the search for accurate diagnosis, are crucial. CONCLUSION: Conclusions: The collected material on various forms of lymphadenitis and their secondary affection is fragmentary to date due to the absence of the unified methodological approach to carrying out differential diagnosis, which requires generalization and systematization of scientific groundwork. Unfortunately, the algorithms of examination of this category of patients, especially with lymphadenopathy, are not sufficiently developed to date, indicating the need for further search and optimization of diagnostic criteria taking into account modern realities.

Odontogenic Keratocysts as First Manifestation of Nevoid Basal Cell Carcinoma Syndrome: Surgical Management and Immunohistochemical Analysis.

Nevoid Basal Cell Carcinoma Syndrome (NBCCS), also known as Gorlin syndrome, is a rare autosomal dominant disorder, with no gender predilection. Individuals with NBCCS are commonly diagnosed between 17 and 35 years old and can present multiple basal cell carcinomas scattered throughout the body, presence of recurrent and early-onset odontogenic keratocysts (OKCs) and skeletal abnormalities. This article describes a case of a 13-year-old white boy who referred complaining of facial asymmetry. Extraoral examination revealed volumetric increase displacing the nasal ala from the right side and extended to the zygomatic bone. The intraoral evaluation showed mixed dentition with moderate degree of malocclusion. In addition, bilateral vestibular fornix swelling was observed in the upper canine region. An increase in volume was also detected on the hard palate on the right side. Computed tomography revealed multiple hypodense lesions with cystic appearance. The aspiration was positive, with a yellowish aspirate of serous consistency of all lesions. Given the numerous lesions, it was decided to decompress them for posterior enucleation procedures. In addition to other manifestations, the patient was diagnosed with NBCCS. Although common, the occurrence of OKCs in pediatric patients, especially in multiple lesions, is highly indicative of NBCCS, and its investigation should be considered, even in the absence of other signs of this syndrome. Synchronous decompression was satisfactory and can be used in similar cases of multiple cystic lesions.

Glandular odontogenic cyst: An updated analysis of 169 cases reported in the literature.

OBJECTIVE: To integrate the available data published on glandular odontogenic cyst (GOC) into a comprehensive analysis of its clinical/radiological and histopathological features. METHODS: An electronic search was undertaken in May/2017. Eligibility criteria included publications having enough clinical/radiological/histological information to confirm the diagnosis. RESULTS: Fifty-eight publications (169 GOCs) were included. The lesion was slightly more prevalent in men than in women. There was a high prevalence in the fifty/sixth decades of life, in the anterior regions, and in mandibles. Lesions were commonly associated with bone expansion (73%) and unilocular radiological appearance (61.5%). GOC was found to be associated with tooth displacement or an unerupted tooth (30.9%), cortical bone perforation (26%), presence of clinical symptoms (24.3%), root resorption (13.9%). Microscopic parameters most commonly were observed in GOCs-in at least 95% of the lesions: presence of hobnail cells, intraepithelial microcysts, epithelial lining with variable thickness. The presence of apocrine snouting was the microscopic parameter less often found (40.4%). CONCLUSION: Although the recurrence rate of GOCs is not as high as previously believed, it is a relevant phenomenon (21.6%). Adjunctive procedures after enucleation should be considered. None of the clinical/radiological and histopathological features evaluated had a statistically significant effect on the recurrence rate.

Primary Closure of Oroantral Communication Using Pedicled Buccal Fat Pad Following Maxillary Cyst Enucleation.

Odontogenic keratocyst (OKC) is a clinically aggressive developmental odontogenic cyst with a high recurrence rate as 62%. Oroantral communication (OAC) is a gateway through the maxillary sinus and the oral cavity, which, if not treated, will develop into oroantral fistula or chronical sinus diseases. Different methods for closure of OAC were described but only few of them have common usage. In recent years, the use of a pedicled buccal fat pad (BFP) in closure of large oroantral defects has been become popular. In our patient, the OAC resulted from the surgical removal of OKC was closed with BFP.

Odontogenic parakeratinized cyst resulting in exophthalmos and palatine, maxillary, and zygomatic bone erosion in a dog.

A novel case of a canine odontogenic parakeratinized cyst (COPC) that resulted in exophthalmos and palatine, maxillary, and zygomatic bone erosion in a 5-year-old Chihuahua dog is reported. Final diagnosis was aided by cross-sectional imaging (magnetic resonance imaging and computed tomography) and confirmed with histologic examination of the cyst wall.

Differences in clinical manifestations of odontogenic and non-odontogenic lymphadenitis.

INTRODUCTION: The acute suppurative lymphadenitis and its chronic forms prevail in the structure of inflammatory processes of the maxillofacial area in children. High incidence of the acute and chronic forms of lymphadenitis of both odontogenic and nonodontogenic origin is caused by the anotomophysiological peculiarities of the structure of the teeth and soft tissues in children in different age periods. THE AIM: The paper was aimed at comparison of clinical manifestations of the acute and chronic odontogenic and non-odontogenic lymphadenitis. MATERIALS AND METHODS: The results of the checkup and 5-year-period treatment of 324 children with the acute and chronic forms of the nonspecific lymphadenitis of the maxilifacial area have been used. Four study groups have been formed. The first and the second group included 16 (38,0%) and 26 (62%) children with the acute submandibular suppurative lymphadenitis of the odontogenic and nonodontogenic origin, respectively. 12 (35,3%) and 22 (64,7) individuals with chronic hyperplastic lymphadenitis have been assigned to the third and the fourth group, respectively. RESULTS: The clinical course of the acute submandibular suppurative lymphadenitis of various etiologies is different. Rapid development of the local clinical manifestations with its dramatic progressing is specific to odontogenic lymphadenitis. Its clinical course is characterized by the more apparent overall response of the body, increase of the body temperature, and these symptoms are more manifested than in nonodontogenic lymphadenitis. The clinical course of chronic hyperplastic lymphadenitis is accompanied by the enlarged regional lymph nodes of various size and shapes and dense-elastic consistency. Clinical manifestations of nonodontogenic lymphadenitis were less apparent and the overall sate was normal in both forms of lymphadenitis. CONCLUSIONS: Nonodontogenic lymphadenitis prevailed in all nosological forms of the acute and chronic nonspecific lymphadenitis.

Marsupialization facilitates movement of the cystic lesion-associated deeply impacted mandibular third molar in spite of its mature roots.

BACKGROUND: The odontogenic cystic lesions happened in the angle and ramus region are frequently associated with impacted mandibular third molars. The treatment plan was difficult to work out for the huge cystic lesions with deeply impacted third molars, since the enucleation with simultaneously removing the deeply impacted teeth may cause serious complications. Therefore, the marsupialization of the cystic lesions followed by enucleation with tooth removal has also been advocated. The aim of this study was to explore the movement of cystic lesion-associated deeply impacted mandibular third molars (IMTM) after marsupialization. MATERIALS AND METHODS: Between July 2009 and December 2015, patients who had mandibular cystic lesion associated with IMTM and underwent marsupialization followed by enucleation with tooth extraction were included in our retrospective study. The clinical and pathological data was collected. The distance and direction of movement of the IMTM after marsupialization was measured on panoramic radiograph and computed tomography. RESULTS: Four male and six female patients whose ages ranged from 14 years to 67 years were enrolled in this study. Among the all impacted molars, there were 3 cases with mature roots. After marsupialization, all the cystic lesions shrunk and all impacted teeth moved toward the bony windows, and the distance of tooth movement were from 8.3mm to 12.1mm. The complications included swelling and pain, while no numbness of the ipsilateral lower lip was happened. CONCLUSIONS: Marsupialization can promote the movement of impacted teeth with or without mature roots, and may be an optimal treatment approach for the huge posterior mandibular cystic lesions with deeply impacted third molar.

Keratocystic odontogenic tumor arising at the mandibular ramus with an impacted tooth: a case report and mimic lesions.

OBJECTIVES: To consider the biologic behaviors of keratocystic odontogenic tumors (KCOTs) and ameloblastomas and dentigerous cysts. METHODS: A 63-year-old Japanese man presented with swelling and discomfort in the left cheek during jaw movement. Examination revealed a multilocular lesion within the mandible extending from the left second premolar to the left mandibular ramus and coronoid process; the lesion contained a deviated impacted tooth. The tumor had expanded beyond the bone and was invading the masseter and medial pterygoid muscles. Marginal mandibulectomy with a free iliac bone graft was performed. RESULTS: No recurrence was observed during a 7-year follow-up. DISCUSSION: The histopathological diagnosis of the lesion showed it was a KCOT. These tumors usually grow within the bone, causing bone expansion. However, this tumor had expanded beyond the bone and invaded surrounding muscles. Thus, KCOTs can, in rare cases, manifest themselves as described here. Evaluating preoperative images and histopathological findings is important to determine the optimal treatment strategy.