Surgical management of dentigerous cyst and keratocystic odontogenic\ntumor in children: a conservative approach and 7-year follow-up
An 8-year-old boy was referred to the Department of Oral Surgery with chief complaint\nof volume augmentation at the left side of mandible, pain and fever for about one\nweek. Panoramic radiograph revealed a unilocular radiolucent cystic lesion with\nsclerotic border associated lateral incisor, canine, first and second premolar\ncrowns. Teeth were dislocated apically and medially. After local bone aspiration and\nincisional biopsy, the histological diagnosis of dentigerous cyst was established\n(). Analysis of capsule fragment\nshowed to be lined by non-keratinized epithelium. Hemorrhagic areas were also\npresent. Under local anesthesia, the patient was submitted to marsupialization after\nextraction of the primary molars ().\nThe oral mucosa was sutured to the cyst capsule and iodoform gauze dressing was\ninserted within lesion cavity. Medication gauze was changed every 5 days until the\nwound edges were epithelialized and afterwards an acrylic plug was inserted in order\nto keep wound opening and decompression. The parents were instructed to irrigate the\ncavity twice a day with saline solution and the acrylic plug was fitted when\nnecessary, attending lumen reduction. Radiographic follow-up was performed\nperiodically. The involved permanent teeth erupted naturally, without any traction\nforces (). Second premolar assumed an\nimpacted position over the first premolar probably because of dental arch space\ndeficiency. Thus, under local anesthesia the second premolar was removed. One year\nafter the first visit, the lesion had completely withdrawn, but the lateral incisor\nstill remained displaced. A space-maintainer was installed and the patient was\nreferred to orthodontic treatment ()\nfor correcting tooth position. The radiographic follow-up of 7 years showed no lesion\nrecurrence ().