![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.](https://image.slidesharecdn.com/cystsofthejaws-170429030902/75/Cysts-of-the-jaws-13-2048.jpg)
![• 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](https://image.slidesharecdn.com/cystsofthejaws-170429030902/75/Cysts-of-the-jaws-50-2048.jpg)
Uploaded byMaxfac Center
Cysts of the jaws
The document provides an extensive overview of cysts in the jaws, including their classifications, clinical features, radiological characteristics, histopathology, pathogenesis, management options, and recurrence rates. It covers multiple classifications such as Kruger’s, Lucas’, Gorlin’s, and WHO’s, detailing various odontogenic and non-odontogenic cyst types. Treatment approaches primarily favor surgical enucleation or marsupialization, with emphasis on the importance of accurate diagnosis and management to prevent complications.
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Cysts of the jaws
- 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’SCLASSIFICATION 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 pathologiccavity 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 PUBLISHEDIN ‘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, PAINLESSPROMINENCE. ‘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 CLINICALFEATURE •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 CLINICALFEATURE •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 CYSTAND 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 CYSTSOF 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 PERIODONTALCYST 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 ODONTOGENICCYST (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 ODONTOGENICCYST 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 CLINICALFEATURE •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 BONECYST 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 CLINICALFEATURE •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 BONECYST 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 typeamong 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 radiolucencysurrounded 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 INITIATIONFORMATION ENLARGEMENT CYST REGRE -SSION
- 40. 1. MARSUPIALISATION (PARTSCHI) 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 & REMOVALOF 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 SIMPLEREGULAR 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 INYOUNG 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.
- 48.
- 49. Cystic lesions arevery 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 Textbookof 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