CYSTS AND CYSTLIKE

LESIONS OF THE JAWS

Dr. Mariya Guy

Oral Medicine Dept.
• A cyst is a pathologic cavity filled with fluid, lined by epithelium, and
surrounded by a definite connective tissue wall
• Originate from the numerous rests of odontogenic epithelium
• Related to a nonvital tooth
 CLINICAL FEATURES

Swelling
No pain
Unerupted tooth
 RADIOGRAPHIC FEATURES

• Location
 RADIOGRAPHIC FEATURES

• Periphery
• Well-defined
• Corticated
• Shape
• Round or oval
• Scalloped
 RADIOGRAPHIC FEATURES

• Internal structure
• RL
• Dystrophic calcifications
• If septa – multilocular appearance
 RADIOGRAPHIC FEATURES

• Internal structure
• RL
• Dystrophic calcifications
• If septa – multilocular appearance
 RADIOGRAPHIC FEATURES

• Effect on surrounding structures

• Displacement and resorption of teeth
• Expansion of cortical plate
• Displacement of inferior alveolar nerve canal
 CYSTS

Odontogenic Nonodontogenic

Inflammatory Developmental Pseudocysts

 CYSTS Nasopalatine duct cyst

Odontogenic Nonodontogenic

Inflammatory Developmental Pseudocysts

Periapical cyst and Dentigerous cyst
granuloma Lateral periodontal cyst
Residual Odontogenic keratocyst
Buccal bifurcation cyst Calcifying odontogenic cyst
Glandular odontogenic cyst
Traumatic bone cyst
Static bone cyst
Aneurismal bone cyst
 ODONTOGENIC CYSTS

• Radicular cyst • Keratocystic odontogenic tumor

• Residual radicular cyst • Dentigerous cyst
• Buccal bifurcation cyst • Lateral periodontal cyst
• Glandular odontogenic cyst
• Calcifying cystic odontogenic tumor
ODONTOGENIC CYSTS
 Inflammatory
RADICULAR CYST

Synonyms
• Periapical cyst
• Apical periodontal cyst
• Dental cyst
 Inflammatory
RADICULAR CYST

Clinical features
• Arise from non vital teeth
• 3-6 dec
• Slight M>F
• No sypmptoms unless secondary infection occurs
• Swelling (large)
 Inflammatory
RADICULAR CYST

Radiographic features
• RL
• 60% - max, incisor – canine area
• Well-defined, cortical border
• Expansion of cortical plate
• Displacement and resorption of roots
• May displace the mandibular alveolar nerve canal
 Inflammatory
RADICULAR CYST

Differential diagnosis
• Apical granuloma (2 cm, histology)
• Early stage of PCD
• Apical scar
• Odontogenic keratocyst
• Lateral periodontal cyst
 Inflammatory
RADICULAR CYST

Management
• Endodontic therapy
• Apical surgery
• Extraction
 Inflammatory
RADICULAR CYST
 Inflammatory
RADICULAR CYST
 Inflammatory
RADICULAR CYST
 Inflammatory
RESIDUAL RADICULAR CYST
 Inflammatory
RESIDUAL RADICULAR CYST

Differential diagnosis
• OKT
• Stafne cyst
 Inflammatory
BUCCAL BIFURCATION CYST

Corona-Rodriguez, J Oral Maxillo. Surg 2010

 Inflammatory
BUCCAL BIFURCATION CYST

Synonyms
• Mandibular infected buccal cyst
• Paradental cyst
• Inflammatory paradental cyst
 Inflammatory
BUCCAL BIFURCATION CYST

Clinical features
• 1-2 dec
• Lack of or delay in eruption of mandibular first or second molar
• Molar may be missing or the L cusp tips
• Vital tooth
 Inflammatory
BUCCAL BIFURCATION CYST

Radiographic features
• RL
• Mandibular 1-st or 2-nd molar
• Centered to furcation
• Well-defined cortical border
• Tipping of roots to the lingual cortical plate of mandible
• May displace and resorb the adjacent teeth (large cysts)
Inflammatory
 Inflammatory
BUCCAL BIFURCATION CYST

Differential diagnosis
• Periodontal abscess
• Radicular cyst
• LCH
 Inflammatory
BUCCAL BIFURCATION CYST

Management : curettage / no treatment

Changes in no need in tooth extraction

treatment
methods Extraction + Enucleation Probing +
over the enucleation irrigation
years

Absorption of cyst
Results No recurrence No recurrence No recurrence
 Developmental

DENTIGEROUS CYST
 Developmental

DENTIGEROUS CYST

Synonym – follicular cyst

 Developmental

DENTIGEROUS CYST

Clinical features
• Around the crown of an unerupted or supernumerary tooth
• No pain or discomfort
• Swelling, facial asymmetry (if large)
 Developmental

DENTIGEROUS CYST

Radiographic features
• Epicenter just above the crown of the involved tooth
• Mand or max third molar or max canine
• Cyst attaches CEJ
• Displace and resorb adjacent teeth
• Displace the associated tooth in an apical direction
• Expansion of cortex of the involved jaw
 Developmental

DENTIGEROUS CYST
 Developmental

DENTIGEROUS CYST
 Developmental

DENTIGEROUS CYST
 Developmental

DENTIGEROUS CYST
 Developmental

DENTIGEROUS CYST
 Developmental

DENTIGEROUS CYST

Differential diagnosis
• Hyperplastic follicle (2-3 mm)
• OKT
• Ameloblastic fibroma
• Cystic ameloblastoma
• AOT
• CCOT
• Radicular cyst of primary teeth
 Developmental

DENTIGEROUS CYST

Management
• Surgical removal
• Marsupalization + Surgical removal (if large)
• Histologic examination
• Tooth extraction?
 Developmental

KERATOCYSTIC ODONTOGENIC TUMOR

Synonyms
• Odontogenic keratocyst
• Primordial cyst
 Developmental

KERATOCYSTIC ODONTOGENIC TUMOR

Clinical features
• 10% of all cystic lesions in the jaws
• 2-3 dec
• M>F
• No symptoms or mild swelling
• High propensity for recurrence
 Developmental

KERATOCYSTIC ODONTOGENIC TUMOR

Radiographic features
• RL
• If internal septa present – multilocular appearance
• Grow along the internal aspect of the jaws – minimal
expansion – late detection – large size
• Posterior body of mandible
• 90% post to canines
• 50% ramus

• Epicenter superior to the inf alveolar nerve canal

 Developmental

KERATOCYSTIC ODONTOGENIC TUMOR

 Developmental

KERATOCYSTIC ODONTOGENIC TUMOR

Radiographic features
• May be associated with unerupted tooth
• Round or oval shape
• Scalloped outline
• Can displace and resorb teeth (less than
dentigerous cyst)
• Displace inf alveolar nerve canal inferiorly
 Developmental

KERATOCYSTIC ODONTOGENIC TUMOR

Differential diagnosis
• Dentigerous cyst (pericoronal)
• Ameloblastoma
• Odontogenic myxoma Multilocular
• Simple bone cyst
• Basal cell nevus syndrome (multiple)
 Developmental

KERATOCYSTIC ODONTOGENIC TUMOR

Management
• Surgical excision
• Curettage or marsupalization
• Resection
• Periodic clinical and radiographic examination 5-10 years
• High propensity for recurrence
 BASAL CELL NEVUS SYNDROME

Synonyms
• Gorlin (-Golz) syndrome
• Nevoid basal cell carcinoma syndrome
 BASAL CELL NEVUS SYNDROME

Synonyms
• Gorlin (-Golz) syndrome
• Nevoid basal cell carcinoma syndrome
 BASAL CELL NEVUS SYNDROME

Clinical featutes
• 5-30 y
• Multiple KOTs
• Multiple BCC of skin
• Skeletal abnormalities (bifid ribs, agenesis, deformity, and synostosis of the
ribs, kyphoscoliosis, vertebral fusion, polydactyly, temporal and
temporoparietal bossing, minor hypertelorism, and mild prognatism)
• Calcifications of falx cerebri
 BASAL CELL NEVUS SYNDROME

Clinical featutes
 BASAL CELL NEVUS SYNDROME

Radiographic featutes
• Multiple KOTs the same location as that of solitary
• Vary in size mm-cm
 BASAL CELL NEVUS SYNDROME

Radiographic featutes
• Multiple KOTs the same location as that of solitary
• Vary in size mm-cm
 BASAL CELL NEVUS SYNDROME

Differential diagnosis
• Multiple myeloma
• Cherubism
• Multiple dentigerous cysts
 LATERAL PERIODONTAL CYST

• Arise from epithelial rests in periodontium lateral to the

tooth root.
• Usually unicystic, if multicystic – botryoid odontogenic cysts
• Intrabony counterpart of the gingival cyst of adult
 LATERAL PERIODONTAL CYST

Clinical features
• 2-9 dec, 5-7 dec (50y)
• M=F
• Asymptomatic
• Vital teeth
 LATERAL PERIODONTAL CYST

Radiographic features
• 50-75% mand (lat incisors – second premolar area)
• RL, unilocular or multilocular
• Well-defined, cortical boundary
• Round or oval
• May efface lamina dura
• Displace adjacent teeth and cause expansion (if large)
 LATERAL PERIODONTAL CYST

Radiographic features
 LATERAL PERIODONTAL CYST

Differential diagnosis Management

• KOT (small) • Excisional biopsy
• Mental foramen • Enucleation
• Neurofibroma • Not tend recur
• Radicular cyst
• Ameloblastoma (multiple)
 Epid Location Clinical Teeth Border Inner Histology
Radicular cyst +/- Symp Non Well defined, RL Thin stratified squam
/granuloma(Res Percussion, vital sclerotic, unless…. inflamation, cholesto
idual) swelling, fistule MO cells, non
/ tenderness keratinized

Buccal child Lower 1st M Swelling, Vital Well defined, RL Thin stratified squam
bifurcation c. +-tender sclerotic inflamation, non
keratinized
Dentigerous 10- 3rd molar, Swelling BL Displac From CEJ, well RL Noninflammed,
cyst 30 unerupted e, defined, sclerotic non keratinized,
tooth Resorp. unless…SCC
mucoEp,
ameloblastomq
KOT (Gorlin) You Man>Max Asym. Unerupt Well defined AP RL 6-8 layers. Pallisadin
(orthoker. ng Post>Ant, Orth< aggres. , less expansion, colmn.
parakeratine) adult 3M resorp scalloping Keratininzed
s Uni/Mult
Lateral 5-7 Man Asym <1cm Vital , Well defined, RL Thin epithel, nodula
Periodontal cyst C-PM PDL Uni/Multi thickening
(ging cyst) (botryoid) non keratinized
 Histology DD Mang
Radicular cyst Thin stratified Overriding cysts Source
/granuloma(Re squam., inflamation, PCD, apical
sidual) cholestol, MO cells, scar, OKT, LPC
non keratinized
Buccal Thin stratified Rad. cyst Obser, minor
bifurcation squam., inflamation, probing
cysts non keratinized
Dentigerous Noninflammed, Hyper. F, KOT, Surgery
cyst non keratinized, Amelo(Uni), Amelobalst /
AOT, CCOC carcinoma

KOT (Gorlin) 6-8 layers. Dentig., Surgery, high

(orthoker. Pallisading colmn. LatPeriodontal recur.
parakeratine) Keratininzed cyst
Lateral Thin epithel, OKC, mental, Surgery, recur
Periodontal nodular thickening ameloblastoma when multipke
cyst non keratinized
Amelobl Dentigerous CGCG Radicular ABC OKC
astoma cyst cyst COC

55% 55% 40% 18% XX% XX%

 GLANDULAR ODONTOGENIC CYST

Synonym
• Sialo-odontogenic cyst

Rare cyst derived from odontogenic epithelium with a spectrum of

characteristics including salivary gland features such as mucous-
producing cells
 GLANDULAR ODONTOGENIC CYST

Clinical features
• 46-50 y
• F>M
• Ant mandible
• Aggressive behavior
• Tendency to recur
 GLANDULAR ODONTOGENIC CYST

Radiographic features
• Anterior mand and in the max (globullomaxillary region)
• RL, Unilocular/multilocular
• Cortical boundary (smooth or scalloped)
• Expansion and perforating the cortex
• Displacement of teeth
 GLANDULAR ODONTOGENIC CYST

Radiographic features
 GLANDULAR ODONTOGENIC CYST

Radiographic features
 GLANDULAR ODONTOGENIC CYST

Differential diagnosis
• Ameloblastoma
• KOT
• Central mucoepidermoid carcinoma
 GLANDULAR ODONTOGENIC CYST

Management
• Resection
• Periodic radiographic examination
CALCIFYING CYSTIC ODONTOGENIC TUMOR

Synonyms
• Calcifying odontogenic cyst
• Calcifying epithelial odontogenic cyst
• Gorlin cyst
CALCIFYING CYSTIC ODONTOGENIC TUMOR

Synonyms
• Calcifying odontogenic cyst
• Calcifying epithelial odontogenic cyst
• Gorlin cyst

Uncommon, slow-growing, benign lesion

CALCIFYING CYSTIC ODONTOGENIC TUMOR

Clinical features
• 2 peaks
• 10-19 y
• 7 dec
• Slow-growing painless swelling
• Sometime expansion
CALCIFYING CYSTIC ODONTOGENIC TUMOR

Radiographic features
• RL, or RL+calcified inclusions
• Uni- or multilocular (rare)
• 75% anterior to the 1-st molar
• Mand = Max
• Well/ill-defined
• 20-50% associated with a tooth
CALCIFYING CYSTIC ODONTOGENIC TUMOR

Radiographic features
• Displacement of the teeth
• Resorption of the roots
• Perforation of cortical plate
CALCIFYING CYSTIC ODONTOGENIC TUMOR

Differential diagnosis
• Dentigerous cysts
(pericoronal no calcification)
• AOT
• Ameloblastic fibro-odontoma
• CEOT
• Long lasting cysts (calcifications)
CALCIFYING CYSTIC ODONTOGENIC TUMOR

Management
• Enucleation and curettage
• Periodic radiographic evaluation
 NON ODONTOGENIC CYSTS

• Nasopalatine duct cyst

• Pseudocysts:
• Simple bone cyst
• Aneurismal bone cyst
• Stafne defect
• Mucous retention pseudocyst
 NASOPALATINE DUCT CYST

Synonyms
• Nasopalatinal canal cyst
• Incisive canal cyst
• Nasopalatine cyst
• Median palatine cyst
• Median anterior maxillary cyst
NASOPALATINE DUCT CYST
 NASOPALATINE DUCT CYST

Clinical features
• 10% of jaw cysts
• 4-6 dec
• M>F 3:1
• Asymptomatic or swelling just posterior to the palatine papilla
• Fluctuant and blue or normal appearing mucosa
• May cause burning sensation or numbness of mucosa
 NASOPALATINE DUCT CYST

Radiographic features
• Nasopalatine foramen or canal
• Not always symmetrical
• Well-defined, corticated
• RL (sometimes with dystrophic calcifications)
• Circular or oval, or heart shape
• Labial-palatal expansion
• Divergence of central incisors roots, occasionally – root resorption
 NASOPALATINE DUCT CYST

Radiographic features
 NASOPALATINE DUCT CYST

Differential diagnosis
• Nasopalatine foramen (6mm)
• Incisive foramen
• Radicular cyst
 NASOPALATINE DUCT CYST

Management
• Surgical enucleation
 SIMPLE BONE CYST

Synonyms
• Traumatic bone cyst
• Hemorrhagic bone cyst
• Extravasation cyst
• Progressive bone cavity
 SIMPLE BONE CYST

• Cavity within a bone that is lined with connective tissue

• May be empty or may contain fluid
• Not a true cyst
 SIMPLE BONE CYST

Clinical features
• Common lesion
• 1-2 dec
• M>F 2:1
• Asymptomatic
• Expansion and tooth movement - unusual
 SIMPLE BONE CYST

Radiographic features
• Mandible (max –rare)
• Post mand and ramus
• Association with cemento-osseous
and fibrous dysplasia
• Well-/ill-defined
• Round or oval
• Smooth or scalloped border
 SIMPLE BONE CYST

Radiographic features
• RL, uni- or multilocular (buy not contain true septa)
• Tooth displacement and resorption – vary rare
• Lamina dura intact
• No or minimal expansion

•
 SIMPLE BONE CYST

Differential diagnosis
• KOT
• BM defect
 SIMPLE BONE CYST

Management
• Conservative opening and curettage
• Periodic follow-up
• Recurrence rare
 ANEURISMAL BONE CYST

Considered to be a reactive lesion of bone rather than cyst or true

neoplasm
 ANEURISMAL BONE CYST

Clinical features
• 90% - younger than 30 y
• F>M
• Rapid bony swelling (buccal or labial)
• Pain is an occasional complain
 ANEURISMAL BONE CYST

Radiographic features
• Mand > max 3:2
• Molar – ramus region
• Well-defined
• RL, often multilocular (53%), septa
positioned at right angles to the
outer border
• Propensity for rapid extreme
expansion
 ANEURISMAL BONE CYST

Radiographic features
• May be associated with other
lesions (20%) such as fibrous
dysplasia, central hemangioma,
giant cell granuloma, and
osteosarcoma
ANEURISMAL BONE CYST
 ANEURISMAL BONE CYST

Differential diagnosis
• CGCT
• Ameloblastoma
• Cherubism

Diagnosis is based on biopsy

results
 ANEURISMAL BONE CYST

Management
• Surgical curettage (50%
recurrence)
• Partial resection (11%
recurrence)
• Follow-up
 Stafne bone cyst

Synonyms
• Lingual salivary gland depression
• Lingual mandibular bone depression
• Developmental salivary gland defect
• Stafne defect
• Stafne bone cyst
• Static bone cavity
 Stafne bone cyst

Definition
Lingual mandibular bone depression represent a concavity in the lingual surface of the
mandible where the depression is lined with an intact outer cortex
Not a true cyst
Stafne bone cyst
Stafne bone cyst
Stafne bone cyst
 Stafne bone cyst

Jung et al. Korean J Oral Maxillofac Radiol 2005

 MUCOUS RETENTION PSEUDOCYST

Synonyms
• Retention pseudocyst
• Retention cyst of maxillary sinus
 MUCOUS RETENTION PSEUDOCYST

Clinical features
• Any sinuses, maxillary – most common
• M>F
• Asymptomatic
• Not related to extractions or periapical disease
 MUCOUS RETENTION PSEUDOCYST

Radiographic features
• Floor of the sinus
• Unilateral or bilateral
• Vary in size
• Well-defined, noncorticated, smooth, dome-shaped, RO
• No effect on on the surrounding structures – lamina dura intact, PDL in
normal width
 MUCOUS RETENTION PSEUDOCYST

Differential diagnosis
• Radicular cyst
• Dentigerous cyst
• KOT
• Antral polips (often multiple)
• Neoplastic mass
 MUCOUS RETENTION PSEUDOCYST

Management
• No treatment is required
• May resolve spontaneously