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Radiology Forum
October 2000

Imaging Quiz Case 4

Arch Otolaryngol Head Neck Surg. 2000;126(10):1272-1273. doi:

A right medial maxillectomy was performed, and the findings confirmed the diagnosis of a dentigerous cyst containing an unerupted tooth. As in this case, symptomatic dentigerous cysts may occupy the entire maxillary sinus at the time of diagnosis and are usually unilocular with well-defined and corticated margins consistent with slow growth. As these cysts expand, they displace and remodel rather than invade or destroy bone.

Dentigerous cysts usually occur in the second to fourth decades of life, with an incidence that is twice as high in men as in women. The term dentigerous means "containing teeth," and these cysts by definition are associated with the crown of an unerupted or impacted tooth. They develop from the accumulation of fluid between the enamel organ remnant and the subjacent tooth crown.1 The sites most commonly affected are essentially the common sites of tooth impaction: maxillary canines and mandibular and maxillary third molars. Dentigerous cysts are usually asymptomatic and discovered on routine radiographs. Pain and swelling may result from infection or extensive expansion. Rapid growth or onset of pain may also indicate the formation of an ameloblastoma. Ameloblastomas, and less frequently, epidermoid and mucoepidermoid carcinomas may arise from the lining of a dentigerous cyst. Treatment of dentigerous cysts depends on size but generally entails enucleation and curettage. The cyst wall consists of fibrous connective tissue lined by stratified squamous epithelium (Figure 3).1

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