دانلود رایگان مقاله انگلیسی کیست پوشش دار اپیتلیوم تنفسی فک بالا: تشخیص افتراقی - هینداوی 2017

Maxillary cysts, including the cysts lined by respiratory epithelium, can present a diagnostic challenge. We report an unusual case of a maxillary cyst on an endodontically treated tooth #16, in which the cavity was totally lined by a respiratory epithelium. The patient, a 35-year-old male, presented with a generalized chronic periodontitis and complained of a pain in the tooth #16 region. A periodontal pocket extending to the root apices with pus coming out from the gingival was found. A combined endodontic periodontal was observed on a panoramic radiography. CBCT-scan revealed a well-circumscribed radiolucent lesion at the apices of the distobuccal root of the 16. A communication with the right maxillary sinus cavity and a maxillary and ethmoidal sinusitis were also observed.The lesion was removed and histological examination revealed a cyst lined exclusively by respiratory epithelium. Ciliated and rare mucous cells were also observed. The diagnosis could evoke a surgical ciliated cyst mimicking the radicular cyst but the patient has no previous history of trauma or surgery in the maxillofacial region. It could also be an unusual radicular cyst in which the stratified squamous epithelium was destroyed by inflammation and replaced by a respiratory epithelium of the maxillary sinus.

3. Discussion

In this particular case, the differential diagnosis of the maxillary cyst in which the cavity is fully lined by respiratory epithelium should include the surgical ciliated cyst or an unusual radicular cyst. In both cases, a resorption of the maxillary sinus floor can happen and cause the communication between the cyst and the maxillary sinus cavity. The surgical ciliated cyst is a cystic lesion which develops after a surgical procedure such as maxillary sinus surgery (e.g., Caldwell-Luc), orthognathic surgery, and trauma caused by dental extraction. They are locally aggressive and may resemble a tumour. Bone expansion, pain, or discomfort in the maxillary region and fistulization in some cases can be present. Radiographically, they can be unilocular or multilocular radiolucent or radiopaque with a well-defined margin and surrounding sclerotic edge in the floor of the maxillary sinus, with or without bony perforation [1–3]. In some cases, the surgical ciliated cyst can involve the apices of the maxillary second premolar or first or second molar and mimic a radicular cyst [3]. According to literature, the development of this cyst would be caused by an entrapment of the sinus mucosa in the wound after the surgical procedure followed by an inflammatory process that would stimulate epithelial proliferation. Finally, the expansion of the cyst would be caused by the osmotic pressure difference [3].