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A case of dentigerous cyst


Academic year: 2022

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報告人: Int. J組 林柏穎 施柏穎 林可蔓 王盛弘 20150526 指導醫師: 陳玉昆主任 林立民教授

OM Case Report

A case of dentigerous cyst


General data

Name: X X X

Sex: Male

Age: 54

Native: 高雄

Marital status: Married

First visit: 104.04.29

Attending staff: X X X醫師


Chief Complaint

Referred from 802 hospital Dr. X X X for

mass over left mandibular body area for a period.


Present illness

802 hospital

-This 54 y/o male complaint about a mass over left

mandible and was referred from 802 hospital Dr. X X X for mass over left mandibular body area for a period.


Past History

Past Medical History

Drug and food allergy: (-)

Systemic disease: DM(+), HbA1c =7

Hospitalization: (+),乳突瘤

Surgery under GA: (+)

Past Dental History

General routine dental treatment

Attitude to dental treatment: co-operative


Personal History

Cigarette smoking (+)

Alcohol drinking (-)

Betel-quid chewing (-)


Extraoral examination

Facial asymmetry: (+),outer skin with mass over auricular area

Swelling: (-)




Intraoral examination


Overlying mucosa: Normal

Expansion of mandible (+), ascending ramus deformation

Palpation pain (-)

Lower lip numbness (-)


X-ray finding






X-ray finding



Left molar region up to ramus of mandible

Maximum dimension: 4 x 3 x cm

Shape: ovoid

Radiodensity: unilocular radiolucency



X-ray finding

Border: well-defined with corticated margin

Internal structure: unilocular radiolucency image

Effect on surrounding structure: displacement and inverted embedded tooth 38, surrounding the left mandibular canal


Differential diagnosis


Differential diagnosis


Peripheral or Intrabony?

Our case Peripheral Intrabony

Mucosal lesion - + -

Induration - + -


expansion - - +/-

Cortical bone

destruction - - +/-


Inflammation, Cyst or Neoplasm?

Our case Inflammation

Redness - +

Swelling - +

Local heat - +

Pain - +

→ Cyst or Neoplasm


Cyst or Neoplasm?

Our case Cyst

Aspiration Unknown +

Fluctuation + +/-


border + +

Bony expansion + +/-


Our case Inflammation cyst


inflammation cyst


tenderness - + -

Local heat - + -

Color Pink Reddish Pink

Progression Slow Fast Slow


margin + - +


Our case Benign Malignant Border Well-defined Well-defined Ill-defined

Sclerotic margin + + -

Destruction of

cortical margin - +/- +

Pain - - +

Induration - - +

Swelling with

intact epithelium + + -

Progress Slow Slow Fast

Metastasis Unknown - +/-

→ Non-inflammation cyst or Benign


Differential diagnosis

Well –defined

Unilocular radilucency

Posterior mandible

Old age


Differential diagnosis

Dentigerous cyst

Odontogenic keratocyst

Unicystic ameloblastoma


Working diagnosis

Our case Dentigerous cyst

sex male Male >female

Age 54 10~30

Site Left mandibular molar area Mandible (3 rd molar)

S/S no Usually asymptom, swelling or

pain if infected,

size 4x3 cm in diameter Average size 3cm~4cm

X-ray features well-defined unilocular ovoid shaped radiolucency with a

sclerotic margins

well-defined, smooth, unilocular, corticated margin,impacted tooth


Our case Odontogenic keratocyst

sex male male

Age 54 10~40 yrs(60%)

Site Left mandibular molar area

Posterior Mandibular, Mostly molar area(49%)

S/S no usually asymptomatic

Large: pain, swelling or drainage.

size 4x3 cm in diameter varies

X-ray features well-defined unilocular ovoid shaped radiolucency

with a sclerotic margins

Well-defined unilocular

radiolucent with smooth and often corticated margin

25~40% unerupted tooth involved Root resorption is less common Clinical


Color: pink Pain(-)

usually asymptomatic


Our case Unicystic ameloblastoma

sex male none

Age 54 Young age, ave 23

Site Right mandibular molar area Post .Mandible

S/S no nil

size 4x3 cm in diameter Average size 4.3cm~6.3cm X-ray features well-defined unilocular ovoid

shaped radiolucency with a sclerotic margins

well-defined, smooth, unilocular ,corticated

margin Clinical


Color: pink Pain(-)

Color: pink Pain(-)


Clinical Impression


Dentigerous cyst, tooth 38


Treatment Course


Tooth 38 complicated odontoectomy + Incisional biopsy + Decompression

button placement insertion


H-p report: Dentigerous cyst



Treatment Course


Follow up, N/S irrigation and BI application


Follow up, N/S irrigation and BI application




Outcome of a Dentigerous Cyst following Decompression using a Removable Appliance: A Case Report OHDM-vol.13-No.1-March 2014

Basak Durmus, Barhan Pekel, Faysal Ugurlu, Ilknur Tanboga



Dentigerous cysts develop around the unerupted tooth, in the absence of an inflammatory stimulus .

Occur frequently in the lower jaws of patients aged 6–12 years.


Reduced enamel epithelium derived from the tooth-forming organ

Radiographic - it appears as a round or

void, well-defined unilocular


In this case, managing a large dentigerous cyst in a child using a customised

Decompression removable appliance.



A 7-year-old female, in good general health with no significant medical history.

Revealed mixed dentition, swelling in the left mandibular region and tenderness over lower left second primary molar with an


well-defined unilocular radiolucency

approximately 3×3 cm in size under the primary left mandibular molar area

extending to the lower border of the mandible.

From distal side of the tooth 34 to the


2 cm long, 2.5 mm wide hole over the cyst from the lower left second primary molar.


the tooth 75 and tooth 35, to which the

cystic lumen was attached, were extracted.


Histopathology revealed

- stratified squamous non-keratinized epithelium

with a fibrous connective tissue&

inflammatory cell.

Dentigerous cyst was confirmed


Resin projection was adjusted to fit the socket of the extracted tooth


Antibiotics and analgesics & irrigation was needed.


6-monthes follow up


The bone density increased and bone trabeculation was seen at the end of the first year .


2-years follow up



Marsupialization or decompression is a

conservative technique that attempts to relieve the intracystic pressure by creating an accessory cavity.

The conservative approach needs a longer healing period and good patient cooperation.



It has marked advantages:

it is minimally invasive

there are no severe complications (infection)

it conserves bone and important anatomic structures(inferior alveolar nerve and

mandibular canal)



In comparison with traditional

decompression techniques, this case

used a customised appliance.



It was easy to apply.

The patient or his/her parents can irrigate the area

Daily recalls are not necessary.

It can be converted into a space retainer to prevent space loss



The resin projection of the appliance was used to decompress the cystic lesion and to prevent the entry of food debris into the cyst cavity. It also prevented the formation of fibrous tissues.

The appliance was not used only as an obturator;

it also served as a space maintainer.



The cooperation of the patient and parents was fundamental to the success of the treatment, as they complied with the postoperative oral hygiene measures fully.



Conservative treatment is a useful

treatment for an extensive dentigerous cyst.

Depending on the size and location of the dentigerous cyst, the age of the patient, and relationship to vital structures



Oral and maxillofacial pathology ,Third edition, Neville Damn Allen Bouquot

Outcome of a Dentigerous Cyst following

Decompression using a Removable Appliance: A Case Report, Basak Durmus, Barhan Pekel, Faysal Ugurlu, Ilknur Tanboga





生命的神聖性(Sanctity of life)



Tom Beauchamp &James Childress 六大原則 - 1979

1. 行善原則(Beneficence):醫師要盡其所能延長病人之生命且減輕病人之 痛苦。

2. 誠信原則(Veractity):醫師對其病人有「以誠信相對待」的義務。

3. 自主原則(Autonomy):病患對其己身之診療決定的自主權必須得到醫師 的尊重。

4. 不傷害原則(Nonmaleficence):醫師要盡其所能避免病人承受不必要的身 心傷害。

5. 保密原則(Confidentiality):醫師對病人的病情負有保密的責任。

6. 公義原則(Justice): 醫師在面對有限的醫療資源時,應以社會公平、正義 的考量來協助合理分配此醫療資源給真正最需要它的人。



Decompression 的做法能降低二次手術危險



















→治療前有完整蒐集病史資料,並與病患溝 通後擬定進一步的治療計畫







1. 本人為原則

2. 病人未明示反對時,亦得告知其配偶與親屬 3. 病人為未成年人時,亦須告知其法定代理人

4. 若病人意識不清或無決定能力, 應須告知其法定代理人、配偶、


5. 病人得以書面敘明僅向特定之人告知或對特定對象不予告知




→Dentigerous cyst最佳的治療方式是 sugical excision,將病灶完整的清除

(enucleation)才能將復發率(recurrence rate) 降到最低。Decompression 降低手術難度及 併發症




應書寫詳盡, 使治療過程有詳實的記錄及治 療順利。








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