Infected Periapical Cyst

DEPARTMENT OF ORAL MEDICINE AND RADIOLOGY A CASE REPORT ON

INFECTED PERIAPICAL CYST Submitted by

ANTONY SEBASTIAN C.R.I.

PERIAPICAL CYST DEFINITION: Epithelium at the apex of a non-vital tooth can be presumably stimulated by inflammation to form a true epithelial lined cyst or periapical cyst. Periapical cyst represents a fibrous connective tissue wall lined by epithelium with a lumen containing fluid and cellular debris. Prevalance:- 15% (approximately ) A similar cyst, best termed a lateral radicular cyst may appear on the lateral aspect of the root. Periapical inflammatory tissue that is not curreted at the time of teeth removal may give rise to an inflammatory

PATHOGENESIS CARIES ↓ PULPAL NECROSIS ↓ PERIAPICAL INFLAMMATION ↓ PERIAPICAL GRANULOMA ↓ PROVIDE RICH VASCULAR AREA TO RESTS OF MALASSEZ ↓ RESTS OF MALASSEZ PROLIFERATE ↓ FORM LARGE MASS OF CELLS ↓ INNER CELLS OF MASS DEPRIVED OF NOURISHMENT ↓ UNDERGO LIQUEFACTION NECROSIS ↓ FORMATION OF A CAVITY IN THE CENTRE OF GRANULOMA ↓ RADICULAR CYST.

RADIOGRAPHIC FEATURES  Loss of lamina dura along adjacent root.  Rounded radiolucency encircles the affected tooth apex.  Root resorption is common. HISTOPATHOLOGICAL FEATURES  Squamous epithelium may show exocytosis, spongiosis or hyperplasia.  Lumen filled with fluid and cellular debris.  Arch-shaped calcifications known as Rushton bodies  Dystrophic calcification, cholesterol clefts multinucleated giant cells,red blood cells.  Areas of hemosiderin pigmentation  Walls of inflammatory cyst will contain Hyaline bodies.

TREATMENT i)

Extraction

ii)

Conservative

combined with

non-surgical

endodontic

therapy

marsupialization, decompression or

fenestration. DIFFERENTIAL DIAGNOSIS  Periapical granuloma 

Periapical abcess



Cementoma (Stage I )



Traumatic bone cyst.

CASE SHEET IDENTIFYING DATA Name

: Mr. Revathi

Age

: 23 yrs

Sex

: Female

Occupation : Phone technician Address

: C-2, Gandhi Nagar, Kichipalayam Salem-15.

OP.No

: 02832

CHIEF COMPLAINT Patient complains of swelling in the lower part of the chin region for the past 3 months

and also complaint of

HISTORY OF PRESENT ILLNESS Patient was apparently normal 3 months back, then she noticed a small swelling in the lower part of the chin region patient also complaint of apetite, fever patient was under medication but the swelling has subside. PAST MEDICAL HISTORY Drug allergy – present allergy to unknown drug. PAST DENTAL HISTORY She has undergone extraction of 36 five years back PERSONAL HABIT Mixed diet Brushes once daily with brush and paste.

FAMILY HISTORY No relevant history CLINICAL EXAMINATION: GENERAL EXAMINATION:Built - Moderately built and nourished Gait Skin

Normal

Sclera Conjunctiva Pallor Cyanosis Oedema Clubbing

Absent

Vital Signs Temperature: Afebrile. Pulse rate

: 74 beats/min

EXTRAORAL EXAMINATION Face

: Symmetrical

Swelling Situation : Lower part of the chin Size

: 1 x 1 cm

Shape

: Oval

Consistency

: Soft

Tenderness

: Absent

Surface of skin : Pinchable Pus discharge

: Present

Nose Lips Eyes

No abnormality detected

Paranasal Sinuses T.M.J Salivary Gland Lymphnode Examination -

Not palpable

INTRAORAL EXAMINATION SOFT TISSUE EXAMINATION: Buccal mucosa Labial mucosa Tongue Floor of the mouth Palate

No Abnormalities detected

Gingiva Colour Greyish pink Contour Scalloped Consistency Firm Bleeding on probing Absent Surface texture Stippling present. Periodontal Pocket Absent. Tonsil / Pharynx No abnormalities detected Pain on palpation In the vestibular sulcus region in relation to 31,16. HARD TISSUE EXAMINATION Number of teeth Present - 31 Missing teeth - 36 Dental Caries - 26 Tenderness on percussion- Pain on percussion in relation to 31,16.

Wasting disorders Attrition Abrasion

Nil

Erosion Mobility Occlusion

-

Nil

Class I

Deposits

-

Calculus (generalized)

present Stains Fractured teeth

-

Absent. -

Nil

SUMMARY Patient named, Revathi, 23 yrs, Female, complaints of swelling in the lower part of chin region for the past 3 months the swelling was single, non tender and 1*1cm she also complaint of fever , loss of apetite, depression. patient is un known allergy to drugs pain on percussion and palpation present in relation to31,16 generalised hard and soft deposit present lymph node was not palpable dental caries in relation to26. PROVISIONAL DIAGNOSIS: Infected periapical cyst in relation to 31.   DIFFERENTIAL DIAGNOSIS : Periapical granuloma Periapical abcess.

INVESTIGATION : IOPA in relation with

31

FINAL DIAGNOSIS : Infected Periapical cyst in relation to 31.   TREATMENT PLAN : RCT in relation to 31. Surgically: Apicectomy in relation to 31.

FACIAL VIEW

INTRA ORAL VIEW

IOPA

BIOPSY

POST OPERATIVE VIEW