Cysts

of the Jaws and Adjacent Soft Tissues

Outline
- Jaw cysts
o Odontogenic
§ Inflammatory
§ Developmental
o Non-Odontogenic
- Pseudocysts of the jaws
- Cysts of the soft tissues of the mouth, face and neck

Odontogenic Inflammatory Cysts (must see inflammatory changes)
- Radicular
o Periapical region of a non-vital tooth
o Rests of Malessez stimulated by inflammatory by-products
o SSNKE
o Inflamed fibrous and granulation tissue
o Differential diagnosis of a periapical radiolucent lesion
§ Early PCD
§ Ameloblastoma
§ KOT
§ Periapical Granuloma
§ CGCG
§ MM
§ Lymphoma
- Residual
o Inflammatoy odontogenic cyst found in an edentulous area of the jaw where a tooth has been
extracted previously
o Differential
§ KOT
§ Unicystic Ameloblastoma
- BBC (mandibular infected buccal cyst)
o Cyst located on the coronal half of the root surface of a vital partly or recently erupted tooth
o ?Inflammatory
o Mandibular molars
o Features
§ Tilting of the tooth crown
§ Swelling and discomfort if large
- Paradental

Developmental
- Dentigerous cyst and eruption cyst
o Develops around the crown of an unerupted tooth
o Always attached to the CEJ
o Histopathology
§ SSNKE
§ REE
§ Inflammatory is secondary
o DDx
§ Unicystic Ameloblastoma
• Ameloblastoma that presents clinically and radiographically as a single
cystic structure
o SSNKE
o Basal layer should be columnar with reverse polarization
o Attempt to find the islands at the periphery
 o Difficult histological diagnosis
- Odonotgenic keratocyst
o Specific histologic appearance
o Lining epithelium has a greater growth potential
o Higher recurrence rate
o May be multilocular
o Features
§ AD inheritance
§ Mutation of the ptch gene
§ Multiple OKC
§ Multiple BCC
§ Vertebral and rib anomalies
§ Calcified falx cerebri
§ Frontal and parietal bossing
§ Dermal cysts and fibromas
§ Kyphoscoliosis
§ Short metacarpals
§ Medulloblastoma
o Histopathology
§ Thin cyst wall
§ Epithelium is uniform in appearance (no rete ridges = tendency to fall off connective
tissue after removal), ribbon like appearance
§ Keratinized epithelium (para = nucleus retained)
§ Basal layer is prominent and dark staining, nuclei should be palisaded
§ Budding from the basal layer
§ Epithelial islands within the wall
§ Satellite cysts
o If lined by ortho keratin = orthokeratinzed odontogenic cyst
§ Less likely to recur after curettage
- Lateral periodontal cyst
o Cyst located on the lateral aspect of an erupted, vital tooth
o Histologically
§ 2-3 layers of squamous and cuboidal cells
§ Bland looking
§ NOT KERATINZED
- Botryoid odontogenic cyst
o Multilocular cyst
o Similar to lateral periodontal cyst in clinical and histologic features
- Calcifying odontogenic cyst
o Uncommon cyst with a thick characteristic lining
o Central or peripheral location
o Often associated with an impacted tooth or an odontome
o Hitsolo
§ Basal layer is columnar
§ Palisaded (and reverse polarized)
§ Loose attachment of suprabasal cells to CT
§ Ghost cells (big pink cells - no nuclei, oddly keratinized)
§ Calcifications

Non-odontogenic Cysts

- Nasopalatine cyst
o Development non-odontogenic cyst
o Midline of maxilla
o Histology
 § Respiratory
§ Cuboidal
§ Mixed
§ Contents of canal (NV bundle, mucous glands)
- Nasolabial Cyst
o Cyst lined by respiratory epithelium

Pseudocysts
- Simple Bone Cysts
o A cavity that develops within bone
o Incidental findings, mostly in young individuals
o Findings at surgery are diagnostic
o Histologic examination - no epithelial lining
- Aneurysmal bone cyst
o Expansile, osteolytic lesion of bone
o Sinusoidal blood-filled spaces within a connective tissue stroma
o Histopath
§ Osteoid
§ Extravasated blood
§ Connective tissue
o Can occur secondarily with chrondomyofibroma, ossifying fibroma (like the association of
SBC with FOD)

Lymphoepithelial Cyst
- Cyst lined by SSK or SSNKE closely associated with lymphoid tissue
- Same as branchial cleft cyst
- Slightly raised, painless, yellow
- SP and posterior lateral oral tongue are the other sites (aside from FOM)

Epidermoid/Dermoid Cysts
- EC lined by SSKE (ortho): i.e. like skin (hence the name)
- DC same by skin appendages within the wall (sebaceous glands)
- Developmental
- <30yo, midline cysts
- Retroperitonem, mediastinum

Thyroglossal Duct Cyst
- Fuck that noise