Lesions resembling globulomaxillary cysts
T
hc glohulomaxillary cyst is a cystic process formed of embryonic wtodermal ~11s entrapped in the globulomasillary fissure. In radiographs, this process ap~wws as a pear-shaped radioluccwt area tlcsccnding into the alveolar crest and pushing asidc the roots of the adjacent lateral and canine teeth which remain vit,iil.’ Because of its peculiar radiographic shape, dentists tend to diagnose an)pear-shaped radioluccnt prowss between the lateral tooth and the canine as a globulomaxillarp cyst. The purpose of this article is to emphasize the possibility of erroneous cliagnosis b;- presenting two caws in which the radiographs indicated a globulomaxillary cyst, but the histopathologic examinations confirmed other features. Such (lewriptions have been reportctl in the literature.‘-7 CASE REPORTS
CASE
1
.L healthy 46.year-old woman was referred to the Department of Oral and Maxillo-Facial Surgery of the Hadnssah School of Dental Medicine for periodontal treatmcwt. The oral examination revealed a nontender buccnl swelling in the, region of the upper right lateral incisor and canine. These tevth reacted \vithin the normal range to an cslcctric vitalomchter test and to temperature stimulation. ‘I’II(~ radiographs showed a large pear-shaped radiolucrnt xrca which had pushcvl aside tllv roots of the upper right lateral incisor and canine (Fig. 1, A). Thus, the clinical diagnosis I\-as globulon~asillary ryst. Treatment A Iwcal mucoperiosteal flap was reflected surgically. The exposed cortical bone rcvealetl 3 small fenestration, lwhind which was meaty tissue, not readily srparable from the l~onc~. Srparation and curettage raised douljts as to the cystic nature of the process. Thcreforr, nftel the spwimcn had Ijeeu removed, the walls of the l)one were cautrrizcvl, and thv spcimen was wb~iectrd to histopathologic rxamination.
25
CASE
2
b’i{/. 2. Photomicrogmph of a section of Ahom~xoma. Typical histologic picture cllaractw iwtl 1)~ stcllate cells sc’p:lratcd h-y intcrcellul:~r myso~d sulmtances. (Hematosylin an11 rosin staiu. hlqyufication, x260.)
DISCUSSION
‘l’hc globulomasiilary cyst was first described 1)~ Thorna’ in 1937. IIc claimed that this process ~)uld always ht found between the roots of the lateral in&or anti the: cw~inc, with the twtli lwiiig pushccl aside but remaining vital. Ratliographically, the prowss had a characteristic pear-shapctl appcarancc, clcscending into the alwolar crest. The cyst is described as having a thick wall covcrecl on the inner side with a hypcrplastic nonodontogScnic stratified squamous epithclium. There arv cases in which the radiograph depicts a glohulomasillary cpst, i~lth(~~~ghone or both of the teeth are not vital hwause of supcrimposetl fac+ors. Ilh~(:f’~r~, the diagnosis of globulomasillar~ cyst remains correct. \Ve have prcsentctl two eases in which the radiographs coul(l indicate an almost. certain diagnosis of glolndomouillar~- cyst. In the first cast, the clinical pictuw confirmed the diagnosis, since both the upper right lateral incisor and caiilline were vital. In the sccontl cast, the upper right canine was vital and fh~ in&w was not vital. In Case 1, histopathologic examinations showetl widencc of a 1umo~‘ous growth of fibromysoma. and in C’ase i2 there was edcncc of a n(mspwific periapical cyst. Opinions as to the csistcnw of the globulomasillar~- cyst \-w-y. Ts Thoma’s hypothesis mrrcct or arc there many processes similar radiographically to gl01)ulo~llitsillary cyst P (“hristi c[cscril)ctl six vases in which the radiographic and
Reprint requeststo : Dr. Hchlomo T&her I)c~l~ar~mcnt of Oral and Mnxillo-Facial Surgery Thea ITolnwv University-Hadnssall School of Dental .Terusnlrm, Israel
Medicine
T
hc glohulomaxillary cyst is a cystic process formed of embryonic wtodermal ~11s entrapped in the globulomasillary fissure. In radiographs, this process ap~wws as a pear-shaped radioluccwt area tlcsccnding into the alveolar crest and pushing asidc the roots of the adjacent lateral and canine teeth which remain vit,iil.’ Because of its peculiar radiographic shape, dentists tend to diagnose an)pear-shaped radioluccnt prowss between the lateral tooth and the canine as a globulomaxillarp cyst. The purpose of this article is to emphasize the possibility of erroneous cliagnosis b;- presenting two caws in which the radiographs indicated a globulomaxillary cyst, but the histopathologic examinations confirmed other features. Such (lewriptions have been reportctl in the literature.‘-7 CASE REPORTS
CASE
1
.L healthy 46.year-old woman was referred to the Department of Oral and Maxillo-Facial Surgery of the Hadnssah School of Dental Medicine for periodontal treatmcwt. The oral examination revealed a nontender buccnl swelling in the, region of the upper right lateral incisor and canine. These tevth reacted \vithin the normal range to an cslcctric vitalomchter test and to temperature stimulation. ‘I’II(~ radiographs showed a large pear-shaped radiolucrnt xrca which had pushcvl aside tllv roots of the upper right lateral incisor and canine (Fig. 1, A). Thus, the clinical diagnosis I\-as globulon~asillary ryst. Treatment A Iwcal mucoperiosteal flap was reflected surgically. The exposed cortical bone rcvealetl 3 small fenestration, lwhind which was meaty tissue, not readily srparable from the l~onc~. Srparation and curettage raised douljts as to the cystic nature of the process. Thcreforr, nftel the spwimcn had Ijeeu removed, the walls of the l)one were cautrrizcvl, and thv spcimen was wb~iectrd to histopathologic rxamination.
25
CASE
2
b’i{/. 2. Photomicrogmph of a section of Ahom~xoma. Typical histologic picture cllaractw iwtl 1)~ stcllate cells sc’p:lratcd h-y intcrcellul:~r myso~d sulmtances. (Hematosylin an11 rosin staiu. hlqyufication, x260.)
DISCUSSION
‘l’hc globulomasiilary cyst was first described 1)~ Thorna’ in 1937. IIc claimed that this process ~)uld always ht found between the roots of the lateral in&or anti the: cw~inc, with the twtli lwiiig pushccl aside but remaining vital. Ratliographically, the prowss had a characteristic pear-shapctl appcarancc, clcscending into the alwolar crest. The cyst is described as having a thick wall covcrecl on the inner side with a hypcrplastic nonodontogScnic stratified squamous epithclium. There arv cases in which the radiograph depicts a glohulomasillary cpst, i~lth(~~~ghone or both of the teeth are not vital hwause of supcrimposetl fac+ors. Ilh~(:f’~r~, the diagnosis of globulomasillar~ cyst remains correct. \Ve have prcsentctl two eases in which the radiographs coul(l indicate an almost. certain diagnosis of glolndomouillar~- cyst. In the first cast, the clinical pictuw confirmed the diagnosis, since both the upper right lateral incisor and caiilline were vital. In the sccontl cast, the upper right canine was vital and fh~ in&w was not vital. In Case 1, histopathologic examinations showetl widencc of a 1umo~‘ous growth of fibromysoma. and in C’ase i2 there was edcncc of a n(mspwific periapical cyst. Opinions as to the csistcnw of the globulomasillar~- cyst \-w-y. Ts Thoma’s hypothesis mrrcct or arc there many processes similar radiographically to gl01)ulo~llitsillary cyst P (“hristi c[cscril)ctl six vases in which the radiographic and
Reprint requeststo : Dr. Hchlomo T&her I)c~l~ar~mcnt of Oral and Mnxillo-Facial Surgery Thea ITolnwv University-Hadnssall School of Dental .Terusnlrm, Israel
Medicine
