504 A Curious Case of a Slow-Growing Intra-Oral Swelling in a Paediatric Patient
R Budhdeo, A Graham, M Vaidyanathan, M Kabban- Surgery
Abstract
Background
A 15-year-old male attended the paediatric dental department as an urgent self-referral. Clinical examination revealed a large, firm lesion in the right maxilla which had been slowly increasing in size for the past year. No altered sensation and facial numbness was detected. The upper right central incisor (UR1) was missing however, a primary central incisor was extracted at the dentist three months prior.
Investigations
An orthopantomogram (OPG) at initial presentation illustrated a well-defined radiolucency extending from the upper right first molar (UR6) to the upper left central incisor (UL1) with root displacement of adjacent teeth. A subsequent cone beam computed tomography (CBCT) scan identified a well-defined corticated radiolucency with an area of radioopacity of mixed density in the posterior-medial aspect. Buccal expansion and root displacement in the premolar segment were noted. The unerupted UR1 was extremely displaced, lying horizontal and just inferior to the nasal cavity.
Diagnosis/Management
Differential diagnoses for the anterior right maxilla radiolucency included calcifying epithelial odontogenic tumour, adenomatoid odontogenic tumour and an odontome. The histopathology of the cystic lining taken under general anaesthetic during enucleation and curettage revealed the diagnosis of a calcifying odontogenic cyst.
Discussion
Calcifying odontogenic cysts are very rare developmental lesions occuring due to proliferation of odontogenic epitheluim and scattered nest cells. As in this case, these cysts are usually associated with unerupted/impacted teeth. Awareness of dental eruption timelines is essential in identifying impacted teeth and associated pathology. Slow growing lesions in the maxilla should be identified early and investigated within multidisciplinary teams.