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CYSTS OF ORAL

CAVITY
Cysts

pathological cavity

often fluid filled lined by


epithelium

in many instances, exact


pathogenesis of these lesions is
still uncertain
Cysts

regardless of origin, once


cysts develop in oral +
maxillofacial region,

tend to slowly increase


in size

possibly in response to
a slightly elevated
hydrostatic luminal
pressure
Cysts of Oral Region

(1) Odontogenic Cysts

(2) Non-odontogenic Cysts


Cysts of Oral Region

(1) Odontogenic Cysts

(a) Radicular Cyst

(b) Dentigerous Cyst

(c) Primordial Cyst

(d) Odontogenic Keratocyst

(e) Lateral Periodontal Cyst


Cysts of Oral Region

(2) Non-Odontogenic Cysts

(a) Globulomaxillary Cyst

(b) Nasolabial Cyst

(c) Median Palatal Cyst

(d) Nasopalatine Canal Cyst


1.1) Odontogenic Cyst
(Radicular Cyst)
also known as Apical
Periodontal Cyst;
Periapical Cyst;
Root End Cyst

common

not inevitable sequela of


periapical granuloma originating
as a result of:

bacterial infection
necrosis of dental pulp
following carious involvement of tooth
Pathogenesis

initial reaction leading


to cyst formation

proliferation of epithelial
rest in the periapical
area involved by granuloma

epithelial proliferation
follows an irregular pattern of
growth
Clinical Features

asymptomatic

present no clinical evidence


of their presence

seldom painful or even


sensitive to percussion
represents chronic
inflammatory process

develops only over


a long period of time
Radiographic Features

identical with periapaical


granuloma

since the lesion is a chronic


progressive one developing
in a pre-existing granuloma

cyst may be of greater


size than granuloma
due to longer duration
occasionally, exhibits
thin, radioopaque line
around the periphery
of radiolucent area

indicates reaction of
bone to slowly expanding
mass
Radiographic Features
Histologic Features

epithelium lining apical


periodontal cyst is usually
stratified squamous in
type
Treatment & Prognosis

similar to periapical
granuloma

involved tooth may be


removed

periapical tissue carefully


curetted
Treatment & Prognosis

under some condition;

root canal therapy

with apicoectomy
of cystic lesion
1.2) Odontogenic Cyst
(Dentigerous Cyst)

also known as Follicular Cyst

2nd most common type of


odontogenic cyst

most common developmental


cyst of the jaws
attached to tooth cervix
(enamel-cementum junction)

encloses crown of unerupted


tooth
Etiology

develops from proliferation


of enamel organ remnant
or reduced enamel epithelium

related to epithelial
proliferation
release of bone-resorbing
factors

increase in cyst fluid


osmolality
Clinical Features

commonly seen in
association most
with 3rd molars commonly
impacted
maxillary canines teeth
Clinical Features

greater incidence in
males

symptoms are generally


absent

delayed eruption being the


most common indication of
dentigerous cyst formation
Radiographic Features

well-defined

unilocular or ocassionally
mutilocular radiolucency
with coricated margins

associated with crown


of unerupted tooth

unerupted tooth is often


displaced
Radiographic Features

mandible

radiolucency may extend


superiorly from 3rd molar
site into ramus

anteriorly + inferiorly
along body of mandible
Radiographic Features

maxilla

if involving canine region


extends into maxillary
sinus

or orbital floor may be


noted
resorption of roots of adjacent
erupted teeth may
ocassionally be seen
Treatment
removal of associated
tooth
enucleation of soft tissue
component
cases where cysts affect
significant portions of
mandible, an acceptable
early treatment approach

exteriorization
marsupialization of cyst
allow for decompression
+ subsequent shrinkage of lesion
reducing extent of surgery at a later date
1.3) Odontogenic Cyst
(Primordial Cyst)
arises from cystic changes in
developing tooth bud

before formation of enamel


+ dentin matrix
since it arise from tooth bud,
tooth will be missing from
dental arch

unless cyst arose from


supernumerary tooth
usually found in children
+ young adults between
10 years and 30 years
of age
Radiographic Features

circular radiolucency

with radiopaque border


with sclerotic or reactive
border

found at site where tooth


failed to develop

more in relation to 3rd molars


Radiographic Features

unilocular or multilocular

seen below or between


roots or near to alveolar
ridge
Treatment

Radical Surgery

curretage of bone
1.4) Odontogenic Cyst
(Odontogenic Keratocyst)

may exhibit aggressive clinical


behavior

significant recurrent rate

associated with nevoid basal


cell carcinoma syndrome
found anywhere in jaws

can radiographically mimic other types of cysts


Etiology

develop from dental lamina remnants in mandible +


maxilla
Clinical Features

common jaw cysts

occur in any age

peak incidence within


2nd-3rd decades of life
Clinical Features

mandible

posterior portion of
body commonly
affected
ramus region

maxilla

3rd molar area


Radiographic Features

well-circumscribed
radiolucency

with smooth radiopaque


margins

most lesions are unilocular

40% was noted to be


adjacent to crown of
unerupted teeth
buccal + lingual enlargements occasionally seen

Treatment & Prognosis

surgical excision with peripheral osseous


curettage

ostectomy

follow up examination are important due to


recurrence rate

most recurrence become clinically evident within


5 years of treatment
1.5) Odontogenic Cyst
(Lateral Periodontal Cyst)
nonkeratinized developmental
cyst

occur adjacent or lateral to


root of tooth
Etiology

believed to be related to
proliferation of rests of
dental lamina
Clinical Features

occur in mandibular
premolar + cuspid region

occasionally in incisor area

in maxilla

primarily in lateral incisor


region
Clinical Features

male predilection

range 20-85 years old

asymptomatic

well-delineated
Radiographic Features

round

teardrop-shaped unilocular
(and occasionally multilocular)
radiolucency with opaque
margin along lateral
surface of vital tooth root
Radiographic Features
Radiographic Features
Radiographic Features
Treatment & Prognosis

local excision

follow-up is suggested for


treated multilocular
odontogenic cysts
(2.1) Non- Odontogenic
Cyst(Globulomaxillary Cyst)

between lateral incisor


+ canine teeth

many are lined by inflamed


stratified squamous
epithelium
between lateral incisor
+ canine teeth

many are lined by inflamed


stratified squamous
epithelium
Radiographic Features
(2.2) Non- Odontogenic
Cyst (Nasolabial Cyst)

rare developmental cyst

occurs in upper lip

lateral to midline

pathogenesis is uncertain
2 theories

1st theory: considers


nasolabial cyst to be
fissural cyst

arising from epithelial


remnants entrapped along
line of fusion of:

maxillary
median nasal
lateral nasal process
2 theories

2nd theory: cyst develop


from misplaced epithelium
of nasolacrimal duct

due to similar location


similar histologic
appearance
Clinical Features
swelling of upper lip
lateral to midline
result in elevation
of ala of nose
enlargement often elevates
mucosa of nasal vestibule
obliterates maxillary
mucolabial fold
on occasion, expansion
may result in:
nasal obstruction
interfere with wearing
of denture
pain is uncommon
cyst may rupture spontaneously
may drain into the oral or nasal cavity
commonly seen in adults

peak prevalence in 4th-5th


decades of life

significant predilection
for women
Radiographic Features

cyst arises in soft tissues

most cases no radiographic


changes are seen

pressure resorption of
underlying bone may
occur
Treatment & Prognosis

complete surgical excision


of cyst via intraoral
approach

because lesion is often close


to floor of nose

sometimes it is necessary
to sacrifice portion of nasal
mucosa to ensure total removal
Treatment & Prognosis
Treatment & Prognosis
(2.3) Non- Odontogenic Cyst
(Median Palatal Cyst)

rare fissural cyst

develops from epithelium


entrapped along embryonic
line of fusion of lateral
palatal shelves of maxilla
Clinical Features

firm or fluctuant swelling of midline of hard palate


posterior to palatine papilla
most frequently in young adults
often asymptomatic
some complain of pain or expansion
average size is 2 x 2 cm, sometimes it can be quite
large
must be stressed out that a true medial palatal cyst
should exhibit clinical enlargement of palate

midline radiolucency without clinical evidence of


expansion is probably a nasopalatine duct cyst
Radiographic Features

occlusal radiographs
demonstrate well-
circumscribed radiolucency
in midline of hard palate

occasional reported cases


have been associated with
divergence of central incisors
Treatment

surgical removal

recurrence should not


be expected
(2.4) Non- Odontogenic Cyst
(Nasopalatine Duct Cyst)

also known as Incisive


Canal Cyst

most common non-odontogenic


cyst of oral cavity

believed to arise from remnants


of nasopalatine duct

embryologic structure
connects oral + nasal cavities in
area of incisive canal
believed to arise from remnants
of nasopalatine duct

normally degenerate in humans


but may leave epithelial
remnants behind in incisive
canals
Clinical Features

almost any age


most common in 4th-6th decades of life
swelling of anterior palate
drainage
pain
asymptomatic
discovered on routine radiographs
rare instances, a nasopalatine duct cyst may develop
in soft tissues of incisive papilla area
without any bone involvement
cyst of incisive papilla
blue discoloration
Radiographic Features

well-circumscribed
radiolucency in or near
midline of anterior
maxilla

between apical to central


incisor
root resorption is rarely
noted

lesion most often is round


or oval with a sclerotic
border
some cases, a classic heart
shape
result of superimposition
of nasal spine
OR because they are notched
by nasal septum
radiographic diameter
can range from small lesions,
less than 6 mm
to destructive lesions as
large as 6 cm
most cyst are in range
1.0- 2.5 cm, with average
diameter of 1.5-1.7 cm
Radiographic Features

radiolucency that is 6 cm
or smaller in this area is
usually considered a normal
foramen

unless other clinical signs


or symptoms are present
Treatment & Prognosis

surgical enucleation

biopsy is recommended

because lesion is not


diagnostic radiographically

benign + malignant lesions


have been known to mimic
nasopalatine duct cyst
Treatment & Prognosis

palatal flap reflected


after incision

made along lingual


gingival margin of
anterior maxillary
teeth

recurrence is rare
References:
Books
Neville, et. al: Oral and Maxillofacial Pathology
3rd Edition
(pages 25-32)

Regezi, et. al: Oral Pathology: Clinical Pathologic


Correlations, 4th Edition
(pages 244-254)

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