A Case Report of Maxillary Anterior Radiolucent Lesion Associated with Impacted Teeth

The unilocular radiolucencies, with its wide range of possible diagnosis, remain the topic of much debate and interest for clinicians. These lesions cannot be diagnosed solely based on radiographic appearance, but should be based on clinical, radiological and histopathological features. Due to high probability of misdiagnosis of this entity, a sound knowledge of various unilocular radiolucencies, adequate use of diagnostic aids and careful observation is important to provide proper diagnosis and treatment. Here, we present a case of a unilocular lesion in the right anterior maxilla with two impacted teeth.


INTRODUCTION
Unilocular radiolucencies of jaw remain a diagnostic dilemma for clinicians as many jaw lesions have similar clinical and radiographic appearance. Most of these cases are benign but can also be locally aggressive and destructive.
Careful consideration of patient's history and observation of site, border and internal structure of the lesion along with its effect on the surrounding structures helps to narrow the differential diagnosis. 1 In this report, we present a case of a unilocular radiolucent lesion in right anterior maxilla associated with impacted teeth. were displaced without resorption of the roots.

Differential Diagnosis
In this case, the radiographic presentation of radiolucency surrounding impacted tooth in anterior maxilla led to differential diagnosis of an odontogenic cyst or neoplasm.
The first presumptive diagnosis was dentigerous cyst as it is the most common pathologic pericoronal radiolucency associated with an impacted tooth. About 0.8 to 45.9% of anterior maxillary lesions reported in English literature are odontogenic cysts. 2 After the third molar, permanent maxillary canine is the most common tooth involved, which supported this differential diagnosis. 3 However, unlike dentigerous cyst, the radiolucency did not show clear attachment to the cementoenamel junction.
Ranking next in the differential diagnosis was adenomatoid odontogenic tumor (AOT) due to characteristic location of  Odontogenic myxoma was also included among the diagnostic possibilities. It mostly presents as a multilocular radiolucency, but, when they occur pericoronal to an impacted tooth, they can also present as a cyst -like unilocular lesion. 4 Ameloblastic fibroma was also considered. It mostly present as an asymptomatic unilocular radiolucent lesion in the first two decades of life. However, unlike our case, the most common location is posterior mandible. 2 The possibility of being a malignant tumor was considered highly improbable because of the painless asymptomatic nature, presence of a well-circumscribed radiolucency and absence of cortical destruction. 1 In summary, our case involved an adolescent male with radiolucent lesion associated with impacted teeth in maxillary anterior region. The clinical and radiographic features of this case were most consistent with diagnosis of dentigerous cyst, AOT, odontogenic myxoma or ameloblastic fibroma.

Diagnosis and Treatment
In this case, complete enucleation of the lesion was performed along with extraction of the retained teeth. Histopathologic  remain unknown until the appearance of a swelling. 7 In our case, the lesion was asymptomatic discovered accidentally.
Radiographically, majority of COFs present as unilocular radiolucent lesion with well-defined borders while some cases appear as multilocular lesions. Few mixed radiolucent and radiopaque appearance with poorly defined borders have also been reported. COF may be associated with impacted tooth, which might give the impression of dentigerous cyst. 5 This is similar to our case, where radiolucent lesion was associated with impacted canine and a supernumerary tooth.
In a study by Barnes et al.,27% of COFs were associated with  In general, the mode of treatment of COF is enucleation or surgical curettage with careful follow up for few years.
Recurrence and malignant transformation are uncommon. 10 CONCLUSION COF is a rare benign tumor with variable clinical and radiological characteristics, which can cause a diagnostic dilemma for the clinicians. Radiographic features of COF occasionally mimic dentigerous cysts. Hence, adequate clinical, radiographical and histopathological analysis is essential in diagnosing these lesions.