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Cureus Oct 2023This study discusses a case of coexistence of two distinct cysts, a nasopalatine duct cyst (NPDC) and a radicular cyst, within the anterior region of the maxilla. NPDC...
This study discusses a case of coexistence of two distinct cysts, a nasopalatine duct cyst (NPDC) and a radicular cyst, within the anterior region of the maxilla. NPDC is a prevalent non-odontogenic developmental cyst, while radicular cysts are commonly found in odontogenic inflammatory cysts. The clinical and radiographic characteristics of these cysts are explored, emphasizing the importance of accurate diagnosis and treatment planning. In this case, a 51-year-old male patient presented with swelling and pain in the maxillary anterior region. Radiographic examinations revealed a heart-shaped radiolucent lesion extending from tooth 13 to 23, associated with the NPDC, and a separate radicular cyst. Surgical enucleation and tooth extraction were performed as the treatment of choice. This unique case underscores the significance of meticulous radiographic assessment to detect multiple cystic lesions within the same area.
PubMed: 37954767
DOI: 10.7759/cureus.46774 -
Journal of Dental Sciences Apr 2023
PubMed: 37021275
DOI: 10.1016/j.jds.2022.10.012 -
The Korean Journal of Pain Jan 2024One of the most common sources of spinal pain syndromes is the facet joints. Cervical, thoracic, and lumbar facet joint pain syndromes comprise 55%, 42%, and 31% of... (Review)
Review
One of the most common sources of spinal pain syndromes is the facet joints. Cervical, thoracic, and lumbar facet joint pain syndromes comprise 55%, 42%, and 31% of chronic spinal pain syndromes, respectively. Common facet joint disorders are degenerative disorders, such as osteoarthritis, hypertrophied superior articular process, and facet joint cysts; septic arthritis; systemic and metabolic disorders, such as ankylosing spondylitis or gout; and traumatic dislocations. The facet pain syndrome from osteoarthritis is suspected from a patient's history (referred pain pattern) and physical examination (tenderness). Other facet joint disorders may cause radicular pain if mass effect from a facet joint cyst, hypertrophied superior articular process, or tumors compress the dorsal root ganglion. However, a high degree of morphological change does not always provoke pain. The superiority of innervating nerve block or direct joint injection for diagnosis and treatment is still a controversy. Treatment includes facet joint injection in facet joint osteoarthritis or whiplash injury provoking referred pain or decompression in mass effect in cases of hypertrophied superior articular process or facet joint cyst eliciting radicular pain. In addition, septic arthritis is treated using a proper antibiotic, based on infected tissue or blood culture. This review describes the diagnosis and treatment of common facet joint disorders.
PubMed: 38072795
DOI: 10.3344/kjp.23228 -
European Journal of Dentistry May 2022This study aimed to analyze claudin-1, -4, and -7 expression in different types of odontogenic cysts (odontogenic keratocysts [OKCs], dentigerous cysts [DCs],...
OBJECTIVE
This study aimed to analyze claudin-1, -4, and -7 expression in different types of odontogenic cysts (odontogenic keratocysts [OKCs], dentigerous cysts [DCs], calcifying odontogenic cysts [COCs], and radicular cysts [RCs]) as well as its association with OKC recurrence.
MATERIALS AND METHODS
Seventy samples of odontogenic cysts samples were immunohistochemically stained to detect claudin-1, -4, and -7 expression. Patient information and OKC recurrence data were recorded. The staining was analyzed semiquantitatively and categorized based on the pattern and percentage of positively stained cystic epithelial cells.
STATISTICAL ANALYSIS
Expression of different claudins between groups was analyzed using the Kruskal-Wallis test with Dunn's test, followed by post hoc pairwise comparison. The association between claudin expression and OKC recurrence was analyzed by the Mann-Whitney U test. Correlations among claudin expression were examined with Spearman's correlation coefficient. Level of significance was at < 0.005.
RESULTS
Claudin-1 was widely expressed in every odontogenic cyst. Most DCs (50%) expressed claudin-1 in more than 75% of cells, as did RCs (65%), while most OKCs (50%) expressed claudin-1 in 26 to 50% of cells. Most COCs (50%) expressed claudin-1 in 51 to 75% of cells. Every sample of OKC and RC was positive for claudin-4, but no sample showed staining in more than 51% of cells. Every odontogenic cyst was positive for claudin-7. DCs (35%), OKCs (55%), and RCs (40%) mostly showed staining in 26 to 50% of cells. High claudin-1 expression was shown in COCs, DCs, and RCs, while low expression of claudin-4 was shown in every odontogenic cyst. For claudin-7, the expression is high only in COCs. Claudin-1 and -4 was significantly different among each odontogenic cyst. High expression of claudin-1 was correlated with OKC recurrence. The correlations of claudin-1 with claudin-7 expression and claudin-4 with claudin-7 expression were significant in DCs. In COCs, claudin-1 and claudin-7 expression was significantly correlated.
CONCLUSIONS
The expression of claudin-1, -4, and -7 was present in every odontogenic cyst, but the proportion of positive staining cells was different. Expression of claudin-1 is associated with OKC recurrence. Dysregulation of claudin expression may play a pathogenic role in cyst pathogenesis.
PubMed: 34808689
DOI: 10.1055/s-0041-1740440 -
Acta Medica (Hradec Kralove) 2018CDC7 is a serine/threonine kinase which has an essential role in initiation of DNA proliferation and S phase. It increases the invasion and proliferation in many...
CDC7 is a serine/threonine kinase which has an essential role in initiation of DNA proliferation and S phase. It increases the invasion and proliferation in many pathologic lesions. This study aimed to evaluate the expression of CDC7 in the most common odontogenic cysts. We evaluated 17 dentigerous cysts, 18 odontogenic keratocysts (OKC) and 13 radicular cysts immunohistochemically. The mean expression of CDC7 was analyzed using ANOVA and Post-HOC methods. All specimens revealed CDC7 expression. Higher expression of CDC7 in OKC and radicular cyst was shown in comparison to dentigerous cyst (P < 0.001), while radicular cyst and OKC groups showed no difference in CDC7 expression (P = 0.738). The high expression of CDC7 in OKC suggests that this protein could be related to the higher proliferation rate and invasiveness of OKC. On the other hand, the higher CDC7 expression in radicular cyst may simply be related to inflammation as this cyst is neither aggressive nor invasive.
Topics: Adolescent; Adult; Cell Cycle Proteins; Dentigerous Cyst; Female; Humans; Immunohistochemistry; Male; Middle Aged; Odontogenic Cysts; Protein Serine-Threonine Kinases; Radicular Cyst; Young Adult
PubMed: 30012245
DOI: 10.14712/18059694.2018.18 -
Journal of Dentistry Aug 2023Dentists and oral surgeons often face difficulties distinguishing between radicular cysts and periapical granulomas on panoramic imaging. Radicular cysts require...
OBJECTIVES
Dentists and oral surgeons often face difficulties distinguishing between radicular cysts and periapical granulomas on panoramic imaging. Radicular cysts require surgical removal while root canal treatment is the first-line treatment for periapical granulomas. Therefore, an automated tool to aid clinical decision making is needed.
METHODS
A deep learning framework was developed using panoramic images of 80 radicular cysts and 72 periapical granulomas located in the mandible. Additionally, 197 normal images and 58 images with other radiolucent lesions were selected to improve model robustness. The images were cropped into global (affected half of the mandible) and local images (only the lesion) and then the dataset was split into 90% training and 10% testing sets. Data augmentation was performed on the training dataset. A two-route convolutional neural network using the global and local images was constructed for lesion classification. These outputs were concatenated into the object detection network for lesion localization.
RESULTS
The classification network achieved a sensitivity of 1.00 (95% C.I. 0.63-1.00), specificity of 0.95 (0.86-0.99), and AUC (area under the receiver-operating characteristic curve) of 0.97 for radicular cysts and a sensitivity of 0.77 (0.46-0.95), specificity of 1.00 (0.93-1.00), and AUC of 0.88 for periapical granulomas. Average precision for the localization network was 0.83 for radicular cysts and 0.74 for periapical granulomas.
CONCLUSIONS
The proposed model demonstrated reliable diagnostic performance for the detection and differentiation of radicular cysts and periapical granulomas. Using deep learning, diagnostic efficacy can be enhanced leading to a more efficient referral strategy and subsequent treatment efficacy.
CLINICAL SIGNIFICANCE
A two-route deep learning approach using global and local images can reliably differentiate between radicular cysts and periapical granulomas on panoramic imaging. Concatenating its output to a localizing network creates a clinically usable workflow for classifying and localizing these lesions, enhancing treatment and referral practices.
Topics: Humans; Periapical Granuloma; Radicular Cyst; Deep Learning; Radiography; Neural Networks, Computer
PubMed: 37295547
DOI: 10.1016/j.jdent.2023.104581 -
Case Reports in Dentistry 2013The nasopalatine cyst is the most common epithelial and nonodontogenic cyst of the maxilla. The cyst originates from epithelial remnants from the nasopalatine duct. The...
The nasopalatine cyst is the most common epithelial and nonodontogenic cyst of the maxilla. The cyst originates from epithelial remnants from the nasopalatine duct. The cells may be activated spontaneously during life or are eventually stimulated by the irritating action of various agents (infection, etc.). It is different from a radicular cyst. The definite diagnosis should be based on clinical, radiological, and histopathological findings. The treatment is enucleation of the cystic tissue, and only in rare cases a marsupialisation needs to be performed. A case of a nasopalatine duct cyst in a 35-year-old male is reviewed. The typical radiologic and histological findings are presented.
PubMed: 24307954
DOI: 10.1155/2013/869516 -
Academic Radiology Oct 2023This study aimed to investigate the reliability and accuracy of high-resolution ultrasonography (US) for diagnosing periapical lesions and differentiating radicular...
RATIONALE AND OBJECTIVES
This study aimed to investigate the reliability and accuracy of high-resolution ultrasonography (US) for diagnosing periapical lesions and differentiating radicular cysts from granulomas.
MATERIALS AND METHODS
This study included 109 teeth with periapical lesions of endodontic origin from 109 patients scheduled for apical microsurgery. Ultrasonic outcomes were analyzed and categorized after thorough clinical and radiographic examinations using US. B-mode US images reflected the echotexture, echogenicity, and lesion margin, while color Doppler US assessed the presence and features of blood flow of interested areas. Pathological tissue samples were obtained during apical microsurgery and subjected to histopathological examination. Fleiss' κ was used to measure interobserver reliability. Statistical analyses were performed to assess the diagnostic validity and the overall agreement between US and histological findings. The reliability of US compared to histopathological examinations was assessed based on Cohen's κ.
RESULTS
The percent accuracy of US for diagnosing cysts, granulomas, and cysts with infection based on histopathological findings was 89.9%, 89.0%, and 97.2%, respectively. The sensitivity of US diagnoses was 95.1% for cysts, 84.1% for granulomas, and 80.0% for cysts with infection. The specificity of US diagnoses was 86.8% for cysts, 95.7% for granulomas, and 98.1% for cysts with infection. The reliability for US compared to histopathological examinations was good (κ = 0.779).
CONCLUSION
The echotexture characteristics of lesions in US images correlated with their histopathological features. US can provide accurate information on the nature of periapical lesions based on the echotexture of their contents and the presence of vascularity. It can help improve clinical diagnosis and avoid overtreatment of patients with apical periodontitis.
Topics: Humans; Radicular Cyst; Periapical Granuloma; Reproducibility of Results; Granuloma; Ultrasonography
PubMed: 37394410
DOI: 10.1016/j.acra.2023.05.039 -
Journal of Dental Sciences Jul 2021Actinomycosis is sometimes associated with a radicular cyst (RC). This retrospective study evaluated the clinical and histopathological features of 6 RCs with...
BACKGROUND/PURPOSE
Actinomycosis is sometimes associated with a radicular cyst (RC). This retrospective study evaluated the clinical and histopathological features of 6 RCs with actinomycosis (AM/RCs).
MATERIALS AND METHODS
The demographic data and clinicopathological features of 6 AM/RCs were collected and analyzed.
RESULTS
The 6 AM/RCs were taken from 2 male and 4 female patients, and 3 were found in the maxilla and the other 3 in the mandible. The involved teeth included maxillary or mandibular incisors (2 cases) and maxillary or mandibular first and second molars (4 cases). The most common symptom was pain (5 cases) and the more frequent signs were sinus tract and pus discharge (4 cases). Microscopically, the actinomycotic colony presented as a mass with filamentous bacteria arranging in a sun-ray pattern at the periphery. The mean actinomycotic colony number was 7.7 ± 6.6 colonies per slide. Due to the severe inflammation in all 6 AM/RCs, the stratified squamous epithelial lining was completely abolished in 2 cases and partially destroyed in 4 cases with the residual epithelial lining varying from approximately 10%-50%.
CONCLUSION
Our results indicate that pain is the most common symptom and sinus tract and pus discharge are the two frequent signs of our 6 AM/RCs. The stratified squamous epithelial lining was either completely abolished (2 cases) or partially destroyed (4 cases) in 6 AM/RCs. Thus, if the endodontically-treated tooth shows a recurrent sinus tract and poor response to repeated conventional root canal treatments, periradicular actinomycotic infection should be highly suspected.
PubMed: 34141095
DOI: 10.1016/j.jds.2021.04.008 -
Journal of Clinical and Experimental... Apr 2022The expression of cyclooxygenase-2 (COX-2) and Keratin-15 (K15) in radicular cysts (RCs) is poorly understood. Identifying the expression of these two markers may modify...
BACKGROUND
The expression of cyclooxygenase-2 (COX-2) and Keratin-15 (K15) in radicular cysts (RCs) is poorly understood. Identifying the expression of these two markers may modify the current treatment of RC. The objective of this study was to evaluate the expression of COX-2 and its relationship to K15 expression in the odontogenic epithelial cells of the RC.
MATERIAL AND METHODS
A total of 18 RCs were immunohistochemically analyzed for COX-2 and K15 expression. The cellular inflammatory reaction in the cyst wall was also assessed by measuring the percentage of inflammatory cells to the total number of cells.
RESULTS
COX-2 expression in the odontogenic epithelium of RC was absent in 11.1 % (n=2), mild in 27.8 % (n=5), moderate in 22.2% (n=4) and strong in 38.9% (n=7). Meanwhile, K15 expression was absent in 27.8% (n=5), mild in 16.7% (n=3), moderate in 44.4% (n=8), and strong in 11.1% (n=2) of the cases. The inflammatory infiltrate was mild in 2 cases (11.1%), moderate in 6 cases (33.3%), and high in 10 cases (55.6%). Spearman's correlation test revealed significant correlation (rho= .533; = .023) between COX-2 and K15 expression in the odontogenic epithelium of RC. However, no correlation was noted between inflammation and expression of COX-2 (rho= 0.248, =.321) or K15 (rho= -0.162, = .520).
CONCLUSIONS
There is high and correlated expression of COX-2 and K15 in the odontogenic epithelium of RC. COX-2 could therefore be involved in epithelial cell differentiation of the cyst. Additionally, the expression of K15 in RC may be an indicator of epithelial cell differentiation. Cyclooxygenase, COX-2, Keratin-15, K15, Radicular cyst.
PubMed: 35419179
DOI: 10.4317/jced.59443