A Gossypiboma Mimicking a Residual Odontogenic Cyst in the M
A 42-year-old woman reported to a dentist for removal of her right mandibular first molar. The patient reported receiving a dental implant in her right premolar region seven years ago. During this surgery, the dentist also removed the right mandibular third molar. Post-operatively, she complained of pain and foreign body sensation for six months in the area of the removed tooth. The dentist undertook several measures but decided against an active treatment and, therefore, the medical problems did not improve.

A panoramic radiograph showed a defined and oval radiolucent area in the socket of her right mandibular third molar. The features in this radiograph could suggest a diagnosis of residual cyst, keratocyst, odontogenic cyst, or unicystic ameloblastoma.

During surgical treatment, a foreign body composed of gauze was found in the oval radiolucent area. There was no infection or abscess formation around the gauze. The mass was completely removed from the bone and sent for histological diagnostic examination.

The histopathologic diagnosis was foreign body reaction around birefringent foreign bodies and calcifications.

Points worth discussion:-
1. CT and CBCT scans are the most effective methods to diagnose gossypiboma, showing a round, low-intensity, ill-defined mass containing a spongiform air bubble.
2. When the pathological tissue shows only a chronic inflammatory lesion with foreign body giant cells, without many birefringent foreign bodies, the diagnosis is oral pulse granuloma. Oral pulse granuloma is most commonly found in the posterior regions of the mandible.
3. Gauze or IVDs are not safe because they can break into fragments during manipulations. Therefore, it is especially important to flush the socket extensively with saline and to check for foreign materials.

Source: https://jmedicalcasereports.biomedcentral.com/articles/10.1186/1752-1947-5-211
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