Dentigerous cyst associated with an impacted mesiodens: report of 2 cases
A 55-year-old male patient reported to the Department of Oral Medicine, Diagnosis, and Radiology with a chief complaint of pain and swelling in the maxillary anterior region for 1 month. Since then, the swelling had gradually increased in size. The patient had taken an unknown medication for the pain and swelling, but he had no relief. On clinical examination, a solitary diffuse extraoral swelling was seen in the upper anterior region of the face. It had anteroposteriorly extended from the tip of the nose to 1 cm lateral to the left ala of the nose, superoinferiorly extending from 2 cm inferior to the left inner canthus of the eye to the inferior border of the upper lip. The tip of the nose was slightly deviated towards the right, and the left nasolabial fold was elevated (). On intraoral examination, a solitary well-defined intraoral swelling measuring about 3 cm×3 cm was seen in the maxillary anterior labial vestibule extending from the left central incisor up to the left first premolar. The swelling was roughly oval in shape. The swelling was tender on palpation and fluctuant in consistency. The overlying mucosa was bluish in color, and the superficial blood vessels were prominent (). The left lateral incisor, canine, and first premolar showed grade III mobility and were tender on vertical percussion.\nOn radiographic examination, the maxillary topographic occlusal radiograph showed a well-defined, round, corticated radiolucency in the anterior maxillary region. A dilacerated supernumerary tooth was seen lying horizontally with the crown facing towards the center and root near the anterior border of the lesion (). The panoramic radiograph showed a well-circumscribed, corticated radiolucent lesion in the anterior maxilla, crossing the midline and extending from the right maxillary first premolar to the left maxillary first premolar. Slight root resorption was seen in association with the right central and lateral incisors, and severe root resorption was seen in association with the left lateral incisor and canine (). On a computed tomography (CT) scan, the coronal section showed a large, radiolucent, well-defined lesion in the anterior maxilla with a supernumerary tooth seen towards the inferior border of the lesion. There was upward displacement of the floor of the nasal cavity and of the floor of the maxillary sinus of the left side. The axial section showed complete destruction of the anterior border of the lesion (). A provisional diagnosis of the infected cyst was made on the basis of the patient's history, clinical examination, and radiographic examination. On aspiration, a viscous brick-red colored fluid was suggestive of an infectious cyst. The lesion was surgically enucleated along with removal of the impacted mesiodens, and the maxillary anterior teeth were extracted (). The histopathological examination showed a cystic lumen with a very thin lining of stratified squamous epithelium and dense fibrocellular connective tissue stroma with chronic inflammatory infiltrate, suggestive of an infected dentigerous cyst (). The patient remained asymptomatic, and no complications were noted after 1 year follow-up.