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