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Objectif: decrire les aspects epidemiologiques, cliniques, therapeutiques, et evolutifs des cellulites cervico-faciales d’origine dentaire au CHU Sylvanus Olympio (SO) de Lome. Patients et methodes : Il s’est agi d’une etude transversale descriptive realisee sur une periode de sept ans, a propos de 373 dossiers medicaux colliges dans le service d’Oto-Rhino- Laryngologie et de Chirurgie Cervico-Maxillo-Faciale du CHU SO de Lome, comportant des informations cliniques et paracliniques faisant cas de cellulites cervico-faciales d’origine dentaire. Resultats : L’âge moyen de nos patients etait de 38,5 ans ± 15,2. Le delai moyen de consultation etait de 11 jours. Les motifs les plus frequents etaient la tumefaction douloureuse (94,1%) et l’odontalgie (90,6%). Une automedication a base AINS/antalgiques a ete retrouvee dans 33,0% des cas. Cliniquement, la tumefaction etait submandibulaire dans 60,1% des cas et associee a la carie dentaire dans 74,8% des cas. Les dents cariees etaient majoritairement les molaires inferieures dans 81,9% des cas. L’examen cytobacteriologie des prelevements a ete realise chez 189 patients et 97 prelevements se sont reveles positifs et isolant le streptocoque dans 32 cas. La radiographie panoramique a permis de noter un granulome dans 51,0% des cas, suivi du kyste apical dans 35,5% des cas. Le traitement medical etait fait d’une bi-antibiotherapie readaptee secondairement sur la base d’antibiogramme. Un drainage chirurgical avec extraction dentaire differee a ete effectue dans 86,1% des cas. L’evolution etait favorable chez la majorite des patients avec 6,9% de deces. Conclusion : Les cellulites cervico-faciales d’origine dentaire restent d’actualite. Le diagnostic doit etre precoce, la prise en charge est pluridisciplinaire mais un accent doit etre mis sur la prevention. Objective: to describe the epidemiological, clinical, therapeutic and progressive aspects of head and neck cellulitis of dental origin at Sylvanus Olympio University Hospital (SO), Lome. Material and method: This was a descriptive cross-sectional study carried out over a period of seven years, concerning 373 medical files collected in the Department of Oto-Rhino- Laryngology and Head and Neck Surgery of the Sylvanus Olympio University Hospital in Lome, with clinical and paraclinical information on head and neck cellulitis of dental origin. Results: The mean age of our patients was 38.5 ± 15.2 years. The average consultation time was 11 days. The most common reasons were painful swelling (94.1%) and toothache (90.6%). Selfmedication based on NSAIDs / analgesics was found in 33.0% of cases. Clinically, swelling was sub-mandibular in 60.1% of cases and associated with tooth decay in 74.8% of cases. The decayed teeth were predominantly lower molars in 81.9% of cases. The cytobacteriological examination of the specimens was carried out in 189 patients and 97 samples were positive and isolating the streptococcus in 32 cases. Panoramic X-ray revealed granuloma in 51.0% of cases, followed by apical cyst in 35.5% of cases. The medical treatment was made of a bi-antibiotherapy rehabilitated secondarily on the basis of antibiogram. Surgical drainage with delayed tooth extraction was performed in 86.1% of cases. The evolution was favorable for the majority of patients with 6.9% of deaths. Conclusion: Head and neck cellulitis of dental origin remains valid. The diagnosis must be early, the management is multidisciplinary but an emphasis must be placed on prevention.

Introduction: The mechanism of the formation of apical cyst has been elusive. Several theories have long been proposed and discussed speculating how an apical cyst is developed and formed in the jaw bone resulting from endododontic infection. Two popular theories are the nu-tritional deficiency theory and the abscess theory. The nutri-tional deficiency theory assumes that the over proliferated epithelial cells will form a ball mass such that the cells in the center of the mass will be deprived of nutrition. The abscess theory postulates that when an abscess cavity is formed in connective tissue, epithelial cells proliferate and line the preexisting cavity because of their inherent tendency to cover exposed connective tissue surfaces. Based on the nature of epithelial cells and the epithelium, nutri-tional theory is a fairy tale, while abscess theory at best just indi-cates that abscess may be one of the factors that allows the stratified epithelium to form but not to explain a mechanism that makes the cyst to form. The hypothesis: Apical cyst formation is the result of proliferation of resting epithelial cells, due to inflammation, to a sufficient number such that they are able to form a polarized and stratified epithelial lining against dead tissues or foreign materials. These stratified epi-thelial lining expands along the dead tissue or foreign materials and eventually wrap around them as a spherical sac, i.e. a cyst. The space in the sac is considered the external environment separating the internal (tissue) environment – the natural function of epithelium. Evaluation of the hypothesis: This theory may be tested by introducing a biodegradable device able to slowly release epithelial cell mitogens in an in vivo environment implanted with epithelial cells next to a foreign object. This will allow the cells to continuously proliferate which may form a cystic sac wrapping around the foreign object.

A case report is presented in which a radiolucentarea in the anterior portion of the mandible was diagnosed clinically as an apical cyst. However, when examined microscopically, it was discovered to be a cystic ameloblastoma. Cystic ameloblastoma is described as a distinctvariant of ameloblastoma in which the response to curettage is favorable with a low recurrence rate. In many cases, it may imitate an endodontic apical lesion, and be mistreated. The importance of precise diagnosis by the endodontist and the treatment recommended in such cases are discussed.

Activation of the epithelial cell rests of Malassez by various means, results in proliferation of these cells and formation of apical periodontal cysts. Several theories for the genesis of apical periodontal cysts have been suggested which are not satisfactory. Available evidence indicates that development and destruction of these lesions are mediated by immunological reactions.

Squamous odontogenic tumor-like proliferations were observed in the wall of an apical cyst in a 45-yr-old man. Review of the literature revealed nine similar cases. In spite of the histological similarity of these proliferations to squamous odontogenic tumors they differ clinically, radiographically, and biologically and, therefore, should be separated.

An unusual case is reported of an infected apical cyst attached to a vital tooth. The clinical and radiographic appearances were compatible with an apical cyst. Histology of the extracted tooth and attached cyst showed the tooth to be vital.