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 Table of Contents  
CASE REPORT
Year : 2017  |  Volume : 29  |  Issue : 1  |  Page : 50-52

Full moon shaped unusual appearance of a globulomaxillary cyst: A case report


Department of Oral Medicine and Radiology, Shree Bankey Bihari Dental College, Masuri, Uttar Pradesh, India

Date of Submission16-Jul-2016
Date of Acceptance13-Jul-2017
Date of Web Publication04-Aug-2017

Correspondence Address:
Lakshmi S Reddy
B 2006, ATS Haciendas, Indirapuram, Ghaziabad, Uttar Pradesh - 201 014
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaomr.JIAOMR_119_16

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   Abstract 

Globulomaxillary cyst is a rare, spurious cyst. It was considered to be an inclusion or developmental cyst that arises from entrapped nonodontogenic epithelium in the globulomaxillary suture. Later, it was included as a fissural cyst secondary to proliferation of entrapped epithelium between the globular portion of the medial nasal and maxillary processes. Because of lack of evidence to support the theory of embryogenic epithelial entrapment in the site, most authors dispute the presence of the lesion. Herein, we are presenting a case of globulomaxillary cyst in a 20 year old female patient with an unusual radiographic appearance as a full moon.

Keywords: Fissural cyst, inclusion cyst, nonodontogenic epithelium


How to cite this article:
Reddy LS, Jain V, Mittal S, Gupta SD. Full moon shaped unusual appearance of a globulomaxillary cyst: A case report. J Indian Acad Oral Med Radiol 2017;29:50-2

How to cite this URL:
Reddy LS, Jain V, Mittal S, Gupta SD. Full moon shaped unusual appearance of a globulomaxillary cyst: A case report. J Indian Acad Oral Med Radiol [serial online] 2017 [cited 2020 May 31];29:50-2. Available from: http://www.jiaomr.in/text.asp?2017/29/1/50/212077


   Introduction Top


Globulomaxillary cyst is a rare cyst with multiple birth conflicts. This is a true, developmental cyst occurring within the bone between the maxillary lateral incisor and its adjacent canine.[1] It arises from entrapped nonodontogenic epithelium in the globulomaxillary suture. It is usually asymptomatic and is discovered on routine radiological examination as an “inverted pear-shaped” or “inverted tear shaped” radiolucency between the roots of the maxillary lateral incisor and canine.[2] Here, we present a case of an unusual appearance of globulomaxillary cyst on radiograph.


   Case Report Top


A 20-year-old female patient of Asian origin reported with the chief complaint of a painless swelling in the left upper lip region for 1 year. The swelling was insidious in onset and peanut in size to begin with, which gradually progressed to the present size. There were no associated symptoms. No history of trauma, missing teeth, and oral sepsis was reported. Past medical, dental, and family history were noncontributory. No abnormality was detected on general physical examination and lymph node examination. Extraoral examination revealed a solitary, ill-defined, spherical swelling in the left middle-third of the face measuring approximately 1.5 cm in diameter, extending from philtrum to the left corner of mouth anteroposteriorly and from ala of nose to vermilion border of upper lip line superioinferiorly. The overlying skin was normal with no local rise in temperature. On palpation the lesion was bony hard in consistency nontender and immobile [Figure 1].
Figure 1: Round localized swelling on left side of the upper lip

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On intraoral examination of the specific lesion, a solitary well-defined, round swelling was seen in relation to 22 and 23 measuring approximately 1 cm in diameter, extending from the mesial side of 22 to distal side of 23 mesiodistally and superioinferiorly from depth of the labial vestibule to free marginal gingiva of the associated teeth. There was marked obliteration of the vestibule [Figure 2]. Palatal expansion was not noticed. The overlying mucosa was normal. The swelling was hard on palpation with crepitus on its mesial side, nontender, and fixed. Spacing was seen between 22 and 23.
Figure 2: Well-defined round swelling in relation to 22 and 23

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A provisional diagnosis of benign cystic lesion of odontogenic or nonodontogenic origin was made. Chairside investigation of electric pulp testing was carried out for 22 and 23; these teeth were found to be vital. Panoramic radiograph revealed a solitary, well-defined, round, unilocular radiolucency with corticated border overlying the displaced roots of 22 and 23 [Figure 3]. Intraoral periapical radiograph (IOPAR) revealed an intact lamina dura around the roots of associated teeth [Figure 4]. On occlusal radiograph, buccal expansion was appreciated in relation to 22 and 23 [Figure 5].
Figure 3: A well-defined, round, unilocular radiolucency with corticated border in between the displaced roots of 22 and 23

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Figure 4: IOPAR revealing an intact lamina dura around the roots of associated teeth

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Figure 5: Occlusal radiograph presenting expansion of labial cortical plate

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Complete enucleation of the cyst was performed [Figure 6]. Histopathological examination reveals a central cystic lumen surrounded by cystic lining with 2–3 cell layer thick stratified squamous epithelium suggesting a nonodontogenic cyst of developmental origin [Figure 7]. Based on the clinical, radiographic, and histopathologic features, a final diagnosis of globulomaxillary cyst was made.
Figure 6: Complete enucleated post-operative image

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Figure 7: Central cystic lumen surrounded by cystic lining with 2–3 cell layer thick stratified squamous epithelium

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   Discussion Top


The globulomaxillary cyst in 1937 was first explained as a true fissural cyst forming at the junction of the globular process and the maxillary process.[3] However, Christ in 1970 disputed the existence of this entity by stating that the development of the anterior maxilla was attributed to the merging of growth centers but not by the fusion of facial processes, and hence, the entrapment of ectoderm in this region was ruled out.[4] Later, Robinson stated that the embryonic epithelial remnants cannot exist in the sutures and the cysts originate in the primordium of supernumerary teeth.[5]

However contrary to Christ and Robinson’s postulates, recent embryologic studies demonstrate that the fusion of facial processes do occur and epithelium can get entrapped in areas that will later lie between the maxillary lateral incisors and canines. This view argues that the globulomaxillary cyst should again be considered embryologically and histopathologically as a definitive clinicopathologic entity.[6]

Radiographically, the globulomaxillary cyst appears as an “inverted pear shaped” or “inverted tear shaped” radiolucency between the roots of maxillary lateral incisor and canine.[2] However, in our reported case we got a full moon-shaped radiolucency for globulomaxillary cyst, which is very rare. Till date no literature has shown such an appearance.

Most authorities are now believing that the majority, if not all, cysts that occur in this region are odontogenic in origin.[7] However, nonodontogenic cysts do occur in this region in day to day practice as the above reported case. An odontogenic cyst, a giant cell granuloma, adenomatoid odontogenic tumor, surgical defects, myxomas, anterior bony clefts, and especially anatomic variations may masquerade as a globulomaxillary cyst.[8] Further research studies are required to confirm the exact etiology and prevalence of globulomaxillary cysts.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Rajendran R, Sivapathasundharam B. Fissural cysts of oral region. Rajendran R, editor. Shafer’s Text Book of Oral Pathology, 5th ed. New Delhi: Elsevier Publishers; 2006. p. 90-1.  Back to cited text no. 1
    
2.
Karjodkar FR. Cysts of Jaws. Textbook of Dental and Maxillofacial Radiology, 2nd ed. New Delhi: Jaypee Brothers Medical Publishers; 2009. p. 522-4.  Back to cited text no. 2
    
3.
Dammer U, Driemel O, Mohren C. Globulomaxillary – Do they really exist? Clin Oral Invest 2014;18:239-46.  Back to cited text no. 3
    
4.
Christ TF. The globulomaxillary cyst: An embryologic misconception. Oral Surg Oral Med Oral Pathol 1970;30:515-26.  Back to cited text no. 4
    
5.
Chauhan M, Meena M, Galav A. Globulomaxillary cyst A rare case report. J Oral Maxillofac Pathol 2014;1:42-3.  Back to cited text no. 5
    
6.
D’Silva NJ, Anderson L. Globulomaxillary cyst revisited. Oral Surg Oral Med Oral Pathol 1993;76:182-4.  Back to cited text no. 6
    
7.
Wysocki GP, Goldblatt LI. The so called “globulomaxillary cyst” is extinct. Oral Surg 1993;76:185-6.  Back to cited text no. 7
    
8.
Wood NK, Goaz PW. Interradicular radiolucencies. Differential diagnosis of oral and maxillofacial lesions, 5th ed. New Delhi: Elsevier Publishers; 1997. p. 300-1.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]



 

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