Cyst of the Oral & Maxillofacial Region

Cysts are the most common cause of chronic swellings of the jaws. Cysts are
more common in the jaws than in any other bone because only the jaws contain
epithelium remaining after tooth formation; cysts can be formed in extra osseous
sites as well
Definition: Cysts are pathological cavities lined by epithelium filled with fluids,
semi fluids or gases.
Pseudo cyst: is a pathological cavity not lined by epithelium containing fluid or
semi fluid material.
Components of a cyst:
1- Connective tissue Wall 2- Epithelial lining 3- Lumen of the cyst.
CLASSIFICATION
ODONTOGENIC CYSTS:
 Inflammatory origin:
• Radicular cyst
• Collateral inflammatory cyst
1) mandibular buccal bifurcation cysts (MBBCs)
2) Paradental cysts ( PCs)
 Developmental origin:
• Dentigerous cyst & eruption cyst
• Odontogenic keratocyst
•Orthokeratinized odontogenic cyst
• Lateral periodontal & botryoid odontogenic cyst
• Gingival cyst
• Calcifying odontogenic cyst
• Glandular odontogenic cyst
NON-ODONTOGENIC CYSTS
 Nasopalatine duct cyst
 Surgical ciliated cyst
 Palatal cyst of the newborn
 Nasolabial cyst
 Sublingual dermoid cyst
 Epidermoid cyst
 Thyroglossal tract cyst.
 Oral lymphoepithelial cyst
 Benign cervical lymphoepithelial cyst.
 Mucous retention.
PSEUDO CYTS
 Mucous extravsation
 Simple bone cyst
 Aneurysmal bone cyst
 Static bone cyst
 ODONTOGENIC CYSTS
Odontogenic cysts derived from odontogenic epithelial remnants such as dental
lamina (rests of Serres), reduced enamel epithelium or rests of Malassez.
Odontogenic cysts, therefore, can only affect the tooth-bearing area of the jaws.
Odontogenic cysts account for most cysts occurring inside jaw bones,By far the
most common is the radicular cyst, followed by dentigerous cyst then the
odontogenic keratocyst.
Key features of jaw cysts
• Form sharply-defined radiolucencies with corticated smooth borders
• Aspiration can confirm fluid contents
• Cysts close to the mucosal surface may be trans-illuminated and appear bluish
• Grow slowly, displacing rather than resorbing teeth
• Symptomless unless infected
• Rarely large enough to cause pathological fracture
• Form compressible and fluctuant swellings if extending into soft tissues.
 Inflammatory Odontogenic Cysts
• Radicular cyst
• Collateral inflammatory cyst
1) mandibular buccal bifurcation cysts (MBBCs)
2) Paradental cysts ( PCs)
Radicular Cyst
Is the most common type of cyst in the jaws it is defined by their location at the
apex of a non-vital tooth, However it may be lateral radicular cyst arise in
relation to a lateral accessory canal.
A residual cyst is a radicular cyst that remains in the jaws after extraction of the
affected tooth.
Etiopathogenesis:
The epithelial lining derives from proliferation of the remnants of the Hertwig
epithelial root sheath (epithelial cell rests of Malassez) in the periodontal
ligament as a result of inflammation following pulpal necrosis, usually due to
dental caries. A cyst cavity is formed, which en larges as a result of hydrostatic
pressure accompanied by bone resorption.
Clinical features:
Age: any age with peak incidence in the fourth and fifth decades of life.
Site: The maxilla is the most common site.
Symptoms:
 Radicular cysts are slowly growing symptomless swelling unless
infected it become painful discovered incidentally on radiological
examination of a carious or non- vital tooth.
  The swelling usually pass through 3 stages:
Hard rounded swelling then Egg-shell crackling sensation is felt when only egg-
shell thickness of bone is left overlying the cyst, then final Fluctuant swelling
when part of the bone become completely resorbed. This swelling has a bluish
hue.
Radiographic picture:
Show a round or oval, unilocular, well defined R.L at the apex fig.1.
Residual cysts are found as well-defined R.L at a site of previous tooth
extraction.
If the cyst becomes infected, the outline becomes hazy.
Effect on surrounding: Displacement of adjacent teeth roots.
Histopathology:
Cyst wall:
Radicular cysts have a wall composed of inflamed fibrous or granulation tissue,
inflammatory infiltrate i s mixed, and may contain foamy histiocytes or deposits
of cholesterol crystals with foreign-body giant cells, Hyaline or Rushton bodies
are often seen and are characteristic (although not specific) of radicular cyst.
Cyst Lining:
Radicular cysts are lined by non-keratinized stratified squamous epithelium with
a characteristic arcading pattern fig.2. Mature cysts and residual cysts less
inflamed and may show a more uniform thin epithelium.
Variation of cyst lining:
The epithelium may be respiratory epithelium (pseudo-stratified columnar
ciliated with goblet cells).This type of epithelium is seen in periapical cysts
involving teeth near maxillary sinus or nasal cavity.

Fig.1. showing well defined RL related to a fractured tooth root

Fig.2. arcading pattern in cyst lining

Collateral Inflammatory Cyst

Inflammatory collateral cysts (ICCs) arise on the buccal aspect of the roots of
partially or recently erupted teeth as a result of inflammation in the pericoronal
tissues. There are two main types: paradental cysts (PCs) arise on the lower
third molars and mandibular buccal bifurcation cysts (MBBCs) arise on the
lower first or second molars.
1) Mandibular Buccal Bifurcation Cyst
The buccal bifurcation cyst characteristically develops on the buccal aspect of
the mandibular first permanent molar, although some cases have involved the
second molar. The
Pathogenesis:
 Uncertain, but it was proposed that when the tooth erupts, an inflammatory
response may occur in the surrounding follicular tissues that stimulates cyst
formation.
 Buccal enamel extensions may predispose to buccal pocket formation,
which could then enlarge to form such cyst in response to pericoronitis.
Clinical features:
 MBBCs often present with painless swelling on buccal bone aspect of
lower first molar which is vital usually tilted buccally, with deep
periodontal pockets.
 Infection with pain and suppuration may be seen.
Radiographic picture:
 well-demarcated buccal radiolucency, which may extend to the lower
border of the mandible fig3.
 A periosteal reaction with laminated new bone formation may be visible at
lower border of the mandible.
NB: bilateral involvement is usual.
Histopathology:
Non specific

Fig.3. Inflammatory collateral cyst. The MBBC is corticated and overlies the roots of a lower second molar
tooth.

2) Paradental Cysts

paradental cyst occur distal or buccal of partially erupted mandibular third

molars with a history of longstanding pericoronitis.
Pathogenesis:
Uncertain
Clinical features:
Age: The peak 1ncidence of PC s is among patients aged 40 Years.
Gender: Male predilection associated teeth are vital.
Radiographic picture:
 Well demarcated RL, often corticated.
 PCs tend to be mesially located on mesioangular impactions, distal on
distoangular impactions fig.4, and buccal on vertical impactions.
 Histopathology:
Non specific
Treatment:
ICCs are treated by simple enucleation.in PCs involved third molars are
usually extracted, but molars involved by MBBC may be conserved

Fig4.Inflammatory collateral cyst. The paradental cyst appears as well-demarcated, corticated radiolucency
at the distobuccal aspect of a partially erupted lower third molar. The periodontal ligament and lamina dura
are intact (arrows).

 Developmental Odontogenic Cysts

• Dentigerous cyst
• Odontogenic keratocyst
• Orthokeratinized odontogenic cyst
• Lateral periodontal and botryoid odontogenic cyst
• Gingival cysts
• Calcifying odontogenic cyst
• Glandular odontogenic cyst
Dentigerous Cyst
Dentigerous cyst is a developmental odontogenic cyst that is attached to the
cervical region of impacted tooth fig. 5A and envelops the crown.
It account for about 20% of all odontogenic cysts and is the second most
common cyst of the jaws.
Pathogenesis:
Uncertain, the cyst may arise due to an accumulation of fluid between the
reduced enamel epithelium of the dental follicle and the crown of the unerupted
tooth.
Clinical features:
Age: peak incidence in the second to fourth decades of life.
Gender: there is male Predilection.
Site: About 75% of dentigerous cysts are associated with unerupted mandibular
third molars followed by maxillary canines then maxillary third molars and
mandibular second premolars.
Symptoms:
 Dentigerous cyst is usually asymptomtic unless infected.
 Usually discovered during radiological investigation for a missing tooth.
 May presented as slowly growing swelling causing expansion of the jaw.
Radiographically:
It appears as well defined unilocular RL with corticated margins surrounding the
crown of the unerupted tooth.
NB: large dentigerous cyst may give the impression of a multilocular appearance
due to persistence of bone trabeculae within the radiolucency.
Dentigerous cyst may be classified according to cyst-to-crown relationship in
radiographs as follows:
 Central: which is the most common, the cyst surrounds the crown of the
tooth
 lateral : usually associated with mesioangular impacted mandibular third
molars that are partially erupted
 Circumferential: the cyst surrounds the crown and extends for some
distance along the root so that a significant portion of the root appears to lie
within it.
Effect on surrounding:
 Root resorption of adjacent erupted teeth can occur.
 The cyst may displace the involved tooth: third molar may be displaced to
the lower border of the mandible or higher into the ascending ramus.
  Maxillary anterior teeth may be displaced into the floor of the nose, and
other maxillary teeth may be moved through the maxillary sinus to the floor
of the orbit.
D.D:
Ameloblastoma
OKC
AOT
Histopathologically:
 The epithelial lining: consists of two to four layers of flattened
nonkeratinizing stratified squamous.
 Epithelium connective tissue interface is flat fig.5B.
 Connective tissue wall: Uninflamed wall of loose fibrous tissue, often with
a slightly myxoid appearance, the wall may contain rests of odontogenic
epithelium.
 Inflamed Dentigerous cyst may exhibit epithelial hyperplasia, with adjacent
cholesterol crystals.
 Metaplastic changes may include mucous cells and cilia fig.5C.

Fig. 5. A Dentigerous cyst attached to CEJ of a tooth, B flat epithelial connective tissue interface, C goblet
cells can be seen in the cyst lining

Complications:
1) Mucus cells in lining may develop in an intra-osseous mucoepidermoid
carcinoma.
2) Neoplastic change in the cyst lining may lead to intra osseous carcinoma.
3) Ameloblastoma can also develope from the cyst lining.
4) Large expansile cysts may lead to pathological fracture.
Treatment:
Enucleation, with removal of the impacted tooth.
ERUPTION CYST
(ERUPTION HEMATOMA)
The eruption cyst is the soft tissue analogue of the dentigerous cyst.
Pathogenesis:
The cyst develops as a result of separation of the dental follicle from around the
crown of an erupting tooth that passed the alveolar bone level and lies within soft
tissue.
Clinical Features
Age: children younger than age 10.
Gender: no predilection
Site: mandibular deciduous incisors or maxillary first permanent molars.
Symptoms: presented as a smooth, soft swelling overlying an erupting tooth. It
appears translucent, but trauma may result in hemorrhage, letting the lesion
appear as a haematoma fig 6A.
Histopathology:
 Surface oral epithelium on the superior aspect fig.6 B.
 Cyst lining: a thin layer of nonkeratinizing squamous epithelium.
 Connective tissue wall: lie in between the cyst lining and the oral
epithelium

A B

Fig 6.soft gingival swelling contains considerable blood, Eruption Cyst. A cystic epithelial cavity can be
seen below the mucosal surface
Treatment and Prognosis
 No treatment required cyst ruptures spontaneously.
 If it prevent eruption deroofing of the cyst will be treatment of choice

Odontogenic Keratocyst (OKC)

The odontogenic keratocyst is a developmental odontogenic cyst which needs
special consideration due to its histopathological features and clinical behavior.
  Its high recurrence rate as the lining is friable fig.7 and fragmented during
removal in addition to the budding of the cyst lining in the under lying
Connective tissue wall.
 Histological appearance of thin parakeratinized lining epithelium with
palisaded ameloblast- like basal cells.
 Third most common odontogenic cyst and may be associated with
syndromes.

Fig.7..Odontogenic keratocyst. Enucleated specimens are often fragmented

Pathogenesis:
Cyst Arises from remnants of the dental lamina. The cysts appear to enlarge by
growth of the wall rather than osmotic pressure.
The cyst wall produces bone-resorbing factors that resorb the surrounding
medullary bone, allowing the cyst to enlarge slowly in posteroanterior direction.
Clinical features:
Age: wide patient age range, with a peak incidence in the second to third decades
of life except for patents with nevoid basal cell carcinoma syndrome it occurs in
younger patients with multiple distributions.
Gender: slight male predilection
Site: 80 % of cases found in the mandible posterior body and ramus.
Lesions of posterior maxilla often associated with nevoid basal cell carcinoma
syndrome.
Symptoms:
 Small OKCs are usually asymptomatic and discovered only during the
course of a radiographic examination.
 Larger OKCs may be associated with pain, swelling, or drainage. Some
extremely large cysts, however, may cause no symptoms.
Radiographic features:
 Well-defined RL with often corticated margins.
 Cysts in posterior body and ramus of the mandible appear multilocular .
 An unerupted tooth may be associated this can be explained as cyst has
arisen from dental lamina rests near an unerupted tooth and has grown to
envelop the unerupted tooth.
Histopathology:
Cyst lining:
 Folded, thin, regular parakeratinized epithelium 5-8 cell layers thick
without rete ridges.
 The parakeratin surface is typically corrugated fig.8A.
 Basal cell layer composed of columnar or cuboidal palisaded cells with,
hyperchromatic nuclei with reversed polarity fig.8B.
Cyst wall:
 Thin fibrous wall is usually devoid of significant inflammation.
 Budding of the basal layer in the underlying connective tissue can detected
fig.8 C.
Small satellite cysts, cords, or islands of odontogenic epithelium may be
seen (daughter cysts) fig.8 D,
 Epithelial connective tissue interface is smooth.
Cyst lumen:
 Filled with a cheesy material that, on microscopic examination, consists of
keratinaceous debris.

Fig.8. A corrugated surface keratin , B focal areas of reversed polarity,C budding of basal layer in the
underlying C.T, D daughter satellite cysts in the C.T.
Effect on surrounding:
 Displacement of adjacent teeth occur rather than resorption.
 Large OKCs may cause displacement of teeth. Maxillary lesions may
displace the orbit.
D.D:
Dentigerous cyst
Lateral periodontal cyst
So-called globulomaxillary cyst now considered to be OKC
ameloblastoma
treatment:
enucleation and to decrease recurrence rate enucleation with Carnoy's solution
was 8%.
Basal cell naevus syndrome
(Gorlin’s or Gorlin-Goltz syndrome)
It is inherited as an autosomal dominant trait, the syndrome is caused by
mutations in (PTCH), a tumor suppressor gene.
 There is great variability in the expressivity of nevoid basal cell carcinoma
syndrome, and no single component is present in all patients.
 The most significant features are basal cell carrcinomas, multiple OKCs
(either appear in metachronous or synchronous fashion)
 Basal cell carcinomas of the skin begin to appear at puberty, varying from
flesh-colored papules to ulcerating plaques most commonly located in the
midface area.
 The diagnosis of this syndrome depends on dividing the clinical symptoms
in to major and minor criteria summarized in the following table (Tab.1)
A diagnosis can be made if the patient has:
1. Two major criteria
2. One major and two minor criteria
3. One major criterion and genetic confirmation
Major criteria Minor criteria
1. Five or more basal cell 1. Macrocephaly
carcinomas or one before the 2. Congenital malformation: Cleft lip or
age of 30 years palate, frontal bossing, coarse facial features,
2. Odontogenic keratocyst and/or hypertelorism
(OKC) 3. Preaxial or postaxial polydactyly
3. Lamellar calcification of the 4. Rib or vertebral abnormalities: bifid,
falx cerebri splayed, or extra ribs; bifid vertebrae
4. Two or more palmar or 5. Ovarian or cardiac fibromas
plantar pits 6. Ocular anomalies: Cataract, coloboma,
5. First degree relative with the and/or microphthalmia
nevoid basal cell carcinoma 7. Lymphomesenteric or pleural cysts
Syndrome
6. Medulloblastoma

Tab.1.Major and minor criteria of Gorlin–Goltz syndrome

Orthokeratinized odontogenic cyst (OOC)
It is an odontogenic cyst that is entirely or predominantly lined by
orthokeratinized stratified squamous epithelium. OOC is a distinct entity.
Pathogenesis:
Uncertain, its origin most likely from remnants of the dental lamina
Clinical features:
Age: wide age range, with peak incidence third and fourth decades of life
Gender: male predilection
Site: mandible, posterior.
Symptoms: asymptomatic swelling usually discovered accidentally during
radiographic examination.
Radiographic features:
Well defined RL. With corticated margin usually associated with impacted tooth.
Histopathology
Cyst wall: uninflamed fibrous wall
Cyst lining: thin, regular keratinizing stratified squamous epithelium 5-8 cell
layers thick.
The surface exhibits orthokeratinization, with a prominent granular cell layer.
 Unlike in odontogenic keratocyst, the keratin surface is not corrugated,
but is lamellated.
 The basal cells are flat or cuboidal, but do not show palisading or
hyperchromatism.
Cystic lumen:
Contains lamellated thick keratin layer that extended from the cyst lining fig.9.

Fig.9. Orthokeratinized odontogenic cyst. A thin, regular, epithelial lining with a thick keratin layer that is
lamellated and extends into the lumen.
D.D:
Dentigerous cyst
OKC
Unicystic ameloblastoma
Treatment:
Treatment is by enucleation. Recurrence is extremely rare.
Lateral periodontal & botryoid odontogenic cysts
The lateral periodontal cyst is a developmental odontogenic cyst that typically
occurs along the lateral root surface of a tooth.
Botryoid odontogenic cyst is a polycystic variant of lateral periodontal cyst,
grossly and microscopically, they show a grapelike cluster of small individual
cysts Fig.10.

Fig. 10. Macroscopic appearance of a botryoid variant showing the grape like cluster ppearence
Pathogenesis:
Arises from odontogenic epithelial remnants, but the source is controversial.
Clinical features:
Age: old age
Gender: male predilection
Site: most common in mandible premolar canine region, if it occurs in maxilla it
will occur in same area.
Symptoms: asymptomatic detected only during a radiographic examination.
Radiographic features:
Unilocular well-defined RL with corticated margin juxtaposed to the lateral
surface of vital tooth root fig.11.
Botryoid variant often has a multilocular radiographic appearance.
Fig. 11. Lateral periodontal cyst appearing adjacent to roots of two lower premolars
Histopathologically:
LPC has a characteristic histopathology:
Cyst lining:
Thin lining of non-keratinized epithelium, typically consisting of a single or
double layer of cells, with focal epithelial thickenings fig.12.
Separation of the epithelial lining from the connective tissue wall is a common
finding.
Foci of clear cells may be interspersed among the lining epithelial cells.
Cyst wall: fibrous uninflamed wall, but may show a hyalinized band immediately
beneath the cyst lining.
Clear cell epithelial rests sometimes are seen within the fibrous wall.
Cystic lumen: may contain clear fluid
The microscopic appearance of BOC is similar to that of LPC, except there
is multiple cystic spaces fig.13.
Fig. 12. Lateral Periodontal Cyst, This photomicrograph shows a thin epithelial lining with focal nodular
thickenings, these thickenings often show a swirling appearance of the cells.

Fig. 13. Botryoid odontogenic cyst. A cyst with several locules and the characteristic lobular thickenings or
plaques of the lining epithelium.
D.D:
Inflammatory lateral periodontal cyst
OKC
Glandular odontogenic cyst
Ameloblastoma
Treatment:
Enucleation with no recurrence.
 Gingival cysts
 Gingival cysts of the new bone (alveolar)
 Gingival cyst of adult
Gingival Cyst of Adult
Developmental odontogenic cyst considered to represent the soft tissue
counterpart of the lateral periodontal cyst being derived.
The diagnosis of gingival cyst of the adult should be restricted to lesions with
the same histopathologic features as those of the lateral periodontal cyst.
Etiology:
Unknown. Gingival cysts are thought to be developmental cysts that arise from
remnants of the dental lamina in the gingival or alveolar soft tissues.
Clinical Features:
Age: old age
Site: mandibular canine and premolar area buccal surface at moveable mucosa, at
its junction with the attached gingiva
Symptoms:
 painless, small, dome-shaped swelling
 Have a bluish translucent appearance, but may appear clear.
 Radiographs: negative as it is soft tissue lesion but it may Cause superficial
erosion of the underlying bone cortex.
Histopathologically:
The histopathologic features of the gingival cyst of the adult are similar to those
of the lateral periodontal cyst, consisting of a thin, flattened epithelial lining with
or without focal plaques that contain clear cells, cyst appear covered by oral
mucosa fig.15.

Fig. 15. Gingival Cyst of the Adult. Low-power photomicrograph showing a thin-walled cyst in the gingival
soft tissue.
D.D:
Extraosseous
odontogenic lesions
fibroma
Treatment:
Surgical excision
 Gingival cysts of the newborn
These are small, superficial, keratin-filled cysts that are found on the alveolar
mucosa of infants. It is found in as many as 90% of neonates < 3 months. Similar
inclusion cysts (e.g., Epstein’s pearls and Bohn’s nodules) are also found in the
midline of the palate or laterally on the hard and soft palate due to confusion
between both entities it is designated best by palatal cysts of the newborn.
Etiology:
Unknown. Gingival cysts are thought to be developmental cysts that arise from
remnants of the dental lamina in the gingival or alveolar soft tissues.
Clinical Features:
Appear as small, usually multiple whitish papules on the mucosa overlying the
alveolar processes.
Maxillary alveolus > mandibular
Histopathologically:
Examination of an intact gingival cyst is very rare; lining is a thin, flattened
epithelial lining with a parakeratotic luminal surface. The lumen contains
keratinaceous debris fig 14.

Fig. 14. Gingival cyst of the newborn, formation of cyst superficial to the developing teeth. The cysts are
lined by keratinizing epithelium, the lumen is filled with keratin
Treatment:
No treatment is indicated for gingival cysts of the newborn because the lesions
spontaneously rupture.

.
 Calcifying Odontogenic Cyst (COC)
Gorlin Cyst
It is one of ghost cell lesions,characterized by odontogenic epithelium containing
“ghost cells,” which then may undergo calcification.
 COC may occur intraosseous or extraosseous
 COC may be associated with odontoogenic tumors mostly odontomas.
Etiology:
There has been considerable debate as to whether consider COC as a neoplasm or
a developmental cyst, On the basis of its behavior and clinicopathological
features, COC is now thought to be a developmental cyst that arises from the
dental lamina
Clinical Features:
Age: mean patient age of about 30 years
Gender: no sex predilection.
Site: mandible = maxilla, anterior region.
Symptoms:
 painless swelling of the jaws painless swelling of the jaws
 Peripheral lesions appear as gingival dome shaped swellings.
Radiographic features:
 The central COC appear as unilocular, well-defined RL.
 Radiopaque structures within the lesion, either irregular calcifications or
tooth like densities, are present in about one-third to one-half of cases
giving mixed RL.RO. appearance fig.16.
 Central COC may be associated with impacted tooth.

Fig. 16. Calcifying Odontogenic Cyst. Well-circumscribed mixed radiolucent/radiopaque lesion in the right
body of the mandible.
Histopathlogically:
 COC is unicystic surrounded by fibrous capsule.
Cyst lining:
 Lining of odontogenic epithelium of variable thickness.
 The basal cells of the epithelial lining may be cuboidal or columnar
ameloblast like cells
 Overlying layer of loosely arranged epithelium resembling the stellate
reticulum cells
 The key histopathologic feature of COC is the presence of variable
number of “ghost cells” within the epithelial component fig.17.
 Ghost cells are eosinophilic altered epithelial cells that are characterized by
the loss of nuclei with preservation of the basic cell outline that may
undergo calcification which is basophilic and fuse to form large masses.
 The nature of the ghost cell is controversial. Some believe that this
represents coagulative necrosis or accumulation of enamel protein; others
considered it to be aberrant keratinization of odontogenic epithelium.
 Epithelial lining may proliferates into the lumen so that the lumen is largely
filled with masses of ghost cells and dystrophic calcifications. Fig.18
Cyst wall:
 A variable amount of dentinoid is sometimes laid down adjacent to the
epithelial lining which believed to be due to inductive effect by the
odontogenic epithelium on the adjacent mesenchymal tissue fig. 19.
 Ghost cells also may proliferate into the fibrous tissue of the capsule.

Fig. 17. Calcifying odontogenic cyst. There is a thin lining of epithelium with a basal layer of palisaded
ameloblast-like columnar cells with stellate reticulum-like suprabasal cells. The lumen s filled by ghost cells
shed into the cyst cavity.
 Fig.18.The epithelium being almost replaced by numerous ghost cells.

Fig.19.Ghost cells accumulate in the lining and form luminal nodules; note the areas of calcification,
dentinoid can be seen in the cyst wall
Effect on surrounding:
 Tooth displacement and root resorption.
 Jaw expansion in large cysts.
D.D:
Dentigerous cyst
OKC
Ameloblastoma
CEOT
Ameloblastic fibro-odontoma
Treatment:
Enculeation
 Glandular Odontogenic Cyst
(Sialo-Odontogenic Cyst)

Glandular odontogenic cyst (GOC) is a developmental cyst with epithelial

features that simulate glandular differentiation.
Etiology
Unknown may arises from remnants of the dental lamina.
Clinical features
Age: wide age range with peak incidence 40-70.
Gender: no sex predilection.
Site: mandible anterior region, mandibular lesions may cross the midline.
Symptoms:
Painless swelling, large cysts produce clinical expansion, which can be
associated with pain or paresthesia
Radiographic features:
The lesion presents as unilocular or multilocular radiolucency with a corticated
rim.
Histopathologically:
Diagnosis of GOC can be made when at least 7 of 10 specific criteria are present
fig.20, 21.
(1) Variable thickness of the epithelium lining, from 2-3 cell layers of flattened
squamous or cuboidal cells to thicker, stratified squamous epithelium.
(2) The luminal layer of cuboidal to low columnar cells, present at least focally.
Other criteria are present in most cases:
(3) Intraepithelial microcysts.
(4) Apocrine metaplasia of the luminal cells.
(5) Clear cells in the basal and parabasal layers.
(6) Papillary projections (tufting) into the lumen.
(7) Mucous cells.
The other three microscopic criteria for diagnosis are
(8) Epithelial spheres similar to those seen in lateral periodontal cyst, which are
frequently identified
(9) Cilia
(10) Multiple cystic compartments may be seen.
Fig.20. Glandular Odontogenic Cyst. The cyst is lined by stratified squamous epithelium that exhibits
surface columnar cells with cilia. Numerous microcysts containing mucinous material are present.

Fig.21. Glandular odontogenic cyst. The epithelial lining has an occasional plaque similar to those in lateral
periodontal cysts and contains small glands or duct-like spaces
Effect on surrounding:
Teeth displacement or root resorption is common
D.D:
Central mucoepidermoid carcinoma
OKC
Ameloblastoma
Central giant cell tumor
Treatment:
Enucleation usually associated with a high recurrence rate, so resection is the
treatment of choice in large lesions.
 NON ODONTOGENIC CYSTS
Nasopalatine Duct Cyst
(Incisive Canal Cyst)
Nasopalatine duct cyst is a non-odontogenic cyst of developmental origin that
arises in the midline of the anterior maxilla.
The cyst is believed to arise from remnants of the nasopalatine duct, an
embryologic structure connecting the oral and nasal cavities in the area of the
incisive canal.
It is one of the most common cystic lesions as it represents about 80% of non-
odontogenic cystic lesions and 5% of all jaw cysts.
Pathogenesis:
uncertain, the lesion most likely represents a spontaneous cystic degeneration of
remnants of the nasopalatine duct.
Clinical features:
Age: 30-60 years
Gender: Male predilection
Site: found exclusively in the midline of the anterior hard palate.
Symptoms:
 Many lesions are asymptomatic
 Some Presented as a sessile swelling just posterior to the incisors in the
anterior palate or as bulging of the floor of the nose
 Large cyst may produce a “through-and-through” fluctuant expansion
involving the anterior palate and labial alveolar mucosa.
 If the lesion traumatized it produce pain and may be infected.
 In rare instances, a nasopalatine duct cyst may develop in the soft tissues of
the incisive papilla area without any bony involvement. Such lesions often
are called cysts of the incisive papilla.
Radiographic features:
Radiology is almost always diagnostic; it has a characteristic heart shape as a
result of superimposition of the nasal spine or because they are notched by the
nasal septum, other lesions may show inverted pear shape fig.22.
 It appears as well defined RL surrounded by corticated margin in the
midline of the hard palate, between the roots of the incisors, which may be
displaced but are vital.
 Intact lamina dura.
NB: asymptomatic small radiolucencies of approximately 6 mm that associated
with vital teeth can be considered to be within normal anatomical limits and only
need to be followed radiographically.
Histopathologically:
Cyst lining:
 More than 90 % of cases lined by stratified squamous epithelium, with
focal areas of cuboidal, columnar or ciliated change fig.23.
 About half of all cases contain areas of respiratory epithelium, but < 10% of
cases are lined entirely by respiratory epithelium The cyst
Cyst wall:
 Wall contains prominent neurovascular bundles and occasionally contains
small mucous glands or cartilage fig. 24.
 Traumatized cysts show inflammatory response.
Effect on surrounding:
 Teeth displacement
Treatment:
Enucleated without recurrence.

Fig.22. Nasopalatine Duct Cyst. Well-circumscribed radiolucency between and apical to the roots of the
maxillary central incisors.

Fig. 23. Nasopalatine Duct Cyst. Cystic lining showing transition from pseudostratified columnar to
stratified squamous epithelium.
Fig. 24. Nasopalatine Duct Cyst. Cyst wall showing blood vessels, nerve bundles, and minor salivary glands.
Palatal Cyst of the Newborn
Common small developmental cysts found in clusters on the palate of newborn
infants.
Epstein’s pearls occur along the median palatal raphe and presumably arise
Bohn’s nodules are scattered over the hard palate, often near the soft palate
junction.
 As similar-appearing lesions of dental lamina origin found on neonates
alveolar ridge the term palatal cysts of the newborn become preferable to
help distinguish them from gingival cysts of the newborn.
 Also it is difficult to ascertain clinically the origin they are arising from
either epithelium entrapped by fusion of the palate or from the developing
minor salivary glands.
Pathogenesis:
Two hypothesis was proposed
First:
 During development of palate in early embryonic life epithelium were
entrapped below the surface along the median palatal raphe and form cysts
Epstein’s pearls origin.
Second:
 These cysts had arisen from epithelial remnants derived from the
development of the minor salivary glands of the palate Bohn’s nodules
origin.
Clinical features:
Age: Neonates
Site: Along the midline near the junction of the hard and soft palates fig.25.
Occasionally, they may occur in a more anterior location along the raphe or on
the posterior palate lateral to the midline.
Symptoms: asymptomatic white or yellow-white papules usually two to six in
number.
Fig.25. Small keratin-filled cysts at the junction of the hard and soft palates
Histopathologically:
Appear as keratin-filled cysts that are lined by stratified squamous epithelium.
Sometimes demonstrating communication with the mucosal surface.
Treatment:
No treatment is required, the cysts rupture onto the mucosal surface and
discharged their keratin contents.
Nasolabial Cyst
Rare developmental cyst that occurs in the upper lip lateral to the midline.
Pathogenesis:
Uncertain, however there are two major theories:
First theory:
It considered the nasolabial cyst to be a “fissural” cyst arising from epithelial
remnants entrapped along the line of fusion of the maxillary, medial nasal, and
lateral nasal processes.
Second theory:
It suggested that these cysts develop from misplaced epithelium of the
nasolacrimal duct because of their similar location and histologic appearance.
Clinical Features:
Age: seen in adults, with peak incidence in the fourth and fifth decades.
Gender: predilection for females.
Site & symptoms:
 Asymptomatic Swelling of the upper lip lateral to the midline, resulting in
elevation of the ala of the nose, elevates the mucosa of the nasal vestibule
and obliterates the maxillary mucolabial fold Fig.26.
 Nasal obstruction may occur.
 Interference with the wearing of a denture.
 10% of the reported cases have been bilateral.
Radiographic features:
Nasolabial cyst arises in soft tissues negative in radiographic examination.
Fig.26. elevation of the ala of the nose,Intraoral swelling fills the maxillary labial fold
Histopathologically:
Cyst lining: pseudostratified columnar epithelium, often demonstrating goblet
cells and cilia Fig.27.
Cyst wall: composed of fibrous connective tissue with adjacent skeletal muscle.
Inflammation may be seen if the lesion is secondarily infected.

Fig. 27. Nasolabial Cyst. Pseudostratified columnar epithelial lining.

Effect on surrounding:
Resorption of the underlying bone may occur.
Treatment:
 The cyst may rupture spontaneously.
 Surgical excision.
Thyroglossal Tract Cyst
(Thyroglossal Duct Cyst)
Thyroglossal duct is an embryological anatomical structure forming an open
connection between the initial area of development of the thyroid gland and its
final position. The thyroglossal duct epithelium normally undergoes atrophy and
is obliterated.
Pathogenesis:
Cystic degeneration in the epithelial remnants of thyroglossal duct, the cause for
this degeneration is uncertain it may be due to inflammation.
Clinical features:
Age: Most common at first two decades of life
Gender: No sex predilection
Site:
 Anywhere from the foramen cecum area of the tongue to the suprasternal
notch at the midline.
 60% to 80% of cases, the cyst develop adjacent to the hyoid bone.
 Suprahyoid cysts may be submental in location.
 Cysts that develop in the area of the thyroid cartilage often are deflected
lateral to the midline because of the sharp anterior margin of the thyroid
cartilage.
Symptoms:
 Painless, fluctuant, movable swelling unless it is complicated by secondary
infection Fig. 28.
 If the cyst maintains an attachment to the hyoid bone or tongue, it will
move vertically during swallowing or protrusion of the tongue.

Fig.28. Thyroglossal Duct Cyst. Swelling (arrow) of the anterior midline of the neck.
Radiographic features: -ve
NB: Lesions that develop at the base of the tongue may cause laryngeal
obstruction
Histopathologically:
Cyst lining: usually are lined by columnar or stratified squamous epithelium,
although occasionally, cuboidal or even small intestine epithelium may be
documented Fig. 29.
Cyst wall: Thyroid tissue may be found in the cyst wall.
Treatment:
Thyroglossal duct cysts are best treated by a Sistrunk procedure to avoid
recurrence (cyst is removed in addition to the midline segment of the hyoid bone
and a generous portion of muscular tissue along the entire thyroglossal tract as
high recurrence rate occurred with less aggressive surgery.
N.B: Carcinoma can arise in a thyroglossal duct cyst
Fig.29. Cyst (top) lined by stratified squamous epithelium. Thyroid follicles can be seen in the cyst wall
(bottom).
BRANCHIAL CLEFT CYST
(CERVICAL LYMPHOEPITHELIAL CYST)
The branchial cleft cyst is a developmental cyst that is derived from remnants of
the branchial arches.
Pathogenesis:
 Branchial arches are covered by ectoderm on the external surface and
endoderm on the internal surface. The outer arch surfaces are separated by
clefts and the inner surfaces are divided by pouches that become obliterated
by ingrowth of mesenchyme
 Incomplete obliteration gives rise to branchial cleft anomalies, such as
cysts.
 N.B: About 95% of these anomalies are believed to arise from the second
branchial arch.
Clinical features:
Age: most frequently develop in children and young adults between the ages of
10 and 40.
Site:
 Second arch cysts appear at upper lateral neck anterior or deep to the
sternocleidomastoid muscle, below the angle of the mandible (most
common) fig.30.
 1st branchial arch near parotid gland.
 3rd & 4th cleft anomalies are very rare and may develop in the lower neck
Symptoms:
 Tender or painful soft, fluctuant swelling.
 Bilateral cysts may develop.

Fig. 30. Branchial cyst lie just anterior to sternomastoid muscle and below the angle of the mandible
Radiographic features: -ve
It can appear as well circumscribed lesion in the neck in CT scan.
Histopathologically:
Cyst lining: 90% of branchial cleft cysts are lined by stratified squamous
epithelium that may or may not be keratinized Fig.31.some cysts will exhibit
respiratory epithelium
Cyst wall:
Typically contains lymphoid tissue, often demonstrating germinal center
formation

Fig.31. Branchial cleft cyst lined by stratified squamous epithelium. Note the lymphoid tissue in the cyst
wall.
Treatment:
Surgical removal with no recurrence.
 Oral Lymphoepithelial Cyst
Oral lymphoepithelial cyst is an uncommon lesion of the mouth that develops
within oral lymphoid tissue. It is microscopically similar to the branchial cleft
cyst but much smaller in size.
Pathogenesis:
 It may develop from salivary or surface mucosal epithelium that becomes
enclaved in lymphoid tissue during embryogenesis.
 Due to close relationship of oral lymphoid tissue to the overlying mucosal
epithelium, where the epithelium invaginates into the tonsillar tissue,
resulting in blind pouches or tonsillar crypts that filled up with keratin
debris and become obstructed producing a keratin-filled cyst within the
lymphoid tissue just below the mucosal surface.
Clinical features:
Age: any age, but they are most common in young adults
Site: locations of normal or accessory oral lymphoid tissue, the most frequently
reported locations are the floor of the mouth, ventral tongue, posterior lateral
border of the tongue, palatine tonsil, and soft palate.
Symptoms:
 Asymptomatic, firm or soft small submucosal swelling.
 The lesion is typically white or yellow with normal covering mucosa fig.32.

Fig.32. Oral Lymphoepithelial Cyst. Small yellow-white nodule of the tonsillar fossa.
Histopathologically:
Cyst lining:
parakeratinized stratified squamous epithelium without rete ridges fig.33.
Cyst wall:
 The most striking feature is the presence of lymphoid tissue in the cyst wall
which may encircles the cyst
 Germinal centers are usually, but not always, present.
Cyst lumen:
Desquamated epithelial cells seen filling the cyst lumen together with keratin
debris.

Fig. 33.left keratin-filled cyst below the mucosal surface. Lymphoid tissue is present in the cyst wall. right,
High-power view showing lymphoid tissue adjacent to the cystic lining.
Treatment:
Surgical excision with no recurrence.
Dermoid &Epidermoid Cysts
 Dermoid and epidermoid cysts are uncommon developmental cystic
malformation. Dermoid cysts are developmental cysts arising from
entrapped midline ectodermal tissue lined by epidermis with skin
appendages present in the fibrous wall.
 Epidermoid cysts are similar cysts lined by epidermis, but without
appendages.
 Dermoid cyst is considered teratomatous lesions but with less complexity
teratoma is a developmental tumor composed of tissue from more than one germ
layer and sometimes all three: 1) ectoderm, 2) mesoderm, and 3) endoderm.
Pathogenesis:
These lesions occur due to entrapment of totipotent blastomeres, which can
produce derivatives of all three germ layers.
Clinical features:
Age: They are most common in children and young adults
Gender: Male predilection
Site& Symptoms:
 Slowly growing painless swelling doughy or rubbery in consistency
retaining pitting after application of pressure
 Cysts above the geniohyoid muscle appear as sublingual swelling that
elevate the tongue toward the roof of the mouth fig.34 creating difficulty in
eating, speaking, or even breathing.
 Cysts that occur below the geniohyoid muscle produce submental swelling,
with a “double-chin” appearance.
Fig. 34. Dermoid Cyst. Fluctuant midline swelling in the floor of the mouth.
Radiographic features:
MRIs, CT scans, or contrast medium radiographs may be helpful in delineating
the extent of the lesion
Histopathologically:
Cyst lining: orthokeratinized stratified squamous epithelium with a prominent
granular cell layer.
Cyst wall:
 Dermoid cyst: The cyst wall is composed of fibrous connective tissue that
contains one or more skin appendages, such as sebaceous glands, hair
follicles, or sweat glands fig.35.
 epidermoid cyst: no skin appendages.
Cyst lumen: filled with keratin

Fig.35. Sublingual dermoid cyst, the cyst is lined by a thin orthokeratinizing epithelium like that of the skin
and a few islands of glandular epithelium lie in the wall. The lumen is filled by keratin flakes.
Treatment:
 Lesions above the geniohyoid muscle surgically removed by an intraoral
approach.
 Lesions below the geniohyoid muscle require an extraoral approach.
 Recurrence is uncommon.
 Mucous Retention
 It is a true developmental cyst that is lined by epithelium that is separate
from the adjacent normal salivary ducts.
 N.B: Cyst like dilatation of salivary ducts also may develop secondary to
ductal obstruction (e.g., mucus plug), which Creates increased intraluminal
pressure. Although some authors refer to such lesions as mucus retention
cysts, such lesions probably represent salivary ductal ectasia rather than a
true cyst.
Patients with prominent ectasia of the excretory ducts of many minor salivary
glands, their lesions have been termed “mucus retention cysts,” although they
probably represent multifocal ductal dilatation.
Pathogenesis:
Uncertain
Clinical features:
Age: occur in adults
Site: it arise either in major or minor glands.
 If arise in major gland so the parotid gland will be the most affected.
 If in arise in minor gland they develop in the floor of the mouth, buccal
mucosa, and lips sequentially.
Symptoms: asymptomatic slowly growing soft, fluctuant swelling that may
appear bluish, depending on the depth of the cyst below the surface fig.36.

Fig.36. Salivary Duct Cyst. Nodular swelling overlying Wharton duct.

Radiographic features: -ve
Histopathologically:
Cyst lining:
 The lining is variable may consist of cuboidal, columnar, or atrophic
squamous epithelium surrounding thin or mucoid secretions in the lumen
Fig.37.
 Unlike ductal ectasia which characterized by oncocytic metaplasia of the
epithelial lining
• Fig. 37. Salivary Duct Cyst. (Left) low-power photomicrograph showing a cyst below the mucosal
Surface, right high-power view of cystic cavity (top) lined by thin cuboidal epithelium. Adjacent to the cyst
is an excretory salivary gland duct lined by columnar epithelium (bottom)
Treatment:
 Isolated salivary duct cysts are treated by conservative surgical excision.
 In major glands, partial or total removal of the gland may be necessary.
 multifocal salivary ductal ectasia local excision of problematic swellings
only as surgical management is not feasible
 Systemic drugs used to relief the pain & stimulate the salivary flow to
prevent accumulation of mucus.
 PSEUDO CYTS
Mucous Extravsation
(MUCOCELE)

The mucocele is a common lesion of the oral mucosa, is not a considered as true
cyst as it lacks epithelial lining.
Pathogenesis:
Mucocele results from rupture of a salivary gland duct and spillage of mucin into
the surrounding soft tissues which may occur as a result of local trauma.
Clinical features:
Age: mucoceles have been reported in patients of all ages, but it is most common
in children and young adults, perhaps because younger people are more likely to
experience trauma that induces mucin spillage
Gender:
Site: lower lip lateral to the midline is the most common site for mucocele about
82% fig.38.
 Mucocele of the floor of mouth is called ranulas
 Superficial mucocele variant: are small single or multiple tense vesicles
they often burst, leaving shallow, painful ulcers that heal within a few days
(The pathologist must be aware of this lesion to avoid Misdiagnosing it as
a vesiculobullous lesion

Fig.38. Mucocele. Blue-pigmented nodule on the lower lip.

Symptoms:
Bluish translucent dome-shaped fluctuant mucosal swellings (deep mucoceles
may be normal in color)
Histopathologically:
The mucocele appear as an area of spilled mucin surrounded by a granulation
tissue response Fig.39.
The inflammation usually includes numerous foamy histiocytes(macrophages)
fig.40 .
In some cases, a ruptured salivary duct may be identified feeding into the area.

Fig.39. Mucocele. Mucin-filled cystlike cavity beneath the mucosal surface. Minor salivary glands are
present below and lateral to the spilled mucin.

.
Fig. 40. Extravasation mucocele. Higher power showing the lining of the mucin-filled space. Macrophages
are migrating into the mucin, and in phagocytosing it develop a foamy or vacuolated cytoplasm.
Treatment:
 Some mucoceles are short-lived lesions that rupture and heal by
themselves.
 Chronic mucoceles need local surgical excision together with any adjacent
minor salivary glands that may be feeding into the lesion to minimize the
risk of recurrence
 o Ranula
Ranula is a term used for mucoceles that occur in the floor of the mouth, arising
from the sublingual gland.
Clinical features:
Age: children and young adults
Site: floor of the mouth lateral to the midline
Symptoms: blue, dome-shaped, fluctuant swelling which can elevate the tongue.
NB: plunging or cervical ranula, occurs when the spilled mucin dissects through
the mylohyoid muscle and produces swelling within the neck.
Histopathologically:
Same of mucocele
Treatment:
Sublingual gland produces a continuous flow of mucus even in the absence of
neural stimulation, which accounts for its ability to produce a ranula after rupture
of one of its multiple ducts so Treatment of the ranula consists of removal of the
feeding sublingual gland to avoid recurrence.
Simple Bone Cyst
(Traumatic Bone Cyst; Hemorrhagic Bone Cyst)
The simple bone cyst is an empty or fluid-containing bone cavity. Because this
lesion lacks an epithelial lining, it represents a pseudocyst rather than a true cyst.
Pathogenesis:
The etiopathogenesis is uncertain, and several theories have been proposed.
Most accepted is the trauma-hemorrhage theory which proposed that trauma
that is insufficient to cause a bone fracture results in an intraosseous hematoma.
If the hematoma does not undergo organization and repair, it may liquefy and
result in a pseudocystic defect.
Clinical features:
Age: Most solitary bone cysts are diagnosed in young patients, with a peak in the
second decade
Gender: equal
Site: any bone in the body, but if it occurs in maxillofacial region it will show
marked mandibular predominance with premolar, molar, and symphyseal regions
being mostly affected.
Symptoms: jaw lesions tend to lack clinical signs or symptoms, discovered
incidentally during radiographic examination.
Radiographic features:
well-defined unilocular radiolucency that scalloped upward between the roots of
adjacent teeth fig.41.
NB: This feature is highly suggestive but not diagnostic of a simple bone cyst.
Fig.40.Panoramic film showing a large simple bone cyst of the showing scalloping at the superior aspect of
the cyst between the roots of the teeth.
Effect on surrounding:
Root resorption, loss of lamina dura, cortical expansion, and cortical thinning
may occur.
The adjacent teeth vitality isn’t affected.
NB: Simple bone cysts at times may arise in association with cemento-osseous
dysplasia and other fibroosseous proliferations. Such cases tend to occur in older
females
Histopathologically:
There is never an epithelial lining.
 The defect walls of are lined by a thin band of vascular fibrous connective
tissue Fig.42.
 In addition, there may be fibrin, scattered erythrocytes, occasional giant
cells, and dystrophic calcifications Fig. 43.
 The bony surface next to the cavity may show resorptive areas (Howship
lacunae) indicative of past osteoclastic activity.

Fig.42 Simple Bone Cyst. Photomicrograph of the bony wall of a simple bone cyst. A thin, vascular
connective tissue membrane is adjacent to the bone, and no epithelial lining is identified.
Fig.43. Simple Bone Cyst. Loose vascular connective tissue exhibiting areas of basophilic lacelike
calcification in the wall of a simple bone cyst.
Diagnosis & Treatment:
Surgical exploration is necessary to establish the diagnosis.
The diagnosis is based on correlating the clinical, radiographic& intraoperative
findings.
Intraoperative findings:
There is an empty cavity with smooth, shiny bony walls or the cavity contains
small amounts of serous fluid.
 Surgical exploration with or without curettage to induce bone regeneration.
 Periodic radiographic examination should be performed until complete
resolution.
Aneurysmal Bone Cyst
The aneurysmal bone cyst is an intraosseous accumulation of variable-sized,
blood-filled spaces surrounded by cellular fibrous connective tissue and reactive
bone.
Aneurysmal bone cysts may arise de novo (primary) or (secondary) arising in
association with another bone lesion.
Pathogenesis:
The etiopathogenesis is poorly understood. Many theories proposed to explain
the nature of the lesion; the Most accepted theory is a neoplasm may disrupt
normal osseous hemodynamics, resulting in an enlarging area of hemorrhage and
osteolysis as 20% to 30% of aneurysmal bone cysts form in association with
other lesions.
Clinical features:
Age: Aneurysmal bone cysts arise primarily in extragnathic bones, gnathic
lesions mainly affect young patients with peak incidence the second decade
Gender: no sex predilection
Site: posterior mandible most affected.
Symptoms: rapidly enlarging swelling. Pain is a variable.
Radiographic features:
unilocular or multilocular radiolucency, often with marked cortical expansion
which described as ballooning or “blow-out” distention of the affected bone and
thinning Fig.44.

Fig. 44. Aneurysmal Bone Cyst. A large radiolucent lesion involves most of the ascending ramus in a 5-
year-old white boy.
Histopathologically:
The aneurysmal bone cyst is characterized by blood-filled spaces of varying size
that lack an endothelial or epithelial lining Fig. 45.
The surrounding cellular fibroblastic tissue contains multinucleated giant cells
that exhibit an osteoclastic phenotype.
Osteoid deposits may appear linear, nodular, or lacelike.
NB: aneurysmal bone cysts may be associated with other pathoses, most
commonly fibro-osseous lesions or giant cell granulomas.

Fig.45. Aneurysmal Bone Cyst, blood-filled space surrounded by fibroblastic connective tissue. Scattered
multinucleated giant cells are seen adjacent to the vascular space
Effect on surrounding:
 Malocclusion, mobility, displacement or resorption of involved teeth may
be present.
 Maxillary lesions often bulge into the adjacent sinus and occasionally cause
nasal obstruction, nasal bleeding.
Treatment:
Curettage or enucleation, sometimes with cryosurgery to control bleeding.
 Static Bone Cyst
Latent Bone Cyst, Stafne’s Bone Cyst
It is not a true cyst but appears as a cystic area in x-ray, it considered ectopic
developmental condition
Ectopia: normal tissue in abnormal site.
Pathogenesis:
It is caused by developmental inclusion or entrapment of part from
submandibular salivary gland within or adjacent to the lingual surface of the
body of the mandible in a deep well defined depression.
Clinical features:
Asymptomatic discovered accidental during routine x-ray.
Radiographic features:

Fig.46.Rounded well defined radiolucent area below and inferior dental canal
Diagnosis:
Diagnosis is made by doing a sialogram (x-ray to salivary gland) using a
radiopaque material injected into the duct of submandibular gland
Treatment:
No treatment required.