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A rare cause of nasolacrimal duct obstruction: dentigerous cyst in the maxillary sinus.

Ray B, Bandyopadhyay SN, Das D, Adhikary B - Indian J Ophthalmol (2009 Nov-Dec)

Bottom Line: Dentigerous cysts are one of the main types of maxillary cysts.These cysts are benign odontogenic cysts which are associated with the crowns of unerupted teeth.The case was successfully managed surgically by Caldwell Luc approach.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology and ENT, Khudiram Bose Sarani, R.G. Kar Medical College & Hospital, Kolkata, India. debabrata_dr@yahoo.com

ABSTRACT
The most common abnormality of the lacrimal drainage system is congenital or acquired nasolacrimal duct obstruction. The causes of acquired nasolacrimal duct obstruction may be primary or secondary. The secondary acquired obstructions may result from infection, inflammation, neoplasm, trauma or mechanical causes. The maxillary sinus cysts usually obstruct the nasolacrimal duct mechanically. Dentigerous cysts are one of the main types of maxillary cysts. These cysts are benign odontogenic cysts which are associated with the crowns of unerupted teeth. The clinical documentations of mechanical nasolacrimal duct obstructions due to a dentigerous cyst in the maxillary sinus are very rare in literature. In this case report, we describe a dentigerous cyst with a supernumerary tooth in the maxillary sinus in an 11-year-old male child causing an obstruction to the nasolacrimal duct. The case was successfully managed surgically by Caldwell Luc approach.

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Axial CT scan of the orbits and sinuses showing the cyst bulging into the nasal cavity and the tooth in the left maxillary antrum (white arrow)
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Figure 0002: Axial CT scan of the orbits and sinuses showing the cyst bulging into the nasal cavity and the tooth in the left maxillary antrum (white arrow)

Mentions: An 11-year-old male child was referred to us for epiphora. He had intermittent mucoid discharge from the inner canthus of the left eye for the last one year. Ocular and medical histories were normal. On examination, his best-corrected visual acuity was 20/20 in both eyes. Pupillary reflexes and extraocular movements were normal. Intraocular pressures were 16 mm of Hg in both eyes. Slit-lamp and funduscopic examinations were normal. On compression of the left lacrimal sac mucoid material regurgitated from the puncta. Lacrimal sac syringing revealed regurgitation of fluid from the opposite punctum and hard stop with probing, suggestive of NLD obstruction. Radiograph of the paranasal sinuses showed opacified left maxillary antrum with a retained tooth near its roof [Fig. 1]. A plain computed tomography (CT) scan of the orbits and paranasal sinuses was done by taking 2-mm axial and 3-mm coronal slices. The CT images were suggestive of a maxillary sinus cyst close to the orbital floor with the crown of the affected tooth projecting into it [Fig. 2]. The cystic mass was pushing the naso-antral wall into the nasal cavity and compressing the NLD. There was no compression of the globe. Left dacryocystogram showed inability of the contrast medium to pass beyond the lacrimal sac [Fig. 3]. Orthopantogram (OPG) detected the presence of a supernumerary tooth in the left maxillary antrum [Fig. 4]. Our colleagues of the ENT department were consulted for management of the cyst in the maxillary sinus. Their examination revealed congested left nasal cavity with grossly restricted airway and bulging of the lateral wall of the left nose. There was no missing tooth. Removal of the cyst was planned by Caldwell Luc's approach. The outer part of the antero-lateral wall of maxilla was thin and its removal exposed the tense cyst wall. About 8 ml of purulent material was aspirated from the cyst. The cyst was removed from the maxillary sinus along with the retained tooth [Fig. 5]. The maxillary sinus walls were found to be intact. Aspirated material on culture was found to be sterile. The postoperative course was uneventful and his symptoms resolved promptly. Postoperative left dacryocystogram revealed free flow of the contrast medium into the nose [Fig. 6]. On six months follow-up the child remained asymptomatic.


A rare cause of nasolacrimal duct obstruction: dentigerous cyst in the maxillary sinus.

Ray B, Bandyopadhyay SN, Das D, Adhikary B - Indian J Ophthalmol (2009 Nov-Dec)

Axial CT scan of the orbits and sinuses showing the cyst bulging into the nasal cavity and the tooth in the left maxillary antrum (white arrow)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2812769&req=5

Figure 0002: Axial CT scan of the orbits and sinuses showing the cyst bulging into the nasal cavity and the tooth in the left maxillary antrum (white arrow)
Mentions: An 11-year-old male child was referred to us for epiphora. He had intermittent mucoid discharge from the inner canthus of the left eye for the last one year. Ocular and medical histories were normal. On examination, his best-corrected visual acuity was 20/20 in both eyes. Pupillary reflexes and extraocular movements were normal. Intraocular pressures were 16 mm of Hg in both eyes. Slit-lamp and funduscopic examinations were normal. On compression of the left lacrimal sac mucoid material regurgitated from the puncta. Lacrimal sac syringing revealed regurgitation of fluid from the opposite punctum and hard stop with probing, suggestive of NLD obstruction. Radiograph of the paranasal sinuses showed opacified left maxillary antrum with a retained tooth near its roof [Fig. 1]. A plain computed tomography (CT) scan of the orbits and paranasal sinuses was done by taking 2-mm axial and 3-mm coronal slices. The CT images were suggestive of a maxillary sinus cyst close to the orbital floor with the crown of the affected tooth projecting into it [Fig. 2]. The cystic mass was pushing the naso-antral wall into the nasal cavity and compressing the NLD. There was no compression of the globe. Left dacryocystogram showed inability of the contrast medium to pass beyond the lacrimal sac [Fig. 3]. Orthopantogram (OPG) detected the presence of a supernumerary tooth in the left maxillary antrum [Fig. 4]. Our colleagues of the ENT department were consulted for management of the cyst in the maxillary sinus. Their examination revealed congested left nasal cavity with grossly restricted airway and bulging of the lateral wall of the left nose. There was no missing tooth. Removal of the cyst was planned by Caldwell Luc's approach. The outer part of the antero-lateral wall of maxilla was thin and its removal exposed the tense cyst wall. About 8 ml of purulent material was aspirated from the cyst. The cyst was removed from the maxillary sinus along with the retained tooth [Fig. 5]. The maxillary sinus walls were found to be intact. Aspirated material on culture was found to be sterile. The postoperative course was uneventful and his symptoms resolved promptly. Postoperative left dacryocystogram revealed free flow of the contrast medium into the nose [Fig. 6]. On six months follow-up the child remained asymptomatic.

Bottom Line: Dentigerous cysts are one of the main types of maxillary cysts.These cysts are benign odontogenic cysts which are associated with the crowns of unerupted teeth.The case was successfully managed surgically by Caldwell Luc approach.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology and ENT, Khudiram Bose Sarani, R.G. Kar Medical College & Hospital, Kolkata, India. debabrata_dr@yahoo.com

ABSTRACT
The most common abnormality of the lacrimal drainage system is congenital or acquired nasolacrimal duct obstruction. The causes of acquired nasolacrimal duct obstruction may be primary or secondary. The secondary acquired obstructions may result from infection, inflammation, neoplasm, trauma or mechanical causes. The maxillary sinus cysts usually obstruct the nasolacrimal duct mechanically. Dentigerous cysts are one of the main types of maxillary cysts. These cysts are benign odontogenic cysts which are associated with the crowns of unerupted teeth. The clinical documentations of mechanical nasolacrimal duct obstructions due to a dentigerous cyst in the maxillary sinus are very rare in literature. In this case report, we describe a dentigerous cyst with a supernumerary tooth in the maxillary sinus in an 11-year-old male child causing an obstruction to the nasolacrimal duct. The case was successfully managed surgically by Caldwell Luc approach.

Show MeSH
Related in: MedlinePlus