Cysts of oral region (5)

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Cysts of oral region (5)

  1. 1. CYSTS OFORAL REGION Prepared by: Dr. Rea Corpuz
  2. 2. Cysts pathological cavity often fluid filled lined by epithelium in many instances, exact pathogenesis of these lesions is still uncertain
  3. 3. 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
  4. 4. Cysts of Oral Region (1) Odontogenic Cysts (2) Non-odontogenic Cysts
  5. 5. Cysts of Oral Region (1) Odontogenic Cysts  (a) Radicular Cyst  (b) Dentigerous Cyst  (c) Primordial Cyst  (d) Odontogenic Keratocyst  (e) Lateral Periodontal Cyst
  6. 6. Cysts of Oral Region (2) Non-Odontogenic Cysts  (a) Globulomaxillary Cyst  (b) Nasolabial Cyst  (c) Median Palatal Cyst  (d) Nasopalatine Canal Cyst
  7. 7. (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
  8. 8. (1) Odontogenic Cyst (Radicular Cyst) 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
  9. 9. (1) Odontogenic Cyst (Radicular Cyst) Clinical Features  asymptomatic  present no clinical evidence of their presence  seldom painful or even sensitive to percussion
  10. 10. (1) Odontogenic Cyst (Radicular Cyst) Clinical Features  represents chronic inflammatory process • develops only over a long period of time
  11. 11. (1) Odontogenic Cyst (Radicular Cyst) 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
  12. 12. (1) Odontogenic Cyst (Radicular Cyst) Radiographic Features  occasionally, exhibits thin, radioopaque line around the periphery of radiolucent area • indicates reaction of bone to slowly expanding mass
  13. 13. (1) Odontogenic Cyst (Radicular Cyst) Radiographic Features
  14. 14. (1) Odontogenic Cyst (Radicular Cyst) Histologic Features  epithelium lining apical periodontal cyst is usually stratified squamous in type
  15. 15. (1) Odontogenic Cyst (Radicular Cyst) Treatment & Prognosis  similar to periapical granuloma • involved tooth may be removed • periapical tissue carefully curetted
  16. 16. (1) Odontogenic Cyst (Radicular Cyst) Treatment & Prognosis  under some condition; • root canal therapy • with apicoectomy of cystic lesion
  17. 17. (1) Odontogenic Cyst (Radicular Cyst)
  18. 18. (1) Odontogenic Cyst (Dentigerous Cyst) also known as Follicular Cyst 2nd most common type of odontogenic cyst most common developmental cyst of the jaws
  19. 19. (1) Odontogenic Cyst (Dentigerous Cyst) attached to tooth cervix (enamel-cementum junction) encloses crown of unerupted tooth
  20. 20. (1) Odontogenic Cyst (Dentigerous Cyst) Etiology  develops from proliferation of enamel organ remnant or reduced enamel epithelium  related to epithelial proliferation
  21. 21. (1) Odontogenic Cyst (Dentigerous Cyst) Etiology  release of bone-resorbing factors  increase in cyst fluid osmolality
  22. 22. (1) Odontogenic Cyst (Dentigerous Cyst) Clinical Features  commonly seen in association most with 3rd molars commonly impacted  maxillary canines teeth
  23. 23. (1) Odontogenic Cyst (Dentigerous Cyst) Clinical Features  greater incidence in males  symptoms are generally absent  delayed eruption being the most common indication of dentigerous cyst formation
  24. 24. (1) Odontogenic Cyst (Dentigerous Cyst) Radiographic Features  well-defined  unilocular or ocassionally mutilocular radiolucency with coricated margins  associated with crown of unerupted tooth
  25. 25. (1) Odontogenic Cyst (Dentigerous Cyst) Radiographic Features  unerupted tooth is often displaced
  26. 26. (1) Odontogenic Cyst (Dentigerous Cyst) Radiographic Features  mandible • radiolucency may extend superiorly from 3rd molar site into ramus • anteriorly + inferiorly along body of mandible
  27. 27. (1) Odontogenic Cyst (Dentigerous Cyst) Radiographic Features  maxilla • if involving canine region extends into maxillary sinus • or orbital floor may be noted
  28. 28. (1) Odontogenic Cyst (Dentigerous Cyst) Radiographic Features  resorption of roots of adjacent erupted teeth may ocassionally be seen
  29. 29. (1) Odontogenic Cyst (Dentigerous Cyst) Treatment  removal of associated tooth  enucleation of soft tissue component
  30. 30. (1) Odontogenic Cyst (Dentigerous Cyst) Treatment  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
  31. 31. (1) Odontogenic Cyst (Primordial Cyst) arises from cystic changes in developing tooth bud before formation of enamel + dentin matrix
  32. 32. (1) Odontogenic Cyst (Primordial Cyst) since it arise from tooth bud, tooth will be missing from dental arch unless cyst arose from supernumerary tooth
  33. 33. (1) Odontogenic Cyst (Primordial Cyst) usually found in children + young adults between 10 years and 30 years of age
  34. 34. (1) Odontogenic Cyst (Primordial Cyst) 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
  35. 35. (1) Odontogenic Cyst (Primordial Cyst) Radiographic Features  unilocular or multilocular  seen below or between roots or near to alveolar ridge
  36. 36. (1) Odontogenic Cyst (Primordial Cyst) Treatment  Radical Surgery • curretage of bone
  37. 37. (1) Odontogenic Cyst (Odontogenic Keratocyst) may exhibit aggressive clinical behavior significant recurrent rate associated with nevoid basal cell carcinoma syndrome
  38. 38. (1) Odontogenic Cyst (Odontogenic Keratocyst) found anywhere in jaws can radiographically mimic other types of cysts
  39. 39. (1) Odontogenic Cyst (Odontogenic Keratocyst) Etiology  develop from dental lamina remnants in mandible + maxilla
  40. 40. (1) Odontogenic Cyst (Odontogenic Keratocyst) Clinical Features  common jaw cysts  occur in any age  peak incidence within 2nd-3rd decades of life
  41. 41. (1) Odontogenic Cyst (Odontogenic Keratocyst) Clinical Features  mandible • posterior portion of body commonly affected • ramus region  maxilla • 3rd molar area
  42. 42. (1) Odontogenic Cyst (Odontogenic Keratocyst) Radiographic Features  well-circumscribed radiolucency  with smooth radiopaque margins  most lesions are unilocular
  43. 43. (1) Odontogenic Cyst (Odontogenic Keratocyst) Radiographic Features  40% was noted to be adjacent to crown of unerupted teeth  buccal + lingual enlargements occasionally seen
  44. 44. (1) Odontogenic Cyst (Odontogenic Keratocyst) Treatment & Prognosis  surgical excision with peripheral osseous curettage  ostectomy
  45. 45. (1) Odontogenic Cyst (Odontogenic Keratocyst) Treatment & Prognosis  follow up examinations are important due to recurrence rate  most recurrence become clinically evident within 5 years of treatment
  46. 46. (1) Odontogenic Cyst (Lateral Periodontal Cyst) nonkeratinized developemental cyst occur adjacent or lateral to root of tooth
  47. 47. (1) Odontogenic Cyst (Lateral Periodontal Cyst) Etiology  believed to be related to proliferation of rests of dental lamina
  48. 48. (1) Odontogenic Cyst (Lateral Periodontal Cyst) Clinical Features  occur in mandibular premolar + cuspid region  occasionally in incisor area  in maxilla • primarily in lateral incisor region
  49. 49. (1) Odontogenic Cyst (Lateral Periodontal Cyst) Clinical Features  male predilection  range 20-85 years old  asymptomatic  well-delineated
  50. 50. (1) Odontogenic Cyst (Lateral Periodontal Cyst) Radiographic Features  round  teardrop-shaped unilocular (and occasionally multilocular) radiolucency with opaque margin along lateral surface of vital tooth root
  51. 51. (1) Odontogenic Cyst (Lateral Periodontal Cyst) Radiographic Features
  52. 52. (1) Odontogenic Cyst (Lateral Periodontal Cyst) Radiographic Features
  53. 53. (1) Odontogenic Cyst (Lateral Periodontal Cyst) Radiographic Features
  54. 54. (1) Odontogenic Cyst (Lateral Periodontal Cyst) Treatment & Prognosis  local excision  follow-up is suggested for treated multilocular odontogenic cysts
  55. 55. (1) Odontogenic Cyst (Lateral Periodontal Cyst) Treatment & Prognosis
  56. 56. (2) Non- Odontogenic Cyst (Globulomaxillary Cyst) between lateral incisor + canine teeth many are lined by inflamed stratified squamous epithelium
  57. 57. (2) Non- Odontogenic Cyst (Globulomaxillary Cyst) between lateral incisor + canine teeth many are lined by inflamed stratified squamous epithelium
  58. 58. (2) Non- Odontogenic Cyst (Globulomaxillary Cyst) Radiographic Features
  59. 59. (2) Non- Odontogenic Cyst (Nasolabial Cyst) rare developmental cyst occurs in upper lip  lateral to midline pathogenesis is uncertain
  60. 60. (2) Non- Odontogenic Cyst (Nasolabial Cyst) 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
  61. 61. (2) Non- Odontogenic Cyst (Nasolabial Cyst) 2 theories  2nd theory: cyst develop from misplaced epithelium of nasolacrimal duct • due to similar location • similar histologic appearance
  62. 62. (2) Non- Odontogenic Cyst (Nasolabial Cyst) 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
  63. 63. (2) Non- Odontogenic Cyst (Nasolabial Cyst) Clinical Features  on occasion, expansion may result in: • nasal obstruction • interfere with wearing of denture  pain is uncommon
  64. 64. (2) Non- Odontogenic Cyst (Nasolabial Cyst) Clinical Features  cyst may rupture spontaneously • may drain into oral or nasal cavity
  65. 65. (2) Non- Odontogenic Cyst (Nasolabial Cyst) Clinical Features  commonly seen in adults  peak prevalence in 4th-5th decades of life  significant predilection for women
  66. 66. (2) Non- Odontogenic Cyst (Nasolabial Cyst) Radiographic Features  cyst arises in soft tissues  most cases no radiographic changes are seen  pressure resorption of underlying bone may occur
  67. 67. (2) Non- Odontogenic Cyst (Nasolabial Cyst) 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
  68. 68. (2) Non- Odontogenic Cyst (Nasolabial Cyst) Treatment & Prognosis
  69. 69. (2) Non- Odontogenic Cyst (Nasolabial Cyst) Treatment & Prognosis
  70. 70. (2) Non- Odontogenic Cyst (Median Palatal Cyst) rare fissural cyst develops from epithelium entrapped along embryonic line of fusion of lateral palatal shelves of maxilla
  71. 71. (2) Non- Odontogenic Cyst (Median Palatal Cyst) Clinical Features  firm or fluctuant swelling of midline of hard palate posterior to palatine papilla  most frequently in young adults  often asymptomatic
  72. 72. (2) Non- Odontogenic Cyst (Median Palatal Cyst) Clinical Features  some complain of pain or expansion  average size is 2 x 2 cm, sometimes it can be quite large
  73. 73. (2) Non- Odontogenic Cyst (Median Palatal Cyst) Clinical Features  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
  74. 74. (2) Non- Odontogenic Cyst (Median Palatal 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
  75. 75. (2) Non- Odontogenic Cyst (Median Palatal Cyst) Treatment  surgical removal  recurrence should not be expected
  76. 76. (2) 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
  77. 77. (2) Non- Odontogenic Cyst (Nasopalatine Duct Cyst) believed to arise from remnants of nasopalatine duct  normally degenerate in humans but may leave epithelial remnants behind in incisive canals
  78. 78. (2) Non- Odontogenic Cyst (Nasopalatine Duct Cyst) Clinical Features  almost any age  most common in 4th-6th decades of life  swelling of anterior palate  drainage  pain
  79. 79. (2) Non- Odontogenic Cyst (Nasopalatine Duct Cyst) Clinical Features  asymptomatic  discovered on routine radiographs
  80. 80. (2) Non- Odontogenic Cyst (Nasopalatine Duct Cyst) Clinical Features  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
  81. 81. (2) Non- Odontogenic Cyst (Nasopalatine Duct Cyst) Radiographic Features  well-circumscribed radiolucency in or near midline of anterior maxilla • between apical to central incisor
  82. 82. (2) Non- Odontogenic Cyst (Nasopalatine Duct Cyst) Radiographic Features  root resorption is rarely noted  lesion most often is round or oval with a sclerotic border
  83. 83. (2) Non- Odontogenic Cyst (Nasopalatine Duct Cyst) Radiographic Features  some cases, a classic heart shape • result of superimposition of nasal spine • OR because they are notched by nasal septum
  84. 84. (2) Non- Odontogenic Cyst (Nasopalatine Duct Cyst) Radiographic Features  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
  85. 85. (2) Non- Odontogenic Cyst (Nasopalatine Duct Cyst) Radiographic Features  radiolucency thatis 6 cm or smaller in this area is usually considered a normal foramen  unless other clinical signs or symptoms are present
  86. 86. (2) Non- Odontogenic Cyst (Nasopalatine Duct Cyst) Treatment & Prognosis  surgical enucleation  biopsy is recommended • because lesion is not diagnostic radiographically • benign + malignant lesions have been known to mimic nasopalatine duct cyst
  87. 87. (2) Non- Odontogenic Cyst (Nasopalatine Duct Cyst) Treatment & Prognosis  palatal flap reflected after incision • made along lingual gingival margin of anterior maxillary teeth  recurrence is rare
  88. 88. 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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