1/13. Bilateral pneumothorax with extensive subcutaneous emphysema manifested during third molar surgery. A case report. This report describes a case of bilateral pneumothorax with extensive subcutaneous emphysema in a 45-year-old man that occurred during surgery to extract the left lower third molar, performed with the use of an air turbine [dental] handpiece. Computed tomographic scanning showed severe subcutaneous emphysema extending bilaterally from the cervicofacial region and the deep anatomic spaces (including the pterygomandibular, parapharyngeal, retropharyngeal, and deep temporal spaces) to the anterior wall of the chest. Furthermore, bilateral pneumothorax and pneumomediastinum were present. In our patient, air dissection was probably caused by pressurized air being forced through the operating site into the surrounding connective tissue. ( info) |
2/13. Unicystic ameloblastoma: a possible pitfall in periapical diagnosis. AIM: To report a clinical case of unicystic ameloblastoma previously misdiagnosed as radicular cyst. SUMMARY: A 49-year-old white male was referred to a private practitioner complaining of an asymptomatic bony hard swelling of the left posterior mandible. The patient's [dental] history indicated that his left mandibular first molar had been extracted approximately 10 years previously. At that time, preoperative radiographic examination demonstrated a radiolucent area of 1.5 cm diameter with well-defined margins involving the distal root of tooth 36. The lesion was diagnosed as cystic and surgery for its removal was advised, but not performed. At presentation, radiography demonstrated a well-defined 3 cm diameter radiolucency extending from the second premolar to the second molar. The lesion was enucleated and histopathological examination confirmed a diagnosis of unicystic ameloblastoma. KEY learning POINTS: *Despite a clinical diagnosis of periapical disease of endodontic origin, a nonendodontic lesion may be present. *Unicystic ameloblastoma located on the periapical area of a tooth can lead to a pulp-periapical misdiagnosis, and should be considered in differential diagnosis. *All tissue specimens recovered in apical surgery should be submitted to histopathological analysis. ( info) |
3/13. Residual and inflammatory radicular cysts. Clinical and pathological aspects of 2 cases. Inflammatory odontogenic cysts include radicular cysts and its etiological variance, residual cysts. Among these lesions, the radicular cyst is the most frequent. It is caused by the growth of remnants of Malassez cells involved in the development of the [dental] organ. Clinically, radicular cysts are difficult to diagnose. Histologic diagnosis is of primary importance in order to definitely discriminate the different kinds of periapical lesions. In this paper, the clinical, radiographic, etio-physio-pathological and microscopic features of these pathological formations are described. A case of a large radicular cyst and a case of residual cyst are reported and the surgical treatment and histologic differential diagnosis are presented. ( info) |
4/13. Nonsurgical treatment of extensive cyst-like periapical lesion of endodontic origin. AIM: To report the repair of an extensive periapical lesion of endodontic origin, following nonsurgical treatment. SUMMARY: Clinical and radiographic examination revealed an extensive periapical lesion related to tooth 22, extending from the distal surface of tooth 21 to the mesial surface of 26. The patient reported a previous history of [dental] trauma involving this quadrant and had been under orthodontic treatment for a year. Intraoral examination revealed an asymptomatic bony hard swelling, mainly confined to the palate. During root canal exploration irregular walls associated with 3 mm of apical calcification were noted. After apical patency was obtained 1 mL of bloody serous exudate was drained. Intracanal aspiration provided a further 2 mL of yellow serous exudate. Following biomechanical preparation, a dressing of calcium hydroxide with anaesthetic solution was applied and replaced four times over a period of 12 months. The clinical-pathological picture demonstrated resolution of the lesion during this period of time. The 14-month clinical and radiographic examinations revealed normal bony contour and a significant resolution of the maxillary radiolucency. KEY learning POINTS: Periapical lesions of endodontic origin may develop asymptomatically and become large. Proper biomechanical preparation followed by calcium hydroxide medication renewed periodically represents a nonsurgical approach to resolve extensive inflammatory periapical lesions. ( info) |
5/13. Central neurilemmoma of the jaw in concurrence with radicular cyst: a case report. We report the features of a central neurilemmoma in the mandible of a patient having an inflammatory apical [dental] (radicular) cyst in the same region. A 29-year-old woman complained of numbness on the right side of the lower lip of 3 months duration and noted following endodontic therapy to the right mandibular first molar tooth. Panoramic radiography revealed a bilocular radiolucency in the right body of the mandible. Excisional biopsy was performed. The histopathology revealed neurilemmoma of the mandible in concurrence with inflammatory apical [dental] (radicular) cyst. No recurrence was detected during a 1-year follow-up. ( info) |
6/13. Conservative treatment of a large radiolucent cyst-like apical lesion--a case report. This case demonstrates the conservative treatment of a large apical radiolucent lesion over a period of one year. It is surmised that a [dental] cyst was present and that resolution was brought about by the use of calcium hydroxide combined with frequent drainage through the root canal. ( info) |
7/13. Large radiolucent area of the anterior mandible. A case and review of the pathogenesis of a large radicular cyst has been presented. The radicular cyst is a common finding in [dental] practice, but is usually confined to the apical area of one to two teeth. Large destructive lesions are uncommon. A thorough clinical and radiographic evaluation should always be completed before [dental] or surgical intervention is performed and all excised tissue should be examined microscopically. ( info) |
8/13. biomedical engineering for the conservation of teeth--the use of a Nd-YAG laser for a treatment of apical focus. When the apical focus (root cyst) is treated, if the tooth concerned can be preserved, the root canal should first be enlarged and cleaned sufficiently, and then sealed with filling materials. However, if an expensive prothesis is placed on the crown of the tooth concerned, or if the root canal is blocked with a post core of calcification, root canal treatment becomes difficult from a practical point of view. We therefore tried irradiation using the Nd-YAG laser, which is known for its high transmissibility into teeth, to the root canal, and the apical area. In its histological images it is considered to the action on bacteria and bacteria-infected substances inside the root canal through calcification of the dentinal surface layer facing the [dental] pulp, closure of the dentinal canal opening, and there was substantial change in the dentine in the outer layer. We have achieved good clinical results using this method; we eventually extracted only two teeth in 200 cases; it is thus very significant that most of the teeth of the patients still maintain their function, although they were diagnosed as non-preservable using conventional methods. ( info) |
9/13. dens in dente: an unusual sequela. Abbreviated case report. dens in dente is the result of an invagination of the enamel organ into the developing [dental] papilla. The full pathologic potential of this lesion is often not fully appreciated. A case is reported in which a cyst resulting from a dens in dente obliterated the maxillary sinus and necessitated root canal therapy and apicoectomies in four adjacent teeth. ( info) |
| Nonspecific gyrate erythemas (NGE) are commonly associated with hypersensitivity reactions to exogenous or endogenous antigens. A case of NGE with clinical resemblance to tinea corporis in a patient with a [dental] radicular cyst is reported. Cutaneous lesions disappeared after surgical excision of the [dental] cyst. The clinical and pathological details are described and the relationship between radicular cyst and cutaneous lesions discussed. Earlier reports are reviewed and the possibility of a focal origin is emphasized. ( info) |