DENTIGEROUS CYST ASSOCIATED WITH ECTOPIC MAXILLARY THIRD MOLAR IN MAXILLARY SINUS: CASE REPORT

Abstract

Dentigerous cysts originate from the accumulation of fluid between the reduced enamel epithelium and the dental crown, and eventually affect maxillary third molars. These cysts can expand and displace the tooth element into ectopic positions. In maxilla, especially, these displacements can reach the inside of the maxillary sinus. In these cases, as a surgical intervention, the Caldwell-Luc approach can be chosen. This is a clinical case report of surgical removal of the maxillary third molar surrounded by a dentigerous cyst inside the maxillary sinus, through the Caldwell-Luc approach. Case description: A 15-year-old patient was referred to the Dental Specialties Center of Sobral, Ceará, complaining of pain and nasal discharge. The CT scan revealed a cystic lesion inside the maxillary sinus involving the crown of tooth 18, in contact with the floor of the orbit. The surgery was performed with local anesthesia and Caldwell-Luc access, for enucleation of the cyst and tooth extraction. During the excision, extravasation of citrine yellow fluid, suggestive of a dentigerous cyst, was observed, which was sent for histopathological analysis. Sinusectomy was performed to completely remove the cystic tissue, and the closure of the bone window was done with a portion of the Bichat's ball, promoting satisfactory healing. Discussion and conclusion: The dentigerous cyst is often associated with unerupted permanent teeth. With a prevalence of 14% to 20%, it occurs mainly in the mandible, affecting young men, rare cases involve dentigerous cysts in the maxillary sinus, associated with impacted third molars. Therefore, the most common surgical approach is the Caldwell-Luc technique, which allows the enucleation of the cyst and the removal of the affected tooth. Although effective, this technique can present some complications, such as epistaxis and lesions in the periorbital region. The choice of treatment should consider patient factors and the surgeon's experience to ensure safety and efficacy.