The document discusses several types of odontogenic and non-odontogenic cysts of the oral cavity. The dentigerous cyst, which arises from follicular epithelium around the crown of an impacted tooth, is the most common developmental cyst. Nevoid basal cell carcinoma syndrome, an inherited condition associated with PTCH gene mutations, is characterized by multiple basal cell carcinomas, odontogenic keratocysts, and other abnormalities. The calcifying odontogenic cyst exhibits ghost cells and often occurs in the incisor/canine region. Other cysts mentioned include the eruption cyst, botryoid odontogenic cyst, and gingival cyst of the newborn.

1. 26th May 2016
Cysts…..

2. • the most common developmental odontogenic cyst that arises from
follicular epithelium around the crown of an impacted tooth

3. • the lining epithelium of this cyst may undergo neoplastic change into
an odontogenic neoplasm -- ameloblastoma, SCC, or an intraosseous
mucoepidermoid carcinoma

4. • this cyst is the soft tissue analogue of the dentigerous cyst, appears
within the soft tissue of an erupting tooth and presents as a soft
gingival mass

5. • chief components of this inherited syndrome are multiple basal cell
carcinomas of the skin, odontogenic keratocysts, rib and vertebral
anomalies, and intracranial calcifications

6. • Nevoid basal cell carcinoma syndrome is due to a mutation of this
tumor suppressor gene that has been mapped to the long arm of
chromosome 9

7. • cyst that develops in place of a tooth that would normally have been
formed

8. • multicompartmentalized variant of lateral periodontal cyst, resembles
"grape-like" cluster of small cysts

9. • this lesion exhibits considerable variation, can be cystic lesion or a
true neoplasm. characterized by ghost cells, majority found in
incisor/canine region

10. • these cells represent a distinguishing histo feature of calcifying
odontogenic cyst -- eosinophillic cells lacking a nucleus that may
undergo calcification

11. • small, superficial, keratin-filled cyst of the alveolar mucosa of infants,
2-3mm, yelow-to-white papules

12. Discussion of individual cyst
• Etiopathogenesis
• Incidence
• Site
• Clinical features
• Radiologic features
• Aspiration contents
• Biochemical analysis
• Histopathology
• Treatment – enucleation / marsupialization
• Recurrence

13. Keratocystic Odontogenic Tumor

14. Keratocystic Odontogenic Tumor (KCOT)
• Etiopathogenesis – primordial odontogenic epithelium (dental lamina)
• Incidence – 5-10% of all cysts (2nd – 4th decades, M>F)
• Site – Mandible>Maxilla (Molar areas)

15. Clinical Features
• missing tooth
• displacement of teeth
• percussion – hollow/dull sound
• Bony expansion of cortices (anterio-posterior – medullary
expansion)
• Painless Swelling
• Teeth adjoining the cyst has vital pulp

16. Radiological features

17. Aspiration :
Dirty White
Biochemical Analysis :
Low protein content (<4gm/100ml)
Histopathology :
5-8 cell layer thick (keratinized squamous epithelium)
devoid of rete-pegs
ortho / para keratinized
picket fence / tomb stone appearance of basal cells

18. Treatment

19. Recurrence
• 5 to 62 %
• Due to
• Presence of satellite cysts
• Left fragile cystic margins
• Strong adherence of cystic lining to bone
• Presence of keratin k19

21. After a
year
follow up

22. Dentigerous Cyst

23. • Etiopathogenesis : Accumulation of fluid in reduced enamel
epithelium or within enamel organ
• Incidence : peak in 3-4th decade.
• M:F ratio 1.6:1
• Site: mandibular third molar>maxillary canine>maxillary third molar
>mandibular premolar

24. Clinical features
• Smooth painless swelling
• Egg-shell crackling
• A tooth from normal series may be missing

25. Radiologic features

26. • Aspiration – clear yellowish fluid / straw colored fluid (presence of
cholesterol crystals)
• Biochemical analysis : protein content 7.5gm/100 ml
• Histopathology :
• Non-keratinized 2-3 cell layer thick epithelium of reduced enamel epithelium
• Cholesterol clefts

27. Treatment

28. After 5 months of
marsupialization

29. Treatment

30. After1 month

31. Recurrence:
• If some epithelium remains
• May give rise to AMELOBLASTOMA – so a/k/a Pre-ameloblastic lesion
• Malignant transformation : 0.13% - 2%, with most of the cases
involving the mandible

32. Radicular Cyst
Periapical cyst, apical periodontal cyst,
dental cyst

33. Etiopathogenesis
• Caries, trauma, pdl diseases
• Death of dental pulp
• Necrotic debris - inflammatory stimulus
• Dental granuloma formation
• Composed of granulation tissue, inflammatory tissue
• Epithelial proliferation
• Periapical cyst formation

34. • Incidence : Most common of all other jaw cysts
• M>F
• Site : Maxilla (anterior)> Mandible (posterior)

35. Clincial features
• Bony hard swelling
• Pain when secondary infection occurs
• Springiness of bone due to fluctuation
• Temporary paresthesia of regional nerve distribution
• Involved tooth is non-vital
• Pathologic fracture if cysts are large

36. Radiologic features

37. • Aspiration: straw colored fluid with shiny particles (if uninfected)
• Dirty white caseous material or frank pus (if secondarily
infected)
• Presence of cholesterol clefts
• Biochemical analysis : protein = 20gm/100 ml
• Histopathology : Non keratinized epithelium arranged in Arcading
patern upto 6-20 layer thick
• Cholesterol crystals in lumen
• Ruston and Russel’s bodies

38. Treatment:
• Extraction/ endodontic treatment (apico-ectomy)
• Enucleation with primary closure
• Marsupialization

39. • Recurrence – rare

40. Residual Cyst
• Etiopathogenesis :
• An incompletely removed periapical
granuloma or cyst, that potentially
enlarges

41. Lateral Periodontal Cyst

42. • Etiopathogenesis:
1. From reduced enamel epithelium.
2. From remnants of dental lamina.
3. Proliferation of cell rests of malassez.
4. As a primordial cyst of a supernumerary tooth germ

43. • Incidence – 2nd to 6th decade
• Site : mandibular bicuspids/ cuspids/ incisors followed by maxillary
anteriors.
• Clinical features
- asymptomatic or present as gingival swelling with mild pain.
-rarely 3cm or more in diameter depicting a springy with egg shell
crackling
-associated teeth vital

44. • Radiographic features :

45. Aspiration :
• Serous or caseous content
Histology:
• -lined by thin non keratinized stratified squamous epithelium
Treatment:
• -surgical enucleation without sacrifice of adjacent teeth

46. Botryoid Odontogenic Cyst
• A variant of lateral periodontal cyst
resembling a bunch of grapes

47. Calcifying epithelial odontogenic cyst
(gorlin cyst)

48. •Etiopathogenesis
•Remnants of dental lamina,
•stellate reticulum,
•reduced enamel epithelium
•Incidence
•Not commonly seen (common in children and young adults)
•Site
•Common – anterior part of mandible

49. •Clinical features
•Painless swelling
•Two clinical variants
• A) Peripheral – within in the gingiva eroding the jaw
• B) Intra osseous – produce a hard bony expansion

50. Radiographic features

51. Histopathology
• Stratified squamous epithelium, 6-8 layers thick
• Ghost cells
• Types :
• Type I A- simple,unicystic[classic gorlin cyst]
I B - odontome producing
I C - ameloblastomatous proliferating type
• Type II - Amelobalstomus with secondary cyst development

52. • Treatment :
• Surgical enucleation
• Recurrence : none

53. Non – Epithelial Cysts

54. Solitary Bone Cyst
• Traumatic / Hemorrhagic bone cyst
• Etiology
• trauma or hemorrhage with failure of organization
• spontaneous atrophy of the tissue in the central benign gaint-
cell lesion
• Abnormal calcium metabolism
• chronic low grade infection
• necrosis of fatty marrow secondary to ischaemia
• Aberration in the development and growth of the local osseous
tissue

55. • Incidence – 10 to 20 yrs, M>F
• Site
• apical region , above the inferior
dental canal in cuspid and molar
region is common
• Radigraphic feature –
• scalloped outline to the upper
border around the roots of the
teeth

56. • Aspiration – deep yellow fluid, fresh blood or air
• Treatment - surgical exploration with gentle curettage

57. Aneurysmal Bone Cyst
• Etiology
• history of trauma
• possible relation with giant cell lesion
• sudden venous occlusion
Site – more in post mandible

58. • Radiographic features:
• unilocular or multilocular with
irregular margin also describe
as honeycomb or soap bubble
appearance
• Aspiration
• Dark venous blood
• Treatment
• surgical curettage with
removal of vascular tissue

59. Stafne bone cyst
• Mandibular salivary gland depression
• Found below the inferior alveolar canal
• Idiopathic bone cavities, no treatment required

60. Non-odontogenic cysts

61. Nasopalatine duct cyst (median palatine or
incisive canal cyst)
• Site- anterior part of the palate along the
incisive canal
• C/F – anterior region swelling and discharge
often describe as salty
• R/F – radiolucent area (heart shaped)
between or above the roots of maxillary
central incisors
• Treatment – surgical enucleation

62. Median mandibular cyst
• Between central incisor
• well defined round /ovoid
radiolucency
• regular/ irregular in shape
• T/t – enucleation without
damage to apices of incisors

63. Soft tissue cysts

64. Nasolabial cyst
• Naso-alveolar Cyst
• occur in soft tissue
• Site – over canine region ,
mucobuccal fold, floor of the
nose
• Treatment – enucleation (
great care is to be taken to
prevent the perforation and
collapse of the lesion)

65. Eruption cyst
• Age – infant and children
• Site – deciduous or permanent having no predecessor
• Treatment – no treatment is required ( as it burst spontaneously)

66. Gingival cyst of infant
• Age – infant
• Site- alveolar ridge
line of fusion of mid palate
junction of hard and soft palate
Treatment – no treatment spontaneous or
disrupt by erupting tooth

67. Gingival cyst of adult
• Age – over 40 yrs or at any age
• Site – free or attached gingiva
• R/F- cannot seen (eroded bone)
• Treatment – enucleation with primary closure

68. Mucocele
• Etiology
• obstruction of salivary duct
• trauma to the salivary duct
• cheek or lip biting
• Site – lower lip at buccal mucosa, cheek, ventral
surface of tongue, floor of mouth, retro molar area
• C/F – 1-2mm up to 2cm in size
• In early stage- round fleshy swelling
• In late stage – cystic hemispherical fluctuant and
bluish
• Treatment –excised with underlying associated
glands and surrounding connective tissue

69. Ranula
• Arises from sublingual or
submandibular salivary gland
• Site – floor of mouth
• C/F – dome shaped bluish
swelling
• Treatment – surgical removal
with sublingual gland

70. Dentigerous Cyst (follicular cyst)
• the most common developmental odontogenic cyst that arises from
follicular epithelium around the crown of an impacted tooth

71. Dentigerous cyst
• the lining epithelium of this cyst may undergo neoplastic change into
an odontogenic neoplasm -- ameloblastoma, SCC, or an intraosseous
mucoepidermoid carcinoma

72. Eruption cyst (eruption hematoma)
• this cyst is the soft tissue analogue of the dentigerous cyst, appears
within the soft tissue of an erupting tooth and presents as a soft
gingival mass

73. Nevoid basal cell carcinoma syndrome (gorlin
syndrome)
• chief components of this inherited syndrome are multiple basal cell
carcinomas of the skin, odontogenic keratocysts, rib and vertebral
anomalies, and intracranial calcifications

74. PTCH gene
• Nevoid basal cell carcinoma syndrome is due to a mutation of this
tumor suppressor gene that has been mapped to the long arm of
chromosome 9

75. primordial cyst
• cyst that develops in place of a tooth that would normally have been
formed

76. botryoid odontogenic cyst
• multicompartmentalized variant of lateral periodontal cyst, resembles
"grape-like" cluster of small cysts

77. Calcifying odontogenic cyst (gorlin cyst)
• this lesion exhibits considerable variation, can be cystic lesion or a
true neoplasm. characterized by ghost cells, majority found in
incisor/canine region

78. ghost cells
• these cells represent a distinguishing histo feature of calcifying
odontogenic cyst -- eosinophillic cells lacking a nucleus that may
undergo calcification

79. Gingival cyst of the newborn
• small, superficial, keratin-filled cyst of the alveolar mucosa of infants,
2-3mm, yelow-to-white papules

80. • Thank you