ORAL PATHOLOGY

Odontogenic cysts Non- odontogenic cysts

1) Developmental cysts 1) Nasopalatine duct cyst
2) Nasolabial cyst
- Odontogenic keratocyst 3) Median cyst
- Dentigerous cysts
- Eruption cysts
- Lateral periodontal cyst
- Gingival cyst
- Glandular odontogenic cyst

2) Inflammation cysts

- Radicular cyst (dental cyst)

• Apical
• Lateral
• Residual

- Paradental cyst
 Odontogenic cysts
- The epithelial lining is derived from epithelial
residues of the tooth-forming organ.
- Can be subdivided into inflammatory &
developmental depending on aetiology.
 Non-odontogenic cysts
- The epithelial lining is derived from sources
other than the tooth-forming organ.
o Dental lamina rests/ glands of Serres
- Odontogenic keratocyst
- Lateral periodontal cyst
- Gingival cyst Some may also from the
same origin
o Reduced enamel epithelium
- Dentigerous cyst
- Eruption cyst
- Paradental cyst
o Rests of Malassez – formed by fragmentation of the
epithelial root sheath of Hertwig.
- Radicular cyst
ODONTOGENIC CYSTS
 Bimodal age distribution – 2nd – 3rd decades & 5th decades.
 More common in males than females.
 70 – 80 % occur in the mandible than maxilla.
 Most common site: 3rd molar region & ascending ramus.
 Few symptoms; cause little expansion but may reach large size
without causing gross bony expansion.
 Enlarge predominantly in anteroposterior region.
 Majority arise sporadically & present as solitary lesions.
 Unilocular/ multilocular, well-defined radiolucency; may mimic
dentigerous cyst.
Hisopatology

 Thin, easily torn wall

 Lined by an even layer of parakeratinized
squamous epithelium.
 Palisaded basal cell layer
 Contains keratinous debris.
 Setellite cysts in capsule.
 Multiple cyst associated with naevoid basal
carcinoma syndrome – Gorlin syndrome.
 Features of Gorlin syndrome:

- Skin - multiple naevoid basal cell carcinoma,

appear around age of puberty.
- Oral – multiple odontogenic keratocyst.
- Skeletal – rib anomalies, vertebral deformities,
cleft palate/lip.
- CNS – calcified falx cerebri, brain tumour.
 Encloses part/ all of the crown of an unerupted tooth.
 Lined by thin non-keratinizng squamous epithelium,
often shows mucous cell metaplasia.
 Attached to amelocemental junction & arises in the
follicular tissues covering the fully formed crown of
unerupted tooth.
 An eruption cyst is a true dentigerous cyst which
arises in an extra-alveolar location.
 Common in males than females.
 Common in mandible than maxilla.
 Frequently involve teeth which are commonly
impacted or erupt late.
 Majority: mandibular 3rd molar, maxillary permanent
canines, maxillary 3rd molar & mandibular premolar.
(in order of decreasing)
 Painless unless there is secondary inflammation.
 Radiographically, well-defined unilocular
radiolucency associated with the crown of
unerupted tooth.
 Involve both deciduous & permanent
dentitions.
 Present as fluctuant swellings on alveolar
mucosa & are often bluish in color because
arise in an extra-alveolar location.
 Trauma result in hemorrhage into cyst cavity.
 Common in neonates & often referred to as Bohn’s
nodules or Epstein’s pearls.
 Most disappear spontaneously by 3 months of age.
 Arise from remnants of dental lamina which
proliferate to form small keratinizing cysts.
 In adults are rare.
 Most represent developmental of lateral
periodontal cyst arise in an extra-alveolar location.
 Frequently in females in interpremolar region of
mandible.
 Uncommon lesion
 Associated with non-vital tooth
 Mainly in canine & premolar region of the mandible
 Middle aged patients
 Radiographically, well-defined radiolucent area with
sclerotic margins.
 Lined by non-keratinized squamous /cuboidal
epithelium
 Multilocular, ‘botryoid’ – resemblance to a bunch of
grapes (botryoid odontogenic cyst)
 Rare
 Developmental odontogenic cyst
 Most in anterior part of the mandible
 Slow growing, painless unilocular/
multilocular radiolucency.
 Lined by epithelium of varying thickness with
a superficial layer of columnar or cuboidal
cells & occasional mucous cells.
 Potentially aggressive, locally invasive &
tendency to recur.
ODONTOGENIC CYSTS
 Subdivided into 3 depending on anatomical
relationship to the root of the tooth;
- Apical
- Lateral
- Residual
 Develop within apical granulomas.
 Lining derives from rests of Malassez.
 Lined by non-keratinizing squamous
epithelium.
 Supported by a chronically inflammed
capsule.
 Contains variable but hypertonic.
 Capsule may contain cholesterole.
Apical radicular cyst
 most common cystic lesions in the jaws
 Associated with apices of non-vital teeth.
 75% of all radicular cysts.
 Arise in any age after tooth eruption but rare
in deciduous dentition.
 Most common between 20 & 60 years of age.
 Radiographically, apical cyst present as a
round/ovoid radiolucency at the root apex.
 Arise alongside a partly erupted 3rd molar involved in
pericoronitis.
 Most common in mandible & most buccally/
distobucally located.
 Teeth associated with this cyst show enamel spur
extending from the buccal cervical margin to the
root furcation.
 Radiographically, well-defined radiolucency related
to the neck of the tooth & the coronal third of the
root.
 Commonest of non-odontogenic cyst
 Arise from epithelial remnants of the nasopalatine
duct which connects the oral & nasal cavities in the
embryo.
 Commonly in 5th & 6th decades
 Males more in females
 May asymptomatic, pain due to secondarily
inflammed.
 Slowly enlarging swelling in the anterior region of
midline of the palate.
 Discharges – salty taste.
 Most originate within the soft tissue of the incisive
papilla.
 Radiographically, well-defined round, oval, ovoid,
heart-shape radiolucency, with sclerotic rim.
 Usually symmetrical.
 Radiolucency not more than 6mm may considered
within normal limits.
 Must differentiated with radicular cyst of present of
standing teeth.
 Lined by stratified squamous epithelium,
pseudostratified ciliated columnar
epithelium, containing mucous cell, cuboidal
epithelium, or columnar epithelium may see
alone or in combination.
 Rare
 Arise from remnants of the lower part of embryonic
origin.
 Arises in soft tissue of the upper lip just below the
ala of the nose.
 Regarded as fissural lesions.
 May arise bilaterally
 Majority present in 4th decade & over 75% occur in
women.
 Lined by pseudostratified columnar epithelium but
stratified squamous epithelium, mucous cells &
ciliated cells may also appear.
 Rare
 Occur in palate/ mandible is uncertain
 Some may represent displaced nasopalatine
duct cyst.
 Very likely that median cyst of the mandible
are of odontogenic origin.
 CYST NASOPALATINE DUCT CYST NASOLABIAL CYST
AGE 4 – 6 decades 4 – 5 decades
GENDER >M >F
SITE Anterior palate Upper lip
SYMPTOMS Swelling on midline of palate, pain, Painless except infected
discharge (salty taste), mostly
asymptomatic
RADIOGRAPH Well-circumscribed radiolucency in/near Well-circumscribed, unilocular
the midline of anterior maxilla between & radiolucency/ apical to the
apical to the central incisor. teeth.
Round, oral/liver/pear/heart-shaped with
sclerotic rim
HISTOLOGY Pseudostratified columnar, simple Pseudostratified columnar
squamous, cuboidal, columnar epithelium, epithelium, goblet cell & cilia
goblet cell & cilia
TREATMENT Surgical enucleation, biopsy before Surgical enucleation
treatment
RECURRENCE Seldom occur Rarely recur