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Case 161250

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Referral category

Troublesome / painful / cracked tooth (Endodontic)

Region of interest

Maxilla

Referral reason

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1 Files Info

Canaray 161250

1. Large marsupialized unilocular cyst occupying entire left maxillary sinus

A large, well-defined unilocular cystic lesion has originated in the left maxillary tuberosity, and has occupied the entire left maxillary sinus. This lesion appears to have marsupialized through the posterior wall of the maxilla into the retromaxillary region. This is likely the source of the reported recurrent swelling of the cheek. The entity is partially composed of fluid and also contains an air space, which suggests that it has self-marsupialized. The residual left maxillary sinus is completely opacified, and exhibits localized expansion of the anterior wall. Teeth 26 and 27 are not the source of this entity, and appear to have been secondarily affected. Mild apical resorption is present at the distobuccal and palatal roots of tooth 27. This radiographic appearance is suggestive of a benign unilocular odontogenic cyst arising within the left maxillary tuberosity.

Axial views of left maxilla

These axial cross sectional images demonstrate the large unilocular cystic lesion that originates in the left maxillary tuberosity and fully occupies the left maxillary sinus. Note the expansion and perforation of the posterior lateral wall of the left maxillary sinus, as well as the expansion of the anterior wall of the sinus. The residual sinus cavity is completely opacified. Note the expansion of the medial wall of the sinus into the nasal cavity. The cystic lesion in the posterior left maxilla has essentially had similar effects on the surrounding structures that would be seen when a sinus mucocele is present

Coronal views of the left maxilla

These coronal cross sectional images demonstrate the expansion of the medial and lateral walls of the left maxillary sinus by the cystic lesion in the posterior left maxilla. The dehiscence in the posterior lateral aspect of the maxillary tuberosity is evident in these images, and is likely the site of marsupialization of the cystic lesion

Sagittal views of posterior left maxilla

These sagittal cross sectional images demonstrate the presence of air and fluid within the marsupialized cystic lesion in the posterior left maxilla. The extension of the cystic lesion to occupy the entire left maxillary sinus is evident in these images. Note the presence of mild resorption of the root apex of tooth 27.

Normal tooth 26

Tooth 26 appears normal radiographically, and does not appear to be the source of any pathology.

Apical root resorption at tooth 27DB+P

The palatal root apex of tooth 27 exhibits mild resorption in the region adjacent to the large unilocular cystic lesion in the posterior left maxilla. The distobuccal root also exhibits a similar appearance. Tooth 27 appears normal otherwise, and is not the source of any pathology. The tooth likely remains vital.