This document provides an overview of cysts of the oral facial region, including: - Definitions of cysts and their growth mechanisms. - Classification systems based on location, pathogenesis, cell type, epithelial tissues. The main types discussed are radicular cysts, dentigerous cysts, and keratocysts. - Clinical features such as swelling, tooth displacement, pain, and effects on bone. Diagnosis involves radiographic and microscopic examination of cyst contents. - Management typically involves enucleation or marsupialization. Additional techniques like cryosurgery are used for keratocysts due to their high recurrence rate.

1. CYSTS OF THE ORALFACIAL
REGION
BY
DR. Kabwe J. KAMINA:
S.C.O.M.F.S

2. DEFINITION OF A CYST OF THE
ORALFACIAL REGION
AN ABNORMAL CAVITY IN HARD OR SOFT
TISSUE WHICH CONTAINS FLUID OR SEMIFLUID
OR GAS AND IS OFTEN ENCAPSULATED AND
LINED BY EPITHELIUM (Killey & Kay 1966)
 CYST IS A PATHOLOGICAL CAVITY HAVING FLUID,
SEMI-FLUID OR GASEOUS CONTENTS THAT ARE
NOT CREATED BY ACCUMULATED PUS,
FREQUENTLY BUT NOT ALWAYS IS LINED BY
EPITHELIUM (Kramer 1974)

3. GROWTH MECHANISM OF CYSTS OF
THE ORALFACIAL REGION
1. Epithelial Proliferation: Epithelial proliferation (the
central cell degeneration in a proliferating mass of
epithelial cells sets up an osmotic pressure
gradient and causes prostaglandin release. This
promotes fluid accumulation)
2. Internal Hydraulic Pressure: Death and
degeneration of granulation tissue and a similar
progression.
3. Bone Resorption
-

4. CLASSIFICATION OF CYSTS OF THE
ORALFACIAL REGION
CYST CAN BE CLASSIFIED ON THE BASIS OF
1. LOCATION
- Jaw
- Maxillary sinus
- Soft tissue of face and neck
2. PATHOGENESIS
- Developmental
- Inflammatory

5. CLASSIFICATION OF CYSTS OF THE
ORALFACIAL REGION CONT’D
3. CELL TYPE
- Epithelial
- Non- epithelial
4. EPITHELIAL TISSUES
- Odontogenic ( Debris of mallassez, Reduced
enamel epithelium & Dental lamina)
- Non- odontogenic

6. CLASSIFICATION OF CYSTS OF THE
ORALFACIAL REGION CONT’D
1. WHO CLASSIFICATION:
A) DEVELOPMENTAL
A1) Developmental odontogenic
- Primordial (Kerato) cyst
- Gingival cyst
- Eruption cyst
- Dentigerous cyst

7. CLASSIFICATION OF CYSTS OF THE
ORALFACIAL REGION CONT’D
A2) Developmental non- odontogenic:
- Nasopalatine duct ( incisive canal) cyst
- Globulomaxillary cyst
- Nasolabial (Naso alveolar ) cyst
B) INFLAMMATORY
- Radicular cyst (Apical & Lateral)
- Residual cyst
- Paradental cyst

8. CLASSIFICATION OF CYSTS OF THE
ORAL FACIAL REGION CONT’D
2. SHEAR’S CLASSIFICATION:
- Location of the cyst:
1. CYST OF THE JAW
2. CYST ASSOCIATED WITH MAXILLARY
ANTRUM
3. CYSTS OF THE SOFT TISSUES OF THE FACE,
NECK & MOUTH

9. CLASSIFICATION OF CYSTS OF THE
ORALFACIAL REGION CONT’D
1. CYSTS OF THE JAW
1) ODONTOGENIC
1A1) EPITHELIAL
1A11) ODONTOGENIC EPITHELIAL
DEVELOPMENTAL
- Primordial cyst, Dentigerous cyst
- Gingival cyst of infants, Eruption cyst
- Gingival cyst of Adults, Calcifying odontogenic
cyst
- Lateral periodontal cyst

10. CLASSIFICATION OF CYSTS OF THE
ORALFACIAL REGION CONT’D
1B12) ODONTOGENIC EPITHELIAL
INFLAMMATORY.
- Radicular cyst
- Residual cyst
- Inflammatory collateral cyst
- Paradental cyst

11. CLASSIFICATION OF CYSTS OF THE
ORALFACIAL REGION CONT’D
1B) ODONTOGENIC NON- EPITHELIAL:
- Simple bone cyst (traumatic, solitary &
haemorrhagic)
- Aneurysmal cyst
2) NON – ODONTOGENIC CYST
- Nasopalatine cyst, Median palatine cyst, Median
alveolar cyst, Nasolabial cyst, Globulomaxillary
cyst, Median mandibular cyst.

12. CLASSIFICATION OF CYSTS OF THE
ORALFACIAL REGION CONT’D
2. CYSTS ASSOCIATED WITH THE MAXILLARY
ANTRUM.
- Begnin mucosal cysts
- Surgical ciliated cyst of the maxilla
3. CYSTS OF THE SOFT TISSUES OF THE FACE,
NECK & MOUTH
- Dermoid & Epidermoid cysts
- Branchial cleft cyst ( lympho- epithelial cyst)
- Thyroglossal duct cyst

13. CLASSIFICATION OF CYSTS OF THE
ORALFACIAL REGION CONT’D
- Oral cyst with gastro intestinal epithelium
- Anterior median lingual cyst
- Cystic hygroma
- Cysts of the salivary glands
- Parasitic cysts ( Hydatid cyst, cysticeous
cellulosae)

14. CLASSIFICATION OF CYSTS OF THE
ORALFACIAL REGION CONT’D
3. SHAFER’S CLASSIFICATION
1. Primordial cyst
2. Dentigerous cyst & Eruption cyst
3. Periodontal cyst
a) Apical Periodontal cyst
b) Lateral Periodontal cyst
4. Gingival cyst
- Gingival cyst of newborn (Dental lamina cyst)
- Gingival cyst of Adult

15. CLASSIFICATION OF CYSTS OF THE
ORALFACIAL REGION CONT’D
5. Odontogenic Kerato cyst (Jaw cyst, Basal cell
nevus & Bifid rib syndrome).
6. Calcifying odontogenic cyst

16. GENERAL CLINICAL FEATURES OF
CYSTS OF THE ORALFACIAL REGION
SWELLING.
DISPLACEMENT OR LOOSENING OF TEETH
PAIN (IF INFECTED)
MOST IMPORTANT CLINICAL SIGN IS
EXPANSION OF BONE (In some instances this
may result in an eggshell – like layer of
periosteal new bone overlying the cyst. This
can break on palpation giving rise to the
clinical sign of Eggshell Cracking.

17. GENERAL CLINICAL FEACTURES OF
CYSTS OF THE ORALFACIAL REGION
CONT’D
Fluctuation is elicited by palpation in cysts
laying in soft tissue or has perforated the
overlying bone. If the cyst becomes infected
the clinical presentation is that of an abscess
with pain syndrome

18. GENERAL RADIOGRAPHIC
EXAMINATION SIGNS OF CYSTS
- Well Defined Margins: peripheral cortication
(radio-opaque margin) is usual except in
solitary bone cysts. Scalloped margins are
seen in larger lesions. Infection of a cyst tends
to cause loss of well defined margin.
- SHAPE: most have round shape. However,
Keratocyst and solitary bone cysts have a
tendency to grow through the medullary bone
rather than expand the jaw.

19. GENERAL RADIOGRAPHIC
EXAMINATION SIGNS OF CYSTS
CONT’D
- LOCULARITY: True locularity (multiple cavities) is
seen occasionally in odontogenic keratocysts.
However, larger cysts of most types may have
multilocular appearance because of ridges in the
bony wall
- EFFECTS UPON ADJACENT STRUCTURES:
Displacement. Roots of teeth may be resorbed
and perforation of the cortical plates at various
point may occur

20. GENERAL RADIOGRAPHIC
EXAMINATION SIGNS OF CYSTS
CONT’D
- EFFECT ON UNERUPTED TEETH: May become
enveloped by any cyst

21. MANAGEMENT OF CYSTS OF THE
ORALFACIAL REGION
Cysts are essentially treated in two ways:
• Enucleation and primary closure:
- If technically possible this is the operation of
choice
- The whole cyst with its lining is removed
- The resulting cavity is curetted out of any soft
tissue remnants followed by primary closure

22. MANAGEMENT OF CYSTS OF THE
ORALFACIAL REGION CONT’D
• Marsupialisation:
- Applicable in larger cysts and in locations
where there are vital organs/structures
- An opening in the cyst is made so that the
contents drain out and the lining epithelium is
exposed to the mouth
- Has the disadvantages of slow healing,
multiple visits/ reviews of the patient and a
second operation

23. RADICULAR CYSTS
- Synonyms: Dental cyst, Periapical cyst or Apical
cyst.
- The most common
- Tooth responsible for the formation may be
extracted but cyst remains and may well increase
in size subsequent to the extraction – Residual
cyst.
- Develops when epithelial debris of mallassez in a
granuloma at the apex of a non-vital tooth is
stimulated to proliferate.

24. RADICULAR CYSTS CONT’D
- The epithelium forms a ball of mass of cells
which may break down centrally, perhaps due
to lack of nutrients to form a liquefied central
area
- Alternatively the epithelium cells may form
strands and sheets that encompass part of the
granuloma with a similar resulting breakdown
of the enclosed granulomatous content to
form a fluid centre of the cyst

25. RADICULAR CYSTS CONT’D
- This leads to the formation of a
semipermeable lining to the cyst content that
allows fluids to enter the lumen by osmosis
and lead to its gradual enlargement (cyst
degeneration)

26. CLINICAL FEATURES OF RADICULAR
CYSTS
Contained within the alveolar bone around
the apex of a non-vital tooth. A this stage the
bone increases its density peripherally around
the lesion. This is possible because of its slow
rate of growth.
As the cyst grows, there is bone expansion
more evident on the buccal than on the
lingual or palatal aspect.

27. CLINICAL FEATURES OF RADICULAR
CYST CONT’D
The cyst continues to expand and eventually
erodes through the ever-thinning bone buccal
covering until it presents as a soft fluctuant
swelling in the sulcus which often appears
slightly blue in colour.
When the overlying expanded bone is very
thin, palpation may elicit the characteristic
eggshell cracking.

28. CLINICAL FEATURES OF RADICULAR
CYST CONT’D
When infection sets in, this will convert the
cyst into an acute apical abscess
 Loosening or displacement of adjacent teeth
is encountered in very large cysts.
Resorption of roots usually results from
repeated infection of the cyst and is relatively
uncommon
Remains painless unless infected

29. DIAGNOSIS OF RADICULAR CYSTS
- Many radicular cysts are found either by
chance Radiographically or because of acute
infection.
- Clinical features that may be present include:
• Usually buccal expansion of bone and hard to
palpation.
• Later it is soft (fluctuant) and bluish in colour.
• The causative tooth will be non-vital

30. DIAGNOSIS OF RADICULAR CYSTS
CONT’D
• Radiographically – round or oval shaped
radiolucency surrounded by a sharply
delineated thin white line of increased bone
density. The affected tooth will show loss of its
apical lamina dura.
• Occasionally there may be evidence of
resorption of adjacent teeth.

31. DIAGNOSIS OF RADICULAR CYSTS
CONT’D
• Repeated infections can cause a haziness in the
sharp radio – opaque delineations of the margin
of the cyst.
• In larger mandibular cysts, there may be clear
evidence of the inferior dental nerve having been
displaced downwards.
• Aspiration of the fluid presents a classic
appearance of a straw-colour in which a shimmer
may be seen due to its cholesterol content.

32. DIAGNOSIS OF RADICULAR CYSTS
CONT’D
• However, if the cyst has been infected, this
characteristic appearance is lost and the fluid
may well consist of pus which may be blood
stained.
• Radicular cysts just like Dentigerous cysts are
associated with a high soluble protein content
than keratocysts but simple cytological
smearing of the suspected keratocysts make
such expensive tests unnecessary.

33. DIAGNOSIS OF RADICULAR CYSTS
CONT’D
• With large cysts especially in the mandible, it
may be prudent to conduct
Histopathologically examination of the lining
(for differential diagnosis)

34. DENTIGEROUS CYSTS
Are developmental: arise when cystic
degeneration occurs in the reduced enamel
epithelium (dental follicle).
Seen around unerupted teeth (therefore most
frequently found in the third molar areas,
upper canine region and less frequently
around the lower second premolars.

35. DENTIGEROUS CYST CONT’D
- May arise in relation to supernumerary
unerupted teeth
 Grow slowly and have the same effect on the
surrounding bone (bone expansion initially
and later a soft fluctuant swelling over the
area of unerupted tooth).
Asymptomatic until infected.
The defining feature is the site of attachment
of the cyst to the tooth involved

36. DENTIGEROUS CYST CONT’D
This must be at the level of the
enamelocemental junction with an
encapsulated crown of the tooth involved-
(PERICORONAL RADIOLUCENCY)
The epithelial lining is of even thickness and
may include mucous cells along with focal
areas of keratinisation of the superficial
epithelial cells.

37. KERATOCYSTS
Derived from remnants of the dental
lamina.
Can be found anywhere in the jaws but
the most common site is at the angle of
the mandible.
Unlike other cysts, their epithelium is a
KERATINISING STRATIFIED SQUAMOUS
EPITHELIUM.

38. KERATOCYSTS CONT’D
THEIR CONTENTS ARE THEREFORE FILLED
WITH DESQUAMATED SQUAMES AND KERATIN
which form a semisolid material that has been
likened to cottage cheese.
 Their mode of growth is also different from
other cysts in that the lining appears to be
more active with passive fluid ingress. It has a
propensity to grow along the medullary cavity.

39. KERATOCYSTS CONT’D
Are also characterized by the formation of
microcysts or satellite cysts which protrude
into the surrounding fibrous tissue and tend
to be left behind during Enucleation –
increases the risk of recurrence
 Active growth of keratocysts appears not to
be evenly distributed. So the cyst does not
expand uniformly as a sphere or oval shaped
lesion.

40. KERATOCYSTS CONT’D
Different rates of activity within areas of the
lining account for the formation of locules
which once the cyst has grown to moderate
size will give rise Radiographically to the
typical multilocular appearance.
They appear to grow selectively within the
looser medulla initially and eventually the
outer cortical plates do show expansion.

41. CLINICAL FEATURES OF KERATOCYSTS
Active growth of keratocysts appears not to be
evenly distributed. So the cyst does not
expand uniformly as a sphere or oval shaped
lesion. Different rates of activity within areas
of the lining account for the formation of
locules which once the cyst has grown to
moderate size will give rise Radiographically to
the typical multilocular appearance.

42. CLINICAL FEATURES OF KERATOCYSTS
CONT’D
They appear to grow selectively within the
looser medulla initially and eventually the
outer cortical plates do show expansion.
 Lingual as well as buccal expansion is often
noted.
Infection often only occurs when the cyst is
quite large and where soft tissue trauma
allows the ingress of bacteria.

43. CLINICAL FEATURES OF KERATOCYSTS
CONT’D
Pain, anaesthesia discharge into the mouth,
bad taste and bad breath become additional
clinical features

44. DIAGNOSIS OF KERATOCYSTS
Based on:
- Clinical features
- Radiographic findings: Multilocular
radiolucency
- Results of aspiration: Dirty cream coloured
semisolid material composed of keratinised
squames
- Biopsy: Keratinised stratified squamous
epithelium

45. ADDITIONAL TREATMENT TECHNIQUES
OF KERATOCYSTS
Due to a high recurrence rate use of chemicals
such as mercuric salts and recently
cryosurgery (liquid nitrogen) are used in
addition to enucleation or marsupialisation.

46. NASOPALATINE CYSTS
> Belong to the non-odontogenic group of cysts.
Classified as fissural cysts (most common).
Arise from epithelial remnants within or near the
Nasopalatine foramen.
 Clinical features include a swelling of the anterior
aspect of the midline of the hard palate. When
infected cause pain & overlying tenderness, on
occasion discharge forming a sinus

47. DIAGNOSIS OF NASOPALATINE CYSTS
Presence of a midline anterior palatine
swelling is the usual clinical finding.
The normal radiographic image is a round or
inverted pear-shaped radiolucency with sharp
radio-opaque margins.
When large, they can cause separation of the
central incisor roots but the lamina dura
remain intact.

48. DIAGNOSIS OF NASOPALATINE CYSTS
CONT’D
Pulp testing can be carried out to differentiate
from radicular cysts.
 TREATMENT OF NASOPALATINE CYSTS:
Enucleation only is performed through a palatal
flap (incision from premolar to premolar).
Marsupialisation is contraindicated in this area (
Can lead to a permanent cavity that will show no
evidence of restoration of the normal contour)