Cysts In The Oral Cavity

Regions

By: Naz Noori BurhanOral surgery 5th GradeGroup E

DefinitionCyst is defined as pathologic cavity having fluid,

semifluid, or gaseous contents and which is not created

by accumulation of pus.

Cysts are a reaction of the body to a condition and are

usually relatively slow growing. They can be sterile or

become infected.

TYPES OF CYSTS TRUE CYSTS: that which is lined by epithelium e.g dentigerous

cyst, radicular cyst etc.

PSEUDO CYSTS: not lined by epithelium, e.g. Solitary bone cyst, Aneurismal bone cyst etc

Classification

Cysts of oral region

Epithelial Lined

Odontogenic

Developmental Inflammatory

Nonodontogenic

Non Epithelial Lined

52.30%

18.10%

11.60%

8%

5.60%

4.20% SHEAR 2006 Radicular cyst

Dentigerous cyst

Odontogenic keratocyst

Residual cyst

Paradental cyst

Unclassified odontogenic cysts

Frequency Of Epithelial Cysts Of Oral Region

CLASSIFICATION OF JAW CYSTS:

A.ODONTOGENIC: DEVELOPMENTAL

Odontogenic keratocyst.

Dentigerous cyst.

Eruption cyst.

Gingival cyst of infants.

Gingival cyst of adults.

Lateral periodontal cyst.

Calcifying odontogenic cyst.

Glandular odontogenic cyst.

INFLAMMATORY

Radicular.

Residual.

Paradental.

B.NON ODONTOGENIC

Nasopalatine duct.

Nasolabial cyst.

Globulomaxillary cyst.

Radicular ( Periapical ) cyst The most common odontogenic cyst of inflammatory origin.

Related to apex of non-vital tooth. More common in anterior of maxilla , small cyst asymptomatic .

Pain if infected with sinus

Paresthesia and pathological fracture

Differential diagnosis: Periapical granuloma.

Periapical abscess .

Cementblastoma.

Traumatic bone cyst .

RESIDUAL CYST

Residual cyst are retained periapical cysts from teeth that have

been removed.

Usually asymptomatic, In both jaws but more in the mandible If

residual cyst remains untreated, continued growth can cause

significant bone resorption and weakening of the mandible or

maxilla.

Paradental cyst

A cyst of inflammatory origin- occurring on lateral aspect of

root of partially erupted mandibular 3rd molar with an

associated history of pericoronitis

Age: 20-40 years

Tooth is vital

Facial swelling

Facial sinus in some cases

Odontogenic kerato cyst

OKC is a cyst containing keratin and lined with keratinized epithelium.

OKC’s arises from cell rests of the dental lamina.

Ocure at any age More frequently in males than in females,.

Mandible: posterior portion of body & ramus.

Maxila: 3rd molar area.

DENTIGEROUS CYST Defined as cyst originating after crown of a tooth is

completely formed, by accumulation of fluid between reduced dental epithelium and tooth substance.

Encloses crown of impacted / unerupted tooth and is attached to its neck.

Dentigerous cyst occurring in soft tissues, instead of bone.

Mandibular 3rd molar, maxillary canine and maxillary 3rd molars.

3 types:

Central

Lateral

Circumferential

ERUPTION CYST Eruption cyst is defined as an odontogenic cyst that

surrounds a tooth crown which has erupted through bone but not soft tissue and is clinically visible as a soft fluctuant mass on the alveolar ridges

found in children of different ages, and occasionally

in adults if there is delayed eruption

SITE : most commonly associated with the first permanent, molars and the maxillary incisors.

GINGIVAL CYST A small developmental odontogenic cyst of the gingival soft

tissue derived from the rests of the dental lamina

Slowly enlarging, well circumscribed painless swelling.

on facial aspect of free / attached gingiva and gingival papilla.

Site: mandibular bicuspid/cuspid/incisor area.

DIFFERENTIAL DIAGNOSIS:

Lateral periodontal cyst.

Lateral periodontal cyst Uncommon intra-osseous odontogenic cyst similar to gingival

cyst of adult

It’s derived from rest of dental lamina

Lateral to the root surface of erupted tooth

Differential diagnosis:Middle age patient ,Both mandible and maxilla

Canine and premolar of mandible ,Near the crest of ridge

Asymptomatic, May produce bone expansion and pain

Tooth is vital .Cyst less than 1 cm.

Nasopalatine (FISSURAL CYSTS)Nasopalatine canal usually contains remnants of the

nasopalatine duct, a primitive organ of smell, and the nasopalatine vessels and nerves. forms in the nasopalatine canal,, Pressure of cyst on adjacent nasopalatine nerve may cause burning sensation or numbness over palatal mucosa.

Asymptomatic

If extends posteriorly involving hard palate

(MEDIAN PALATAL CYST)

if expands anteriorly between central incisors,destroying or expanding labial plate of bone and causing teeth to diverge MEDIAN ANTERI OR MAXILLARY CYST

Nasopalatine

Simple/Solitary Bone CystTraumatic bone cyst , or hemorrhagic bone cyst.

Children and adolescent, Mandibular premolar and molar ,rarely in maxilla

Painless swelling ,Round radio-lucent and less sharply defined

Bony wall lined by thin loose C.T.

Treatment

Cysts of the jaws are treated in one of the following four basic methods:

(1) Enucleation,

(2) Marsupialization,

(3) A staged combination of the two procedures, and

(4) Enucleation with curettage.

1. Enucleation

Enucleation: This technique involves complete removal of

the cystic sac and healing of the wound by primary intention.

This is the most satisfactory method of treatment of a cyst

and is indicated in all cases where cysts are involved, whose

wall may be removed without damaging adjacent teeth and

other anatomic structures.

The surgical procedure for treatment of a cystwith enucleation includes the following steps:

1. Reflection of a mucoperiosteal flap.2. Removal of bone and exposure of part of the cyst.3. Enucleation of the cystic sac.4. Care of the wound and suturing.

Enuculation

Surgical removal the of the cyst

2.Marsupialization

This method is usually employed for the removal of large cysts

by opening a surgical window above the lesion.

A circular incision is made, which includes the mucoperiosteum,

the underlying perforated (usually) bone, and the respective

wall of the cystic sac.

Then the contents of the cyst are evacuated, and interrupted

sutures are placed around the periphery of the cyst , suturing

the mucoperiosteum and the cystic wall together.

Afterwards, the cystic cavity is irrigated with saline solution and

packed with iodoform gauze.

Technique of Marsupiaiization

1) Anesthesia.

2) Aspiration.

3) Incision.

4) Removal of bone.

5) Removal of cystic lining specimen.

6) Visual examination of residual cystic lining.

7) Irrigation of cystic cavity.

8) Suturing Cystic lining sutured with the edge of oral mucosa.

Marsupialization method. Circular incision

includes mucosa and periosteum.

Exposure of buccal cortical plate and

removal of portion of bone with round bur

Exposure of cyst

after removal of

bone

Suturing of wound

margins with cystic

wall

Packing of cystic

cavity with iodoform

gauze

Cystic cavity after

insertion of gauze

Marsupialization

Refrences

http://en.wikipedia.org/wiki/Cysts_of_the_jaws

http://www.gorlingroup.org/jupgrade/index.php/about-gorlin-

syndrome/11-jaw-cysts

http://www.slideshare.net/makkahguys/jaw-bone-

chttp://www.slideshare.net/JanmiPascual/cysts-of-oral-

region-5?related=1yst

https://www.bestdentistguide.com/oral-cysts