A Dilated Dental Follicle Mimicking a Maxillary Ciliated Cyst: The Importance of Clinicopathological Correlation

A dilated dental follicle can closely mimic a maxillary (antral) ciliated cyst, both radiographically and histologically, when an impacted maxillary third molar's follicular space abuts a thinned or perforated sinus floor. I report a case in which a deeply impacted, distally inclined maxillary right third molar (tooth 18) with a large pericoronal radiolucency extending to the sinus floor was removed under general anaesthesia; the sinus floor was breached during delivery of the tooth, and a fragment of antral lining was included with the specimen. Initial histopathology favoured a maxillary ciliated cyst, but specialist review revised the diagnosis to a dilated dental follicle with incidentally avulsed antral mucosa and chronic sinusitis. At clinical review 9 years and 5 months postoperatively, the patient remained asymptomatic with no evidence of recurrence. This case illustrates that respiratory epithelium in such specimens does not, by itself, confirm a true antral cyst, and underscores the value of specialist oral pathology review when the histopathological findings do not fit with the clinical and radiological features.