A case of an extensive dentigerous cyst in the maxillary sinus leading to epiphora and nasal obstruction

Abstract

Background: The dentigerous cyst is defined as a cyst that originates by the separation of the follicle from around the crown of an unerupted tooth. The clinical examination reveals a missing tooth or teeth and possibly a hard swelling, sometimes resulting in facial asymmetry and possible pathologic fracture. A large maxillary cyst involves the whole sinus and can transmit pressure to the walls of the sinus and, consequently, cause ophthalmologic and nasal symptoms to develop.

Objectives: To report the case of an extensive dentigerous cyst with swelling of the right cheek, accompanied by unilateral nasal obstruction and epiphora.

Case report: A 21-year-old man presented with swelling of the right cheek, right-sided nasal obstruction, and watering of the right eye. Panoramic radiography revealed a relatively large and well-defined radiolucency enveloping an unerupted maxillary canine tooth. Computed tomography scan showed a cystic lesion measuring 5.2 cm horizontally, 4.3 cm vertically, and 4 cm sagittally, with expansion and erosion of the anterosinus cortical bone. The mass was seen to extend into the right half of the nasal cavity up to the right ethmoid air cells, and was in contact with the base of the skull. The bony margins of the right maxillary antrum were thinned out, the osteomeatal complex was pushed medially-superiorly, and the pterygoid plates were intact. Excision of the dentigerous cyst of the right maxilla was performed using the Caldwell-Luc approach under general anesthesia.

Conclusion: A dentigerous cyst arising from an unerupted tooth should be considered in the differential diagnosis of nasal obstruction, watering or epiphora of the eye, and fistula of the gingivobuccal sulcus.