Jaw bone cyst

Jaw bone cysts
DR: Mazen Abood Bin Thabit. M.D, FRCPath
Assistant Prof Of Pathology
Senior lecturer of Oral pathology and oral
histology

Introduction
Definition :
Cyst is pathological fluid , simi-fluid or gas filled cavity lined by
epithelium .
Most common lesion .
Most common casus of jaw swelling .
Often destructive and produce signs and symptoms .
True cyst Vs Pseudo-cyst

Copyright 2003, Elsevier Science (USA). All rights reserved.

General feature of cyst
 Sharpe radiolucent with well defined margin .
 Fluid may be aspirated .
 Tran-illuminated .
 Grow slowly
 Displacing rather than resorbing .
 Symptomless .
 Rarely cause pathological fracture
 Forms compressible and fluctuant swelling .
 Appears plush close to the mucosa .
 Cystic epithelium some time undergo neoplastic transformation.


Approach of diagnosis
 Complete history:
Pain , duration , tooth mobility or loss , occlusion ,swelling ,
delay eruption

 Physical examination :
Inspection , palpation , percussion .

 Radiology:
Plan X-ray ,panoramic, dental radiograph, CT.

 FNAC:
 Biopsy:


Classification
I. Odontogenic cysts :
Developmental cysts
1. Dntigerous cyst .
2. Eruption cyst .
3. Odontogenic keratocyst
4. Gingival cyst
5. Lateral periodontal cyst
6. Botryoid odontogenic cyst .
7. Gandular Odontogenic cyst
8. Calcifying odontognic cyst


Classification
Inflammatory cysts
1. Radicular cyst .
2. Paradental cyst .
3. Residual cyst
4. Inflammatory collateral cyst .
Neoplastic cyst
1. Cystic ameloblstoma
2. Calcifying odontogenic cyst
II. Non odontogenic cyst :
1. Nasopalatine cyst .
2. Nasolabial cyst


Classification

III. Cysts without epithelial lining ( Pseudocyst) :
1. Solitary ( Simple ) bone cyst
2. Aneurysmal bone cyst
IV. Cyst of soft tissue:
1. Dermoid and epidermoid cyst
2. Lympho-epithelial cyst .
3. Thyro-glossal cyst


Embryological origin of cyst
 Rest Of Malassez .
 Reduced Enamel epithelium
 Remnant of dental lamina


Radicular ( Periapical ) cyst
 The most common odontogenic
cyst of inflammatory origin. Pathogenesis
 65-70%
 Related to apex of non-vital tooth.


Periapical ( Radicular ) cyst:
 Clinical feature :
 3rd -4th decades
 Male .
 More common in anterior
maxilla .
 Tooth is non vital
 Small cyst asymptomatic .
 Large cyst may produce slow
growing hard bony swelling
 Springiness .
 Fluctuation if bone is eroded
 Pain if infected with sinus Radicular csyt
 Paresthesia and pathological
fracture
 Lateral radicular cyst .

Radicular cyst

Well defined ,unilocular radio-lucent with well
defined cortical margin

 Histopathology:
 Stratified squamous 6-20cell
thick .
 Surrounded C.T shows chronic
inflammation .
 Cholesterol cleft.
 Russel bodies .
 Multinucleated giant cells
 Epithelium may undergo
malignant transformation


 Differential diagnosis:
 Periapical granuloma.
 Periapical abscess .
 Cementblastoma.
 Traumatic bone cyst .

Treatment:
Small cyst : Root canal treatment
Large cyst : Enaculation or
marsupialization


Residual cyst
 Cystic lesion may present at
the site of tooth extraction

Edentulous region

Residual cyst


Dentigerous cyst
 2nd most common .
 Enclose part or all the crown
 Caused by accumulation of
fluid between REE and Enamel

CEJ


Dentigerous cyst

 Attached to CEJ
 Forming cyst in which the
crown located within it’s
lumen and the root out side

CEJ


Dentigerous cyst
 Clinical presentation:
1. Asymptomatic .
2. swelling or pain .
3. Common in mandible
4. Mandibular 3rd molar , maxillary
permanent canine and mandibular
premolar .
5. More common in adult male
6. 20-50 years .
7. Permanent dentition may be missed
8. Large cyst may cause bone expansion
and tooth displacement
9. may associated with supernumerary
teeth or odontomas


Dentigerous

Radiograph :
 Unilocular radiolucent area
 Well circumscribed
 Contains crown
 Surrounded by sclerotic bone
outline

Radiolucent space
around the crown


Dentigerous cyst
 Types :
The cyst attached to CEJ and the
crown related to cyst in three
ways:

1.Central type .
2.Lateral type .
3.Circumferential type


Histopathology
 Non keratinized squamous epithelium
 2-10 cell thick .
 May be atrophic or ulcerated .
 Wall dense fibrous and no inflammation .
 Islands of odontogenic epithelium may seen.
 Cyst filled proteineous material and cholisterol
cleft
 Long standing cyst may shows dysplasia
 Neoplastic tumors may arise from cyst


Dentigerous cyst
 Treatment:
Marsupialization .
Enaculation
 Differential diagnosis:
1.Adenomatoid odontogenic tumor .
2. Unilocular cystic ameloblastoma.
3. primordial cyst .
4. Ameloblastic fibroma
5. CEOC


Eruption cyst
 Odontogenic cyst similar
to dentigerous cyst with
teeth about to erupt.

Tooth crown has erupt
through the jaw bone


Eruption cyst
 Clinical feature :
1. Affect children in both dentition
2. Superficial appears as soft , bluish
fluctuant swelling on the alveolar
ridge .
3. Repetitive trauma may induce
hemorrhage with the cyst ( Eruption
hematoma) .


Odontogenic keratocyst
 Also called Primordial
cyst and arises mainly
from remnant of dental
lamina

Jaw bone

Cyst cavity


Primordial cyst
 Clinical feature:
1. 1st peak 20- 30 years and the
2nd peak 50-70 years .
2. Male predominance .
3. 2/3 in the mandible in the
posterior alveolar ridge .
4. In the maxilla , the 3rd molar
region is more affected .
5. Cyst have remarkable growth
potentiality .
6. Grow in antero-posterior
direction


Primordial cyst
 Clinical feature:
7. Usually single , occasionally
multiple ( Golin –Gottz syndrome ).
8. Small cyst discovered incidentally
by X-ray .
9. Large cyst cause bone swelling
10 . Pain , mobility and displacement
of teeth .
11. Occasional paresthesia of lower
lips and teeth .
12. In some cases extraosseous
extension to gingiva.
13. Pus discharge and sinus


Primordial cyst
 Radiography :
1. High and remarkable growth
potential .
2. May attain a large destructive
size.
3. High recurrence rate after
enaculation 25-60%
4 . Recent WHO classification
designate this cyst as Keratocystic
adontogenic tumor .


Primordial cyst
 Clinical behavior :
1. High and remarkable growth
potential .
2. May attain a large destructive
size.
3. High recurrence rate after
enaculation 25-60%
4 . Recent WHO classification
designate this cyst as Keratocystic
adontogenic tumor .


 Histopathology:
The cyst lined by thin parakeratinized
odontogenic squamous epithelium of 6-10 Parakeratin layer
cell layer .
Palisaded layer of columnar or cuboidal
basal layer with reverse polarity .
Corrugated layer of parakeratin on it’s
luminal surface .
The junction between cyst and connective
tissue is weak with focal separation.
Cyst contains desquamated parakeratin ,
and cheesy material
Basal layer
Inflammation absent .
Thin fibrous wall .


Primordial cyst
 Causes of recurrence:
1. Thin fragile lining .
2. Budding or finger like cyst .
3. Daughter cyst .
4. Other dental lamina
5. Focal separation of the
epithelium


Primordial cyst

Daughter cyst


Primordial cyst
 Treatment :
1. Small : Simple enaculation .
2. Large: Enaculation with or
without peripheral osteomy.
3. Complete resection with 1cm
margin .
4. Long term follow up .


Lateral periodontal cyst

Uncommon intra-osseous
odontogenic cyst similar
to gingival cyst of adult

It’s derived from rest of
dental lamina

Lateral to the root surface
of erupted tooth


Lateral periodontal cyst
Clinical feature:
0.7% of jaw bone cyst .
Middle age patient .
Both mandible and maxilla
Canine and premolar of mandible .
Near the crest of ridge
Asymptomatic.
May produce bone expansion and pain
Tooth is vital .
Cyst less than 1 cm .

X-ray: Tear or drop shape
radiolucency

Differential diagosis

Lateral periodontal cyst :
 Histopathology:
Thin non keratinized squamous
epithelium
One or two cell thick .
Some cells are of clear cystoplasm
The cyst separate from PDL.

Surgical excsion of cyst along
with the tooth
Clear cells

Gingival cyst of adult
An extra-osseous odontogenic
cyst of the gingival tissue
Arise from rest of dental lamina

Gingival cyst


Gingival cyst of adult
Clinical feature:
Rare
4o years
Firm , compressible and dome shape
swelling less than 1cm
Facial gingiva of incisor or premolar

Histopathology :
Very thin flat non keratinized squamous
epithelium

Gingival cyst


Gingival cyst of newborn
Called Dental lamina cyst of newborn
Uncommon .
Multiple superficial nodules .
Resolve without treatment .
Thin keratinized squamous epithelium

Varient :
1. Epstein’s pearls: Mid palatine raphe.
2. Bohn’s nodules: Junction of hard and
soft palate

Gingival cyst


Botryoid odontogenic cyst
 Rare odontogenic cyst
resembles the cluster of grapes .
 Cystic changes of multiple
adjacent dental lamina
 Polycystic variant .
 Expensile , painless central
swelling .
 Multilocular cysts with fine
septa.
 Flat nonkeratinized epithelium
with clear cells
 Strong tendency to recurrence


Glandular cyst
 Also called sialo-odontogenic cyst .
 Intra osseous from dental lamina .
 Rare .
 Large single unilocular or multi
 Anterior mandible .
 Uni or multilocular radio-luncent .
 Thin stratified squamous with small
glandular or microcyst ( Pseudo-duct
like )
 High tendency to recurrence


Solitary bone cyst
 Traumatic bone cyst , unicameral
bone cyst or hemorrhagic bone
cyst.
 Children and adolescent.
 Mandibular premolar and molar
 Painless swelling .
 Round radio-lucent and less X-Ray
sharply defined . Unicameral cyst
 Bony wall lined by thin loose C.T
, RBCs or hemosedrin laden C.T.Scan
macrophages
 Unknown


Aneurysmal bone cyst
 Rare in the jaw .
 Posterior part of body or
angle of the mandible
 10-20 years
 Firm and painless swelling .
 Numerous non endothelial
lining spaces , filled with
blood , fibrous septa with
giant cells


 Uni or multilocular radio-lucent
 Balloon like



Nasopalatine ( Incisive canal ) cyst
 The most common nonodntogenic
 Remnant of nasopalatine duct.
 Slow growing swelling in the
anterior region of midline palate .
 Intermittent salty discharge .
 Should differentiated from palatine
fossa
 Incisive papillae

Well defined ovoid or heart
shape radio-lucent
Pathology:
1. Pseudo-stratified columnar .
2. Stratified squamous
The wall has nerve and small macular arteries
and veins

Globulomaxillay cyst
 Common .
 Bone fusion between maxilla
and premaxilla
 Cyst between maxillary lateral
incisor and canine
 Asymptomatic unless infected.
 Pseudo- stratifeid columnar
or squamous
 Pathogenesis .

Inverted pear shaped
radiolucent cyst .


Naso-labial cyst :
 Uncommon .
 Female of 4th decade
 Upper lip
 Remnant of nasolacrimal duct
 Swelling obliterate the naso-
labial fold and nostrils .
 Pseudo-s stratified columnar

1. Median cyst :
2. Median mandibular cyst Pseudo-startified columnar with
mucus cells


Lympho-epithelial cyst :
 Deep to sternomatoid muscles
or at the level of mandibular
angle
 Rarely intra-oral .
 Remnant of brachial arches .
 Stratied squamous and the wall
coantins lymphoid follicles

Thyro -glossal duct cyst
In the region of hyoid bone .
Rarely intra-oral at the
midline of tongue or floor

Residual cyst


Glandular odonto


Trumatic bone cyst


Jaw bone cyst

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Viewers also liked

Viewers also liked (20)

Similar to Jaw bone cyst

Similar to Jaw bone cyst (20)

More from Saeed Bajafar

More from Saeed Bajafar (20)

Jaw bone cyst