PMC6169230_01
Extraoral photographs of the patient at first presentation in 2012.
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The 8-year-old boy first presented in January 2012, having been referred by the family dentist, to the Department of Orthodontics at the Medical Center of the University of Gottingen for a routine orthodontic control and evaluation of treatment need (Figure 1).
Panoramic radiograph (January 2012). Unclear radiolucency at teeth 13 and 23. Ectopic tooth 27.
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The radiological examination showed three suspicious hypomineralisations visible as radiolucencies in the panoramic radiograph associated with the retained teeth 13 and 23 and the ectopic tooth 27 (Figure 2).
Histopathologic specimen (HE stain, 5x magnification).
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The basal cells are palisading, with hyperchromatic nuclei (HE staining, 5x magnification) (Figure 3).
Panoramic radiograph (August 2012). 6 months after therapy, the radiolucent area in the region of tooth 23 was controlled. On the basis of the previous pathological findings, no further surgery was indicated.
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Due to the high recurrence of OKCs, a radiological control interval of 6 months was indicated (Figure 4).
Panoramic radiograph (August 2014). Evaluation of the region of tooth 13. No manifest change and therefore no indication for further therapy. Radiolucency around the crown of the retained tooth 47, with indication for cystectomy.
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In August 2014, during a regular radiological control, a new radiolucency was detected, associated with the retained and displaced teeth 47 and 48 (Figure 5).
Follow-up panoramic radiograph (October 2015) shows a clear enlargement of the translucent area at tooth 13, as well as new changes associated to the crowns of teeth 18, 17, 37, 38, and 48.
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The regular control examinations were interrupted by missed appointments, so the next evaluation took place one year later, in October 2015 (Figure 6).
Postoperative control panoramic radiograph (October 2015).
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The postoperative radiological examination is depicted in Figure 7.
Enucleation of the cystic lesion. (a) Radiological finding of the affected area on the left side of the mandible. (b) Clinical situation, tooth 37 is not erupted. (c) Lifting of the mucoperiosteal flap, a perforation of the cortical bone is visible, as well as tooth 37. (d) Exposition of the displaced tooth 38. (e) Clinical situation after radical cystectomy. The lower alveolar nerve is intact and marked with an asterisk (*). (f) Insertion of a collagen graft and suture. (g) Cystic lesion in toto.
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After a careful removal of a thin bone cortex, the cystic capsule was found (Figure 8(a)) and separated from the bone with an obtuse instrument. In the area of the mandible, the use of Carnoy's solution was not indicated because of the exposure of the lower alveolar nerve (Figure 8(e)).
Panoramic radiograph (October 2016) 12 months after the third surgery.
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Follow-up panoramic radiograph (August 2017). Bone apposition in the former cystic cavities. No new lesions or recurrence is visible.
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