Abstract

A 66-year-old female patient was referred to the oral surgery unit for the enucleation of a radicular cyst centered at the apex of the necrotic tooth 12. Initial panoramic and intraoral periapical radiographs suggested a persistent periapical cystic lesion despite previous root canal treatment. However, cone-beam computed tomography (CBCT) revealed the coexistence of two distinct lesions within the same anatomical region: a periapical lesion associated with tooth 12, radiographically suggestive of a radicular cyst, and a second well-defined lesion centered within the nasopalatine canal, consistent with a nasopalatine duct cyst and not detectable on conventional radiographs. This unusual association represented a significant diagnostic challenge, as the clinical and two-dimensional radiographic findings initially suggested a single persistent endodontic lesion. Surgical enucleation of both lesions was performed. Histopathological examination confirmed the diagnosis of a nasopalatine duct cyst for the lesion located within the incisive canal, whereas the periapical lesion was confirmed as a radicular cyst. Postoperative follow-up at 10 days, 3 months, 6 months, and 1 year demonstrated satisfactory healing without recurrence or complications. This case highlights the diagnostic value of CBCT in the identification of coexisting odontogenic and non-odontogenic lesions of the anterior maxilla, particularly when conventional radiography is insufficient to distinguish separate pathologies.

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