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Journal of Peking University (Health Sciences) ›› 2021, Vol. 53 ›› Issue (2): 396-401. doi: 10.19723/j.issn.1671-167X.2021.02.027

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Three-dimentional radiographic features of 67 maxillary radicular cysts

MENG Yuan1,ZHANG Li-qi1,ZHAO Ya-ning1,LIU Deng-gao1,Δ(),ZHANG Zu-yan1,GAO Yan2   

  1. 1. Department of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
    2. Department of Oral Pathology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
  • Received:2019-06-02 Online:2021-04-18 Published:2021-04-21
  • Contact: Deng-gao LIU E-mail:kqldg@bjmu.edu.cn
  • Supported by:
    National Natural Science Foundation of China(11435007)

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Abstract:

Objective: To analyze the three-dimensional radiographic characteristics of maxillary radi-cular cysts using cone-beam computed tomography (CBCT) and spiral CT. Methods: Clinical records, histopathological reports, and CBCT or non-enhanced spiral CT images of 67 consecutive patients with maxillary radicular cysts were retrospectively acquired, and radiographic features, including size, shape, expansion, internal structure and relationship with the surrounding tissues, were analyzed. The lesions were divided into three types according to the involved tooth number, as follows: type Ⅰ (single tooth), the epicenter of the cyst was located at the apex of a nonvital tooth, without involvement of the neighbo-ring tooth; type Ⅱ (adjacent tooth involvement), the cyst was located at the apex of a nonvital tooth with involvement of the mesial and/or distal tooth root; and type Ⅲ (multi-teeth), the cyst involved the apexes of ≥4 teeth. Besides, these cysts were classified as another three types on sagittal views, as follows: centripetal, the root apex was oriented centripetally to the center of the cyst; palatal, the cyst was located mainly at the palatal side of the apex; and labial/buccal, the cyst was located mainly at the labial/buccal side of the apex. Results: Totally, 67 patients with maxillary radicular cysts were acquired, including 38 males and 29 females, and their ages ranged from 13 to 77 years. Among them, 46 lesions (68.7%) were located in the anterior maxilla and 65 (97.0%) were round or oval. Labial/buccal cortex expansion was present in 43 cases (64.2%) and palatal cortex expansion in 37 cases (55.2%). The nasal floor was invaded in 27 cases (40.3%), the maxillary sinus was invaginated in 26 cases (38.8%), and root resorption was present in 9 cases (13.4%). The average diameter of lesions was (20.89±8.11) mm mesio-distally and (16.70±5.88) mm bucco-palatally. In spite of the 4 residual cysts, the remaining 63 lesions included 14 type Ⅰ, 26 type Ⅱ and 23 type Ⅲ cysts according to the involved tooth number. Besides, the 63 lesions included 46 centripetal, 15 palatal and 2 buccal cysts on sagittal views. Conclusion: The maxillary radicular cysts were frequently well-circumscribed round or oval radiolucency, with significantly different sizes. According to the involved tooth number, it can be divided into single tooth, adjacent tooth involvement and multi-teeth types. On sagittal views, the root-cyst relationship was centripetal in most cases, while a minority of cysts expanded palatally or buccally.

Key words: Radicular cyst, Maxilla, Diagnostic imaging, Tomography, spiral computed, Cone-beam computed tomography

CLC Number: 

  • R781.34

Figure 1

Radicular cyst of single tooth type A, axial cone-beam CT showed a radicular cyst originating from the left maxillary central incisor, without involvement of the neighboring tooth root; B, panoramic view of the cyst."

Figure 2

Radicular cyst of adjacent tooth involvement type A, axial cone-beam CT showed a radicular cyst of the left maxillary lateral incisor, which involved the roots of 21-23; B, panoramic view of the cyst; C and D, histopathologic images showed a non-keratinized multilayered squamous epithelium with irregular proliferation of pegs and infiltration of lymphocytes and plasma cells (C, HE ×40; D, HE ×200)."

Figure 3

Radicular cyst of multi-teeth type A, axial spiral CT with bone algorithm showed a right maxillary radicular cyst, the cyst involved the roots of 11-16 with interruption of the palatal cortex; B, panoramic view of the cyst."

Figure 4

Sagittal relationships of radicular cysts relative to the corresponding roots A, sagittal cone-beam CT showed a “centripetal” radicular cyst in the left maxilla, the root apex was oriented centripetally to the center of the cyst; B, sagittal cone-beam CT showed a “palatal” radicular cyst in the left maxilla, the cyst was located mainly at the palatal side of the apex; C, sagittal cone-beam CT showed a “labial/buccal” radicular cyst in the right maxilla, the cyst was located mainly at the labial/buccal side of the apex."

Figure 5

Gender and age distribution of patients with maxillary radicular cysts"

Table 1

Radiographic features of the maxillary radicular cysts"

Items n (%)
Position
Right posterior 11 (16.4)
Anterior 46 (68.7)
Left posterior 10 (14.9)
Axial shape
Circular 54 (80.6)
Oval 11 (16.4)
Kidney-like 2 (3.0)
Mesio-distal classification
No tooth 4 (6.0)
Single tooth 14 (20.9)
Adjacent tooth involvement 26 (38.8)
Multi-teeth 23 (34.3)
Bucco-palatal expansion
No tooth 4 (6.0)
Centripetal 46 (68.7)
Palatal 15 (22.4)
Labial/Buccal 2 (3.0)

Table 2

Invasion of surrounding structures in the maxillary radicular cysts"

Items n (%)
Invagination of sinus
Level 1 41 (61.2)
Level 2 25 (37.3)
Level 3 1 (1.5)
Invasion of nasal floor
Level 1 40 (59.7)
Level 2 5 (7.5)
Level 3 22 (32.8)
Resorption of root
Presence 9 (13.4)
Absence 58 (86.6)
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