Dental cyst Maxilla excision via Caldwell Luc approach

By

Dr. T. Balasubramanian M.S. D.L.O.

Synonyms: Radicular cyst, Periapical cyst

 This is the commonest of all odontogenic cysts.  This is usually caused due to root infection involving the tooth closely related to the maxillary sinus antrum.  The resulting pulpal necrosis causes release of toxins at the apex of the tooth leading to periapical inflammation.  This inflammation stimulates the Malassez epithelial rests, which are found in the periodontal ligament, resulting in the formation of a periapical granuloma that may be infected or sterile.  The epithelium undergoes necrosis and the granuloma becomes a cyst.  The cyst could well be sterile if the patient had received antibiotic treatment for dental infection.  These lesions when small can easily be missed until and unless a routine radiograph is taken.  
     Radiographically it is virtually impossible to differentiate granuloma from a cyst.  If the lesion is large it is more likely to be a cyst.  Radiographically both granuloma and cyst appear to be radiolucent, associated with the apex of non vital tooth. 
     These lesions can grow into large lesions because they apply pressure over the bone causing erosion.  The toxins released by the granulation tissue is one of the common  causes of bone erosion.  These are non neoplastic lesions.  Microscopically, the epithelium is a nondescript stratified squamous epithelium without keratin formation.  Evidence of inflammation may be observed in the lining wall. 

Clinical features:  As the cyst expands it causes erosion of the floor of the maxillary sinus.  As soon as it enters the maxillary antrum the expansion starts to occur a little faster because there is space available for expansion.  When it reaches a size wherein it fills up the whole antrum, it can erode the anterior wall of the maxilla (in the canine fossa area).  This is the weakest portion of the maxillay bone.  When it erodes the anterior wall of the maxilla it could cause expansion of the maxilla which could be seen as a swelling in the cheek area.  On palpation egg shell crackling may be felt in the anterior wall of the  maxilla over the canine fossa.  There will be associated tenderness. 
     Tapping the teeth with a tongue depressor will cause tingling sensation because of involvement of the root of the teeth.  


In the video clip shown below you will be seeing a dental cyst which has eroded the anterior wall of maxilla.  The cyst was approached via Caldwell Luc procedure sublabially.  On incising the muco perichondrium, yellowish fluid started pouring out of the defect in the anterior wall of the maxilla.  The contents of the maxillay sinus along with its mucosal lining was curretted out.  Inferior meatal antrostomy was performed.  Ointment impregnated gauze was used to pack the antrum.  The wound was closed with catgut.