Endoscopic Finding of a Dentigerous Cyst

A 36-year-old male with a 2-year history of left nasal obstruction was referred to our hospital. Nasal endoscopy revealed a reddish colored exophytic mass in the left nasal cavity (Figure 1). Nasopharynx, larynx, and oral cavity were normal. Computed tomography demonstrated a 3-cm, homogenous mass with eggshell calcification in the left nasal cavity and maxillary sinus (Figure 2). There was an unerupted tooth inside the mass, and we suspected it to be a dentigerous or globulomaxillary cyst. We performed a transnasal endoscopic surgery, which revealed that the mass was cystic, and after incision a dark brown fluid was aspirated. Marsupialization was done with a microdebrider. After the mass was uncapped, an unerupted tooth on the maxilla was found and removed with cup forceps (Figure 3).

Figure 1.

Nasal endoscopy shows a reddish encapsulated cyst in left vestibule (white arrow).

Figure 2.

Coronal paranasal CT revealed a large cyst occupying the left maxillary sinus and nasal cavity with peripheral calcification. Note the supernumerary tooth of the inverted mesiodens within the cyst. CT indicates computed tomography.

Figure 3.

After the cyst was uncapped, an impacted tooth in the anterior maxillary area was found (white arrow). The tooth was removed with cup forceps.

Histopathological analysis of the specimen demonstrated a dentigerous cyst lined with ciliated stratified squamous epithelium. The postoperative period was uneventful and there was no recurrence for 1 year.

Dentigerous cyst is a developmental odontogenic cyst that surrounds the crown of an unerupted permanent tooth. ¹ The most likely affected group is between 10 and 30 years of age and predominantly male. ² This disease is usually associated with an impacted third molar or maxillary canine, but rarely with a supernumerary tooth. A dentigerous cyst related to a supernumerary tooth is usually found in the maxillary anterior region, especially the mesiodens. ³

Radiographically, this kind of cyst is seen as a unilocular radiolucency with a sclerotic border, which suggests that reduced enamel epithelium surrounds the crown of the tooth.

Histological analysis shows multiple layer thickness of nonkeratinized stratified squamous epithelium. Treatment of the cyst includes enucleation with extraction of the involved tooth or marsupialization. However, the treatment modality can vary, depending on the age of the patient and site of the cyst.