CYSTS 0F THF JAwS CYSTS 0F THF JAwS

I. )inv v{vvi I. )inv v{vvi

Definition Definition
A pathologic cavity A pathologic cavity
lined wholly or in lined wholly or in
part by epithelium part by epithelium
having fluid or having fluid or
semisolid content semisolid content
not created by pus not created by pus
accumulation accumulation
Cysts of the Jaws Cysts of the Jaws
,88ific,tion ,ccording to ,88ific,tion ,ccording to ining ining
epitheium origin epitheium origin
dontogenic dontogenic
Non dontogenic Non dontogenic
73 73 Odontogenic Cysts Odontogenic Cysts
ental lamina: ental lamina:
- - dontogenic dontogenic
keratocyst, keratocyst,
- - lateral periodontal lateral periodontal
cyst cyst
namel rgan namel rgan: :
- - entigerous cyst entigerous cyst
33 Hertwig Hertwig
epithelial root epithelial root
sheath: sheath:
- - Radicular cyst Radicular cyst
Odontogenic Cysts Odontogenic Cysts
nf,mm,tory nf,mm,tory
- - Radicular cyst Radicular cyst
- - Paradental cyst Paradental cyst
Deveopment, Deveopment,
- - entigerous cyst entigerous cyst
- - ruption cyst ruption cyst
- - dontogenic dontogenic
keratocyst keratocyst
Primordial cyst Primordial cyst
- - Glandular Glandular
odontogenic cyst odontogenic cyst
- - Lateral periodontal Lateral periodontal
cyst cyst
- - Calcifying Calcifying
odontogenic cyst odontogenic cyst
on on- -odontogenic Cysts odontogenic Cysts
Deveopment, Deveopment,
Nasopalatine duct Nasopalatine duct
cyst cyst
Nasolabial Nasolabial
!8eudocy8t8 !8eudocy8t8
$imple bone cyst $imple bone cyst
$tafne bone $tafne bone
defect defect
Aneurysmal bone Aneurysmal bone
cyst cyst
#adicular cyst #adicular cyst
Apical Apical
Lateral Lateral
Residual Residual
#adicular Cyst #adicular Cyst
(Periapical Cyst) (Periapical Cyst)
Apical: Apical:
of all radicular cysts of all radicular cysts
Always with apices of non Always with apices of non
vital teeth vital teeth
$mall: symptom less $mall: symptom less
Large: expansion of bone Large: expansion of bone
- - mm/year mm/year
- - gg gg- -shell crackling shell crackling
- - $ubmucosal swelling $ubmucosal swelling
#adicular Cyst #adicular Cyst
Enlargement Enlargement
v Tvnoo,, !
n
cviion,
ovn. vnv ovnvn
#adicular Cyst #adicular Cyst
(Periapical Cyst) (Periapical Cyst)
Apical: Apical:
Pain is rare Pain is rare
- - xcept if there is acute xcept if there is acute
exacerbations exacerbations
Radioghraphically: Radioghraphically:
- - round radiolucency at the round radiolucency at the
root apex with or without root apex with or without
radioopaque margin radioopaque margin
- - 40 40 of all PA radiolucencies of all PA radiolucencies
are cystic are cystic
#adicular Cyst #adicular Cyst
(Periapical Cyst) (Periapical Cyst)
Residual: Residual:
nly nly 20 20 of all radicular cysts of all radicular cysts
Remains after tooth extraction Remains after tooth extraction
Lateral: Lateral:
Very uncommon Very uncommon
xtension along lateral root xtension along lateral root
canals canals
#adicular cyst #adicular cyst
Pathogenesis: Pathogenesis:
Proliferation of epithelial Proliferation of epithelial rests of rests of
Malassez Malassez within chronic periapical within chronic periapical
granuloma granuloma
- - Not all granulomas progress to cysts Not all granulomas progress to cysts
$timulus: $timulus:
controversial, controversial,
- - Persistence of chronic inf stimuli Persistence of chronic inf stimuli
- - bacterial endotoxins, bacterial endotoxins,
- - cytokines, cytokines,
- - growth factors growth factors
Mechanism of cyst formation: Mechanism of cyst formation:
egeneration of the central portion egeneration of the central portion
of epithelial mass of epithelial mass
- - pithelium is avascular pithelium is avascular
- - Critical size Critical size
R R
egeneration of granulation tissue egeneration of granulation tissue
- - Isolation of G T by strands of Isolation of G T by strands of
epithelium epithelium
- - Release of toxic products Release of toxic products
#adicular Cyst #adicular Cyst
Microscopic Features Microscopic Features
- - Lined by non Lined by non- -keratinized stratified squamous epithelium keratinized stratified squamous epithelium
- - Fibrous tissue capsule, Richly vascular Fibrous tissue capsule, Richly vascular
- - Inflammatory infiltrate Inflammatory infiltrate
- - May surround root apex (pocket cyst), or separated by May surround root apex (pocket cyst), or separated by
tissue capsule (more common) tissue capsule (more common)
- - Metaplasia of cyst lining: Metaplasia of cyst lining:
Mucous cells Mucous cells
Ciliated cell Ciliated cell
- - 0 0 shows Rushton bodies: epithelial product? shows Rushton bodies: epithelial product?
- - Cholesterol clefts: dead epithelial cells and RBCs Cholesterol clefts: dead epithelial cells and RBCs
ewly formed cyst ewly formed cyst
Established cysts Established cysts
#ushton bodies #ushton bodies
Cholesterol clefts Cholesterol clefts
v Tvnoo,, !n cviion, ovn. vnv ovnvn
Pocket Cyst
Cyst contents Cyst contents
egenerating cells egenerating cells
$erum proteins $erum proteins
Hypertonic compared to serum Hypertonic compared to serum: :
Protein concentration: Protein concentration: - - g/dl g/dl
- - Higher levels of Ig Higher levels of Ig
Water and electrolytes Water and electrolytes
Cholesterol crystals Cholesterol crystals
Cyst expansion Cyst expansion
xpand equally in all directions xpand equally in all directions
- - Controlled by rate of bone resorption Controlled by rate of bone resorption
Bone resorption Bone resorption
- - activation of osteoclasts by activation of osteoclasts by PG and PG and cytokines cytokines
- - degradation of bone matrix by degradation of bone matrix by enzymes collagenase enzymes collagenase
sstimulated by IL timulated by IL and IL and IL66
smotic gradient smotic gradient $emipermeable $emipermeable
membrane (cyst wall) membrane (cyst wall)
- - Hydrostatic pressure Hydrostatic pressure
- - $eperation of cyst lumen from lymphatic $eperation of cyst lumen from lymphatic
drainage drainage
Color Atlas oI Clinical Oral Pathology
Neville, Damm and White, 2nd edition
Radicular Cyst
apical
ateral Radicular Cyst
Color Atlas oI Clinical Oral Pathology
Neville, Damm and White, 2nd edition
Residual Cyst
v Tvnoo,, !n cviion, ovn. vnv ovnvn
Residual Cyst
#adicular Cyst #adicular Cyst
(Periapical Cyst) (Periapical Cyst)
Management and Prognosis Management and Prognosis
- - Treatment of the involved tooth Treatment of the involved tooth
- - $urgical enucleation or curettage of the $urgical enucleation or curettage of the
cyst cyst
- - Little tendency for recurrence or Little tendency for recurrence or
neoplastic transformation neoplastic transformation
"uestions "uestions
evelopmental evelopmental
Odontogenic Cysts Odontogenic Cysts
entigerous Cyst entigerous Cyst
(Follicular Cyst) (Follicular Cyst)
The most common The most common
developmental odontogenic developmental odontogenic
cyst cyst
accounts for accounts for 2 2 of all jaw of all jaw
cysts cysts
Associated with unerupted Associated with unerupted
teeth teeth
- - Attached to cementoenamel Attached to cementoenamel
junction junction
Central type Central type
Lateral type Lateral type
Color Atlas oI Clinical Oral pathology
Neville, Damm and White, 2nd edition
Dentigerous Cyst
(Follicular Cyst)
rigin: reduced enamel epithelium rigin: reduced enamel epithelium
between the follicle and the tooth crown between the follicle and the tooth crown
- - enlarges by accumulation of fluid enlarges by accumulation of fluid
between proliferating, reduced enamel between proliferating, reduced enamel
epithelium and crown epithelium and crown
entigerous cyst entigerous cyst
entigerous Cyst entigerous Cyst
(Follicular Cyst) (Follicular Cyst)
Pathogenesis Pathogenesis
Proliferation of outer layer of reduced enamel Proliferation of outer layer of reduced enamel
epithelium epithelium
and cyst formation and cyst formation
R R
22 Compression of the follicle fluid Compression of the follicle fluid
exudate exudate
separation of the reduced enamel epithelium from separation of the reduced enamel epithelium from
the crown the crown
33 May arise due to accumulation of inflammatory May arise due to accumulation of inflammatory
exudate from exudate from primary tooth primary tooth/ mainly mandibular / mainly mandibular
premolars premolars
entigerous Cyst entigerous Cyst
(Follicular Cyst) (Follicular Cyst)
Clinical features Clinical features
- - Most common with Most common with 33
rd rd
molars, maxillary molars, maxillary
canines and canines and
mandibular premolars mandibular premolars
supernumerary teeth supernumerary teeth
dontomes dontomes
- - Asymptomatic unless Asymptomatic unless
Large Largebone expansion bone expansion
Infected Infectedpain pain
entigerous cyst entigerous cyst entigerous cyst entigerous cyst
Radiographic Radiographic
Features Features
- - well circumscribed, well circumscribed,
corticated border corticated border
- - usually unilocular usually unilocular
- - NT IAGN$TIC NT IAGN$TIC
dontogenic dontogenic
keratocyst keratocyst
Unicystic Unicystic
ameloblastoma ameloblastoma
Microscopic Features Microscopic Features
- - nonkeratinized nonkeratinized
stratified squamous stratified squamous
epithelial lining epithelial lining
- - may have occasional may have occasional
sebaceous or mucous sebaceous or mucous
cell metaplasia cell metaplasia
- - thick fibrous thick fibrous
connective tissue wall connective tissue wall
- - epithelial rests epithelial rests
- - inflammation +/ inflammation +/- -
entigerous cyst entigerous cyst
entigerous Cyst entigerous Cyst
(Follicular Cyst) (Follicular Cyst)
Microscopic features Microscopic features
entigerous Cyst entigerous Cyst
Treatment and Prognosis Treatment and Prognosis
- - nucleation and removal of the nucleation and removal of the
affected tooth affected tooth
- - Little tendency to recur when Little tendency to recur when
completely removed completely removed
Why should the dentigerous cyst be Why should the dentigerous cyst be
removed? removed?
Can cause extensive bone Can cause extensive bone
destruction destruction
Resorption of adjacent roots Resorption of adjacent roots
isplacement of teeth isplacement of teeth
Neoplastic transformation: Neoplastic transformation:
- - Ameloblastoma Ameloblastoma
- - $quamous cell carcinoma $quamous cell carcinoma
- - Central mucoepidermoid carcinoma Central mucoepidermoid carcinoma
eoplastic transformation in eoplastic transformation in
dentigerous cyst dentigerous cyst
eoplastic transformation in eoplastic transformation in
dentigerous cyst dentigerous cyst
Eruption Cyst Eruption Cyst
$oft tissue analogue of the $oft tissue analogue of the
dentigerous cyst dentigerous cyst
$oft, translucent swelling in the $oft, translucent swelling in the
mucosa mucosa
Relatively common in children Relatively common in children
No treatment is necessary No treatment is necessary
ruption Cyst
Color Atlas oI Clinical Oral pathology
Neville, Damm and White, 2nd edition
Color Atlas oI Clinical Oral pathology
Neville, Damm and White, 2nd edition
ruption Cyst
"uestions? "uestions?