Swollen Cheek

Originally painless, has become painful in the last month.

Figure 1. Few well defined, expansible, mixed density lesions are noted arising from alveolar process of maxilla and mandible bilaterally.

Figure 2. On bone window, the lesion on the left side protrudes into the floor of left maxillary sinus with canine, first premolar, accessory tooth, and third molar tooth appear embedded within the lesion. The root of the right first, second premolar, and first molar tooth appear embedded within the lesion.

Figure 3. On contrast window, the lesions are nonenhancing suggestive of dentigerous cyst.

An intraoral clinical examination revealed a nontender bilaterally palpable swelling.

On CT, few well-defined, expansible, nonenhancing, mixed density lesions are noted arising from the alveolar process of maxilla and mandible bilaterally.

Dentigerous cysts are the most common type of developmental odontogenic cysts, arising from the crowns of impacted, embedded, or unerupted teeth.

About 95% of dentigerous cysts involve the permanent dentition and only 5% are associated with supernumerary teeth.

Dentigerous cysts are asymptomatic, except if secondarily infected, and are generally discovered through a panoramic radiographic examination.

Diagnosis of dentigerous cysts can be done by conventional radiography, histopathological examination, CT, and MR.

The differential diagnosis includes unicystic ameloblastoma, adenomatoid odontogenic tumor (AOT), gorlin cyst, calcifying epithelial odontogenic tumor (CEOT), ameloblastic fibroma, ameloblastic fibro-odontoma, and odontogenic keratocyst.

Odontogenic keratocyst may be found in patients from infancy to old age, is commonly found in posterior body and ascending ramus of mandible.