Download - Infected Periapical Cyst
DEPARTMENT OF ORAL MEDICINE AND RADIOLOGY
A CASE REPORT ON
INFECTED PERIAPICAL CYST
Submitted by
ANTONY SEBASTIANC.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 cyst called a residual periapical cyst.
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. Dense fibrous connective tissue with infiltration of lymphocytes, neutrophils, histocytes, mast cells, eosinophils, plasma cells.
TREATMENT
i) Extraction
ii) Conservative non-surgical endodontic therapy
combined with marsupialization, decompression or
fenestration.
DIFFERENTIAL DIAGNOSIS Periapical granuloma Periapical abcess Cementoma (Stage I ) Traumatic bone cyst.
CASE SHEETIDENTIFYING 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 pus and blood discharge.
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.
Frequency of changing brush- once in three months
FAMILY HISTORY
No relevant history
CLINICAL EXAMINATION: GENERAL
EXAMINATION:-
Built - Moderately built and nourished
Gait
Skin Normal
Sclera
Conjunctiva
Pallor
Cyanosis Absent
Oedema
Clubbing
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 No Abnormalities detected
Floor of the mouth
Palate
Gingiva Colour - Greyish pinkContour - ScallopedConsistency - FirmBleeding on probing - AbsentSurface 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 EXAMINATIONNumber of teeth Present - 31Missing teeth - 36Dental Caries - 26Tenderness on percussion- Pain on percussion in relation to 31,16. Root Stump - 16
Wasting disorders
Attrition
Abrasion Nil
Erosion
Mobility - Nil
Occlusion - Class I
Deposits - Calculus (generalized)
present
Stains - Absent.
Fractured teeth - 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 granulomaPeriapical abcess.Cementoma Traumatic bone cyst
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