Cysts part 1


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Cysts part 1

  1. 1. Cysts of The Oral & Paraoral Regions
  2. 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. 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. 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. 5. Odontogenic Cysts Classification KeratinizedPeriodontal Dentigerous Primordial & calcifying odontogenic Odonto- (KCOC) Inflamm. Central genic keratocyst Gorlin’s Development Lateral cyst (OKC) Circumferential
  6. 6. Periodontal CystsInflammatory Developmental Apical Lateral Lateral Gingival C. adults Gingival C. Residual newborn
  7. 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. 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. 9. Mechanism of Cyst Enlargement Tissue ↑osmoticbreakdown pressure Fuid Osteoclastictransport to bonecystic cavity resorption Enlarging the bony cavity
  10. 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. 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. 12. Histology of Inflammatory Apical Cyst 1-C.T wall 2- Epith. lining 3- Cyctic fluid
  13. 13. Histology of Inflammatory Apical Cyst
  14. 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. 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. 16. Cholesterol Crystals Cholesterol Clefts Rushton Bodies Russel Bodies
  17. 17. Lumen Content or Fluid of Apical Cyst•The lumen containsfluid which stainseosinophilic.•Sometimes containscholesterol in greatamount.•Chemically: containsalbumin, globulin,cholesterol &nucleoproteins.
  18. 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. 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. 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. 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. 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. 23. X-ray of Developmental Lateral Periodontal Cyst•Small , rarely over1 cm.•Radiolucent area.•May or may notwell circumscribedwith an opaquemargin.
  24. 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. 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. 26. Developmental Gingival Cysts Of The New Born Of Adulthood (Bohn’s Nodules)
  27. 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. 28. Developmental Gingival CystsOf Adulthood Of The New Born
  29. 29. Thanks Presented by:Marwa Assem Salama