Kurien Nikhil M, Kumar L K Surej, Uma P B, Vivek V, Joseph Anna P
Department of Oral and Maxillofacial Surgery, PMS Dental College, Vattappara, Trivandrum, India.
Ann Med Surg (Lond). 2017 Jul 6;21:30-33. doi: 10.1016/j.amsu.2017.07.017. eCollection 2017 Sep.
Glandular odontogenic cyst is a rare developmental odontogenic cyst, which often pose a challenge to diagnose it clinically.
A 32 year old female patient was referred to the oral and maxillofacial surgery department with a chief complaint of a painless swelling in the anterior mandible, extending from mandibular left premolar to right first molar region, with fluctuancy and egg shell crackling at right premolar region. The associated teeth were firm. Radio graphically a large radiolucent lesion was seen extending from mandibular left premolar to right first molar region.
We had many differential diagnoses including keratocystic odontogenic tumour, ameloblastoma and radicular cyst. Incisional biopsy was taken from the most fluctuant area, which was histopathologically suggestive of glandular odontogenic cyst. Enucleation of the cyst, peripheral ostectomy, extraction of teeth and Carnoy's solution application were done under general anaesthesia.
We often neglect to include uncommon lesions in the differential diagnosis, which may lead to inadequacy in the management protocol. Whenever possible, incisional biopsy should be performed to confirm the lesion before surgical enucleation. Here we present a case in which we were fortunate enough to diagnose the lesion by an incisional biopsy and managed according to the standard protocol.
腺牙源性囊肿是一种罕见的发育性牙源性囊肿，临床上对其诊断常常具有挑战性。
一名32岁女性患者因下颌前部无痛性肿胀被转诊至口腔颌面外科，肿胀范围从下颌左侧前磨牙延伸至右侧第一磨牙区，右侧前磨牙区有波动感及蛋壳样爆裂声。相关牙齿稳固。影像学检查显示下颌左侧前磨牙至右侧第一磨牙区有一较大的透射性病变。
我们进行了多种鉴别诊断，包括角化囊性牙源性肿瘤、成釉细胞瘤和根端囊肿。在波动最明显的区域进行了切开活检，组织病理学提示为腺牙源性囊肿。在全身麻醉下进行了囊肿摘除术、周边骨切除术、牙齿拔除及应用卡诺氏液。
我们常常在鉴别诊断中忽略罕见病变，这可能导致治疗方案不完善。只要有可能，在手术摘除前应进行切开活检以确诊病变。在此我们报告一例，幸运的是通过切开活检诊断了病变并按照标准方案进行了治疗。
