Cysts of oral region (5)

CYSTS OF
ORAL REGION

Prepared by:
Dr. Rea Corpuz

Cysts

 pathological cavity

 often fluid filled lined by
epithelium

 in many instances, exact
pathogenesis of these lesions is
still uncertain

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

Cysts of Oral Region

 (1) Odontogenic Cysts

 (2) Non-odontogenic Cysts


 (1) Odontogenic Cysts

 (a) Radicular Cyst

 (b) Dentigerous Cyst

 (c) Primordial Cyst

 (d) Odontogenic Keratocyst

 (e) Lateral Periodontal Cyst


 (2) Non-Odontogenic Cysts

 (a) Globulomaxillary Cyst

 (b) Nasolabial Cyst

 (c) Median Palatal Cyst

 (d) Nasopalatine Canal Cyst

(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

(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

(Radicular Cyst)
 Clinical Features

 asymptomatic

 present no clinical evidence
of their presence

 seldom painful or even
sensitive to percussion

(Radicular Cyst)

 represents chronic
inflammatory process

• develops only over
a long period of time

(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

(Radicular Cyst)

 occasionally, exhibits
thin, radioopaque line
around the periphery
of radiolucent area

• indicates reaction of
bone to slowly expanding
mass

(Radicular Cyst)

(Radicular Cyst)
 Histologic Features

 epithelium lining apical
periodontal cyst is usually
stratified squamous in
type

(Radicular Cyst)
 Treatment & Prognosis

 similar to periapical
granuloma

• involved tooth may be
removed

• periapical tissue carefully
curetted

(Radicular Cyst)

 under some condition;

• root canal therapy

• with apicoectomy
of cystic lesion

(Radicular Cyst)

(Dentigerous Cyst)

 also known as Follicular Cyst

 2nd most common type of
odontogenic cyst

 most common developmental
cyst of the jaws

(Dentigerous Cyst)

 attached to tooth cervix
(enamel-cementum junction)

 encloses crown of unerupted
tooth

(Dentigerous Cyst)

 Etiology

 develops from proliferation
of enamel organ remnant
or reduced enamel epithelium

 related to epithelial
proliferation

(Dentigerous Cyst)

 Etiology

 release of bone-resorbing
factors

 increase in cyst fluid
osmolality

(Dentigerous Cyst)


 commonly seen in
association most
with 3rd molars commonly
impacted
 maxillary canines teeth

(Dentigerous Cyst)


 greater incidence in
males

 symptoms are generally
absent

 delayed eruption being the
most common indication of
dentigerous cyst formation

(Dentigerous Cyst)


 well-defined

 unilocular or ocassionally
mutilocular radiolucency
with coricated margins

 associated with crown
of unerupted tooth

(Dentigerous Cyst)


 unerupted tooth is often
displaced

(Dentigerous Cyst)


 mandible

• radiolucency may extend
superiorly from 3rd molar
site into ramus

• anteriorly + inferiorly
along body of mandible

(Dentigerous Cyst)


 maxilla

• if involving canine region
extends into maxillary
sinus

• or orbital floor may be
noted

(Dentigerous Cyst)


 resorption of roots of adjacent
erupted teeth may
ocassionally be seen

(Dentigerous Cyst)

 Treatment

 removal of associated
tooth

 enucleation of soft tissue
component

(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

(Primordial Cyst)

 arises from cystic changes in
developing tooth bud

 before formation of enamel
+ dentin matrix

(Primordial Cyst)

 since it arise from tooth bud,
tooth will be missing from
dental arch

 unless cyst arose from
supernumerary tooth

(Primordial Cyst)

 usually found in children
+ young adults between
10 years and 30 years
of age

(Primordial Cyst)

 circular radiolucency

 with radiopaque border
with sclerotic or reactive
border

 found at site where tooth
failed to develop

 more in relation to 3rd molars

(Primordial Cyst)


 unilocular or multilocular

 seen below or between
roots or near to alveolar
ridge

(Primordial Cyst)

 Treatment

 Radical Surgery

• curretage of bone

(Odontogenic Keratocyst)

 may exhibit aggressive clinical
behavior

 significant recurrent rate

 associated with nevoid basal
cell carcinoma syndrome


 found anywhere in jaws

 can radiographically mimic
other types of cysts


 Etiology

 develop from dental lamina
remnants in mandible +
maxilla



 common jaw cysts

 occur in any age

 peak incidence within
2nd-3rd decades of life


 mandible

• posterior portion of
body commonly
affected
• ramus region

 maxilla

• 3rd molar area



 well-circumscribed
radiolucency

 with smooth radiopaque
margins

 most lesions are unilocular



 40% was noted to be
adjacent to crown of
unerupted teeth

 buccal + lingual enlargements
occasionally seen



 surgical excision with
peripheral osseous
curettage

 ostectomy



 follow up examinations
are important due to
recurrence rate

 most recurrence become
clinically evident within
5 years of treatment

(Lateral Periodontal Cyst)

 nonkeratinized developemental
cyst

 occur adjacent or lateral to
root of tooth


 Etiology

 believed to be related to
proliferation of rests of
dental lamina



 occur in mandibular
premolar + cuspid region

 occasionally in incisor area

 in maxilla

• primarily in lateral incisor
region



 male predilection

 range 20-85 years old

 asymptomatic

 well-delineated



 round

 teardrop-shaped unilocular
(and occasionally multilocular)
radiolucency with opaque
margin along lateral
surface of vital tooth root



 local excision

 follow-up is suggested for
treated multilocular
odontogenic cysts

(2) Non- Odontogenic Cyst
(Globulomaxillary Cyst)

 between lateral incisor
+ canine teeth

 many are lined by inflamed
stratified squamous
epithelium

(Globulomaxillary Cyst)


(Nasolabial Cyst)

 rare developmental cyst

 occurs in upper lip

 lateral to midline

 pathogenesis is uncertain

(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

(Nasolabial Cyst)
 2 theories

 2nd theory: cyst develop
from misplaced epithelium
of nasolacrimal duct

• due to similar location
• similar histologic
appearance

(Nasolabial Cyst)

 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

(Nasolabial Cyst)

 on occasion, expansion
may result in:

• nasal obstruction
• interfere with wearing
of denture

 pain is uncommon

(Nasolabial Cyst)

 cyst may rupture
spontaneously

• may drain into
oral or nasal cavity

(Nasolabial Cyst)

 commonly seen in adults

 peak prevalence in 4th-5th
decades of life

 significant predilection
for women

(Nasolabial Cyst)

 cyst arises in soft tissues

 most cases no radiographic
changes are seen

 pressure resorption of
underlying bone may
occur

(Nasolabial Cyst)

 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

(Nasolabial Cyst)

(Median Palatal Cyst)
 rare fissural cyst

 develops from epithelium
entrapped along embryonic
line of fusion of lateral
palatal shelves of maxilla


 firm or fluctuant swelling
of midline of hard palate
posterior to palatine
papilla

 most frequently in young
adults

 often asymptomatic


 some complain of pain
or expansion

 average size is 2 x 2 cm,
sometimes it can be quite
large


 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


 occlusal radiographs
demonstrate well-
circumscribed radiolucency
in midline of hard palate

 occasional reported cases
have been associated with
divergence of central incisors

 Treatment

 surgical removal

 recurrence should not
be expected

(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

 believed to arise from remnants
of nasopalatine duct

 normally degenerate in humans
but may leave epithelial
remnants behind in incisive
canals


 almost any age

 most common in 4th-6th
decades of life

 swelling of anterior palate

 drainage

 pain


 asymptomatic

 discovered on routine
radiographs


 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


 well-circumscribed
radiolucency in or near
midline of anterior
maxilla

• between apical to central
incisor


 root resorption is rarely
noted

 lesion most often is round
or oval with a sclerotic
border


 some cases, a classic heart
shape

• result of superimposition
of nasal spine
• OR because they are notched
by nasal septum


 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


 radiolucency thatis 6 cm
or smaller in this area is
usually considered a normal
foramen

 unless other clinical signs
or symptoms are present


 surgical enucleation

 biopsy is recommended

• because lesion is not
diagnostic radiographically

• benign + malignant lesions
have been known to mimic
nasopalatine duct cyst


 palatal flap reflected
after incision

• made along lingual
gingival margin of
anterior maxillary
teeth

 recurrence is rare

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)

Cysts of oral region (5)

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