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  • 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 TissueOdontogenic 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 KeratinizedPeriodontal Dentigerous Primordial & calcifying odontogenic Odonto- (KCOC) Inflamm. Central genic keratocyst Gorlin’s Development Lateral cyst (OKC) Circumferential
  • 6. Periodontal CystsInflammatory 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 DegenerationEpith. Lined Separation +cavity filled of cells in liquefication with fluid the central of central formed portion cells Apicalperiodont al cyst
  • 9. Mechanism of Cyst Enlargement Tissue ↑osmoticbreakdown pressure Fuid Osteoclastictransport to bonecystic 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 orovoid• Margin: Well-defined•Radiolucency.•Size : (5mm –several cm).•Related Tooth: mayhas a large cariouscavity or large filling.
  • 12. Histology of Inflammatory Apical Cyst 1-C.T wall 2- Epith. lining 3- Cyctic fluid
  • 13. Histology of Inflammatory Apical Cyst
  • 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 containsfluid which stainseosinophilic.•Sometimes containscholesterol in greatamount.•Chemically: containsalbumin, 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 ofthe root of a pulplesstooth.•Cause: a result ofopening of a lateralroot canal & irritationof periodontal tissue.
  • 20. 3- Inflammatory Residual Periodontal Cyst•Cause:-The pulpless tooth fromwhich a periapical cystmay persist in the jawbone.•Complication:-Interfering with thefittness of dentures. -Enlarge to the extent ofweakning of the jaw. -Jaw fructure
  • 21. Developmental Lateral Periodontal Cyst•Def.: a non-inflammatorydevelopmental cyst whichoccurs adjacent or lateralto the root of vital tooth.•Cause: proliferation ofrests of odontogenicepithelium at lateral sideof 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 over1 cm.•Radiolucent area.•May or may notwell circumscribedwith an opaquemargin.
  • 24. Histology of Developmental Lateral Periodontal Cyst•C.T wall: may haveinflammatory cell ifthe cys get infected.•Epith. Lining:-Stratified squamous .-Thin( 1-2)layers.-Epith. Cells with clearcytoplasm& smalldeeply stained nuclei.-Parakeratin ororthokeratin.
  • 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 CystsOf Adulthood Of The New Born
  • 29. Thanks Presented by:Marwa Assem Salama