RADIOGRAPHIC FINDINGS OF DENTIGEROUS CYSTS WITH CHOLESTEROL GRANULOMA

Abstract

<h3>BACKGROUND</h3> Dentigerous cysts are common benign odontogenic cysts.¹ A dentigerous cyst is characterized by an epithelium attachment that is associated with the crown of an unerupted tooth and appears radiographically as a well-defined radiolucency.^2,3 The dentigerous cyst may be a cholesterol granuloma histopathologically when it is associated with numerous cholesterol clefts with foam cells, foreign body giant cells, and macrophages filled with hemosiderin.⁴ Cholesterol granuloma often occurs in the middle ear and may be found in other sites.⁵ There are very few reported cases of cholesterol granuloma in the jaws. <h3>CASE REPORT</h3> We present 4 cases of dentigerous cysts with cholesterol granuloma. All 3 lesions were in the mandible. The first patient was a 34-year-old man who had a lesion in his right mandibular ramus. The second patient was a 45-year-old man with a lesion in the left posterior mandible. The third patient was a 77-year-old man with 2 lesions in the posterior mandible bilaterally. The lesions were mostly well defined. Three were unilocular and one multilocular with sclerotic margins, suggestive of peripheral bone reaction to a possible inflammatory process. The histopathologic diagnosis of these cases was dentigerous cyst with cholesterol granuloma. <h3>DISCUSSION/CONCLUSIONS</h3> The pathogenesis of cholesterol granuloma is still unclear.⁴ Cholesterol granuloma may form because of either possible disruption of ventilation and/or improper drainage and hemorrhage into a closed cavity.⁵ Cholesterol granuloma could lead to the expansion of the lesion and may have a leading role in cyst growth. The formation of large cholesterol crystals causes a foreign body reaction that releases macrophages and multinucleated giant cells. The cholesterol granulomas resist the action of phagocytes and continue to release inflammatory and bone resorptive products that may lead to expansion along with aggressive radiographic features.