Appearance can be deceptive: Dentigerous cyst crossing the midline
An 80-year-old man, reported to the Department of Oral Medicine and Radiology with the chief complaint of pus discharge from the left lower front region of face since 2 years. Pus discharge was spontaneous, intermittent and started and stopped on its own. The pus discharge was not associated with any discomfort [].\nOn examination, extra-orally a fibrosed sinus opening was present on the left parasymphyseal region. The skin surrounding the sinus appeared normal in color with no secondary changes. On palpation, sinus opening was non-tender and fixed to the underlying bone with no frank discharge but a single, non-tender, movable left submandibular lymph node was palpable. Intra-orally generalized wasting disease of the teeth was present. Root stump in relation to 17, 21, 22, 27, 46 were present and 26, 34, 35, 43 were missing.\nIOPA in relation to 35, 36, 37 revealed radiolucency in the periapical region of 36 not contacting the teeth.\nMandibular cross-sectional occlusal radiograph showed diffuse radiolucency extending from 34 to 44 region, latero-medially and from periapex to lower border of mandible superior-inferiorly. The cortical plates are not expanded [].\nOPG showed a unilocular well-defined radiolucency extending lateromedially from the distal root of 36 to the mesial root of 47 and superior-inferiorly from the furcation area of the teeth to the lower border of the mandible. The periphery of the radiolucency is scalloped with sclerotic border. A well-defined radio-opacity is seen at the lower border of the mandible on the right side in the periapex of 44, which was identified as impacted canine (43) [].\nOn the basis of history, clinical and radiological examination, a provisional diagnosis of Odontogenic keratocyst was given.\nEnucleation of the cyst with chemical cauterization was done conserving the impacted canine to avoid fracture of lower border of the mandible. The teeth involved in the cystic lining were extracted. The surgery was done using local anesthesia and under antibiotic cover.\nThe cystic lining was sent for further histopathological examination. Histopathological examination revealed cystic epithelium comprising of 2-3 layers of non-keratinized stratified squamous epithelium. Fibrous connective tissue and slight inflammatory cell infiltrate was observed in connective tissue stroma. Hence, the diagnosis of Dentigerous cyst was confirmed [].\nHealing was uneventful and 1 week after the surgery, the surgical site showed good healing and the sutures were removed. The patient was recalled for follow-up every week and Iodoform dressing was given. The post-operative OPG taken after 2 weeks revealed healing by secondary intention []. Patient was lost to follow-up.