PMC5107584_01
A) panoramic radiograph evidenced intimate relationship between central incisors apexes as well as mesial region of lateral incisors. Anterior tooth were endodontically treated maybe on the first analysis, because of intimate relationship between anterior tooth apexes, it was though to be an endodontic-related lesion. No canine relationship was observed. B) tomographic analysis showed cortical expansion, a well-delimited lesion with an intimate relationship between incisors apexes. Buccal cortex was found to be delicate and it was thought that might be a perforation of nasal floor. No root reabsorption was evidenced. C) Tomography was taken to evidence relationship between central incisors as well as mesial region of lateral incisors. D) Figure shows involvement of maxilla and central region of maxilla and buccal cortex. E) Figure shows relationship between the lesion and palate.
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Cortical expansion was associated with volume increase in anterior maxilla, mainly perceptible in palatine cortex (Figs. 1, 2 and 3).
histopathological analysis. At the miscroscopic observation, the examination of hematoxylin and eosin stained revealed fragment of cystic capsule, composed of dense and vascularized connective tissue with hemorrhagic foci. In contiguity in the lumen it was observed a coating of non-keratinized squamous stratified epithelium, composed of 3-4 layers of cells, compatible with de diagnosis of fissural cyst. (original magnification 100x).
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Cortical expansion was associated with volume increase in anterior maxilla, mainly perceptible in palatine cortex (Figs. 1, 2 and 3).
A) Labial approach was used to access region of interest. After incision, tissues and periosteum were separate from bone using molt retractors. Bone osteotomy was preferably designed on lateral region of nasal cavity. B) Nasal cavity was disengaged from maxilla to expose FC. Separation of maxilla was conducted using Smith retractors to expose the lesion. Lesion was well delimited in intimate relationship with central and lateral incisors apexes. C) After enucleation, the remaining space was filled with BIOSs and bioguide. It was applied in all walls of the lesion to accelerate. D) Lesion was well delimited in intimate relationship with central and lateral incisors apexes. E) In order to correct occlusion, osteotomy was designed and plates and screws positioned. Subsequently, plates were removed and maxilla downfracture was conducted. Later cystic enuclation, maxilla was placed in the same predetermined location. Removed material was also sent for histological analysis.
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Cortical expansion was associated with volume increase in anterior maxilla, mainly perceptible in palatine cortex (Figs. 1, 2 and 3).
A and B) imaging showing no relapses of the lesion. After 12 months, patient is stable, without functional or aesthetic complaints.
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Anterior tooth were endodontically treated due to its intimate relationship with the lesion, and because it was firstly thougth to be an endodontic-related lesion (Fig. 4).