FISSURAL CYSTS

A number of different types of fissural cysts of bone occur in the jaws and have been
considered to be arising along the lines of fusion of various bones or embrayonic process. These
cysts are synonymously termed as inclusion cysts or developmental cyst. They are true cysts, the
epithelium being derived from epithelial cells which are entrapped between the embryonic processes
of bones at union lines.
They are classified as follows:
1) Nasopalatine duct cyst.
2) Median palatal cyst
3) Globulomaxillary cyst
4) Median mandibular cyst.
There are several additional developmental cysts derived from embryonic structures or faults which
involve the oral and adjacent soft tissues.
They are:
1) Nasoalveolar cyst
2) Palatal cysts of new born.
3) Thyroglossal tract cyst
4) Benign cervical lymphoepithelial cyst
5) Epidermoid and dermoid cyst
6) Heterotophic oral gastrointestinal cyst.
NASOPALATINE DUCT CYST:
Most common non odontogenic cyst.
Occurs in about 1% of the population.
Synonyms: Incisive canal cyst, nasopalatine canal cyst
Clinical features:
They can form within the incisive canal, which is located in palatine bone and behind the
alveolar processes of maxillary central incisors or in the soft tissues of the palate that overlies
the foramen, called the cysts of incisive canal.
Seen in 3-6th decade, Males > females (4:1).
Swelling in the anterior region of midline of palate
Swelling also seen in midline of labial aspect of alveolar ridge.
Through and through fluctuation may be elicited between labial and palatal swellings.

 Cyst may produce bulging of floor of nose.

Round to ovoid smelling measuring 1-2.5 cm.
Swelling is associated with pain through pressure on the nasopalatine nerves; as well as
discharge.
Discharge may be mucoid with salty taste and purulent with foul taste
Patients with cyst on palatine papilla has history of recurrent swellings that periodically
discharge and then go down.
Symptoms are not severe generally.

The late clinical presentation may be responsible for large size at time of diagnosis.

In diagnosis, its essential to rule out periapical lesion using pulp vitality test, OKC should also
be included in the list of differential diagnosis.
Cyst of incisive papilla may present as a translucent or bluish colored, dome shaped swelling.
Tooth displacement is common finding.
Bony expansion may be seen in very large cases.
Radiological features:
Cyst is distinguished from normal incisor tossa which rarely exceeds 6 mm in diameter
Occurs in incisive canal and hence its difficult to decide if radiolucency is a cyst or a large
incisive fossa. Lamina dura intact, teeth are vital.
The shape of fossae were round, oval, diamond, triangular and sometimes funnel shaped,
heart shaped.
Anteroposterior measurements were greater than the widths. Small cysts are 3x3 mm and
larger cysts are 7x5 mm.
Incisive canal cysts are found between the roots of the central incisor in the midline.
Lesions are round, ovoid, heart shaped either because they become notched by the nasal
septum during their expansion or because the nasal spine is superimposed on radiolucent
area or if they are bilateral cysts.
Cysts may also develop on the major lateral canals of stensons duct.
Margins of these cysts are well demarcated but exhibit varying degree of cortication.
Tooth displacement was common.
Radiolucencies ranged from 9 52 mm in greatest diameter.
Amorphous intraluminal calcifications were seen in few areas.

Pathogenesis:
Develop from epi of nasopalatine ducts in incisive canal.
In humans, vestigeal renunants of this duct may be formed as epithelial lined ducts, cords,
rests or combination of both.
Epithelial rests may show central degeneration,
Ducts were lined by squamous epithelium
In most cases these were in oral and middle third of incisive canals.
Cuboidal lining was present in nasal third.
The vomer nasal organs of Jacobson are thought to be possible sources but there is no enough
evidence to support it.
Trauma, bacterial infection stimulates the duct renunants to proliferate.
Inflammatory infiltrate are seen in the walls of cysts of palatine papillae.
Mucous glands seen in association with ducts are suggested hypothesis for cyst development.
Main (1970) postulated that small cystic dilatations of portions of nasopalatine ducts are
occasionally seen in fetal material in comparison to OKC.
The tendency for epithelial proliferation was lesser and hence its slow growth and moderate
size.
Fluid attraction by osmosis of serum through normal capillary wall may occur and absence of
lymphatic drainage led to cyst formation.
Osmotically active particles were formed by cells breakdown which shed into the cyst cavity.
Exact triggering factor for this cyst development is unknown.
Histological features:
Epithelial linings may be stratified squamous, pseudostraified columnar, cuboidal, columnar or
primitive flat epithelium may be seen.
Goblet cells may be found in pseudostatified columnar epithelial linings and cilia.
Stratified sq. epi is more frequently found followed by pseudostratifed columnar.
The fact that majority of cyst linings have a combination of epithelial varieties suggests their
orgin from pluripotential epithelium but possibility of metaplasia should also be considered.
The diagnostic feature is the presence of nerves and blood vessels in the fibrous capsule.

 Muscular arteries and numerous small veins were present. The explanation is that the long
nasopalatine nerve and vessels that pass through the incisive canal are either included in cyst
wall or are removed with the cyst in the course of surgical enuleation.
Small foci of mucous glands are found in fibrous capsule.
Inflammatory infiltrate may or may not be present.
Islands of hyaline cartilage may be rarely seen in cyst walls.
Occasionally epithelial linings contains granules of pigment which are identified
histochemically as melanin or possibly lipofuschin. It was possible to determine dendritic
melanocytes in the basal layer of epithelium, thereby identifying the pigment as melanin.
Treatment:
Surgical enucleation.
Malignant transformation is a rare complication.
MEDIAN PALATAL CYST
Previously, it had been thought that these cysts developed from epithelium entrapped in
process of fusion of embryonic process.
Its now belived that they represent posterior extension of an incisive canal cysts in case of
median palatine cyst, anterior extension in case of median alveolar cyst; range of odontogenic
cysts, frequently OKC, in case of globulomaxillary cysts.
Median alveolar cyst may be a keratocyst derived from dental lamina in midline of maxilla.
If a median palatine cyst indeed existed it would be necessary to postulate its origin as being
by enlargement of a midpalatine raphae cyst or epithelial inclusion in that particular area.
It is located on the midline of hard palate posterior to palatine papillae.
Seen in young adults, asymptomatic.
Pain, expansion may be later complaints.
Average size is 2x2cm.
Radiologically, it is a wall circumscribed radiolucency in the midline of palate, occasionally
causing root divergence. It is usually bordered by sclerotic layer of bone.
True median palatal cyst exhibit clinical enlargement of palate.

A midline radiolucency

without bone resorption would probably indicate a nasopalatine duct cyst.

1)

Microscopic examination shows a cyst lined by stratified squamos epithelium. Areas of

ciliated pseudostratified columnar epithelium is reported

Treatment:
Surgical excision.
GLOBULOMAXILLARY CYST:
Traditionally been described as fissural cyst found within the bone between the maxillary
lateral incisor and canine teeth.
Radiologically, well defined radiolucencies that cause divergence of roots of adjacent teeth.
The first description was by Thoma (1937).
It was thought to be arising from non odontogenic epithelium included at the site of fusion
of the globular process of medial process and maxillary process.
Next concept was that these cysts originated at the junction of premaxilla and maxilla,
hence they called it premaxillary maxillary cysts.
Sicher embryologically pointed out that the surface bulges seen in nasomaxillary process
of embryo are facial process, they are not prolongations with free ends that meet at free
ends.
The facial processes are elevations or ridges that correspond to centres of growth in
underlying mesenchyme. These are covered by a continous sheet of folded epithelium. As
these growth centres proliferate and develop, surface furrows between them become more
shallow and smooth out.
Several authors found that a wide variety of cysts resembled globulomaxillary cysts - AOT,
myxoma, hemmorhagic bone cyst, lateral periodontal, lateral dentigerous and keratocyst.
This was a clinical and radiological finding.
Rarely, respiratory epi was found in cyst linings which could be explained on the basis of
metaplasia.
On histological examination, radicular cysts, periapical granuloma, developmental lateral
periodontal cysts, keratocysts, giant cell granulomas, calcifying odontogenic cyst,
odontogenic myxoma, AOT, ameloblastoma was noted which was misdiagnosed as
globulomaxillary cyst on clinical and radiological grounds.
Some authors believe that processes that join by merging may still entrap epithelium
between them if mesenchymal growth is retarded below the groove that separates them.

 The conclusion was that the so called globulomaxillary cyst is not an entity but a variety of
cysts and tumors that occur at well demarcated radiolucent lesions in the lateral incisor
canine region of maxilla
MEDIAN MANDIBULAR CYST
A cyst occasionally occurs in the midline of the mandible.
Produces a well defined round, ovoid or irregular radiolucent area and separate the roots of
lower incisor teeth.
Some reported cases, the associated teeth had non vital pulps.
Initially its origin is thought to be from epithelial inclusions trapped in the area during
embryonic development.
This concept is not acceptable because mandible forms in the mandibular process which
develops a single unit.
Allard (1982) stated that if during the process of merging, the mesenchyme inferior to the
dividing groove becomes relatively inactive and the mesenchyme in protruding eminences
continues to grow at a normal or accelerated rate, the ectodermal surfaces could come into
contact and form a source of fissural epithelium.

Rebuilding of midlines portion of

mandible about meckels cartilage reduces the chances of survival of any enclaved
epithelial rests.
Cysts associated with non vital tooth were radicular cysts, those lined with ciliated
pseudostratified columnar epithelium may be possibly the result of secretory metaplasia.
Some cysts showed their epithelial lining resembling reduced enamel epithelium and may
possibly be a lateral periodontal cyst.
Intraosseous dermoid cyst in the midline of mandible was reported and it should be
considered in the differential diagnosis of midline cystic lesions of mandible.
Hence it could be a OKC, solitary cyst, lateral periodontal cyst or radicular cyst.
Therefore there is little evidence to indicate that the median mandibular cyst is an entity.
Histological examination of the lesion shows a thin, stratified squamous epithelium often
with many folds and projections, lining a central lumen. In some cases cyst may be lined
by pseudostratified ciliated columnar epithelium.
Some cysts located in this region turned out to be periapical cyst, odontogenic kertocyst or
lateral periodontal cyst.

 Treatment is by surgical enucleation.

Recurrence is not expected.
NASOALVEOLAR CYST
Earlier thought to be soft tissue variants of globulomaxillary cysts.
Occurs outside the bone in nasolabial folds below the ala nasi.
As the alveolus is not involved, the term nasolabial is preferred to nasoalveolar cyst.
It is not found within the bone hence it is a soft tissue cyst.
Clinical features:
Wide age distribution ranging from 12 75 years.
Peak frequency in 4 5th decade.
Predominantly in female (3:1)
Duration of symptoms is from less than one month to as many as 40 years.
Pain and difficulty in nasal breathing.
Difficulty in retention of upper denture.
Large size cause facial deformity.
Most cysts are unilateral.
Slow growing, produces swelling of lip.
They fill out the nasolabial fold, lift the ala nasi, distort the nostril and produce swelling of
floor of nose.
Intraorally, they form a bulge in labial sulcus.
Cysts are fluctuant on bimanual palpation.
Fluctuation may be elicited between the swelling on floor of nose and that in labial sulcus.
Infected cysts may discharge into the nose
Radiological features:
Increased radiolucency of alveolar process above the apices of incisor teeth. Usually detected
as a depression on labial surface of maxilla.
When the depression extends to lateral margin of anterior bony aperture of nose there is
resorption of lower part of nasal notch.
The inferior margin of anterior bony aperture of the nose is distorted by the lesion.

 The cyst may be aspirated and a radio opaque liquid introduced, after which it may be viewed
in tangential and postero anterior view of the jaws or in vertex occlusal view. It is normally a
spherical or kidney shaped lesion lying against the inferior and lateral borders of anterior
bony aperture of the nose, extending from midline to canine fossa.
CT scans showed a well demarcated, low density cystic lesion lateral to the pyriform fossa.
No invasion to bone was seen in any patients.
MRI confirmed that lesions were extra osseous but that scalloping of the underlying bone may
be seen. Sedimentation levels, when present, confirmed the cystic nature of the lesions.
Pathogenesis:
Traditionally, it arises from epithelium enclaved at the site of the globular, lateral nasal and
maxillary process.
Embryological basis for it is seriously disputed.
It was also thought to develop from the lower anterior part of nasolacrimal duct.
When the margins of lateral nasal and maxillary bulges coalesce, the ectoderm along the
boundry between them gives rise to a solid cellular rod which at first develops as a linear
surface elevation, the nasalacrimal ridge, and then sinks into the mesenchyme.
Its caudal end proliferates to connect with the caudal part of lateral nasal wall while its
cranial extremity later connects with the developing conjunctional sac. This solid rods then
becomes canalized to form nasolacrimal duct.
The location of nasolabial cysts is such that they develop from remnants of embryonic
nasolacrimal duct, if not from lower anterior portion of mature duct.
The mature nasolacrimal duct is lined by psudo stratified columnar epithelium and this is the
type of epithelium found usually lining the nasolabial cysts.
There is general agreement that they are of developmental origin with 10.6% of cases
occurring bilaterally. This cyst shows a female predominance.
Histological features:
Lined by non ciliated pseudostratified colunar epithelium.
Goblet cells were seen in varying members.
Small, localized areas of squamous metaplasia was seen.
Epithelial lining either consisted of cuboidal epi or one to two layers of flat squamous cells. In
some specimen entire epi thickness was eroded.
Fibrous cyst walls are raltively acellular and either loosely or densely collagenous.

 Inflammatory infiltrate, mucous glands, hemorrhagic were also seen rarely in capsule.
Treatment:
Surgical excision, because floor of nose is closer to this cyst an alternative transnasal approach has
been suggested.
PALATAL CYSTS OF NEWBORN
This cyst arises from epithelial inclusion at the line of fusion of palatal folds and nasal
processes.
Usually completed by end of the fourth month.
After birth the epithelial inclusion usually atrophy and become resorbed.
Some produce keratin containing micro cysts which extend to the surface and rupture during
first few months after birth.
Burke (1966) suggested the possibility that they represent abortive glandular differentiation
leading to cyst formation.
They do not increase in number with time.
These authors suggested that as the cysts developed, their epithelium differentiated, fused with
oral epithelium and their contents were discharged.
Clinical features:
Quite common seen in 65 85% of neonates.
Small, 1-3mm white or yellowish white papules that appear at the midline along the junction
and hard and soft palate.
Occasionally, they may occur in more anterior location along the raphae or on posterior palate
lateral to midline.
Frequently a cluster of six cysts are reported although they can occur singly.
Histologic features:
Cysts are round or ovoid with smooth or undulating outline.
There is a thin lining of stratified squamous epi with a parakeratotic surface and keratin fills
the cyst cavity, usually in concentric laminations contaning flattened cell nuclei.
Basal cells are flat, unlike OFC.
Sometimes these cyst communicate with mucosal surface.
Treatment:
They are innocuos lesion, no treatment required.

THYROGLOSSAL TRACT CYST

The median lobe of thyroid gland develops at fourth week of intrauterine life from a site at the
base of tongue recognized as foramen caecum.
A hollow epithelial stalk known as thyroglossal duct extends caudally and passes ventral to
hyoid bone to ventral aspect of thyroid cartilage where it joins the developing lateral lobes.
The thyroglossal duct disintegrates at 10th week, but cyst may form residues of duct at any
point along its line of descent.
Etiology is unknown but inflammatory conditions which lead to reactive hyperplasia of
lymphoid tissue adjacent to remnants of thyroglossal duct and may stimulate the epi remnants
themselves.
Clinical features:
Present as a palpable midline swelling which is asymptomatic, in midline at or below the level
of hyoid bone.
Neck mass moves with swallowing.
Patients will have neck pain or dysphagia (rare).
Persistent duct may promote infection and form a fistula.
Tract may lie dormant for years unless the stimulation which may lead to cystic dilation.
Infection may cause recurrence.
Spontaneous drainage occurs in some cases.
When they occur in mouth, these cysts are seen at foramen caecum.
Most of them are 3cm in size but occasionally may be as large as 10cm.
Diagnosis is made clinically.
Histologic features
Lined by pseudostratified columnar epithelium which may be ciliated or by a stratified sq.
epi.
Thyroid tissue may be seen, mucous cells, mucous glands (if in lingual area), germinal centres
may all be seen in capsule.
Malignant changes reported.
Treatment:
Surgical excision.

 Sistrunk operation.
Antibiotics indicated in infection.
It is important to perform thyroid function tests preoperatively.
BENIGN CERVICAL LYMPHOEPITHELIAL CYST
Also called branchial cleft cyst.
Its pathogenesis has evoked considerable controversy as to why it is referred by two names.
1) Branchial cleft cyst (neck)
2) Lymphoepithelial cysts of parotid gland.
3) AIDS related bilateral lymphoepithelial cyst.
4) Intra oral lymphoepithelial cyst.
LYMPHOEPITHELIAL CYST OF NECK

Superficially in neck, close to angle of mandible, anterior to sternocledomastoid muscle.

Occur at all ages, equal distribution from first to sixth decade.

No sex prediliction.

Neck lesions vary in size from small to vary large (10cm in diameter)

Swelling, pain may be present.

Lesions enlarge in response to dental or upper respiratory tract infection.

Because of thick wall and fluid contents, they impart on palpation, a sensation similar to that
of a partly filled hot water bottle is seen.

96% of cysts was lined by stratified sq epi and wall contained lymphoid tissue arranged in
follicular pattern.

Cyst lined with ciliated or non ciliated columnar epi. was occasionally described.

Pathogenesis

Traditionally, thought to originate from epithelial remnants of branchial clefts and pouches.

Berneir (1959) postulated that they represent cyst in cervical lymph modes, are not branchial
origin. The cystic change occurs in salivary gland epi which is trapped in nodes of neck
during embryogenesis. They suggested that it should be called lymphoepithelial cyst than
branchial cyst.

Little (1967) concluded that several structures may give rise to epithelium lining the cysts
that occur in the neck. They either represent salivary gland inclusions in parotid lymph
nodes or from epi remnants of upper portion of branchial apparatus.

Majority of cysts found in midneck region could develop from epithelial remmants of the
cervical sinus and / or the branchial pharyngeal pouches, both of which are part of branchial
apparatus.

The cysts found in lower neck region may develop from remnants of thymus duct or from
lower portion of branchial apparatus.

Histochemical studies indicated that epi lining of branchial cyst of neck is similar to crypt of
epithelium of palatine tonsils, suggesting the origin from the cyst linings.

IHC studies concluded that they are derived both from epithelial remnants of branchial
apparatus and from salivary inclusions in lymph modes.

LYMPHOEPITHELIAL CYST OF PAROTID GLAND

Occurs in parotid gland.
Age range is from 16-69 years.
F = M is 3:1
Important to differentiate it from cystic low grade mucopidermoid carcinoma and from cystic
types of benign lymphoepithelial lesion.
Histologically, consisted of epithelial lined multilocular cystic spaces enclosed by a dense
lymphoid tissue compared of small lymphocytes, plasma cells and germinal centers.
No subcapsular or medullary lymphatic sinusoids were seen.
Few areas invagination of epithelium into adjacent lymphoid or fibrous stroma formed small
epi nests that were both solid and micro cystic. In other areas, epithelium was papillary.
Treatment was by parotidectomy.
Aids

related

bilateral

lymphoepithelial

cysts

of

parotid

associated

with

cervical

lymphadenopathy:
Association between lymphoepithelial cysts of parotid, cervical lymphadenopathy and
infection by human immnodeficency virus was noted.
All patients had bilateral painless facial swellings with multiple enlarged bilateral lymph
modes.

 FNAC showed benign lymphocytes and squamous or cuboidal epi cells.

Histologically, lesion consisted of cyst lined by cuboidal and squamous epithelium surrounded
by lymphoid tissue with prominent germinal centres.
Hence CT findings of multiple parotid cysts and cervical adenopathy may indicate, before the
onset of opportunistic infection, that the patient is infected with HIV virus.
Partial obstruction of ducts of salivary glands within hyperplastic parotid lymphoid tissue was
also thought to lead to development of cysts.
Multinucleated giant cells with abundant eosinophilic cytoplasm were found in lumen of the
cyst or just below the epi lining or in lymphohistocystic infiltrate.
Atrophy of surrounding salivary gland parenchyma with lymphocytic infiltration of ductal
epithelium suggested cell mediated immune destruction of epithelium cells of the ducts in
response to infection by virus.
ORAL LYMPHOEPITHELIAL CYST
Is considered as a psuedocyst and not fissural cyst.
EPIDERMOID CYST
Common cyst of stain that is lined by epidermis like epithelium.
Most epidermoid cysts are derived from follicular infundibulum hence called influndibular
cysts. They arise after localized inflamation of hair follicle and represent a non neoplastic
proliferation of influndibular epithelium resulting from healing process.
Sebaceous cyst is used as a synonym for both epidermoid cyst and another cyst of scalp
known as pilar, tricholemmal cyst.
Etiology:
Form by sequestration and implantation of epidermal rest during embryonal period, occlusion
of pilosebaceous unit or iatrogenic or surgical implantation of epithelium into jaw
mesenchyme.
HIV infection and eccrine duct infection are additional factors in development of palmoplantar
epidermoid cyst.
Epidermoid cyst result from proliferation of epidermal cells within a circumscribed space of
dermis.
Analysis of lipid pattern had shown its origin from epidermis and not of sebaceous origin.
CK 1 and 10 are expressed in suprabasilar layer of epidermis. The source is infundibulum of
hair follicle. Inflammation is mediated by horny content present in epidermoid cysts.

Clinical features:
Indolent, slow to progress, asymptomatic until secondary infected.
Occurrence of secondary malignancies of BCC, SCC, Bowens disease and mycosis fungoides
have been reported.
M : F = 2:1
3rd 4th decade is common.
Gardners syndrome is an exception the average age of onset being 13 years.
History of foul swelling cheese like material is a common complaint.
Cyst becomes inflamed or infected causing pain and tenderness.
Rapid growth, triability and bleeding reported in uncommon event of malignancy.
When located orally, causes difficulty in feeding, swallowing or speaking.
Firm, round, mobile, flesh colored to yellow or white subcutaneous nodule of variable size.
Central core or punctum is inconsistent finding.
Pigmented epidermoid cysts are also reported.
Face, trunk, neck, extremities, scalp sites of involvement.
Syndromes associated are
o Gardners syndrome
o Basal cell nevus syndrome
o Pachyonychia congenita
Histologic features:
Lined by stratified squamuos epi with glandular differentiation, filled with desquamated
keratin disposed in laminar pattern.

Dystrophic calcification and reactive foreign body

reaction seen in cyst capsule.

Melanin pigments and melanophages seen in cyst capsule.
Malignant transformation rare.
HPV infected palmoplantar cysts show intra cytoplasmic eosinophilic inclusion bodies in cyst
wall, vacuolated cells, cells with condensed keratohyaline granules, elongated retepegs,
parakeratotic nuclei in keratinous mass.
Structures resembling eccrine ducts are noted.
Treatment:
Surgical excision,

 unusual complication sialdenitis due to presence on

submandibular salivary duct.

DERMOID CYST:
A hamartomatous tumor contining multiple sebaceous glands and almost all skin adnexa, this
may contain substances such as nails and dental, cartilage and bone like structure.
Origin is thought to be due to sequestration of skin and subsequent implantation of it along the
lines of embryonic closure.
Clinical features:
Dermoid cysts occurs mostly on face, neck or scalp.
In addition to the skin, dermoid cysts can be intracranial, intraspinal or perispinal.
Intra abdominal cysts such as cystic tumor of the ovary or omentum, occurs as well.
No racial predilection, occur in female population.
Occurs in all ages.
Intracranial or perispinal dermoid cysts are most often found in infants, children or young
adolescents.
Dermoid cyst in floor of mouth are seen at 10 30 years.
Congenital dermoid cysts are localized on head, neck and trunk and visible at birth.
Occasionally they are present on the neck or midline.
When on head, they are adherent to perisoteum.
Usual diameter of lesion is 1 4 cms.
If cyst develops above the geniohyoid muscle, a sublingual swelling may displace the tongue
toward the roof of mouth and create difficulty in eating, speaking or breathing.
Cysts below geniohyoid muscle produce a submental swelling with a double chin appearance.
Lesion presents as doughy or rubbery mass that retains pitting after application of pressure.
Secondary infection can occur, lesion may drain intraorally or into the skin.
Histological features:
Lined by epidermis possess epidermal appendages.
Appendages are fully mature.
Hair follicles containing hair project into lumen.
Dermis contain sebaceous glands, eccrine glands and apocrine gland.

 Lining epi may proliferate as papillary projection towards the lumen of cyst.
This proliferation may be diagnosed as epidermal carcinomatous proliferation.
HETROTROPHIC ORAL GASTROINTESTINAL CYST
Heterotropic islands of gastric mucosa have been found in oesophagus, small intestine,
thoracic cavity, pancreas, gall bladder and meckels diverticulum.
Rarely, gastric or intestinal cyst occur in oral cavity, tongue, floor of mouth probably from
misplaced embryonal rests.
Clinical features:
Choriostomatic cyst can be found in patients of any age, although the majority have been
infants or young children.
It may be significant that the lesion occurs overwhelming in males.
The cyst presents as a small nodule entirely within the body of the tongue, either anterior or
posterior, or in floor of mouth, in neck or adjacent submaxillary gland.
Asymptomatic or may cause difficulty in eating or speaking.
Some cysts communicate with surface mucosa by a tube or duct like structure.
Histologic features:
Cyst is usually lined by stratified sq epi and partly by gastric mucosa (presence of parietal and
chief cells). Intestinal epithelium is also found including paneth, goblet and argentaffin cells.
Muscularis mucosa may or may not be present.
Treatment: Surgical excision.
OTHER DEVELOPMENTAL CYSTS
1) Anterior median lingual cyst:
Rare lesion, fluctuant swelling on ant. dorsum of tongue.
Lined by psudostratified ciliated columnar and cuboidal epithelium. Capsule contains chronic
inflammatory cells.
Thought to be cyst of foregut origin since ciliated epithelium is the hallmark of primitive
foregut.
2) Cystic Hygroma:
Developmental anomaly where there is progressive dilation of lymphatic channels.
Involves face and neck.
Present at birth but diagnosed before 2 years of age.

 Swelling, painless, compressible.

Overlying skin blue, history of gradual or sudden onset.
Histologically, has dilated cystic spaces lined by endothelial cells.
3) Nasopharyngeal cysts:
Congential or acquired.
Caused by coalescence of median recess of pharyngeal tonsil.
Lined by ciliated or non ciliated epithelium with areas of squamous metaplasia in response to
inflammatory stimuli.
Lymphoid follicle are present in capsule.
Cyst cavity is packed with epithelial debris.
Lateral nasopharyngeal cysts are lymphoepithelial origin.
4) Thymic cysts:
Arise from persistent thymic tissue which may occur in any location between the angle of
mandible and midline of the upper neck to the sternal notch.
Cyst is lined by squaneous and cuboidal epithelium and thymic tissue is present in the wall.