Unusual Clinicoradiographic Presentation of a Lateral Periodontal Cyst
A 13-year-old girl reported to the department of oral and maxillofacial radiology with a complaint of pain and swelling in the right side of the face of 3 days duration. Two weeks earlier the patient had pain in the same region for which she consulted a local physician. The pain subsided after she used antibiotics. No history of trauma, nasal discharge or ear discharge was detected. There was a history of swelling in the same region 4 years before that had regressed after pus discharge.\nOn examination, diffuse swelling was noticed in the left cheek area, measuring approximately 3×4 cm extending anteriorly up to the left ala of the nose, posteriorly up to the anterior border of the left ramus, superiorly 2 cm from the infra orbital rim, inferiorly 2 cm above the left lower border of the mandible. The nasolabial fold was obliterated on the left side. The overlying skin was normal in color. On palpation, no local rise in temperature was observed.\nThe swelling was non-tender, soft in consistency and the overlying skin was pinchable. Submandibular lymph nodes were palpable bilaterally, tender and mobile. On intraoral examination, the mucosa apical to 24 and 25 showed diffuse swelling approximately 1×1 cm in size which was erythematous (). The swelling was firm to hard in consistency and caused partial obliteration of the vestibular space in the same region.\nThe teeth were non-tender on percussion. On examination, normal complement of the teeth for the patient’s age were present. Electric pulp testing showed no response with respect to 24 and 25. On radiographic examination, intraoral periapical radiograph showed mesially inclined root of 24 and distally inclined root of 25. A comparatively radiolucent interradicular triangular area was seen between 24 and 25, the base of the triangle was forming an upward arc. Roots of 24, 25, 26 and 27 showed incomplete apexogenesis ().\nThe panaromic radiograph showed tilt in the long axis of 24 and 25, the triangular area could not be visualized adequately (). Radiographic differential diagnosis of lateral periodontal cyst include lateral radicular cyst, lateral periodontal cyst, botryoid odontogenic cyst, odontogenic keratocyst, unicystic odontogenic tumors.\nOn surgical exploration, a triangular mucoperiosteal flap was elevated, which showed a perforated buccal cortical plate (). A cyst like lesion was present interdentally between 24 and 25. The cyst was enucleated and the area was thoroughly curetted. The space was filled with hydroxyapatite bone graft material and the flap was sutured back in place.\nHistological examination of H&E stained slides showed a cystic lumen lined by stratified squamous non-keratinized epithelium of 3 to 4 cell-layer thickness. The surrounding connective tissue showed collagen fibres with lymphocytes ().\nThe patient was followed up for a period of 6 months. Satisfactory healing of the lesion was noticed. Radiologic examination of the surgical site showed satisfactory uptake of the graft materials and osseous repair ().