CYSTIC LESIONS OF

OROFACIA REGIO
L N
CYST….DEFINITIO
N
Any epithelium lined pathological cavity
containing fluid or semifluid other than
pus
CLASSIFICATION
• ODONTOGENIC CYSTS: • NON ODONTOGENIC
Periapical (radicular) cysts CYSTS:
Lateral periodontal cysts Globulomaxillary cyst
Gingival cyst of newborn Nasolabial cyst
Dentigerous Media mandibular
Eruption
cyst cyst Nasoplatine canal cyst
n cyst
Glandular odontogenic
cyst
Odontogenic keratocyst • SOFT TISSUE CYSTS OF
NECK
Calcifying odontogenic Branchial cyst
• PSEUDOCYSTS: :
cyst
Aneurysmal bone Dermoid
cyst
Traumatic bone cyst cyst
Thyroglossal tract cyst
Static bone Cyst
Focal Osteoporotic bone
marrow defect
How a present
will patient …
• Patient may present with swellin
• expanding
Unerupte teeth g
•d
• Pain tooth
• Discolore trauma to
•d teeth
Pathological fracture of
mandible
History of
How you a
will
• History diagnose cyst?
• Clinical examination( extraoral/
• intraoral)
• Aspiration
Radiographic: PA, OPG, vie
• occlusal w
• CT scan for extensive lesions Laser
Tooth vitality tests: cold,
•
heat,
1
doppler flowmetry
.
2 Lab
. investigations:
Understandin followin terms
g g
1 MARSUPILIZATION:
. Creating a small window in the cyst wall
•
and
Advantage
• removal
s: of cystic
Lesser amount ofcontents.
surgery
• Saving vital structures if involved in
cyst
Disadvantag
es:
• second surgical procedure is required
to
• remove the cyst
• Cavity is present which needs to kept
clean
The whole epithelium is not available
e, rI
ENUCLEATION
• Removing the cyst lining as a
whole
Advantages: for
• The whole epithelial lining is
available histopath exam
• The surgery is curative
Diasadvantages: the jaw
leaving itmay
• Surgery weak and prone
involve large to
pathological
portions of
fractures
• Vitals structures may be
Enucleatio
n
 ENUCLEATIO WITH
N
PERIPHERAL OSTECTOMY
• Used for aggressive lesions.
• Enucleation is followed removal of all
remnants
possible from bony cavity by burs
means of
ENUCLEATIO WITH CHEMICA
N CAUTERIZATIONL
• Used for aggressive lesions
• Enucleation is followed by treating
with cornoys solution or liquid
nitrogen
PERIAPICAL (RADICULAR CYST)
• Most common cyst of orofacial
• region
Epithelial lining is derived proliferation rests of
from
• malassez within the PDL
60 -75%
INCIDENCE:
One third of all cysts 75%
cases
AGE DISTRIBUTION:
Third to sixth decade of
life
LOCATION:
Anterior maxilla, maxill ,
posterior region followed by a manmandibular
anterior
region in
descending order
ETIOLOGY/ PATHOGENESIS
Caries/trauma/ periodontal
disease

Pulpal
necrosis

Apical
boneinflammation
Dental granuloma
formation
Epithelial
proliferation

Periapical cyst
formation
MECHANISM CYS EXPANSIO
OF T N
• 3 mechanism by which cysts form and
expand
1 Hydrostatic mechanism…fluid ingress
. due to
2. increased osmotic pressure
Bone resorbing factors….prostaglandins,
3. interleukins, proteinases
Mural growth of surrounding epithelium
mechanis
m
• Bacterial antigen irritants from necrotic
and
• pulp capsule
• Inflammation of cell
• cyst infiltration
Cytokines eg interleukins-1
• Chronic
Either fibroblast proliferation
• inflammatory
Or prostaglandins collagenases
osteoclast formation pge2 pgf2 pgd
CLINICAL FEATURES
• They are usually
asymptomatic except
when they are
secondarily
• infected
They cause painless
• bone expansion
The involved .
tooth be
will
non vital / discoloured
or
• root canal treated.
When sufficient bone
expands, egg shell
• crackling will be
present.
Cyst may range few
 RADIOGRAPHIC VIEW
• Unilocular radiolucency
with
narrow opaque margins
continuous with the
lamina
• Differential diagnosis
dura of the involved tooth
1 Granuloma
. Traumatic bone
2 cyst
. Giant cell lesions
3 Odontogenic
. tumours
4
.
TREATMENT
• Options:
3 Extraction of teeth
1. with
2. periapical currettage
Root canal filling
3. followed by
apicectomy
Perform root canal and
4. wait for periapical
lesion to resolve (if
small)
If tooth is extracted
and lesion is not
removed, then
DENTIGEROUS CYSTS
• Second most cyst of the jaw 10
common 15%
• It is attached to the
tooth of the unerupte
crown
cementoenameld
the
junction and
ETIOLOGY / PATHOGENESIS:
It encloses
develops from of
proliferation
tooth
reduced enamel epithelium
Expansion of cyst occurs
from
hydrostatic mechanism and
release of bone resorbing
RADIOGRAPHIC FEATURES
• Lucency associated with
crown
of impacted tooth
• Third molars/canine teeth
most commonly affected.
SIGNS & SYMPTOMS:
Swelling
Pain
Unerupted tooth
DIFFERENTIAL DIAGNOSIS
• Odontogenic
• keratocysts
• Ameloblastoma
Odontogenic tumors
POSSIBLE COMPLICATION:
bone destruction
Resorption of roots
Displacement of teeth
Neoplastic transformation…
ameloblastoma…carcinoma
rarely
TREATMENT
• Removal of
adjacent tooth
and enucleation
of
cystic
content.
• Marsuplization to shrink the lining and
allow eruption of tooth.
ERUPTION CYST
• Results from fluid accumulation in the
follicular space around an erupting
• tooth
• With trauma, blood may fill up this
space
• No treatment is required , as cyst
• disintegrates with eruption of
• tooth ting on extra
Fluctuant bluish swelling
Pesent in both perm and
ODONTOGENIC KERATOCYST
• They are different from other cyst to
due an
aggressive nature, high recurrence d
rate
their association with basal cell
nevoid
ETIOLOGY:
syndrome.
They develop from dental lamina in
remnants
the maxilla and mandible
However, an origin from basal cells of
the
PATHOGENESIS
High proliferation
rate

Overexpression of protein Bcl-

antiapoptotic 2

Overexpression of matrix metalloproteas-es, MMP

2,9
Mutation of PTCH,overexpression of sonic
hedgehog
pathway , formation of smoothened protein
SUFU gene
mutation
CLINICAL FEATURES
• Age group involved
is of
second to third
• decade
• life.
Approx 5% of all
5-15%ofOKC
patients all cysts.
have basal cell
nevoid syndrome.
• More common in the
mandible, posterior
portion
of body and angle area
•
most commonly
BASA CEL NEVOID SYNDROM
L• MultipleLodontogenic cystsE
• Basal cell carcinomas on skin
• Frontal bossing, parietal
• bossing
• Spina
Mandibular bifid ribs
bifidaprognathism
• and
• Kyphoscoliosis
Calcified falx cerebri
• Palmer/planter keratosis
• Hypertelorism
• Also called gorlin goltz
syndrome
RADIOGRAPHIC FEATURES
• Multilocular
radiolucency is
• present
• With smooth margins
Resorption of roots
may be seen.
Diagnosis
• Two types of
1 orthokeratinized…. Less common, not
keratocysts:
. syndrome associated and lower
recurrence
2. rate
Parakeratinized… epithelial budding
and
daughter cysts, higher recurrence rate.
TREATMENT
• Surgical enucleation followed by peripheral

• osseous
currettage or ostectomy.
• Chemical cauterization
In some larger cysts can also be ca bewith
done don to
cornoys n e
marsupilization
solution/ liquid nitrogen.
reduce the size of the cyst.
RECURRENCE:
10-30% recurrence rate due
to; Daughter / satellite cysts
1
. Fragile lining
2 Epithelial proliferate rate is very high
. Production of bone resorbing factors
3 Finger like extension into cancellous
. bone
Inf standard of treatmen
4 pseudooccuren t
. ce
5
Lateral periodont cyst
al
• Cyst present beside a tooth and tooth is
• vital
Near the crest of ridge two types
 Botryoid glandul
 Most common in mandibubular ar premolar and
canine
area and have clear glycogen containing and
cell bud
 While glandularlike
hasproliferation
pools of mucous cells and
• mucin
Multilocular ,strong tendency
to recur,enucleation
NASOPALATINE DUCT CYST also called
median palatine, median alveolar, mid
palatine
• Presents as a swelling in the midline of anterior
palatine pappila
palate
• Patient may complain of salty discharge and
irritation
•
to the tongue
• On radiograph, heart shaped radiolucency is
present
• greater than 6 mm. Divergence of the roots is
seen
•
It is believed to arise from the remnants of
nasopalatine duct within the incisive canal.
Stimulus for cyst formation is either bacterial
NASOLABIAL CYST
• It appears as a
swelling
in the nasolabial fold
• and upper lip,bilateral
The swelling is
painless unless
• infected,distorts
nostrils
It is a soft tissue
• swelling so not
visible
radiographically
• It is believed to arise
from remnants of
Concep of fissural cysts
t
• Globulomaxillary, midline mandibular
cysts
were initially thought as cysts arising
from
• epithelial residues trapped in the line of
fusion
• However new concept has changed in
these views.
These cysts may actually be any
other cyst the making.
 PSEUDOCYSTS
ANEURYSMA BON CYS
L like cysts but
• Appear E not lined
T by
epithelium
• 40 % are in mandible, 25% in maxilla
Etiology: appear
association to be abone
with primary reactive lesion,
lesions
in
like
fibrous dysplasia, CGCG etc with
Clinical Features: 10
female predilection young
20yrs of age
patients(<30
The posterior yr)
regions are involved
mostly
No bruit on auscultation
Radiographi features
c• Presence of a destructive , osteolytic
lesion
• with slightly irregular margins.
• Multilocular pattern ,soap bubble
appearance,
Teeth may be
Differential displaced with/
Diagnosis: OKC, without
Giant cell
lesions,
external root
odontogenic resorption
tumors
Histopathology: Giant cell lesions, with
bloodsinusoids
filled
Treatment: excision with cryotherapy is
the
treatment of
 TRAUMATIC BONE CYSTS
Traumatic bone cyst is pseudocyst that is a
actually empty bony cavity n
Etiology: usually associated with trauma.
• Hypothesis is that hematoma
develops..clot
• breaks down…empty
Other theories bone cavity
are cystic of tumors
degeneration ,
disorders of calcium metabolism
Clinical
Features: females are usually
Teenagers
involved
Mandible is the commonest site.
Rarely
bilateral lesions are present. bone
Radiographi Features
c
Radiolucency
withscalloping is
irregular margins.
present
 Cyst expands b/w
Interradicular
roots
of teeth
 Much larger
radiolucency than
size
of
swelling
Treatment:
 STATIC BONE CYST
• This is anatomic indentation of the
posterior
lingual mandible that appears as a cyst
• on
radiograph
• It may also be due to entrapment of
the salivary gland tissue during
development
Location:
• ItLocated
may also be due to
bilaterally in hyperplastic
the mandible
• salivary
Oval radiolucency below the inferior
gland tissue
alveolar canal
Clinical Features: No symptoms, no
FOCAL OSTEOPOROTIC BONE
MARROW DEFECT
• Uncommon asymptomatic radiolucencies
where
hematopoiesis is see normally(angle of
mandible,maxillary
1 one theory statestuberosity)
that abnormal healing
•. Pathogenesis is unknown,
following tooth extraction
2. Another theory states that residual
remnants
3.
of fetal marrow may persist
It may be a focus of extramedullary
No hematopoiesis that becomes
 SOFT TISSUE CYSTS OF
OROFACIAL/NECK REGION
DERMOI CYS
•D T
It is a developmental cyst. In the orofacial
region, it occurs in the midline of the floor
• of

• mouth
If it occurs below the mylohyoid, it
• becomes
• swelling
Most commonin the location
neck is the midline of floor
All lesions(may
themouth
of are soft andrespiratory
cause doughy
because of
obstruction
•
keratinlarge).
when and sebum.
THYROGLOSSAL DUCT CYST
• Most common developmental cyst of the
• neck
The basis for this pathology is thyroid gland
• development.
Derivatives of first and second branchial
arches
• form the posterior portion of tongue. Thyroid
tissue grows downwards from the foreman
• Moves
caecumwith swallowing
to its permanentand protrusion
location of
in the ,
tongue
neck
• if attached to the hyoid bone or tongue.
It occur anywhere along the thyroglossal
Surgical excision is the treatment, but
duct
before
tract.
BRANCHIAL CYST
• These are developmental cysts located in
the
lateral portions of the neck, anterior to
• the
Floor of mouth is also common
•asternomastoid. sitethey are
Current theory states that
formed
• of epithelial entrapment within lymph
nodes
• Soft fluctuant in nature. May have a
draining sinus
Excision is the treatment of choice.
D/D of floor of mout lesion
h s
• Ranula
• Dermoid cyst
• Lymphangioma
• Salivary gland
• tumor
• Sialadenitis/
• sialolith
Mesenchymal
tumors
lymphomas
 D/D of Palata Swelling
• Tori
l s
• Palatal abscess
• Radicular cyst
• Dentigerous cyst
• Mucous
retention cyst
• Salivary gland
• tumor
Tumors from the
• max sinus
Patient presents with swelling of
left
buccal OPG shows
sulcus. radiolucent
lesion incyst? ramus• Early
• Radicular area. D/D
ossifying
angle
• Dentigerous cyst • fibroma
• Odontogenic Giant celltotumor
anterior if
1st mola
• keratocyst • Brown’s r
• Static bone cyst • tumor very
• Aneurysmal cyst Osteosarcom
• Traumatic cyst a
• Ameloblastoma uncommon
• Odontogenic myxoma
Ameloblastic fibroma