Dentigerous Cyst Associated with an Ectopic Tooth in the Maxillary Sinus-Case Report

上頷竇之含齒囊腫以及異位牙－病例報告

張家豪(Chia-Hao Chang) ； 林傳益(Chuan-Yi Lin)

《台灣耳鼻喉頭頸外科雜誌》 56卷3期 (2021/09) Pp. 164-168

https://doi.org/10.6286/jtohns.202109_56(3).164

摘要

Dentigerous cyst is the second most common type of odontogenic cyst after periapical cyst. The dental follicle of unerupted tooth is believed to be its origin, and the mandibular third molar is the most frequently involved tooth. Ectopic tooth is the erupted tooth outside the dental arch, which has reportedly been observed in the nasal septum, mandibular condyle, coronoid process, palate, and maxillary sinus. The etiology of ectopic tooth eruption is still unclear. Dentigerous cyst associated with an ectopic tooth in the maxillary sinus is somewhat rare. Symptoms related to rhinosinusitis usually appear late in the process. Surgical approaches include transoral Caldwell-Luc procedure or transnasal endoscopic surgery, and the standard treatment is the enucleation and extraction of the associated tooth. In case of large cysts, marsupialization decompression is advocated. A 41-year-old woman with the complaint of postnasal drip and hyposmia for the last 2 months presented to our ENT department. Noncontrast sinus computed tomography scan revealed an ectopic tooth located in the posterosuperior aspect of the left maxillary sinus and surrounded by an expansile cyst. This case report demonstrates a minimally invasive management by transnasal endoscopic decompression via maxillary antrostomy, followed by removal of most of the cyst lining epithelium while preserving the ectopic tooth, to prevent internal maxillary artery injury and oroantral fistula formation. The patient remained asymptomatic over a postoperative follow-up time of half-year, and no recurrence was observed on sinoscope examination.

關鍵字

dentigerous cyst ； ectopic tooth ； maxillary sinus ； transnasal endoscopic surgery

並列摘要

含齒囊腫是第二常見的齒源性囊腫，僅次於根尖囊腫，好發於未萌發牙或阻生牙，與牙囊發育失敗有關，最常見於下顎骨第三大臼齒。異位牙指牙齒存在牙弓之外的位置，曾被發現萌發於鼻中膈、下顎骨髁突、冠狀突、上顎、和上頷竇，其病因尚不明。上頷竇之含齒囊腫以及異位牙的案例非常罕見，晚期會造成鼻竇炎相關症狀。手術方式可分為經口Caldwell-Luc手術或經鼻內視鏡手術，病灶的處理原則為囊腫摘除及異位牙拔除，若囊腫過大可行造袋術減壓。1名41歲女性因鼻涕倒流和嗅覺變差持續兩個月至本科求治，電腦斷層顯示左側上頷竇中有一異位牙萌發於後上壁，伴隨著囊腫包圍部分牙冠。此個案以鼻竇內視鏡手術採微創方式進行，經上頷竇開口將囊腫減壓，並移除大部分的囊腫內襯上皮，且保留異位牙，為避免上頷動脈損傷及口竇廔管等併發症。術後追蹤半年復原狀況良好，鼻竇內視鏡檢查無復發情形。

並列關鍵字

dentigerous cyst ； ectopic tooth ； maxillary sinus ； transnasal endoscopic surgery（含齒囊腫 ； 異位牙 ； 上頷竇 ； 經鼻內視鏡手術）