SURGICAL ENUCLEATION OF A LARGE RADICULAR CYST IN THE MAXILLA: A CASE REPORT

Joanna Sancharita Biswas*, Babu G. V. and Shilpy Dwivedi

ABSTRACT

Radicular cysts usually present as an osteolytic lesion at the periapical area of a tooth with an infected necrotic pulp. This case is a presentation of a massive radicular cyst in the maxillary anterior region of the jaw removed by surgical enucleation after endodontic treatment. A 15-year-old girl had come to the department with a chief complaint of pain and swelling in the left upper front region of the jaw. The girl had fallen down the stairs and hit her teeth 8 years ago. Since then, there was occasional pus discharge from a sinus tract that had formed above 21. Based on clinical, radiological and analysis of aspirate, a provisional diagnosis of an infected radicular cyst was made. Management of cyst by endodontic treatment followed by surgical excision was planned under local anaesthesia. Root canal treatment was done and surgically enucleated lesion was sent for biopsy. Histopathology revealed that underlying sub-epithelial tissue showed moderate inflammatory infiltrates of lymphocytes, plasma cells and few multinucleated giant cells and was rimmed by bony trabeculae confirming a radicular cyst. These cysts can occur in the periapical area of any teeth, at any age but are seldom seen associated with the primary dentition. Anatomically, the apical cysts occur in all tooth-bearing sites of the jaws but are more frequent in maxillary than mandibular teeth. The recommended treatment option available for radicular cyst is the conventional endodontic approach combined with decompression or surgical enucleation of a cyst with extraction of the offending tooth.

Keywords: Anterior trauma, Infected radicular cyst, Surgical enucleation, Endodontic treatment, Apicoectomy.