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Cysts of The Oral &
 Paraoral Regions
Definition of Cyst
• A cyst is an epithelial lined pathologic
  cavity occuring either in hard or soft
  tissue and may contain a fluid or
  semi-fluid material (True Cyst).
• Some cysts may not be epithelial-
  lined & therefore are not true cysts
  (Pseudocysts).
Cysts Classification
                    Non-       Pseudo-       Soft Tissue
Odontogenic                      cyst
                 Odontogenic                   Cysts

                    Naso-                        Dermoid, Ep
  periodontal                   Traumatic
                   Palatine                       idermoid
                                 Bone C.
                   Tract C.
   Dentigerous                                      Thyro-
                                                 glossal tract
                                Aneurysmal            C.
                   Fissural       Bone C.
  Primordial
                                                   Benign
                                                  lympho-
                                 Static
    KCOC,                                         epithelial
                                Bone C.
   Gorlin’s
     cyst                                          Mucous
                                                  Retention
                                                 ,Extravasat.
1- Odontogenic Cysts
• Def.: these arise from epithelial remnants
  associated with the development of teeth
  odontogenic epithelium.
• Site: Affect the tooth bearing region of the jaw.
• Origin of epithelium:
- Enamel organ.
- Reduced enamel epithelium.
- Epithelial rests of Malassez.
- Epithelial rests of Serres (dental lamina
  remnants).
Odontogenic Cysts Classification

                                              Keratinized
Periodontal    Dentigerous    Primordial     & calcifying
                                             odontogenic
                                 Odonto-        (KCOC)
    Inflamm.     Central
                                  genic
                                keratocyst      Gorlin’s
 Development      Lateral                        cyst
                                    (OKC)

                  Circumferential
Periodontal Cysts
Inflammatory   Developmental



    Apical        Lateral


    Lateral      Gingival C.
                   adults

                  Gingival C.
   Residual
                  newborn
Periodontal Inflammatory Cysts
• Cause: it results from inflammatory
  hyperplasia of the epithelial rests of Malassez
  in the periodontal ligament following death of
  the pulp.
• Types according to its location:
- Apical or periapical or radicular : related to
  root apex.
- Lateral: related to lateral root surface &
  accessory root canal.
- Residual: left after extraction in edentulous
  area of jaw.
1-Inflammatory Periodontal
    Apical (Periapical, Radicular) Cyst
  Periapical     Inflammatory     ↑↑epith.
  granuloma       proliferation    mass


                 Degeneration
Epith. Lined                      Separation
                       +
cavity filled                      of cells in
                 liquefication
 with fluid                       the central
                   of central
  formed                            portion
                      cells


  Apical
periodont
 al cyst
Mechanism of Cyst
       Enlargement
  Tissue         ↑osmotic
breakdown        pressure



    Fuid        Osteoclastic
transport to       bone
cystic cavity   resorption


 Enlarging
 the bony
   cavity
Clinical Features of Inflamm. Apical
                  Cyst
• Age: adult (3rd -6th )decade.
• Sex: male ˃ female.
• Site: maxilla ( anterior area).
• Symptoms:
- No infection → painless.
- Infection occurs → painful.
- Rounded swelling
• Signs:
-non-vital tooth, eggshell crackling sensation
  under pressure then fluctant swelling.
X-ray of Inflammatory Apical Cyst
•Shape: Round or
ovoid
• Margin: Well-
defined
•Radiolucency.
•Size : (5mm –
several cm).
•Related Tooth: may
has a large carious
cavity or large filling.
Histology of Inflammatory Apical Cyst

                          1-C.T
                          wall
                             2-
                           Epith.
                           lining
                              3-
                           Cyctic
                            fluid
Histology of Inflammatory Apical Cyst
The Epithlium Lining of Apical Cyst
• Stratified squamous
  epith. Acanthosis (20
  cell layer).
• Newly formed cyst:
• -Hyperplasic, forming
  rings around
  inflammatory cells.
• Fully formed cyst:
• - Regular, flattened
  with few
  inflammatory cells.
Connective Tissue Wall of Apical Cyst
• Collagen fibers bundles,
  fibroblasts & B.capillaries.
• Acute inflamm. Cells (
  PMNL) toward epith. &
  macrophages.
• Chronic inflamm. Cells (
  plasma cells &
  lymphocytes) deeper in CT.
• Dystrophic calcification
  foci.
• Cholesterol clefts.
• Multinucleated giant cells
• Russel bodies.
• Rushton bodies.
• Hemosidren &foam cells.
Cholesterol Crystals   Cholesterol Clefts




 Rushton Bodies          Russel Bodies
Lumen Content or Fluid of Apical Cyst
•The lumen contains
fluid which stains
eosinophilic.
•Sometimes contains
cholesterol in great
amount.
•Chemically: contains
albumin, globulin,
cholesterol &
nucleoproteins.
Treatment of Inflammatory Apical Cyst
              • Enucleation.
  Small       • Apicectomy.


              • Enucleation.
Medium        • Extraction of tooth.

              • Marsupilization to avoid
                imp. Structures e.g.
  Large         antrum & inf. Alveolar
                nerve.
2- Inflammatory Lateral Periodontal Cyst
• Less common ˃
periapical.
•Site: at the side of
the root of a pulpless
tooth.
•Cause: a result of
opening of a lateral
root canal & irritation
of periodontal tissue.
3- Inflammatory Residual Periodontal Cyst
•Cause:
-The pulpless tooth from
which a periapical cyst
may persist in the jaw
bone.
•Complication:
-Interfering with the
fittness of dentures.
 -Enlarge to the extent of
weakning of the jaw.
 -Jaw fructure
Developmental Lateral Periodontal Cyst
•Def.: a non-inflammatory
developmental cyst which
occurs adjacent or lateral
to the root of vital tooth.

•Cause: proliferation of
rests of odontogenic
epithelium at lateral side
of adjacent vital tooth.
Clinical Features of Developmental Lateral
               Periodontal Cyst
• Age: any age.
• Sex: male ˃female.
• Site:     2
          543
• Signs : may cause a slight
  bulge although the
  overlying mucosa is
  normal.
• Symptoms:
- Asymptomatic
- Vital tooth.
X-ray of Developmental Lateral
              Periodontal Cyst
•Small , rarely over
1 cm.

•Radiolucent area.

•May or may not
well circumscribed
with an opaque
margin.
Histology of Developmental Lateral
              Periodontal Cyst
•C.T wall: may have
inflammatory cell if
the cys get infected.
•Epith. Lining:
-Stratified squamous .
-Thin( 1-2)layers.
-Epith. Cells with clear
cytoplasm& small
deeply stained nuclei.
-Parakeratin or
orthokeratin.
Developmental Gingival Cysts
                                   Of The New Born
       Of Adulthood                 (Bohn’s Nodules)
• Origin: from dental          • Origin: from dental
  lamina remnants in the         lamina remnants which
                                 proliferate to form small
  ST between the oral            cyst.
  epith.& periosteum.
• Shape:                       • Shape: multiple white
  wellcircumscribed              nodules.
  swelling of the gingiva.
• Size: small ˃1cm.            • Size: ˃ few mm.
                               • Site: on the alveolar
• Site: free & attached          ridge of new born infant
  gingiva or papilla(adult).
Developmental Gingival Cysts
                  Of The New Born
 Of Adulthood     (Bohn’s Nodules)
Developmental Gingival Cysts
      Of Adulthood                   Of The New Born
• X-ray: (-ve) soft tissue &   •   X-ray: (-ve) soft tissue.
  vital tooth.                 •   Histology:
• Histology:                   -   Thin epith.
- Thin epith., flattened st.   -   The lumen filled with
  sq.cells.                        desqumated keratin.
- Non- keratinized.
                               • Treatment:
• Treatment:                   - No treatment &
- No treatment.                   discharge their content
                                  into the oral cavity.
Developmental Gingival Cysts
Of Adulthood    Of The New Born
Thanks
   Presented by:
Marwa Assem Salama

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Cysts part 1

  • 1. Cysts of The Oral & Paraoral Regions
  • 2. Definition of Cyst • A cyst is an epithelial lined pathologic cavity occuring either in hard or soft tissue and may contain a fluid or semi-fluid material (True Cyst). • Some cysts may not be epithelial- lined & therefore are not true cysts (Pseudocysts).
  • 3. Cysts Classification Non- Pseudo- Soft Tissue Odontogenic cyst Odontogenic Cysts Naso- Dermoid, Ep periodontal Traumatic Palatine idermoid Bone C. Tract C. Dentigerous Thyro- glossal tract Aneurysmal C. Fissural Bone C. Primordial Benign lympho- Static KCOC, epithelial Bone C. Gorlin’s cyst Mucous Retention ,Extravasat.
  • 4. 1- Odontogenic Cysts • Def.: these arise from epithelial remnants associated with the development of teeth odontogenic epithelium. • Site: Affect the tooth bearing region of the jaw. • Origin of epithelium: - Enamel organ. - Reduced enamel epithelium. - Epithelial rests of Malassez. - Epithelial rests of Serres (dental lamina remnants).
  • 5. Odontogenic Cysts Classification Keratinized Periodontal Dentigerous Primordial & calcifying odontogenic Odonto- (KCOC) Inflamm. Central genic keratocyst Gorlin’s Development Lateral cyst (OKC) Circumferential
  • 6. Periodontal Cysts Inflammatory Developmental Apical Lateral Lateral Gingival C. adults Gingival C. Residual newborn
  • 7. Periodontal Inflammatory Cysts • Cause: it results from inflammatory hyperplasia of the epithelial rests of Malassez in the periodontal ligament following death of the pulp. • Types according to its location: - Apical or periapical or radicular : related to root apex. - Lateral: related to lateral root surface & accessory root canal. - Residual: left after extraction in edentulous area of jaw.
  • 8. 1-Inflammatory Periodontal Apical (Periapical, Radicular) Cyst Periapical Inflammatory ↑↑epith. granuloma proliferation mass Degeneration Epith. Lined Separation + cavity filled of cells in liquefication with fluid the central of central formed portion cells Apical periodont al cyst
  • 9. Mechanism of Cyst Enlargement Tissue ↑osmotic breakdown pressure Fuid Osteoclastic transport to bone cystic cavity resorption Enlarging the bony cavity
  • 10. Clinical Features of Inflamm. Apical Cyst • Age: adult (3rd -6th )decade. • Sex: male ˃ female. • Site: maxilla ( anterior area). • Symptoms: - No infection → painless. - Infection occurs → painful. - Rounded swelling • Signs: -non-vital tooth, eggshell crackling sensation under pressure then fluctant swelling.
  • 11. X-ray of Inflammatory Apical Cyst •Shape: Round or ovoid • Margin: Well- defined •Radiolucency. •Size : (5mm – several cm). •Related Tooth: may has a large carious cavity or large filling.
  • 12. Histology of Inflammatory Apical Cyst 1-C.T wall 2- Epith. lining 3- Cyctic fluid
  • 14. The Epithlium Lining of Apical Cyst • Stratified squamous epith. Acanthosis (20 cell layer). • Newly formed cyst: • -Hyperplasic, forming rings around inflammatory cells. • Fully formed cyst: • - Regular, flattened with few inflammatory cells.
  • 15. Connective Tissue Wall of Apical Cyst • Collagen fibers bundles, fibroblasts & B.capillaries. • Acute inflamm. Cells ( PMNL) toward epith. & macrophages. • Chronic inflamm. Cells ( plasma cells & lymphocytes) deeper in CT. • Dystrophic calcification foci. • Cholesterol clefts. • Multinucleated giant cells • Russel bodies. • Rushton bodies. • Hemosidren &foam cells.
  • 16. Cholesterol Crystals Cholesterol Clefts Rushton Bodies Russel Bodies
  • 17. Lumen Content or Fluid of Apical Cyst •The lumen contains fluid which stains eosinophilic. •Sometimes contains cholesterol in great amount. •Chemically: contains albumin, globulin, cholesterol & nucleoproteins.
  • 18. Treatment of Inflammatory Apical Cyst • Enucleation. Small • Apicectomy. • Enucleation. Medium • Extraction of tooth. • Marsupilization to avoid imp. Structures e.g. Large antrum & inf. Alveolar nerve.
  • 19. 2- Inflammatory Lateral Periodontal Cyst • Less common ˃ periapical. •Site: at the side of the root of a pulpless tooth. •Cause: a result of opening of a lateral root canal & irritation of periodontal tissue.
  • 20. 3- Inflammatory Residual Periodontal Cyst •Cause: -The pulpless tooth from which a periapical cyst may persist in the jaw bone. •Complication: -Interfering with the fittness of dentures. -Enlarge to the extent of weakning of the jaw. -Jaw fructure
  • 21. Developmental Lateral Periodontal Cyst •Def.: a non-inflammatory developmental cyst which occurs adjacent or lateral to the root of vital tooth. •Cause: proliferation of rests of odontogenic epithelium at lateral side of adjacent vital tooth.
  • 22. Clinical Features of Developmental Lateral Periodontal Cyst • Age: any age. • Sex: male ˃female. • Site: 2 543 • Signs : may cause a slight bulge although the overlying mucosa is normal. • Symptoms: - Asymptomatic - Vital tooth.
  • 23. X-ray of Developmental Lateral Periodontal Cyst •Small , rarely over 1 cm. •Radiolucent area. •May or may not well circumscribed with an opaque margin.
  • 24. Histology of Developmental Lateral Periodontal Cyst •C.T wall: may have inflammatory cell if the cys get infected. •Epith. Lining: -Stratified squamous . -Thin( 1-2)layers. -Epith. Cells with clear cytoplasm& small deeply stained nuclei. -Parakeratin or orthokeratin.
  • 25. Developmental Gingival Cysts Of The New Born Of Adulthood (Bohn’s Nodules) • Origin: from dental • Origin: from dental lamina remnants in the lamina remnants which proliferate to form small ST between the oral cyst. epith.& periosteum. • Shape: • Shape: multiple white wellcircumscribed nodules. swelling of the gingiva. • Size: small ˃1cm. • Size: ˃ few mm. • Site: on the alveolar • Site: free & attached ridge of new born infant gingiva or papilla(adult).
  • 26. Developmental Gingival Cysts Of The New Born Of Adulthood (Bohn’s Nodules)
  • 27. Developmental Gingival Cysts Of Adulthood Of The New Born • X-ray: (-ve) soft tissue & • X-ray: (-ve) soft tissue. vital tooth. • Histology: • Histology: - Thin epith. - Thin epith., flattened st. - The lumen filled with sq.cells. desqumated keratin. - Non- keratinized. • Treatment: • Treatment: - No treatment & - No treatment. discharge their content into the oral cavity.
  • 28. Developmental Gingival Cysts Of Adulthood Of The New Born
  • 29. Thanks Presented by: Marwa Assem Salama