Cysts of the Jaws & Oral Soft Tissues

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ORAL PATHOLOGY

Transcript of Cysts of the Jaws & Oral Soft Tissues

Page 1: Cysts of the Jaws & Oral Soft Tissues

ORAL PATHOLOGY

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Odontogenic cysts Non- odontogenic cysts

1) Developmental cysts

- Odontogenic keratocyst- Dentigerous cysts- Eruption cysts- Lateral periodontal cyst- Gingival cyst- Glandular odontogenic cyst

2) Inflammation cysts

- Radicular cyst (dental cyst)• Apical• Lateral• Residual

- Paradental cyst

1) Nasopalatine duct cyst2) Nasolabial cyst3) Median cyst

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Odontogenic cysts- The epithelial lining is derived from

epithelial residues of the tooth-forming organ.

- Can be subdivided into inflammatory & developmental depending on aetiology.

Non-odontogenic cysts- The epithelial lining is derived from

sources other than the tooth-forming organ.

Odontogenic cysts- The epithelial lining is derived from

epithelial residues of the tooth-forming organ.

- Can be subdivided into inflammatory & developmental depending on aetiology.

Non-odontogenic cysts- The epithelial lining is derived from

sources other than the tooth-forming organ.

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o Dental lamina rests/ glands of Serres- Odontogenic keratocyst- Lateral periodontal cyst- Gingival cyst

o Reduced enamel epithelium- Dentigerous cyst- Eruption cyst- Paradental cyst

o Rests of Malassez – formed by fragmentation of the epithelial root sheath of Hertwig.

- Radicular cyst

Some may also from the same originSome may also from the same origin

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ODONTOGENIC CYSTS

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Bimodal age distribution – 2nd – 3rd decades & 5th decades.

More common in males than females.

70 – 80 % occur in the mandible than maxilla.

Most common site: 3rd molar region & ascending ramus.

Few symptoms; cause little expansion but may reach large size without causing gross bony expansion.

Enlarge predominantly in anteroposterior region.

Majority arise sporadically & present as solitary lesions.

Unilocular/ multilocular, well-defined radiolucency; may mimic dentigerous cyst.

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Hisopatology

Thin, easily torn wallLined by an even layer of

parakeratinized squamous epithelium.

Palisaded basal cell layerContains keratinous debris.Setellite cysts in capsule.

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Multiple cyst associated with naevoid basal carcinoma syndrome – Gorlin syndrome.

Features of Gorlin syndrome:

- Skin - multiple naevoid basal cell carcinoma, appear around age of puberty.

- Oral – multiple odontogenic keratocyst.- Skeletal – rib anomalies, vertebral

deformities, cleft palate/lip.- CNS – calcified falx cerebri, brain tumour.

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Encloses part/ all of the crown of an unerupted tooth.

Lined by thin non-keratinizng squamous epithelium, often shows mucous cell metaplasia.

Attached to amelocemental junction & arises in the follicular tissues covering the fully formed crown of unerupted tooth.

An eruption cyst is a true dentigerous cyst which arises in an extra-alveolar location.

Common in males than females. Common in mandible than maxilla.

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Frequently involve teeth which are commonly impacted or erupt late.

Majority: mandibular 3rd molar, maxillary permanent canines, maxillary 3rd molar & mandibular premolar. (in order of decreasing)

Painless unless there is secondary inflammation.

Radiographically, well-defined unilocular radiolucency associated with the crown of unerupted tooth.

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Involve both deciduous & permanent dentitions.

Present as fluctuant swellings on alveolar mucosa & are often bluish in color because arise in an extra-alveolar location.

Trauma result in hemorrhage into cyst cavity.

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Common in neonates & often referred to as Bohn’s nodules or Epstein’s pearls.

Most disappear spontaneously by 3 months of age.

Arise from remnants of dental lamina which proliferate to form small keratinizing cysts.

In adults are rare. Most represent developmental of lateral

periodontal cyst arise in an extra-alveolar location.

Frequently in females in interpremolar region of mandible.

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Uncommon lesion Associated with non-vital tooth Mainly in canine & premolar region of the

mandible Middle aged patients Radiographically, well-defined radiolucent

area with sclerotic margins. Lined by non-keratinized squamous

/cuboidal epithelium Multilocular, ‘botryoid’ – resemblance to a

bunch of grapes (botryoid odontogenic cyst)

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Rare Developmental odontogenic cyst Most in anterior part of the mandible Slow growing, painless unilocular/

multilocular radiolucency. Lined by epithelium of varying

thickness with a superficial layer of columnar or cuboidal cells & occasional mucous cells.

Potentially aggressive, locally invasive & tendency to recur.

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ODONTOGENIC CYSTS

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Subdivided into 3 depending on anatomical relationship to the root of the tooth;

- Apical- Lateral- Residual

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Develop within apical granulomas.Lining derives from rests of

Malassez.Lined by non-keratinizing squamous

epithelium.Supported by a chronically

inflammed capsule.Contains variable but hypertonic.Capsule may contain cholesterole.

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Apical radicular cyst most common cystic lesions in the jaws Associated with apices of non-vital teeth. 75% of all radicular cysts. Arise in any age after tooth eruption but

rare in deciduous dentition. Most common between 20 & 60 years of

age. Radiographically, apical cyst present as a

round/ovoid radiolucency at the root apex.

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Arise alongside a partly erupted 3rd molar involved in pericoronitis.

Most common in mandible & most buccally/ distobucally located.

Teeth associated with this cyst show enamel spur extending from the buccal cervical margin to the root furcation.

Radiographically, well-defined radiolucency related to the neck of the tooth & the coronal third of the root.

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Commonest of non-odontogenic cyst Arise from epithelial remnants of the

nasopalatine duct which connects the oral & nasal cavities in the embryo.

Commonly in 5th & 6th decades Males more in females May asymptomatic, pain due to

secondarily inflammed. Slowly enlarging swelling in the anterior

region of midline of the palate. Discharges – salty taste.

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Most originate within the soft tissue of the incisive papilla.

Radiographically, well-defined round, oval, ovoid, heart-shape radiolucency, with sclerotic rim.

Usually symmetrical. Radiolucency not more than 6mm may

considered within normal limits. Must differentiated with radicular cyst of

present of standing teeth.

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Lined by stratified squamous epithelium, pseudostratified ciliated columnar epithelium, containing mucous cell, cuboidal epithelium, or columnar epithelium may see alone or in combination.

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Rare Arise from remnants of the lower part of

embryonic origin. Arises in soft tissue of the upper lip just

below the ala of the nose. Regarded as fissural lesions. May arise bilaterally Majority present in 4th decade & over 75%

occur in women. Lined by pseudostratified columnar

epithelium but stratified squamous epithelium, mucous cells & ciliated cells may also appear.

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RareOccur in palate/ mandible is

uncertainSome may represent displaced

nasopalatine duct cyst.Very likely that median cyst of the

mandible are of odontogenic origin.

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CYST NASOPALATINE DUCT CYST NASOLABIAL CYST

AGE 4 – 6 decades 4 – 5 decades

GENDER > M > F

SITE Anterior palate Upper lip

SYMPTOMS Swelling on midline of palate, pain, discharge (salty taste), mostly asymptomatic

Painless except infected

RADIOGRAPH Well-circumscribed radiolucency in/near the midline of anterior maxilla between & apical to the central incisor.Round, oral/liver/pear/heart-shaped with sclerotic rim

Well-circumscribed, unilocular radiolucency/ apical to the teeth.

HISTOLOGY Pseudostratified columnar, simple squamous, cuboidal, columnar epithelium, goblet cell & cilia

Pseudostratified columnar epithelium, goblet cell & cilia

TREATMENT Surgical enucleation, biopsy before treatment

Surgical enucleation

RECURRENCE Seldom occur Rarely recur