PMC6343985_01
Preoperative and postoperative examination. The abnormal radiolucency also displaced upwards the bud of the left maxillary first premolar (A). The periapical radiograph showed a reduction in the size of the radiolucent lesion and a spontaneous eruption of T24 (B); and the marsupialization, the crown of T24 could be seen through the cyst window (C) 3 months after the procedure.
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F1
The panoramic radiograph illustrated a well-defined uniocular and oval-shaped radiolucency in the left maxillary region with a regular hyperostotic margin which extended from the distal surface of the root of T63 to the distal surface of T65, and surrounding totally the root of T64 without absorption of the root of T63 and T65 (Fig. 1A). At 3 months after the procedure, periapical radiograph showed a reduction in the size of the radiolucent lesion and a spontaneous eruption of T24 (Fig. 1B). Moreover, the crown of T24 could be seen through the cyst window (Fig. 1C).
Marsupialization of the cystic cavity. Following T64 removal, the extraction socket was widened to make a cyst window and a biopsy sample was incised from the wall of the lesion for histopathological examination (A). It was clearly seen that there was gutta-percha sealer in both root canals of T64 (B). The impression of cyst opening was made with silicone before preparing the obturator (C). A customized acrylic obturator was prepared (D). 1 week after the procedure, the obturator was put into the cyst opening. Patient and her parents were carefully notified how to wear and remove the obturator (E).
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F2
T64 removal, the extraction socket was widened to make a cyst window and a biopsy sample was incised from the wall of the lesion for histological examination (Fig. 2A). The underlying cyst lining was thick, soft and looked like granulation tissue. It was clearly seen that there was gutta-percha sealer in both root canals of T64 (Fig. 2B). 500mg of Augmentin (Amoxicillin Clavulanate) and a Chlorhexidine gluconate 0.12% mouthwash were daily prescribed for one day before and ten days after surgery in order to avoid the postoperative contagiousness. Subsequently, a customized acrylic obturator was prepared and put into the cyst window 1 week after the procedure (Fig. 2C-E).
The histopathological examination of the cystic lesion. The histopathological examination of the lesion illustrated a cystic lumen lined with an inner non-keratinized stratified squamous epithelium with an outer connective tissue (A). There was an inflammatory cells infiltration in the non-keratinized stratified squamous epithelium (B). The proliferative fibro-vascular connective tissues with a significant infiltration of inflammatory cells consisting of the lymphocytes, plasma cells, macrophages and neutrophils (C).
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F3
The tissue sample was conserved in 10% formalin solution then stained with Hematoxyline and Eosin for digital histomorphometry analysis (Fig. 3A-C).