Endoscopic view of a maxillary dentigerous cyst.

A 45-year-old man was seen for evaluation of intermittent, recurring, right-sided facial pressure of 4 years' duration. Findings on endoscopic examination of the nose were within normal limits. Computed tomography (CT) of the sinuses detected a cystic mass in the right maxillary sinus that contained a radiopaque structure (figure, A). The radiologist confirmed our diagnosis of a dentigerous cyst, and the radiopaque structure was an embedded tooth.

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The patient elected to undergo right functional endoscopic sinus surgery. A large middle meatal maxillary antrostomy was created at the time of surgery, and a fibrocystic mass was encountered. The mass contained dense fibrocystic tissue, which was resected with a curved microdebrider blade. This revealed the toothlike mass embedded in the fibrocystic tissue (figure, B). The toothlike mass was carefully removed under direct endoscopic visualization (figure, C). After removal, the well-defined crown of a molar tooth was identified (figure, D). Postoperatively, the patient reported no further right facial discomfort.

Cystic masses of the maxillary sinus are common. Many are asymptomatic and found incidentally on sinus CT. (1) A dentigerous cyst occurs in conjunction with the crown of an unerupted tooth. When there are problems with recurrent facial discomfort and recurrent sinusitis, surgical intervention should be contemplated. (2) The presence of a fully developed free-floating tooth within a maxillary cyst is not a common finding.

References

(1.) Cho JG, Lim HW, Zodpe P, et al. Nasal septal abscess: An unusual presentation of dentigerous cyst. Eur Arch Otorhinolaryngol 2006;263 (11): 1048-50.

(2.) Costa F, Emanuelli E, Robiony M, et al. Endoscopic surgical treatment of chronic maxillary sinusitis of dental origin. J Oral Maxillofac Surg 2007;65(2):223-8.

From the Department of Otolaryngology, University of South Florida College of Medicine, Tampa, and the Halifax Medical Center, Daytona Beach, Fla. (Dr. Christmas and Dr. Mirante), and the Southern New England Ear, Nose, Throat, and Facial Plastic Surgery Group; the Section of Otolaryngobogy, Hospital of St. Raphael; and the Section of Otolaryngology, Yale University School of Medicine, New Haven, Conn. (Dr. Yanagisawa).