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is more than 5 mm. These cysts may also convert 3.0 cm × 4.5 cm in size. The erupting left lower third
[1]
into ameloblastomas, mucoepidermoid carcinoma and molar was displaced and lying in close proximity to that
squamous cell carcinoma. [10] of the sigmoid notch and the crown of the tooth was
involved in the lesion. Second molar on the same side
The growth rate may be quite rapid, with lesions growing was also impacted wherein the lesion had encompassed
up to 5 cm in diameter in 3‑4 years. It can, however, the entire tooth. Gross thinning of both the cortices was
become extremely large and is sometimes associated noted in relation to the lesion and no definitive resorption
with cortical expansion and erosion. The expansion of the root of any tooth was seen. Lesion was extending
[3]
of these cysts is usually related to an increase in the anteriorly to the root of left canine. Coronal and axial
osmolality resulting from passage of inflammatory cells computed tomography (CT) scans [Figure 3] revealed
and desquamated epithelial cells into the cystic lumen. [11]
almost symmetrical expansion of the medial and lateral
We report a challenging case of massive dentigerous cortices of the left condyle and also that of the ramus. No
cyst involving the whole half of the mandible, which was temporal bone involvement was seen.
successfully treated with conservative therapy. This report Considering the factors such as age, site, as well as the
also illustrates a simplified surgical treatment for a large high regenerative capacity of the musculo‑periosteal
dentigerous cyst in the mixed dentition period.

CASE REPORT

A 13‑year‑old female child reported to the Department of
Oral, Maxillofacial Surgery of Bapuji Dental College and
Hospital, Davangere with a chief complaint of swelling
over the left lower third of the face. The swelling was
gradual and progressive as noted by the patient till the
time of presentation [Figure 1]. There was no history of
trauma. No episode of pain or discharge from the site was
reported by the patient.
Patient was subjected to routine general systemic
examination. She had no relevant past and present
medical history. There was no history of cachexia or
weight loss. Patient reported no contributory significant
dental history. Local examination revealed an extraoral Figure 1: Preoperative profile
solitary swelling, which was oval in shape measuring
about 5 cm × 4.5 cm. Swelling extended superiorly from
the zygomatic arch region to 1 cm below the inferior
border of the mandible inferiorly. Anteroposteriorly,
it was extended about 3 cm from the tragus of the ear
to the oral commissure. On palpation, the swelling was
bony hard in consistency with a smooth surface. It was
nontender with no pulsations; no egg‑shell crackling was
evident. Overlying skin was pinchable with no rise in local
temperature and no secondary changes were evident. The
patient had normal functioning cranial nerves V and VII.
Lymph node examination ruled out the presence of any
pathology with the nodes. Figure 2: Preoperative orthopantomogram

The patient had a maximal interincisal opening of 35 mm.
Teeth present were the second molar to second molar in
the maxilla, and she had clinically missing both of the third
molars. In the mandible, both the third molars as well as
the second molar on the left side were absent. Lingual and
buccal cortical expansion on the left side was evident.
Routine hematological investigations revealed normal
values. The swelling was aspirated using a large bore
needle and the straw‑colored fluid revealed a high protein
content of 5.1 g/100 mL.
Orthopantomogram [Figure 2] showed an expansile
radiolucent lesion involving the left body, the ramus,
condyle and coronoid processes measuring approximately Figure 3: Preoperative CT scan

Plast Aesthet Res || Vol 2 || Issue 5 || Sep 15, 2015 295