Oral Cysts

ORAL CYSTS

PRESENTED BY:DR IRRUM ZEBDR AYESHA KIYANI

DEFINITION

Pathological cavity may or may not be lined by epithelium,having fluid or semifluid or gaseous content.

It is not created by the accumulation of pus

CLASSIFICATIN OF CYST1. EPITHELIAL CYST

Odontogenic Cysts DEVELOPMENTAL

Dentigerous Odontogenic

keratocyst Glandular

odontogenic lateral periodontal Eruption Gingival

Inflammatory Radicular Paradental

NON ODONTOGENIC CYSTS

Nasopalatine duct cyst Nasolabial cyst Median cyst

NON-EPITHELIZED BONE CYSTS Solitary bone cyst Aneurysmal bone cyst Stafene,s idiopathic bone cavity

Diagnosis

Complete history Pain, loose teeth,

occlusion, swellings, dysthesias, delayed tooth eruption

Thorough physical examination Inspection, palpation,

percussion, auscultation Plain radiographs

Panorex, dental radiographs

CT for larger, aggressive lesions

Diagnosis

Differential diagnosis

Obtain tissue FNA – r/o vascular

lesions, inflammatory

Excisional biopsy – smaller cysts, unilocular tumors

Incisional biopsy – larger lesions prior to definitive therapy

Origins Of Odontogenic Cysts Epithelial rests

persisting after dissolution of dental lemina

Reduce enamel epithelium

Rests of malaises

1.Odontogenic Keratocyst

Unusual growth pattern(antero-post direction)

Tendency to recur Common in males Most often in ramus and angle Multiple cyst is associated with Gorlin

syndrome Radiographically Well-marginated, radiolucency• Uni or Multilocular

Odontogenic Keratocyst

Odontogenic Keratocyst

Histology

Thin wrinkled folded ortho/parakeratenized

Pallisading basal layer

Flat retepegs Inc. protien

content

Treatment of OKC Depends on extent of

lesion Small – simple

enucleation, complete removal of cyst wall

Larger – enucleation with/without peripheral ostectomy

Bataineh,et al, promote complete resection with 1 cm bony margins (if extension through cortex, overlying soft tissues excised)

Long term follow-up required (5-10 years)

2.Dentigerous (follicular) Cyst Most common Encloses part or all of unerupted tooth Attach to amelocemental junction Twice common in mandible then in maxilla Pathogenesis: it arises due to proliferation of outer

layer of reduced enamel epithelium,followed by breakdown of cells within islands,leadind to cyst formation

Radiographic findings

Unilocular radiolucency with well-defined sclerotic margins

Histology

Thin ,regular 2-5 cell thick lining

Nonkeratinizing squamous epithelium

Supported by fibrous conective tissue

Treatment

enucleation, decompression

3.LATERAL PERIODONTAL CYST

Uncommon Mostly occcur in canine

and premolar area of middle aged patient

Presents with expansion Radiografically:well

defined radiolucency with sclerotic margin

Occasionally it appear as multiloccular leison botryoid odontogenic cyst

LATERAL PERIODONTAL CYST

Derived from reduced enamel epithelium or rests of dental lemina

Histolgically:non keratinized squamous or cuboidal epithelium

Focal of plaque like thickenings

HISTOLOGY

TREATMENT

enucleation, curettage with preservation of adjacent teeth

4.ERUPTION CYST

Involve both permanent and primary dentition

Extra alveolar cyst Presents with

fluctuant swelling on mucosa and bluish in color

HISTOLOGY

Subacutely inflamed and hemorrhagic cyst wall:lined by nonkeratinizing stratified squamous epithelium:

usually thin

TREATMENT

 Treatment of the eruption cyst is not always undertaken immediately. However, if necessary, the most common method used has been the removal of a portion of the tissue overlying the crown of the tooth to facilitate eruption.

5.GLANDULAR ODONTOGENIC CYSTS Rare Mostly appear in

anterior mandible Presents as slow

growing,painless,uni or multiloccular radiolucency

Potentially aggressive,locally invasive and tendency to recur.

HISTOLOGY

epithelium is stratified squamous in type, but covered by cuboidal or columnar cells (sometimes ciliated) interspersed with microcystic spaces simulating salivary gland ducts (but not true salivary gland ducts), thus the name “glandular.”

TREATMENT

Considerable recurrence potential 25% after enucleation or curettage Marginal resection suggested for

larger lesions or involvement of posterior maxilla

close follow-up

6.GINGIVAL CYST

Common in neonates Also called bohn’s

nodule or epstien’s pearl

Mostly disapear by 3 moths of age

Arise from reminants of dental lamina proliferate to form small keratinized cyst

Extra alveolar location

Radicular (Periapical) Cyst

Most common (65%) Epithelial cell rests of

Malassez Response to

inflammation Radiographic findings

Pulpless, nonvital tooth Small well-defined

periapical radiolucency Treatment –

extraction, root canal

HISTOLOGY

Paradental Cyst

Associated with partially impacted 3rd molars

Result of inflammation of the gingiva over an erupting molar

0.5 to 4% of cysts Radiology – radiolucency in apical

portion of the root Treatment – enucleation

RADIOGRAPHICALLY