Odontogenic Cysts Management

1. MANAGEMENT OF CYSTS
Dr. Hadi Munib
Oral and Maxillofacial Surgery Resident

2. OUTLINE
• Definition of cysts and key features of it
• Diagnosis of cysts
• Classification of cysts
• Surgical Management of Jaw Cysts
• Common Clinical Cysts
• References

3. DEFINITION OF CYSTS
• A Pathological cavity having fluid or semi-fluid contents.
• Epithelial Lining
• More common in the jaws than any other bone

4. KEY FEATURES OF CYSTS
• Asymptomatic unless they become secondarily infected.
• Expand slowly and rarely cause fractures
• Displacing and loosening rather than resorbing of teeth and roots.
• Sharp Well-Defined Radiolucency surrounded by smooth borders

5. SIGNS AND SYMPTOMS
• Range from:
• None
• Swelling
• Intra-Oral Discharge
• Pain
• Denture Difficulties
• Looseness of teeth
• Eggshell cracking.
• Paresthesia
• Pathological Fractures

6. DIAGNOSIS OF CYSTS
• History and Examination [Inspection, Palpation, Percussion and Auscultation]
• Aspiration
• Vitality tests of teeth
• Imaging
• Biopsy
• Albumin level in serum ( <4 g/dL or > 4 g/dL)

7. DIAGNOSIS OF CYSTS

8. TYPES OF CYSTS
Odontogenic
• >90% of all cysts.
• Developmental:
Odontogenic keratocyst
Dentigerous (follicular) cyst
Eruption cyst
Lateral periodontal cyst
Gingival cyst of adult
Glandular cyst
• Inflammatory
Radicular
Paradental
Non-Odontogenic
-Epithelial lined:
Nasopalatine duct cyst
Nasolabial cyst
Median palatine cyst
Median mandibular cyst
Globulomaxillary cyst
-Nonepithelial lined:
Solitary bone cyst
Aneurysmal bone cyst
Stafne’s bone defect

9. SURGICAL MANAGEMENT
• Marsupialization
• Enucleation
• Enucleation and Curettage
• Enucleation with Peripheral Ostectomy
• Enucleation with Carnoy’s Solution
• Enucleation with Bone Grafting
• Marsupialization followed by Enucleation
• Resection

10. MARSUPIALIZATION
• Decompression – Creating a surgical window in the wall of the cyst
• Indications:
1. Poor Medical Health.
2. Size of the cysts.
3. Assistance in eruption.
4. Difficult access.
• Advantages: Simple, safe and can be done by any practitioner
• Disadvantages: High dependence on compliance and leaving pathological tissues.
• Technique

14. ENUCLEATION
• Total Removal of cystic lesion.
• Indications: the treatment of choice for removal of cysts of the jaws that can be
safely removed without unduly sacrificing adjacent structures.
• Advantages: Total removal of cystic lesion, not dependent on compliance
• Disadvantages: Requires a professional and risky
• Technique

17. ENUCLEATION AND CURETTAGE
• After enucleation a curette or bur is used to remove 1 to 2 mm of bone around
the entire periphery of the cystic cavity.
• Indications: Odontogenic Keratocyst and Recurrent cysts
• Advantage: Decrease likelihood of recurrence
• Disadvantage: Destructive

18. ENUCLEATION WITH PERIPHERAL OSTECTOMY
• Enucleation
• Bone removal 3 – 5 mm
• High Recurrence Rate Cysts

19. ENUCLEATION AND CARNOY’S SOLUTION
• Enucleation
• Carnoy’s Solution contains 100% ethanol, chloroform and glacial acetic acid in a
6:3:1 ratio with added ferric chloride.
• Penetrates into bone up to depth of 1.54 mm after 3-5 minutes of application
• Odontogenic Keratocyst

20. ENUCLEATION AND BONE GRAFTING
• Enucleation
• Not recommended
• If autogenous bone used this will increase morbidity
• If synthetic bone used this will delay healing

21. MARSUPIALIZATION FOLLOWED BY ENUCLEATION
• After initial healing of Marsupialization, enucleation is done.
• Indications: if the cyst does not totally obliterate after marsupialization and if the
patient is finding difficulty in cleaning
• Advantages: Simple procedure that spares adjacent vital structures for
Marsupialization and total removal of cystic cavity for Enucleation
• Disadvantages.

22. RESECTION

23. COMMON CLINICAL CYSTS

24. TYPES OF CYSTS
Odontogenic
• >90% of all cysts.
• Developmental:
Dentigerous (follicular) cyst
Odontogenic Keratocyst
Eruption cyst
Lateral periodontal cyst
Gingival cyst of adult
Glandular cyst
• Inflammatory
Radicular
Paradental
Non-Odontogenic
-Epithelial lined:
Nasopalatine duct cyst
Nasolabial cyst
Median palatine cyst
Median mandibular cyst
Globulomaxillary cyst
-Nonepithelial lined:
Solitary bone cyst
Aneurysmal bone cyst
Stafne’s bone defect

25. RADICULAR CYSTS
• Most common inflammatory cyst
• Three types: apical, residual and lateral
• Associated with non-vital tooth
• Apical radiolucency indistinguishable from a periapical granuloma
• May be symptomless
• Treatment?

27. DENTIGEROUS CYSTS
• Developmental
• Associated with an unerupted tooth. [Most common teeth]
• Three types: Central, Lateral and Circumferential types
• Differential Diagnosis.
• Gardner’s Syndrome
• Treatment?

28. ODONTOGENIC KERATOCYST
• More aggressive with higher rate of recurrence.
• Nevoid basal cell carcinoma syndrome association
• Recurrence Rate is up to 62%
• Posterior Mandible
• Anterior-Posterior Growth
• Unilocular vs. Multilocular
• Treatment

32. GLANDULAR ODONTOGENIC CYSTS
• Aggressive
• Anterior portion of the jaws
• Recurrence 30%
• Differential Diagnosis
• Treatment.

33. LATERAL PERIODONTAL CYST
• Vital tooth
• Asymptomatic
• Lower Premolars
• Botryoid

34. NASOPALATINE DUCT CYSTS
• Most common non-Odontogenic cyst
• Palatal to upper centrals
• > 7 mm Heart shaped Radiolucency
• Treatment

35. GLOBULOMAXILLARY CYSTS
• Umbrella term
• Cystic lesions appearing between the upper lateral incisor and canine tooth.
• Embryonic Fusion
• Apical cysts.
• Treatment is by enucleation.

36. MEDIAN MANDIBULAR CYST
• Cystic lesions in the midline of the jaw.
• Odontogenic in origin

37. NASOLABIAL CYSTS
• Soft tissue cyst with unknown etiology.
• Fourth and Fifth decades
• Male: Female 1:4.
• Swelling at the nasal fold.
• Local resorption of the maxilla.
• It can be lined by squamous or respiratory epithelium
• Treatment is by excision.
• Ultrasound

38. ANEURYSMAL BONE CYST
• Aggressive
• Radiographically Well-Circumscribed soap bubble–type lesion.
• Histologically has Giant Cell Component.
• It responds well to moderately aggressive curettage, although hemorrhage can be a
problem.
• Recurrences are rare.

39. SOLITARY BONE CYST
• Traumatic
• Asymptomatic
• Posterior Mandible
• Biopsy is curative

40. STAFNE’S BONE DEFECT
• Salivary Gland Depression
• Mandible
• Contains ectopic salivary tissue in continuity with the submandibular salivary gland.
• Bilateral anomaly
• Sialography ?
• Beneath ID canal

41. REFERENCES
• Oral Pathology 4th Edition Chapter 6: Cysts of the jaws
• Peterson’s Principles Of Oral And Maxillofacial Surgery Chapter 30: Cysts
• Contemporary Oral And Maxillofacial Surgery Chapter 23: Surgical Management of
Oral Pathologic lesions

42. THANK YOU