Dentigerous Cyst Associated with Ectopic Canine and a Supernumerary Tooth: A Rare Occurrence
A 10 year-old boy presented with a painless swelling in the left maxillary anterior region of 8-9 months duration. On general examination, the patient was apparently healthy with normal growth and development for his age and there was no history of systemic diseases or trauma. Clinical examination revealed an extraoral swelling on the left side of the face with elevation of the nostril and lateral border of the nose. The swelling was extending from the lateral wall of the nose to zygomatic region mediolaterally and from infraorbital region to right upper lip superoinferiorly. There was obliteration of the nasolabial fold. The swelling was soft, fluctuant, painless with positive crepitus.\nIntraorally the swelling was extending from maxillary left central incisor to the premolar region with obliteration of the vestibule []. The mucosa overlying the swelling appeared to be intact. Paranasal view of the radiograph [] showed a well defined unilocular radiolucency surrounding two teeth in the left anterior region of the maxilla. Displacement of the roots of the maxillary left lateral incisor was also seen. The lesion was extending from the lateral wall of the nose to zygomatico maxillary region mediolaterally and from maxillary alveolar ridge to infraorbital rim superoinferiorly.\nFine needle aspiration revealed the presence of straw colored fluid within the lesion. After clinical and radiographic examination, a provisional diagnosis of dentigerous cyst involving impacted teeth was made. Routine hematological investigations was normal. Surgical excision of the lesion was planned under general anesthesia. All aseptic precautions were taken. Crestal incision was given in the region of left maxillary central incisor and extended as crevicular incision around left maxillary first premolar. Vertical releasing incision was given distal to left upper premolar at an angle of 45°. Using a periosteal elevator carefully the full thickness mucoperiosteal flap was raised. On reflection of mucoperiostium, the exposed buccal cortical plate was found to be very thin and perforated in the region of retained deciduous canine. The cystic lining was located on removal of thin buccal cortical plate. Carefully the cystic lining was separated from the underlying bone along with the impacted teeth (permanent ectopic canine, supernumerary teeth), [Figures –] retained deciduous canine and lateral incisor, which was mobile and involved with the lesion. The supernumerary teeth were conical in shape resembling a peg shaped incisor.\nThe lesion was found to be measuring around 3 cm × 3 cm, involving the sinus wall. The perforated sinus wall was repaired using autogenous bone graft from anterior sinus wall. Due precaution was taken to avoid perforation or tearing of lateral nasal wall, which was closely attached to the cystic lining. After complete removal of the cystic lining, the mucoperiosteal flap was approximated and suturing done using 3-0 Mersilk. Dressing was given. The post-operative healing was uneventful. The suture removal was carried out after 7 days. Histological examination of the specimen confirmed the diagnosis of a DC []. Patient was under follow-up for 6 months and presented no complications, meanwhile, he was advised for orthodontic and prosthetic rehabilitation to correct the malocclusion and alleviate problems with patients lack of dentition.