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 Table of Contents  
CASE REPORT
Year : 2014  |  Volume : 26  |  Issue : 3  |  Page : 351-354

Lateral periodontal cyst: An outlandish anamnesis


1 Departments of Oral Medicine and Radiology, Meghna Institute of Dental Sciences, Nizamabad, Telangana, India
2 Departments of Oral and Maxillofacial Surgery, Meghna Institute of Dental Sciences, Nizamabad, Telangana, India

Date of Submission14-Sep-2014
Date of Acceptance01-Nov-2014
Date of Web Publication19-Nov-2014

Correspondence Address:
Harshavardhan Talla
House No. 1-2-133, 3rd Lane, JKC Nagar, Guntur - 522 006, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-1363.145031

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   Abstract 

Lateral periodontal cysts are an uncommon type of developmental odontogenic cysts that typically occur along the lateral aspect of teeth, usually involving mandibular lateral incisors and canines. They are known to commonly originate from the cell rests of Serre and represent the intrabony counterpart of gingival cysts of adults. In majority of cases with no apparent signs and symptoms, they are revealed on routine radiographic examinations; however, definitive diagnosis is made only by histopathological examination. The purpose of this article is to report an unusual case of lateral periodontal cyst located in the anterior region of mandible and to discuss the clinical, radiological, and histopathological features of the cyst.

Keywords: Gingival cysts, lateral periodontal cyst, odontogenic cyst


How to cite this article:
Adamala SR, Talla H, Medikonda SK, Soujanya S. Lateral periodontal cyst: An outlandish anamnesis . J Indian Acad Oral Med Radiol 2014;26:351-4

How to cite this URL:
Adamala SR, Talla H, Medikonda SK, Soujanya S. Lateral periodontal cyst: An outlandish anamnesis . J Indian Acad Oral Med Radiol [serial online] 2014 [cited 2022 May 18];26:351-4. Available from: https://www.jiaomr.in/text.asp?2014/26/3/351/145031


   Introduction Top


Lateral periodontal cyst (LPC) was first described by Standish and Shafer in 1958. [1] Later, in the same year, Holder and Kunkel [2] published a case report with clinical, radiological, and histopathological features similar to those of LPC, which they called as periodontal cyst. Since then, more than 300 well-documented cases of LPC have been reported in English literature. Botryoid odontogenic cyst, a variant of LPC, was first described by Weathers and Waldron in the year 1973. [3]

Lateral periodontal cyst is a rare variant of a developmental odontogenic cyst most commonly known to occur in the mandibular canine-premolar region. Many times it is diagnosed as a radicular cyst, odontogenic keratocyst, or ameloblastoma because of their common rate of occurrence. [4] However, careful examination of the lesion and adjacent teeth by pulp vitality test, aspiration of fluid, radiographic and histopathological examination helps in accurate diagnosis of the lesion to provide appropriate treatment. Here, we are presenting a case report of LPC in a 60-year-old female patient.


   Case Report Top


A 60-year-old female patient came to the Department of Oral Medicine and Radiology with the chief complaint of loosening of her left lower front teeth and swelling of the same region since 1 year. Patient gave a history of mobility of teeth since 1 year, accompanied by swelling, which was insidious in onset and gradually progressed to the present size, and was not associated with any other symptoms or aggravating and relieving factors. Medical history revealed that the patient was a known diabetic and hypertensive and was under medication since 10 years. The past dental history revealed that the patient had visited a dentist few weeks earlier for the same complaint following which her two lower front teeth were extracted with no remission of her symptoms. Extraoral examination revealed an ovoid swelling on the left lower side of the face near canine-premolar region, with its greatest diameter measuring about 5 cm approximately [Figure 1] with no abnormal pulsations or color changes. On palpation, it was afebrile, non-tender, smooth, and soft in consistency. An oval, solitary, non-tender left submandibular lymph node of approximately 20 mm in size was palpable, which was firm in consistency. Intraoral examination revealed obliteration of labial vestibule in relation to 32-35 region, which was soft in consistency and non-tender on palpation [Figure 2]. Grade II mobility of 33, 34, and 35 teeth with a non-vital hue and severe attrition were appreciated. Teeth numbers 31, 32, and 41 were missing.
Figure 1: Facial photograph showing diffuse swelling on the left side of the lower face

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Figure 2: Intraoral photograph showing obliteration of the vestibule from 32 to 35 region

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Based on these features, odontogenic cyst, odontogenic tumor, and fibro-osseous lesion were considered as the differential diagnoses. However, initial aspiration of whitish fluid resembling "coconut water" [Figure 3] from the lesion ruled out other lesions except for the odontogenic cyst. The aspiration of a clear, straw-colored fluid ruled out an odontogenic keratocyst which usually shows a dirty yellowish-brown color.
Figure 3: Photograph of the aspirated fluid

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An old orthopantomograph (OPG), which was taken before the extraction of her lower front teeth, revealed a well-defined multilocular radiolucency surrounded by a sclerotic border extending from 31 to 34 region. The borders of the radiolucency were continuous with the root apices of 32 and 33 with loss of lamina dura for these teeth [Figure 4]. An occlusal radiograph revealed the multilocular nature of the cyst with thin wispy septa which had expanded buccally giving a soap bubble appearance to the lesion [Figure 5]. Radiographic differential diagnoses of periodontal cyst, cystic ameloblastoma, and radicular cyst were considered.
Figure 4: Photograph of old OPG showing the lesion

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Figure 5: Occlusal radiograph showing buccal expansion of the lesion

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The patient was referred to the Department of Oral and Maxillofacial Surgery where complete enucleation of the cyst was done under general anesthesia and the specimen was sent for histopathological examination which revealed a delicate, friable, cystic epithelial lining detached from the underlying connective tissue capsule. The epithelium was 2-3 cell layer thick and was 10 cell layer thick in a few areas, resembling reduced enamel epithelium. The epithelial cells were squamoid to round, with small and pyknotic nuclei. Clear cells were appreciated in the epithelium with juxtaepithelial eosinophilic hyalinization in the connective tissue capsule suggestive of an LPC [Figure 6].
Figure 6: Photomicrograph of the excised specimen

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OPG taken 8 months after enucleation revealed small persistent radiolucencies measuring 5 × 5 mm in the edentulous area in the left mandibular premolar region, raising the suspicion of recurrence of the lesion [Figure 7]. The patient was advised regular follow-up once in every 3 months to rule out the recurrence of the lesion. Patient is under follow-up since 18 months and we did not observe any increase in the size of the locules.
Figure 7: Follow-up OPG after 8 months showing small locules

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   Discussion Top


Lateral periodontal cyst is a rather uncommon developmental odontogenic cyst, representing fewer than 1% of the jaw cysts typically occurring along the lateral surface of the tooth, which is most of the time identified in routine radiographic examination. [5],[6] However, in 1992, in the World Health Organization's monograph of the histological typing of odontogenic tumors, LPC was added as a clinicoradiological entity. In the recent past, LPC has more or less changed from being a clinicoradiological entity to a histopathological one and it is considered as developmental in origin. [7] Lateral periodontal cyst is known to originate from the cell rests of Serre, which are remnants of the dental lamina. However, according to some authors, the origin remains controversial, where the lesion is suspected to originate from the epithelial rests of Malassez, remnants of Hertwig's epithelial root sheath, and from the reduced enamel epithelium. [8]

The LPC was described for the first time by Standish and Shafer in 1958. [1] In the year 1973, Wysocki et al. considered it as a representation of intrabony counterpart of the gingival cyst of adults. In the same year, Weather and Waldron reported for the first time an unusual form of the LPC called botryoid odontogenic cyst owing to its appearance as a bunch of grapes. [3] Wysocki et al. suggested that the polycystic variant of LPC formed through cystic transformation of multiple islands of dental lamina and some authors consider it to originate from fusion of adjacent multiple LPCs. [8]

The LPC is most commonly known to occur at a mean age of 50 years (22-85 years) and is more common in males. The age of the present case was more or less consistent with the mean age of occurrence of an LPC. However, the reported LPC occurred in a female patient, which is not common. It most commonly shows preponderance in the mandibular canine-premolar region (as seen in the present case), followed by the mandibular incisor region (67%) and then in the maxillary anteriors (33%). [9] The majority of cases have no signs and symptoms; it is revealed on routine radiographic examination where occasionally a swelling is appreciated on the labial or buccal surface of the teeth and the involved teeth are always vital. The present case, however, reported to us with the complaints of swelling and mobility of teeth.

Radiographically, LPC usually appears as a small radiolucency with a well-defined sclerotic border on the lateral surface of roots of teeth, which is rarely greater than 1 cm in diameter, and is multilocular in appearance. [10] However, few authors have mentioned that the presence of multilocular appearance radiographically may not show a polycystic configuration microscopically and vice versa. [1],[9],[10]

The LPC shows peculiar histopathological features such as the presence of a cystic lining epithelium of one to five cell layer thickness resembling reduced enamel epithelium, [8],[10],[11] composed of cuboidal or columnar cells and glycogen-rich cytoplasmic cells called clear cells which are usually stained by per-iodic acid schisf (PAS). [12] This epithelial lining is usually incomplete and sloughs easily, and in some cases shows focal thickenings called as plaques which are predominant in botryoid odontogenic cyst. The other peculiar features include remnants of dental lamina in the connective tissue, (sometimes) subepithelial hyalinization, thick, fibrous, and non-inflamed cyst wall, and the retepegs are usually devoid of inflammatory cells (except in secondary infection). The cyst on aspiration usually yields a straw-colored fluid.

The common treatment modality for LPC includes enucleation of the cyst in toto. [13],[14] In general, LPC has a low rate of recurrence from 3 to 4%, whereas botryoid odontogenic keratocyst has a recurrence rate of 30%; hence, long-term follow-up is necessary.

 
   References Top

1.Standish SM, Shafer WG. The lateral periodontal cyst. J Periodontol 1958;29:27-33.  Back to cited text no. 1
    
2.Holder TD, Kunkel PW Jr. Case report of a periodontal cyst. Oral Surg Oral Med Oral Pathol 1958;11:150-4.  Back to cited text no. 2
    
3.Weathers DR, Waldron CA. Unusual multilocular cysts of the jaws (botryoid odontogenic cysts). Oral Surg Oral Med Oral Pathol 1973;36:235-41.  Back to cited text no. 3
    
4.Siponen M, Neville BW, Damm DD, Allen CM. Multifocal lateral periodontal cysts: A report of 4 cases and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;111:225-33.  Back to cited text no. 4
    
5.Altini M, Shear M. The lateral periodontal cyst: An update. J Oral Pathol Med 1992;21:245-50.  Back to cited text no. 5
    
6.Kreidler JF, Raubenheimer EJ, van Heerden WF. A retrospective analysis of 367 cystic lesions of the jaw - The Ulm experience. J Craniomaxillofac Surg 1993;21:339-41.  Back to cited text no. 6
    
7.Kramer IR, Pindborg JJ, Shear M. Histological typing of odontogenic tumors. 2 nd ed. Berlin, Heidelberg: Springer-Verlag; 1992. p. 37.  Back to cited text no. 7
    
8.Wysocki GP, Brannon RB, Gardner DG, Sapp P. Histogenesis of the lateral periodontal cyst and the gingival cyst of the adult. Oral Surg Oral Med Oral Pathol 1980;50:327-34.  Back to cited text no. 8
    
9.Shear M, Pindborg JJ. Microscopic features of the lateral periodontal cyst. Scand J Dent Res 1975;83:103-10.  Back to cited text no. 9
    
10.Rasmusson LG, Magnusson BC, Borrman H. The lateral periodontal cyst. A histopathological and radiographic study of 32 cases. Br J Oral Maxillofac Surg 1991;29:54-7.  Back to cited text no. 10
    
11.Eliasson S, Isacsson G, Köndell PA. Lateral periodontal cysts. Clinical, radiographical and histopathological findings. Int J Oral Maxillofac Surg 1989;18:191-3.  Back to cited text no. 11
    
12.Greer RO Jr, Johnson M. Botryoid odontogenic cyst: Clinicopathologic analysis of ten cases with three recurrences. J Oral Maxillofac Surg 1988;46:574-9.  Back to cited text no. 12
    
13.Buchner A, David R, Carpenter W, Leider A. Pigmented lateral periodontal cyst and other pigmented odontogenic lesions. Oral Dis 1996;2:299-302.  Back to cited text no. 13
    
14.Kerezoudis NP, Donta-Bakoyianni C, Siskos G. The lateral periodontal cyst: Aetiology, clinical significance and diagnosis. Endod Dent Traumatol 2000;16:144-50.  Back to cited text no. 14
    


    Figures

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



 

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