This document describes a case study of a 39-year-old male patient who presented with pain and swelling in the left upper back tooth region. Clinical and radiographic examination revealed a large radicular cyst extending from the upper left canine to third molar region. The cyst was initially enucleated through an intraoral approach. Later, a functional endoscopic sinus surgery was performed through the maxillary antrum to inspect for any residual cyst lining, since the patient also had a deviated nasal septum requiring septoplasty. No residual cyst was observed during endoscopy. This case report demonstrates that large maxillary radicular cysts can be effectively treated through both conventional intraoral enucleation and an end
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
The antralpseudocyst originates from the accumulation of serous inflammatory exudate in the sinus membrane without a specific etiology, this cyst has not of age group or gender preference. Radiographically, it is associated with a soft dome-shaped radiopaque pattern. This case is about a male patient of 58 years of age, with increased volume in the malar and left genic region of smooth, fluctuating consistency, which crackles at the pressure. Intraorally with the corresponding increase in volume in the sac, without changes in the oral mucosa. The tomography showed a radiolucent lesion that occupies and destroys left jaw and orbital fl oor. Thus, complete enucleation of the lesion and reconstruction of adjacent structures were performed. Clinical and imaging follow-up was carried out without postoperative complications and 8 years free of injury. It is of vital importance a correct diagnosis to guide the treatment adequately, however it is not necessary to underestimate the behavior of benign lesions and described as non-invasive.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
The antralpseudocyst originates from the accumulation of serous inflammatory exudate in the sinus membrane without a specific etiology, this cyst has not of age group or gender preference. Radiographically, it is associated with a soft dome-shaped radiopaque pattern. This case is about a male patient of 58 years of age, with increased volume in the malar and left genic region of smooth, fluctuating consistency, which crackles at the pressure. Intraorally with the corresponding increase in volume in the sac, without changes in the oral mucosa. The tomography showed a radiolucent lesion that occupies and destroys left jaw and orbital fl oor. Thus, complete enucleation of the lesion and reconstruction of adjacent structures were performed. Clinical and imaging follow-up was carried out without postoperative complications and 8 years free of injury. It is of vital importance a correct diagnosis to guide the treatment adequately, however it is not necessary to underestimate the behavior of benign lesions and described as non-invasive.
Differential diagnosis of oral and maxillofacial lesionsAhmed Adawy
A wide variety of lesions from the soft and hard tissues may arise in the orofacial region. Clinical diagnosis is a cognitive process of applying logic and knowledge in a series of step-by-step decisions, to create a list of possible diagnosis.
Combined endodontic periodontic treatment of a palatal groove/ dental implant...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
Differential diagnosis of oral and maxillofacial lesionsAhmed Adawy
A wide variety of lesions from the soft and hard tissues may arise in the orofacial region. Clinical diagnosis is a cognitive process of applying logic and knowledge in a series of step-by-step decisions, to create a list of possible diagnosis.
Combined endodontic periodontic treatment of a palatal groove/ dental implant...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
DOI:10.21276/ijlssr.2016.2.4.12
ABSTRACT- Mucocele is a commonly found benign, mucus-containing cystic lesion of the minor salivary gland caused
due to the damage or blocking of the glands. The damaged duct causes the saliva to build up and a cyst like swelling
ensues. Histologically they are of two types: Extravasation cyst and Retention cyst. Clinically they present themselves as
soft, bluish and transparent cyst like swelling especially on the lower lip. This case report presents a case of a 35 year old
male patient reporting with a soft bluish swelling on the inside of the lower lip. The history revealed the patients habit of
biting on the lower lip hence a differential diagnosis of mucocele, oral hemangioma, oral lympangioma, lipoma, and soft
tissue abscess was made. Fine needle aspiration cytology showed increase in amylase and protein content. A final
diagnosis was formulated as mucocele from the history of trauma, clinical features, and investigation (chemical analysis).
Complete excision of the lesion was done and sent for histopathological investigation which revealed a mucin-filled
cyst-like cavity beneath the mucosal surface. The patient was kept under observation for 3 months. The healing was
devoid of any scar formation commonly associated with such surgery’s. There was no recurrence of the cyst after 6
months. Alternative treatment modalities are cryosurgery, intralesional steroid injections. Key-words- Mucocele, Cyst, Salivary Retention, Salivary glands, Duct
Traditionally, obtaining tissue diagnosis from the Temporomandibular Joint (TMJ) has required invasive open techniques. In this case-series, the authors demonstrate a minimally invasive technique using arthroscopy to diagnose and treat Pigmented Villonodular Synovitis (PVNS) and pseudogout of the TMJ, followed by a review of the literature.
Endodontic Management of Unusual Case of Type II Dens Invaginatus – A Case Re...QUESTJOURNAL
ABSTRACT: A thorough knowledge of the normal anatomy of the root canal system as well as the possible aberrancies is imperative for success of endodontic therapy .The challenge lies in diagnosing these conditions properly, complete debridement of the root canal system, and 3-dimensional sealing of the same. Morphological dental anomalies of the maxillary lateral incisors are relatively common . Endodontic treatment for teeth that exhibit the dental anomaly, dens invaginatus, can be difficult due to the bizarre anatomy and relative inaccessibility of the diseased pulp tissue. Dens invaginatus is a developmental malformation of teeth. Affected teeth show a deep infolding of enamel and dentine starting from the foramen caecum or even the tip of the cusps and which may extend deep into the root. . The malformation shows a broad spectrum of morphologic variations and frequently results in early pulp necrosis. Dens invaginatus is a critical condition for endodontic treatment once it frequently presents a complex internal anatomy and might be associated with incomplete root and apical development. Therefore every effort must be made to identify and diagnose the variation. This article presents an Unusual case of Endodontic Management of maxillary left lateral incisior with Type II Dens Invaginatus .
Dr. Ahmed M. Adawy
Professor Emeritus, Dep. Oral & Maxillofacial Surg.
Former Dean, Faculty of Dental Medicine
Al-Azhar University. By definition, a cyst is a “pouch” or sac without an opening, provided with a distinct membrane, and containing fluid or semifluid material, abnormally developed in one of the natural cavities or in the substance of an organ. Cysts of the oral region may be epithelial or non-epithelial, odontogenic or non-odontogenic, developmental, or inflammatory in origin. The distribution of jaw cysts according to diagnosis in a general population is given. The treatment of choice is dependent on the size and localization of the lesion, the bone integrity of the cystic wall, its proximity to vital structures and patient age.Treatment modalities are discussed.
orthognathic surgery is very intresting and well knowing branch in oral surgery ....this presentation is dealing with jaw correction surgery in upper jaw.
Endoscopic Endonasal Excision of Odontoid Processiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
An Examination of Effectuation Dimension as Financing Practice of Small and M...iosrjce
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Does Goods and Services Tax (GST) Leads to Indian Economic Development?iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
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IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
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IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Customer’s Acceptance of Internet Banking in Dubaiiosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
A Study of Employee Satisfaction relating to Job Security & Working Hours amo...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
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IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Student`S Approach towards Social Network Sitesiosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Broadcast Management in Nigeria: The systems approach as an imperativeiosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
A Study on Retailer’s Perception on Soya Products with Special Reference to T...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
A Study Factors Influence on Organisation Citizenship Behaviour in Corporate ...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Consumers’ Behaviour on Sony Xperia: A Case Study on Bangladeshiosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Design of a Balanced Scorecard on Nonprofit Organizations (Study on Yayasan P...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Public Sector Reforms and Outsourcing Services in Nigeria: An Empirical Evalu...iosrjce
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Media Innovations and its Impact on Brand awareness & Considerationiosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Customer experience in supermarkets and hypermarkets – A comparative studyiosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Social Media and Small Businesses: A Combinational Strategic Approach under t...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Secretarial Performance and the Gender Question (A Study of Selected Tertiary...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Implementation of Quality Management principles at Zimbabwe Open University (...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Organizational Conflicts Management In Selected Organizaions In Lagos State, ...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
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MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
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The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Two Way Approach For Enucleation Of Maxillary Radicular Cyst.
1. IOSR Journal of Dental and Medical Sciences (IOSR-JDMS)
e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 14, Issue 11 Ver. V (Nov. 2015), PP 01-05
www.iosrjournals.org
DOI: 10.9790/0853-141150105 www.iosrjournals.org 1 | Page
Two Way Approach For Enucleation Of Maxillary Radicular
Cyst.
Dr.Soumi Samuel1
, Dr. Freddy Kersi Mistry2
, Dr. Marina Saldanha3
,
Dr. Shaji Thomas4
, Dr. Ajay pillai5
, Sakshi Gautam6
1.
Reader, A.B. Shetty Memorial Institute of Dental Sciences, Mangalore
2.
Post Graduate Student A. B. Shetty Memorial Institute of Dental Sciences, Mangalore
3.
Senior Resident,K.S.Hegde Medical Academy
4.
Dean , PCDS&RC, Bhopal
5.
Prof & In Charge,Dept of Maxillofacial Surgery. PCDS&RC, Bhopal
6.
Intern, Dept of Maxillofacial Surgery , PDA,Bhopal
Summary: Radicular cyst is the most common odontogenic cystic lesion of inflammatory origin. It is also
known as periapical cyst, apical periodontal cyst, root end cyst or dental cyst. It arises from epithelial residues
in periodontal ligament as a result of inflammation. The inflammation usually follows death of dental pulp.
Radicular cysts are found at root apices of involved teeth.The treatment of radicular cyst depends on the
condition of the teeth involved, the extent of the bone destroyed and accessibility of treatment. We report a case
of Maxillary radicular cysts which requires a complete enucleation of the cyst because of its presenting features
and extent. This article highlights the two surgical approaches possible for enucleating the same cyst one being
the conventional enucleation through oral cavity whereas other being the endoscopic approach through median
maxillary antrostomy.
Background:Radicular cysts are the most common (52%-68%) among the inflammatory types and occur solely
at the apices of non-vital teeth as a reactive process, especially in adults.1
Their prevalence is higher among the
population in their third decade with more predilection for males.They form as a result of the stimulation of the
odontogenic epithelium (Rests of Malassez) in the vicinity of the root tip, by the necrotic pulp, and the contents
of the root canal system.2
Different forms of treatment of jaw cysts have been described, such as enucleation,
curettage, decompression, marsupialisation and resection with or without jaw continuity. However, in large
cysts that extend into the maxilla, difficulties may be encountered due to the limited exposure and access for the
enucleation unless a generous incision is made.3
The purpose of publishing this case report is to show that
though the enucleation was done intraorally through a large sulcular incision and reflecting a flap there is also
possibility of enucleating the same cyst through Functional Endoscopic Sinus Surgery (FESS) via Median
Maxillary Antrostomy (MMA) which was done later in this case to rule out any residual pathology as the patient
had to undergo septoplasty to treat his nasal obstruction caused by deviated nasal septum.
Key Words: Radicular Cyst, Enucleation, Functional Endoscopic Sinus Surgery (FESS), Median Maxillary
Antrostomy (MMA)
I. Case Presentation:
A 39yr old male patient came with a complaint of pain in the left upper back tooth region since two weeks. Pain
was also associated with swelling which was gradual in onset since past two weeks attaining the size shown in
(Fig. 1) on clinical presentation. Mild facial asymmetry was present due to swelling. Patient was febrile around
the area of swelling with no other signs of inflammation except calor seen extra orally.
Fig:1 Fig:2
2. Two Way Approach For Enucleation Of Maxillary Radicular Cyst
DOI: 10.9790/0853-141150105 www.iosrjournals.org 2 | Page
Fig. 1: Extra oral examination showing facial asymmetry on the left side and Fig. 2: Intra oral examination
showing diffuse buccal swelling extending from upper left canine to the third molar.
On intraoral examination (Fig. 2) it was observed that solitary swelling was extending from the left
upper canine region till the third molar region bucally obliterating the buccal vestibule measuring 2.5 cm in
length and 1 cm in height, there was no sign of surface discharge or change in colour of the over lying tissues,
there was no signs of swelling in the palatal region . On palpation the swelling was bony hard in consistency,
mild tenderness with neither any discharge nor bleeding.
A provisional clinical diagnosis of odontogenic cyst was arrived based on clinical presentation
Investigations:
Panoramic radiograph: It revealed a well-defined unilocular radiolucent lesion extending anteriorly from
apical end of lateral incisor till distal aspect of third molar posteriorly. OPG also showed root stumps of first
molar which was the causative factor for the cyst formation. Calcification was not evident on radiograph (Fig.
3).
Fig. 3: OPG View
Paranasal Sinus View (PNS View): It revealed altered shape of left maxillary sinus. It also showed deviated
nasal septum to the left (Fig. 4).
Fig. 4: PNS View
Histopathological examination: Hand E stained slides shows a lumen lined by epithelium and surrounded by
connective tissue capsule (Fig. 5). The lining epithelium shows parakeratnised stratified squamous epithelium.
The connective tissue capsule shows collagen fibres, chronic inflammatory cells like lymphocytes and plasma
cells, blood vessels, extravasted RBCs and cholesterol clefts .
Histological diagnosis of infected radicular cyst was arrived at.
3. Two Way Approach For Enucleation Of Maxillary Radicular Cyst
DOI: 10.9790/0853-141150105 www.iosrjournals.org 3 | Page
Fig. 5 : Histopathological examination
Differential Diagnosis
Periapical Granuloma
Traumatic Bone Cyst
Surgical Ciliated Cyst
Globulomaxillary Cyst
Aneurysmal Bone Cyst
PeriapicalCemental Dysplasia
PeriapicalCemento-osseous Dysplasia
Pumice Cyst
Periapical Scar
Periapical Surgical Defect
treatment
Enucleation of the lesion along with extraction of 26 was performed through the buccalsulcular
approach (Fig. 6). The entire cystic lining was removed In Toto and was sent for histopathological examination.
(Fig. 7). The dead space was than packed with strip of gauze impregnated with tincture of benzoin and antibiotic
ointment. Primary Closure was achieved with a piece of gauze projecting out of the cavity so it can be replaced
with a new pack on the following post-operative visits.
Fig. 6: Enucleation of the cyst via buccalsulcular approach.
4. Two Way Approach For Enucleation Of Maxillary Radicular Cyst
DOI: 10.9790/0853-141150105 www.iosrjournals.org 4 | Page
Fig. 7: Cystic lining sent for histopathological examination
Dressing was changed after post- operative day four and a new dressing of smaller size was placed till
post-operative day seven following which the area was sutured completely for good healing.
The patient was on close follow up every fortnight for first one month followed by once every month.
Three months post operatively patient came with complaint of nasal obstruction and nasal discharge.
As there was presence of deviated nasal septum as it is clearly seen in the PNS view (Fig. 5) patient was referred
to the Dept. of Otorhinolaryngology. On ENT examination patient was diagnosed to have “Gross Deviated
Nasal Septum to the Left Side with a Spur Touching the Inferior Turbinate”. Patient was posted for Septoplasty
under General Anaesthesia. Even Left Uncinectomy and Medial Maxillary Antrostomy (MMA) was performed
to rule out if any pathological tissue is remaining from the enucleated cyst. Functional Endoscopic Sinus
Surgery (FESS) was done to have direct visual view of the maxillary lining (Schniderian Membrane) which
didn’t show any Pathologic remnants (Fig.8 & 9).
Fig. 8 & 9: FESS view showing Schniderian Membrane free of pathological cystic remnants
Outcome And Follow-Up
After correction of deviated septum and FESS a close follow up of every 3 months is done. Follow up after one
year shows patient is asymptomatic with no signs of recurrence neither there is difficulty in breathing nor any
nasal discharge.
II. Discussion
Radicular cyst arise from the cell Rest of Malassez present in the periodontal tissue as a result of
proliferation of the inflammatory process cause by an infected tooth whose root canal system is irreversibly
affected.4
Traditionally larger cystic lesions of the jaws can be treated more conservatively by a decompress
technique, aiming to reduce the size of the lesion for further performing of total enucleation in a less invasive
manner. With marsupialization, the cystic lesion is decompressed allowing new bone to fill the defect, leading to
substantial reduction in the size of the cystic cavity. It shows lower morbidity compared to enucleation in terms
of preservation of important anatomical structures as the maxillary sinus, the adjacent teeth and the inferior
alveolar nerve.5-6
However, marsupialization is a time-consuming treatment that can only be performed in a
compliant patient.7
In our case looking at the size of the bone involvement and patient compliance it was decided
to go ahead with enucleation.The affected teeth are extracted along with the cyst walls. The complications, such
as oroantral fistulas and chronic rhino sinusitis, may be caused by dental extractions in odontogenic cysts which
involve the maxillary sinus, even inadequate dental treatment may cause the recurrenceof the cyst.8
In our case
also the affected upper left first molar was extracted.
For the treatment of patientswith odontogenic maxillary cysts, endoscopic treatment hasbeen used in
addition to the dental procedure.Cedin et al first removed the cyst wallsfrom the maxillary sinus using small
clamps with an endoscopethrough a 10 mm circumferential hole of the canine fossa.9
5. Two Way Approach For Enucleation Of Maxillary Radicular Cyst
DOI: 10.9790/0853-141150105 www.iosrjournals.org 5 | Page
Trans nasal removal of large radicular cysts of themaxillary sinus has been also reported using the
endoscopicapproach through the maxillary sinus and opening of inferior meatus, authors of this literature also
suggest that partialresection of the cyst wall may be sufficient for the endoscopictreatment of the radicular
cysts.10
As in our case endoscopy was only used to visualise the residual cystic lining we support Satoshi Seno et
al10
that endoscopy can be used as the primary treatment of choice for enucleation of the radicular cyst but the
entire cystic lining needs to be enucleated completely as it can further act as a nidus for future pathology.
Endoscopy assisted enucleation is an innovative upcoming method for enucleation of the radicular and
various other odontogenic cyst causing even lesser morbidity than marsupialization, allowing preservation of
important anatomical structures and reduced healing period.11
Learning Points/Take Home Messages :
1.Maxillary Radicular Cyst can primarily be enucleated by FESS through MMA
2.As FESS is done under general anaesthesia it is a more comforting treatment plan rather to excise cyst
intraorally under local anaesthesia.
3.FESS is less invasive than conventional dental procedures, and it prevents oroantral fistula formation and
chronic maxillary sinusitis.
References
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