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Impacted / delayed / malpositioned / extra teeth
Region of interest
Please asses anterior maxilla for supernumerary teeth.
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Odontogenic cyst or cystic tumor in left maxilla
There is a well-defined, thinly-corticated, cystic radiolucent lesion located within the left maxilla, which extends from the lateral border of the developmental palatal cleft to elevate the floor of the left maxillary sinus and occupies almost the entire maxillary sinus cavity. Significant expansion of the medial and lateral walls of the left maxillary sinus is noted. The floor of the left nasal fossa is thinned and elevated, but appears intact. The floor of the left orbit appears intact. Teeth 21, 22, 23, and 24 are absent and the roots of teeth 62, 63, and 64 exhibits severe resorption and are located within the cystic lesion. A developing tooth with a gemination appearance has been displaced towards the posterior superior aspect of the left maxillary sinus within the cystic lesion. Overall, these findings suggest the presence of an odontogenic cyst or cystic tumor in the left maxilla, with the most likely interpretation being that of a dentigerous cyst associated with the displaced geminating tooth. Biopsy with histopathologic correlation is recommended to rule out the possibility of other similarly-appearing lesions, such as a keratocystic odontogenic tumor.
Orthogonal measurements of the cystic lesion
These orthogonal cross-sectional images demonstrate the approximate mesiodistal, buccolingual, and coronoapical dimensions of the cystic entity in the left maxilla and maxillary sinus.
Coronal views of the left maxilla
These coronal cross sectional images demonstrate the expansion of the medial and lateral walls of the left maxillary sinus by the cystic lesion in the left maxilla. The dehiscence in the medial aspect of the maxillary may be present , which is likely the site of marsupialization of the cystic lesion.
Axial views of the left maxilla
These axial cross-sectional images demonstrate that the cystic lesion in the left maxilla has caused extensive medial displacement of the medial wall of the left maxilla. This wall appears significantly thinned, and may be partially dehiscent. The lateral wall of the sinus appears intact despite the thinning and expansion. A developing geminated tooth has been displaced in a superior and posterior direction by this lesion within the maxillary sinus.
Possible Geminating supernumerary tooth
A supernumerary tooth that resembles a geminating tooth is present within the cystic lesion and has been displaced superiorly and posteriorly in the maxillary sinus. This tooth does not demonstrate follicle surrounding its crown and the root of the tooth exhibits minimal formation. This tooth may be the source of the cystic lesion if the pathologic evaluation were to be a dentigerous cyst.
1. Developmental cleft in left maxilla
A developmental cleft extends through the left anterior maxillary alveolar process at midline. This cleft involves the nasal floor, and extends through the buccal and palatal cortical plates of the maxilla to the posterior nasal spine along the hard palate. Teeth 21, 22, 23, and 24 are absent.
Relatively normal mixed dentition in first quadrant
The primary and developing permanent dentition in the right maxilla exhibit a relatively normal development. However, teeth 11, 12, and 13 exhibit coronal malformation.