The various cysts of the jaws, few key points for the diagnosis and the treatment options available for each. Mentor: Dr Saikat Saha MDS, OMFS, SIliguri, West Bengal, India Address: MAXFAC Center for Oral and Maxillofacial and Head & Neck Surgery, Siliguri Email : maxfacmail@gmail.com

1. Maxfac
Center for Cranio - Maxillofacial & Head and Neck Surgery
maxfacmail@gmail.com
Mentor & Guide :
Dr Saikat Saha MDS OMFS
CYSTS OF THE JAWS
Presenter : Dr Mukesh Chhetri BDS
Fellow Trainee at Maxfac

2. INTRODUCTION
CLASSIFICATION
KRUGER’S CLASSIFICATION
LUCAS’ CLASSIFICATION
GORLIN’S CLASSIFICATION
WHO CLASSIFICATION
SIGNS & SYMPTOMS
VARIOUS CYSTS OF THE JAW
ODONTOGENIC KERATOCYST
DENTIGEROUS CYST
GINGIVAL CYST AND MID PALATINE RAPHE CYST OF NEWBORN
GINGIVAL CYST OF ADULT
LATERAL PERIODONTAL CYST
CALCIFYING ODONTOGENIC CYST
NASOPALATINE DUCT CYST
GLANDULAR ODONTOGENIC CYST
NASOLABIAL CYST
GLOBULOMAXILLARY CYST
SOLITARY BONE CYST
STAFNE CYST
ANEURYSMAL BONE CYST
RADICULAR CYST
MANAGEMENT
MARSUPIALISATION
ENUCLEATION
CONCLUSION
REFERENCES

3. Definition: ‘‘a pathologic cavity having fluid, semisolid
or gaseous content and it is frequently, but not always
lined by epithelium.’’- Kramer, 1974

4. KRUGER’S CLASSIFICATION (1964)
A) CONGENITAL CYST
THYROGLOSSAL
BRANCHIOGENIC
DERMOID
B) DEVELOPMENTAL CYST
I) NON-DENTAL ORIGIN
A) FISSURAL. TYPE
NASO-ALVEOLAR
MEDIAN
INCISIVE CANAL CYST (NASO-PALATINE)
GLOBULOMAXILLARY
B) RETENTION TYPE
MUCOCOELE
RANULA
II) DENTAL ORIGIN
(I) PERIODONTAL
PERIAPICAL
LATERAL
RESIDUAL
(II) PRIMORDIAL
(III) DENTIGEROUS

5. LUCAS’ CLASSIFICATION(1964)
INTRA-OSSEOUS CYSTS
A) FISSURAL CYSTS
MEDIAN MANDIBULAR
MEDIAN PALATAL
NASO-PALATINE
GLOBULOMAXILLARY
NASO-LABIAL
B) ODONTOGENIC CYSTS
DEVELOPMENTAL
(I) PRIMORDIAL
(II)DENTIGEROUS
INFLAMMATORY
RADICULAR
C) NON-EPITHELIAL BONE CYSTS
SOLITARY BONE CYST
ANEURYSMAL BONE CYST

6. GORLIN’S CLASSIFICATION (1970)
A) ODONTOGENIC CYSTS
1. Dentigerous Cyst
2. Eruption Cyst
3. Gingival Cyst Of The New-born Infants
4. Lateral Periodontal And Gingival Cyst
5. Keratinising And Calcifying Odontogenic Cysts
(Cystic Keratinising Tumour)
6. Radicular (Periapical Cyst)
7. Odontogenic Keratocyst
(A) Primordial Cyst
(B) Gorlin-goltz Syndrome
B) NON-ODONTOGENIC AND FISSURAL CYSTS
1. Globulomaxillary (Premaxilla-maxillary) Cyst
2. Naso-alveolar (Naso-labial / Klestadt’s) Cyst
3. Naso-palatine (Median Anterior Maxillary) Cyst
4. Median Mandibular Cyst
5. Anterior Lingual Cyst
6. Dermoid And Epidermoid Cyst
7. Palatal Cysts Of New-born Infants
(C) CYSTS OF NECK, ORAL FLOOR AND SALIVARY GLANDS
1. Thyroglossal Duct Cyst
2. Lymphoepithelial (Branchial Cleft) Cyst
3. Oral Cyst With Gastric / Epithelial Epithelium
4. Salivary Gland Cyst – Mucocoele And Ranula
(D) PSEUDOCYSTS OF JAWS
1. Aneurysmal Bone Cyst
2. Static (Developmental / Lateral) Bone Cyst
3. Traumatic (Haemorrhagic / Solitary) Bone Cyst

7. WHO CLASSIFICATION PUBLISHED IN ‘HISTOLOGIC TYPING OF
ODONTOGENIC TUMOURS’ (KRAMER, PINDBORG, SHEAR – 1992)
I) CYSTS OF THE JAWS
(A) EPITHELIAL
(I) DEVELOPMENTAL
(A) ODONTOGENIC
1. Gingival Cysts Of Infants
2. Odontogenic Keratocyst (Primordial Cyst)
3. Dentigerous (Follicular) Cyst
4. Eruption Cyst
5. Lateral Periodontal Cyst
6. Gingival Cyst Of The Adults
7. Botryoid Odontogenic Cysts
8. Glandular Odontogenic (Sialo-odontogenic /
Mucoepidermoid-odontogenic) Cyst
9. Calcifying Odontogenic Cyst
(B) NON-ODONTOGENIC
1. Naso-palatine Duct (Incisive Canal) Cyst
2. Naso-labial (Naso-alveolar) Cyst
3. Midpalatine Raphae Cyst Of Infants
4. Median Palatine, Median Alveolar And Median
Mandibular Cysts
5. Globulomaxillary Cyst
(C) INFLAMMATORY
1. Radicular Cyst (Apical / Lateral)
2. Residual Cyst
3. Paradental (Mandibular Infected Buccal) Cyst
4. Inflammatory Collateral Cyst

8. B) NON-EPITHELIAL
1. Solitary (Traumatic/Simple/Haemorrhagic) Bone Cyst
2. Aneurysmal Bone Cyst
II ) CYSTS ASSOCIATED WITH THE MAXILLARY ANTRUM
1. Benign Mucosal Cyst Of The Maxillary Antrum
2. Post-operative Maxillary Cyst (Surgical Ciliated Cyst Of The Maxilla)
III) CYSTS OF THE SOFT TISSUES OF THE MOUTH, FACE AND NECK
1. Dermoid And Epidermoid Cyst
2. Lymphoepithelial (Branchial Cleft) Cyst
3. Thyroglossal Duct Cyst
4. Anterior Median Lingual Cyst (Intralingual Cyst Of Fore-gut Origin)
5. Oral Cyst With Gastric / Intestinal Epithelium (Oral Alimentary Tract
Cyst)
6. Cystic Hygroma
7. Naso-pharyngeal Cysts
8. Thymic Cysts
9. Cysts Of The Salivary Glands
10. Mucous Extravasation Cyst
11. Mucous Retention Cyst
12. Ranula
13. Polycystic (Degenerative) Disease Of Parotid10. Parasitic Cysts
14. Hydatid Cyst
15. Cysticerus Cellulosae
16. Trichinosis
WHO Contd.

9. SIGNS
SYMPTOMS
SMOOTH, HARD, PAINLESS PROMINENCE.
‘TENNIS BALL’ FEELING.
‘EGG-SHELL CRACKLING’
MOBILITY OF TEETH
DISPLACEMENT OF TEETH
INVOLVE THE NEUROVASCULAR BUNDLE
DISTORTION OF NOSTRIL AND NASAL CONGESTION.
EXPANSION/INFECTION
PAIN AND SWELLING
BAD TASTE & FOUL ODOUR
DISCOLORATION, EXTRUSION/MALALIGNMENT OF TEETH

11. NAME ODONTOGENIC KERATOCYST
CLINICAL FEATURE •Growth in Anteroposterior direction within
the Medullary cavity
•Nevoid basal cell carcinoma sydrome(Gorlin-
Goltz syndrome)
RADIOLOGICAL FEATURE Well defined radiolucent
area(smooth/corticated margins)~unilocular
HISTOPATHOLOGY •Basal epithelial layer-”Tombstone
appearance/Picket Fence”
•Small Satellite cysts/cords/islands
PATHOGENESIS Arise from Dental Lamina/remnants
Primordial cyst
ASPIRATORY CONTENT Aspiration-clear fluid with keratin crystals & ↑
Protein content
RECURRENCE RATE 5-62%(angle or ascending ramus of the
mandible)
PROGNOSIS Poor (KOT-Toller)
TREATMENT PLAN Marsupialization
Enucleation & primary closure
Enucleation and packing open

13. NAME DENTIGEROUS CYST
CLINICAL FEATURE •Associated with
Impacted/Embedded/Unerupted teeth.
•Most common in mandibular third molars.
•Cleidocranial Dysplasia & Maroteaux-Lamy
syndrome.
RADIOLOGICAL FEATURE •Radiolucency of at least >5 mm(enlarged
follicle). [Normal 3-4mm]
•Variations:- Central, Lateral, Circumferential.
HISTOPATHOLOGY •Lining epithelium-2-4 layers
thick(flat/cuboidal) & no rete pegs
•Rushton bodies within lining epithelium.
PATHOGENESIS Fluid accumulation between the REE &
enamel surface>>crown within the lumen
ASPIRATORY CONTENT Aspiration-thin watery, yellow straw-coloured
fluid.
RECURRENCE RATE uncommon
PROGNOSIS Untreated can transform into
Ameloblasrtoma or Mucoepidermoid
Carcinoma
TREATMENT PLAN Smaller lesions- surgical removal in toto.
Large lesions- surgical
drain/Marsupialization.

15. NAME GINGIVAL CYST AND MIDPALATINE
RAPHAE CYST OF INFANTS
CLINICAL FEATURE •“Epstein’s pearls” – Occur along Midpalatine
Raphae & “Bohn’s nodules” - Seen around
Dental Ridges.
•Small whitish papules (1-3mm) with cluster
of 2-6 cysts.
RADIOLOGICAL FEATURE Extraosseous, only faint shadow indicates
superficial bone erosion.
HISTOPATHOLOGY •Thin epithelial lined lumen filled with
Keratin (onion rings)
PATHOGENESIS •Gingival cysts – remnants of Dental
lamina(rest of Serres)
•Midpalatine raphae - from epithelial
inclusions at the line of fusion of the palatal
folds and the nasal process.
ASPIRATORY CONTENT Cream/white colored
RECURRENCE RATE Rare after 3 months of age
PROGNOSIS Good
TREATMENT PLAN Self healing

17. NAME GINGIVAL CYSTS OF ADULTS
CLINICAL FEATURE •Rare (0.5% of all the jaws cysts)
•Small, well circumscribed painless gingival
swelling (resembling mucocele)
•Seldom measures over 1 cm in diameter
RADIOLOGICAL FEATURE Soft tissue lesion. No findings
HISTOPATHOLOGY •Glycogen rich cells in lining epithelium.
PATHOGENESIS •From dental lamina/Rests of Serres
•Traumatic implantation of surface
epithelium.
•Similar to Lateral Periodontal cyst.
ASPIRATORY CONTENT
RECURRENCE RATE
PROGNOSIS Good
TREATMENT PLAN Local surgical excision

19. NAME LATERAL PERIODONTAL CYST
CLINICAL FEATURE •Most frequently- Mandibular Premolar area>
Anterior Maxilla.
RADIOLOGICAL FEATURE •Well circumscribed area lateral to roots of
vital teeth.
• < 1cm in diameter
•Polycystic appearance-”Botryoid
Odontogenic cyst”.
HISTOPATHOLOGY •Foci of Glycogen rich cells interspersed in the
lining epithelium.
PATHOGENESIS •Could arise from: Reduced enamel
epitheliem/Dental lamina remnants/Cell rests
of Malassez.
ASPIRATORY CONTENT
RECURRENCE RATE Botryoid variety(multilocular)- ↑ recurrence
PROGNOSIS
TREATMENT PLAN Unilocular lesion – surgical enucleation

21. NAME CALCIFYING ODONTOGENIC CYST (COC)
CLINICAL FEATURE •Uncommon (about 1% of all jaw cysts)
•A cystic lesion and also a solid neoplastic
lesion.
RADIOLOGICAL FEATURE •Usually unilocular well defined radiolucency,
may be multilocular also.
HISTOPATHOLOGY •Variable no. of eosinophilic Ghost cells seen
within epithelial component.
•Spherical calcifications seen
PATHOGENESIS •Cystic (Simple/Odontome/Ameloblastoma
associated)
•Neoplastic (Dentinogenic Ghost cell tumor)
ASPIRATORY CONTENT
RECURRENCE RATE Few recurrences reported
PROGNOSIS Good
TREATMENT PLAN Surgical enucleation excision

23. NAME NASOPALATINE DUCT (INCISIVE CANAL)
CYST
CLINICAL FEATURE •Most common non-odontogenic cyst of oral
cavity.
•Swelling of anterior palate(midline), pain &
drainage.
RADIOLOGICAL FEATURE •Well circumscribed radiolucency above or
between roots of Central Insisors.
•Radiolucency >6mm with other clinical S&S.
•Round/ovoid/heart shaped radiolucency
HISTOPATHOLOGY •Characteristic is presence of neurovascular
bundle in the wall.
PATHOGENESIS •Embryonic epithelial residues in the
Nasopalatine canal/ From epithelium
included in the lines of fusion of facial
processes.
ASPIRATORY CONTENT
RECURRENCE RATE
PROGNOSIS
TREATMENT PLAN Surgical enucleation

25. NAME GLANDULAR ODONTOGENIC CYST
CLINICAL FEATURE •Unusually large (solitary/multilocular) cyst.
•Same location as lateral periodontal cyst.
•Anterior region(incisor & canine)
RADIOLOGICAL FEATURE •Well defined with multilocular patterns &
sclerotic rim.
HISTOPATHOLOGY •St. squamous epithelium with numerous
mucus-secreting cells(goblet).
PATHOGENESIS •Remarkable aggressive behavior.
ASPIRATORY CONTENT Mucinous materials
RECURRENCE RATE 30% or more
PROGNOSIS
TREATMENT PLAN Enucleation or curettage.

27. NAME NASOLABIAL (KLEDSTADT’S) CYST
CLINICAL FEATURE •Non-odontogenic fissural cyst
•Outside bone in the nasolabial folds below
the alae nasi.
•Female prediliction.
•Obliteration of labial sulcus & nasolabial fold
•Mostly unilateral.
RADIOLOGICAL FEATURE •localised increased radiolucency of the
alveolar process due to depression on the
labial surface of the maxilla.
HISTOPATHOLOGY •lined by non-ciliated pseudo-stratified
columnar epithelium
PATHOGENESIS •From remnant of nasolacrimal duct/
Epithelial lining of FOM.
ASPIRATORY CONTENT Straw coloured or whitish mucous fluid.
RECURRENCE RATE
PROGNOSIS
TREATMENT PLAN Surgical excision.

29. NAME GLOBULOMAXILLARY CYST
CLINICAL FEATURE •Develops between Max. Lateral Incisior &
Cuspids.
RADIOLOGICAL FEATURE •Well circumscribed unilocular radiolucency
(Inverted Pear between apices of teeth)
HISTOPATHOLOGY •lined by inflamed stratified squamous
epithelium
PATHOGENESIS •Previously described as Fissural cyst.
•Junction b/w globular portion of Medial
Nasal Process & Maxillary Process,
globulomaxillary fissure.
ASPIRATORY CONTENT Straw coloured or whitish mucous fluid.
RECURRENCE RATE Variable recurrence rate.
PROGNOSIS
TREATMENT PLAN Surgical enucleation.

31. NAME SOLITARY BONE CYST
CLINICAL FEATURE •Mandible>Maxilla.
•Pseudo cyst
RADIOLOGICAL FEATURE •Smooth outlined radiolucent area
•Thin sclerotic border(duration)
•Lobulated when affecting roots
HISTOPATHOLOGY •Extensive osteophytic reaction on outer
surface of cortical plate
•Rbcs, Giant cells
PATHOGENESIS •Intramedullary Hemorrhage>>Failure of
early org. of haematoma >> Liquefaction
>>Altered/obstructed lymphatic or venous
drainage
ASPIRATORY CONTENT Sero-sanguinous fluid, necrotic blood clot,
fragments of fibrous con. tissue.
RECURRENCE RATE
PROGNOSIS
TREATMENT PLAN Surgical exploration

33. NAME STAFNE CYST
CLINICAL FEATURE •Bilateral, inferior border of mandible(2nd &
3rd molar region)
•Deep well circumscribed depression/
indentation adjacent to lingual surface of
mandible
RADIOLOGICAL FEATURE •Ovoid radiolucency between mandibular
canal & inferior border of mandible
HISTOPATHOLOGY •Salivary duct cells seen.
PATHOGENESIS •Enslavement of salivary gland within
mandible during embryonic development.
ASPIRATORY CONTENT
RECURRENCE RATE
PROGNOSIS
TREATMENT PLAN No treatment required

35. NAME ANEURYSMAL BONE CYST
CLINICAL FEATURE •Mandible> Maxilla.
•In young adults(under 20-30 yrs of age)
•Upon entering lesion, excessive
bleeding(‘welling up’) from tissue.
RADIOLOGICAL FEATURE •Bone expanded. Cystic with Honeycomb/
Soap-bubble apperance & eccentrically
ballooned.
HISTOPATHOLOGY •Fibrous connective tissue stroma with many
cavernous/ sinusoidal blood filled spaces,
which may or may not show thrombosis.
PATHOGENESIS •Osteolytic initial phase>>Active growth
phase>>Mature phase>>Healing phase.
ASPIRATORY CONTENT
RECURRENCE RATE
PROGNOSIS
TREATMENT PLAN Surgical curettage/ excision

37. Most common type among jaw cysts.
Males>Females
Common site- Maxillary anterior region associated with non-vital teeth.
.
v
• SLOWLY ENLARGING
SWELLING
• BONY HARD INITIALLY
• BONY COVERING BECOMES
THIN
• BONE GET ERODED
• BECOMES FLUCTUANT

38. Well circumscribed radiolucency surrounded by well
corticated border.
Obliteration of lamina dura.
When more than 1.5-2cm, the diagnosis of cyst may be
made(differentiation from Periapical Granuloma)

39. OSMOTIC THEORY
OF ENLARGEMENT
INITIATION FORMATION ENLARGEMENT
CYST
REGRE
-SSION

40. 1. MARSUPIALISATION (PARTSCH I)
MODIFICATIONS:
A. DECOMPRESSION >>ENUCLEATION
B. MARSUPIALISATION WITH NASAL
ANTROSTOMY
2. ENUCLEATION
A. PRIMARY CLOSURE (PARTSCH II)
B. WITH OPEN PACKING

41. ELEVATION OF
FLAP
HYDROSTATIC
DISSECTION &
REMOVAL OF
BONE
PACKING OF
THE CAVITY

42. BONE REGENERATION WITH ↓ CAVITY SIZE
SECOND STAGE OF ENUCLEATION
KEPT OPEN WITH A DRAIN
MEDICATED GAUGE PACK>> ACRYLIC
PLUG
DECOMPRESSION FOLLOWED BY
ENUCLEATION
SMALL OPENING IN THE CYST
CAREFUL CLOSURE OF THE WOUND
WITHOUT TENSION
INTRANASAL ANTROSTOMY PERFORMED
PACKING OF
COMBINED CYST-
SINUSCAVITY
DRAIN PLACED AND
SECURED
MARSUPIALISATION WITH NASAL
ANTROSTOMY
REMOVAL OF ENTIRE
CYSTIC LINING
CONTINUITY
BETWEEN THE CYST
AND ANTRAL CAVITY

43. ADVANTAGES DISADVANTAGES INDICATIONS
SIMPLE REGULAR POST-OP
CARE
YOUNG CHILDREN
LA IS ENOUGH LONG OPERATING
DURATION
LARGE CYST
VITAL STRUCTURES NOT
DAMAGED
UNFAVOURABLE
COMPLICATIONS
TO PRESERVE THE
INTEGRITY OF VITAL
STRUCTURE
TOOTH CONSERVED &
ERUPTION PERMITTED
CHANCE OF
RECURRENCE
TEETH VITALITY
PRESERVED WHEN
LARGE CYST INVOLVES
APICES OF MANY TEETH
PACK MAY AVOID
PATHOLOGICAL #
LESS BLOOD LOSS

45. ADVANTAGES DISADVANTAGES
COMPREHENSIVE
H/P EXAMINATION
IN YOUNG PTS,
TOOTH GERM
REMOVED
RAPID HEALING PATHOLOGICAL
JAW #
LESS CHANCE OF
RECURRENCE
ADJACENT VITAL
STR. ENDANGERED
LESS TREATMENT
TIME, LESS FOLLOW
UPS
DIRECT
OBSERVATION OF
WOUND HEALING
NOT POSSIBLE
LESS
COMPLICATIONS
INDICATIONS
SMALL CYSTS
SMALL/LARGE CYSTS
NOT ENDANGERING
VITAL
STRUCTURE/PATHOLOGI
CAL #
HIGH RECURRENCE~
OKC

46. ENUCLEATION
BONE
REMOVAL

48. INFECTION RECURRENCE
MALIGNANT
TRANSFORMATION

49. Cystic lesions are very common in jawbones and it includes
those of both odontogenic and non-odontogenic origin.
By the time of diagnosis, most of the cyst will be enlarged
considerably weakening the bones.
This leads to various sequelae such as fractures.
Other complications even though rare such as malignant
transformation of cystic lining is of considerable
importance of various surgical modalities available,
enucleation with primary closure should be treatment of
choice wherever possible because of the least unfavourable
sequelae.
.

50. • Shafer’s Textbook of Oral Pathology(seventh edition)~ Shafer, Hine, Levy.
Editors- R Rajendran, B Sivapathasundharam.
• Textbook of ORAL & MAXILLOFACIAL SURGERY(Second edition)~ S.M.
Balaji.
• Cysts Of Jaws (Posted on 15/05/2016). Available at
https://maxfactutorial.wordpress.com/2016/05/15/cysts-of-jaws/
• Jaws: Cysts and Odontogenic Neoplasms(Topic 10). PTHL 312b: Oral and
Maxillofacial Pathology. Available at
http://www.patologiabucal.com/index_htm_files/QyTO.pdf
• Cysts of the jaws [Kompatibilis mód]. Available at
http://semmelweis.hu/oralis-diagnosztika/files/2012/11/Cysts-of-the-jaws.pdf

51. Maxfac
Center for Cranio - Maxillofacial & Head and Neck Surgery, Siliguri
Contact us at : maxfacmail@gmail.com
Mentor & Guide :
Dr Saikat Saha MDS OMFS
Dr Mukesh Chhetri BDS
Fellow Trainee at Maxfac
Thank You