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Author: admin, 18.07.2014
The patent urachus is purely congenital and represents about 50% of all cases of congenital anomalies.
These anomalies are usually associated with congenital abnormalities of the lower urinary tract such as posterior urethral valves or complete ureteral atresia.
Most patients with urachal anomalies (except those with a patent urachus) are asymptomatic. The patent urachus is a tubular connection between the anterosuperior wall of the bladder and the umbilicus. The urachal diverticulum develops when the supravesical portion of the urachus is not closed and therefore the urachus communicates only with the bladder dome. Ultrasound easily demonstrates a fluid-filled sac protruding extraluminally and not communicating with the umbilicus. They become symptomatic when enlarged but sometimes are found in the form of incidental masses during a routine examination. The scan can show a better definition of the anatomical relationship of the cyst with the bladder and its morphology and extension. Superinfected urachal cyst is seen as a thickening of the wall showing greater attenuation than water on CT and mixed echogenicity on US.
The alternating sinus is a cystic dilatation of the urachus that periodically empties into the bladder or the umbilicus. It is a very rare anomaly whose clinical and radiological characteristics are similar to those of urachal sinus. They are most common in the middle age and elderly populations and about 70% of affected individuals are male. These histological features are the ones which correlate with survival being the mucinous tumors the ones that have best prognosis compared to other subtypes. A primary bladder carcinoma arising in the mucosa of the bladder dome is often manifested with less extravesical  component than seen in urachal neoplasm. The minority of them are in the center of the urachus (6% of cases) or near the umbilical end (4%). Some tumors are diverted to the right or left paramedian because during embryonic development.
Calcifications in a midline  supravesical mass are considered almost diagnostic of urachal carcinoma.

US allows tumor localization and detection of highly echogenic calcifications and solid components of the tumor in the anterior abdominal wall. These tumors are considered radioresistant and does not seem to respond to the usual chemotherapy treatments. 2 clicks for more privacy: On the first click the button will be activated and you can then share the poster with a second click. Dentigerous cyst associated with an ectopic third molar in the maxillary sinus: A rare entity.
Dentigerous cyst associated with an ectopic third molar in the maxillary sinus: A case report and review of literature. The teeth most involved are in descending order of occurrence, the third molars, the canines, and the second premolars. 2 adult males( A, B) with a small, anterosuperior outpouching representing an urachal diverticulum arising from the apex of the bladder. US images show longitudinal sections (A and B) and axial (C) of the umbilical region, where a patent urachus (*)is identified.
As with other cysts, dentigerous cyst expands the cortical plates and may involve other teeth causing destruction of the tissues as it expands. There was slight obvious facial asymmetry caused by the swelling over the right maxillary region. Paranasal sinus (PNS) radiographic view demonstrates dentigerous cyst (arrow) and impacted third molar in the right maxillary sinus. Based on the clinical and radiological findings, a diagnosis of infected dentigerous cyst of maxillary sinus arising from an ectopic third molar was arrived at. Excised specimen shows the cystic lining remnants along with the impacted third molar.Click here to viewHistopathological examination revealed non-keratinized stratified squamous epithelium confirming the clinical diagnosis of dentigerous cyst [Figure 9].
Postoperative panoramic radiograph after 6-months showed a normal maxillary sinus [Figure 10].
However, there have been a few reports of tooth erupting in the nose, mandibular condyle, coronoid process, and maxillary sinus, which is also the largest of the paranasal sinuses. Usually these teeth are associated with dentigerous cysts, which can occupy the maxillary sinus partially or totally and can be the cause of various symptoms. Usually these teeth are detected during routine radiographic examination or the patient could have a history of typical, sinus-related symptoms.

It is also important to completely remove all diseased antral tissues and thoroughly assess all resected soft tissue histologically with proper follow-up for a period of 1 year.
Unicystic ameloblastoma occurs in people under the age of 30 years, is seen equally in both genders, and has a tendency to occur in the posterior mandible associated with the crown of an unerupted third molar. Approximately one-third of cases are associated with an unerupted tooth, most often a canine. CEOT is an uncommon lesion, which is most often encountered between 3 rd and 5 th decades, occurs equally in both genders, and has a tendency to occur in posterior mandible associated with an impacted third molar. Ameloblastic fibroma is an uncommon tumor, occurs in the first 2 decades, more common in males, commonly found in posterior mandible, and is associated with an unerupted tooth in about 75% of cases.
Ameloblastic fibro-odontoma often occurs in the maxilla and is associated with an impacted tooth. However, the ameloblastic fibro-odontoma is rarely found within the maxillary sinus and usually occurs in young adults under the age of 20 years. Odontogenic keratocyst may be found in patients in any age group, is commonly found in posterior body and ascending ramus of the mandible, and in 25-40% of cases, an unerupted tooth is involved. Cases of ameloblastoma or epidermoid carcinomas developing from the lining epithelium of a dentigerous cyst are adequately documented as potential long-term complications, whereas mucoepidermoid carcinomas are less well-documented. In large cysts, an initial marsupialization to diminish the size of the osseous defect, followed by enucleation and tooth extraction, has been followed.
The major disadvantage of marsupialization is recurrence or persistence of the lesion along with the residual cystic lining. Endoscopic approach for management of dentigerous cyst of maxilla is also described in the literature. Imaging studies including CT scans aid in diagnosis of dentigerous cysts and associated tooth abnormalities. Management of dentigerous cyst arising from ectopic third molar in the maxillary sinus is usually enucleation.
Caldwell-Luc procedure along with enucleation and primary closure was followed in this case as the ectopic tooth was the cause of recurrent sinusitis and purulent rhinorrhea in spite of administering antibiotics repeatedly.

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