cyst of jaws

1. MANU MATHEW
DEPT. OMFS
CYSTS OF JAWS

2. INTRODUCTION
 Cysts (a pathological cavity) are relatively
common and may be encountered in virtually any
organ or tissue with in the body.
 Head and neck and jaws are most common site
 Usually cyst of jaws, maxillary antrum and soft
tissues of mouth, face, neck and salivary glands
 The most common benign destructive lesions of
the jaws.

3. PARTS OF A CYST

4. DEFINITION
 Killey and Kay(1966)
An epithelium –lined sac filled with fluid or
semifluid material
 Killey and Kay (1966)
“Abnormal cavity in hard or soft tissues which
contains fluid, semifluid or gas and is often
encapsulated and lined by epithelium”
 Kramer (1974)
A cyst is a pathological cavity having
fluid,semifluid or gaseous contents and that are not
created by accumulation of pus and frequently but
not always lined by epithelium

5. TYPES OF CYSTS
TRUE CYSTS PSEUDO CYSTS
EPITHELIUM NOT LINED BY EPITHELIUM
DENTIGEROUS CYST,
RADICULAR CYST
SOLITARY BONE CYST,
ANEURISMAL BONE CYST

6. Robinson’s classification (1945)
A. From odontogenic tissues
1. Periodontal cyst
2. Dentigerous cyst
3. Primordial cyst
B. From Non dental tissues
1. Median cyst
2. Incisive canal cyst
3. Globulo-maxillary cyst
CLASSIFICATION

7. Odontogenic Periodontal
Dentigerous
Primordial
Fissural Nasopalatine
Globulo maxillary
Naso labial
Median cysts
Bone cysts Solitary bone cyst
Aneurysmal bone cyst
Stafne’s bone cavity
Lucas classification (1964)

8. THOMA, ROBINSON, BERNIER
CLASSIFICATION (1960)
I. Odontogenic ectodermal
epithelial cyst.
A. Follicular cyst
(a) primordial cyst
(b) dentigerous cyst
(i) lateral
(ii) Central
B. Periodontal cyst
(a) Apical
(b) Lateral
C. Residual cyst
(a) follicular
(b) periodontal
D. Multiple cyst
E. Multilocular cyst
F. Polycytoma cyst
G. Cholesteatoma
II. Non odontogenic ectodermal
epithelial cyst
A. Intraosseous cyst
(a) Median
(b) Intermaxillary
(c) Nasoalveolar
B. Nasoplatine cyst
(a) Incisive canal cyst
(b) Cyst of papilla palatina

9. KRUGER’S CLASSIFICATION (1964)
A) Congenital cyst
Thyroglossal
Bronchogenic
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
a) Periodontal
• Periapical
• Lateral
• Residual
b) Primordial
c) Dentigerous

10. Classification WHO- 1992
 Epithelial cysts of the jaws
 Developmental
 Inflammatory
 Nonepithelial cysts of the jaws (Pseudocysts)
 Aneurysmal bone cyst
 Solitary bone cyst (simple, traumatic, hemorrhagic, idiopathic bone
cavity)
 Other cysts in the Head & Neck region
 Soft tissue cysts
 Pseudocysts
 Miscellaneous

11. Classification WHO- 1992
 Epithelial cysts of the jaws
 Developmental
 Gingival cyst of infant ( Epstein pearls)
 Gingival cyst of Adult
 Eruption cyst
 Odontogenic Keratocyst
 Dentigerous cyst
 Lateral periodontal cyst/ Botryoid odontogenic cyst
 Glandular odontogenic cyst (Sialo-odontogenic cyst)
 Calcifying odontogenic cyst (Gorlin’s cyst)
 Nasolabial cyst (Nasoalveolar cyst)
 Nasopalatine duct cyst (Incisive canal cyst)

12. Classification WHO- 1992
 Epithelial cysts of the jaws
 Inflammatory
• Radicular cyst (Periapical / Periradicular)
 Apical
 Lateral
 Residual
• Paradental cyst (Mandibular infected buccal
bifurcation cyst, inflammatory
collateral cyst)

13. Classification WHO- 1992
 Other cysts in the Head & Neck region
 Soft tissue cysts
• Epidermoid cyst
• Thymic cyst
• Bronchogenic cyst
• Thyroglossal cyst
• Gastric Heterotrophic cyst
• Salivary duct cyst
• Ciliated cyst of the maxillary antrum
• Lymphoepithelial: oral cervical
 Pseudocysts
• Mucus retention cyst
• Mucocele of the sinus
• Cystic hygroma
 Miscellaneous
• Dermoid cyst
• Polcystic disease of parotid
• HIV associated lymphoepithelial lesion

14. Summarised by LASKIN
 Odontogenic epithelial origin
 Keratinising (keratocyst)
1. Primordial cyst
2. Extrafollicular dentigerous cyst
 Non keratinising
1. Periodontal(radicular)cyst
a. Periapical
b. Lateral
c. Residual
2. Dentigerous cyst
a. Pericoronal
b. Lateral
c. Residual
3. Eruption cyst

15.  Non odontogenic epithelial origin
Nasopalatine cyst
Nasoalveolar cyst
Median palatal cyst
 Bone cysts
Solitary bone cyst
Aneurysmal bone cyst

16.  In general there are 2 phases in a cyst
pathogenesis:
Initiation or cyst formation
Enlargement or expansion of cystic cavity
PATHOGENESIS

17. Factors responsible for cyst formation
 Proliferation of epithelial lining
 Intra cystic fluid accumulation
 Resorption of bone as fluid accumulates and
epithelial lining proliferates

18. Theories of cyst enlargement
 Harris (1974)
Mural growth .
 Peripheral cell division.
 Accumulation of the contents.
Hydrostatic enlargement.
 Secretion (transdutations or
exudation).
British medical bulletin 1975

19. Increase in surface area and lining:
In few cysts like OKC, keratin formation is
more than hydrostatic and osmotic factors. In
such cases, instead of uniform expansion, there
are finger like projections into the surrounding
bone. This factor determine the recurrence and
aggressiveness of a cyst.

20. DIAGNOSTIC TOOLS
 CLINICAL FINDINGS
 SYMPTOMS
 RADIOGRAPHIC EXAMINATION
 ASPIRATION
 BIOPSY

21. DIAGNOSIS OF CYSTIC LESIONS
Clinical Examination:
A- Physical Signs:
 Although some small cysts do not present any clinical
signs and can only be detected by means of routine
radiography.
 But the vast majority of cysts -swelling.

22.  Palpation may reveal the
swelling to be bony hard, or
it could present with thin
bone giving a feeling on
touch , comparable to
compressing a table-tennis
ball between the fingers.
 If the bone has grown even
thinner we would feel what
we call egg-shell crackling.

23.  If all the buccal expanded bone has
been resorbed then we could feel
a frank fluctuation on the cyst
surface.

24.  Benign cysts rarely
cause loosening of the
adjacent teeth unless
the cyst is very large,
 While the clinical
absence of one or more
teeth while excluding
the history of
extraction could be an
indication

25. Parasthesia and/or Anesthesia of the
lower lip
 Not common findings but could exist
in cases of very large cysts
encroaching over the inferior alveolar
nerve,
 If it is infected the sudden increase in
pressure from pus accumulating in
the cyst sac may exert the pressure
leading to the parasthesia of the
nerve.

26. Teeth vitality:
 Teeth adjoining an
odontogenic keratocyst, a
developmental cyst, a
solitary bone cyst or lateral
periodontal cyst will have
vital pulps.
 While inflammatory
periapical cysts are
associated with non vital
pulps.

27. Percussion:
 Percussion on teeth overlying a
solitary bone cyst will produce
a dull or hollow sound in
comparison to the high pitched
sound of the teeth on the
opposite side of the jaw.

28.  If a sinus is evident then it should
be dried and examined since
pressure may cause the discharge
of a “glairy” cholesterol-
containing fluid, or it may be a
yellow purulent discharge.
 Expansion
 Bone expansion in the mandible -
labiobuccal plate of bone and
rarely affects the lingual plate.

29.  In maxilla- labiobuccal or
labiopalatal plates of bone.
 Nasolabial cysts and large
anterior maxillary cysts -
distortion of the ala of the
nose or the nostril.
 Maxillary sinusitis- extends
into sinus

30. SYMPTOMS
 Small cyst – Asymptomatic
 Pain and swelling- infected
 Lump in sulcus
 Pathologic fracture- when large
 Displacement of teeth

31. RADIOGRAPHIC EXAMINATION
 The radiographic appearance of cysts is characteristic
 Exhibits a distinct, dense periphery of reactive bone
(Condensing Osteitis) with a radiolucent center.
 Most cysts are unilocular in nature
 Multilocularity seen in keratocysts and cystic
ameloblastomas.

32. TYPES OF RADIOGRAPHS
A- Intra oral films:
1) Periapical films.
2) Standard occlusal films.
3) Lateral or topographical occlusal views.
B- Extra oral films:
1) Lateral oblique views.
2) Postero-anterior view.
3) Water’s sinus view.
4) Lateral sinus view.
5) Panoramic view.
6) C.T. scan and M.R.I.

33. Use of radio opaque medium
Useful to demonstrate the
relationship of naso labial
cyst to the surface of the
maxilla and to the nasal
cavity

34. ASPIRATION
Light straw coloured fluid rich in cholesterol indicates
periodontal, dentigerous, fissural cysts
Light yellow cheese like material indicates odontogenic
keratocyst
Presence of blood under pressure indicates aneurysmal
bone cyst
Minute amount of serous fluid indicates solitary bone cyst
A wide bore needle should be inserted into the suspected cystic
lesion under L.A and cavity then aspirated

35. Aspiration
Odontogenic Keratocyst
Electrophoresis :The protein content of
the cystic fluid is less than 4 grams per
100 ml.
Identification of Keratin under microscope
Cysts of the jaws

36. BIOPSY
This is performed to facilitate microscopic
examination of tissue retrieved from the
lesion by either excisional or incisional
biopsies.

37. Aims of treatment
 Removal of lining or enable the body to rearrange position of
abnormal tissue to eliminate from within, and prevention of
recurrence.
 Minimum trauma to patient and maximum conservation of
tissue mainly of dental components.
 Preserve adjacent important structures
 Achieve rapid healing; to minimize number of visits
 Restore the part to near normal and normal function
 Prevention of pathologic fracture
 Facial esthetics.

38. REASONS FOR TREATMENT
1. Progressive increase in size
2. Likely to get infected
3. Constitute an area of weakness
4. May result in pathological fracture
5. To confirm the benign nature
6. Encroachment on neighbouring structures

39. Operative procedures
 Enucleation of cyst and primary closure
 Enucleation and open packing
 With removal of teeth
 With tooth conservation
 Combined with Caldwell Luc operation
 Combined with fixation of pathologic fracture
 Enucleation with curettage
 Marsupialisation(Partsch operation,decompression)
 Combination: marsupialisation followed by
enucleation after cavity shrinks

40. Enucleation Of The Cyst(Surgical Procedure)
PARTSCH-II

41.  With larger cysts a
mucoperiosteal flap must
be done and some bone
removal (buccal plate) to
expose the cyst lining.
 Access is obtained then
enucleation
 A thin bladed curette is the
most suitable instrument
for separating the
connective tissue cyst wall
from the bone.

42.  largest curette that can be
accommodated into the bony
cavity
 apply it by facing its concave
side towards the bone while the
convex side is facing the cyst
wall to strip it from the bone.

43.  Irrigation and drying the cavity with gauze
 bony margins are filed(bone file) prior to primary
closure.
 Any roots included in or around a cyst should be
curetted aggressively
 if apex exposed -Endodontically treated with
apicoectomy

44.  primary closure
 the bony cavity will be filled
with a blood clot which
organizes with time.
 Areas xpanded by cystic
growth will remodel and
return to normal.

45.  Radiographic post operative follow-up
 complete bone healing can take 6-12 months
depending on the size of cyst
 If the primary closure breaks down usually
in large cysts, dehiscence occurs then the
bony cavity needs to be packed open and
left to heal by secondary intention.

46. Marsupialization.
 Marsupialization, decompression,
deroofing and the Partsch operation all
refer to creating a surgical window in the
cyst wall.(Partsch 1)
 window is removed -cyst lining is left in
situ.
 decrease of intra-cystic pressure allow for
shrinkage of the cyst and the regain of lost
bone.
 Either alone or followed by enucleation

47. Marsupialization Principles
Oral Mucosa
Bone
Connective tissue
Epithelial
lining
Cystic fluid
The inside
pressure of the
cystic fluid will
stimulate the
osteoclasts
Eliminating
this pressure
will give
chance to the
osteoblasts to
build a new
bone
IAN

48. Marsupialization Principles
1- Making an opening
in the oral mucosa
2- Then an opening in
the bony tissue.
3-Removing portion of
the cystic membrane
Letting the fluid to
drain out the cavity

49. Indications:
The following factors should be
considered.
1- Amount of tissue injury:
If enucleation of a cyst would cause oro-
nasal or oro-antral fistulae, injury to major
neurovascular structures or devitalization
of healthy teeth then marsupialization is
considered.

50. 2- Surgical access:
If the portions of the cyst are inaccessible
and parts of the cyst wall might be left
behind which will eventually lead to its
recurrence then marsupialization could be
considered as an initial treatment.
3- Extent of surgery:
In unhealthy or debilitated patients where
extensive surgery is contraindicated.

51. 4- Assistance in eruption of teeth:
If a tooth/teeth are involved in the cyst or
prevented from eruption by the cyst
5- Size of cyst:
In cases where the size of the cyst is very
large and there is a risk of jaw fracture.

52. Advantages:
 it is a simple procedure to perform
 spares vital structures from damage.
Disadvantages:
1) The presence of pathologic tissue in the
jaws without examination.

53. 2)patient discomfort-need for frequent
irrigation of cavity
 This might continue for several months
depending on the size of the cyst cavity
and the rate of bone healing.

54. Surgical Procedure
 Anesthetise the area
 create a large
window into the
cystic cavity with a
circular or elliptical
incision (1cm or
more).

55. Marsupialization
•If the bone has
been expanded
and
thinned then the
incision could
involve the bone
and the cystic wall

56. Marsupialization
 The contents of
the cyst are then
evacuated,
irrigation of the
cyst lumen is
done
inspection of
the remaining
tissue

57.  There could be thickening or ulceration in
other parts of the cyst wall and in this case
we should either take incisional biopsy
from the suspicious area or resort to
complete enucleation.
 If the cyst lining is thick enough then
sutured to the oral mucosa
 if not packed with strip gauze impregnated
with tincture of benzoin or an antibiotic
ointment.

58.  The pack is left in place for 10-14 days to
prevent the oral mucosa from healing over
the cyst window.
 After that strict cleansing of the
cavity.
 If the cavity is kept clean there shouldn’t
be a problem.

59. Marsupialization followed by
Enucleation (WALDRON)
 Common than marsupialisation alone
 After a certain period of time the
improvement decreases or nearly stops
 Then enucleation maybe performed
without harm to vital structures or teeth.

60. Indications:
 Same as those for marsupialization:
 Inability for the patient to keep the cavity
clean.
 Excision biopsy

61. Advantages:
 secondary enucleation is an easier procedure
Disadvantages:
 Is that there is pathological tissue left untill
the second stage of treatment.

62. Technique
 After marsupialization, osseous healing is
allowed to progress
 followed-up by radiographic examination
until the evidence of adequate bone
formation or tooth/teeth eruption
 Then enucleation is performed

63. Enucleation with curettage
 In this procedure enucleation is carried out
and then a bur or curette are used to remove
1-2 mm of bone around the entire periphery
of the cystic cavity.
Indications:
 to remove any remaining epithelial cells that
may be present to prevent the recurrence of
the cyst.

64. Other treatment modalities
 Enucleation with
carnoy’s solution
 Peripheral ostectomy
 Peripheral ostectomy
with carnoy’s solution
 Resection

65. Enucleation and primary closure with
reconstruction / bone grafting
 Reconstruction with
stainless steel or
titanium reconstructive
plates
 Autogenous bone
grafts: Iliac crest,
costochondral

66.  synthetic bone
hydroxyapatite
crystals
 Plasma rich fibrin
matrix

67. Complications of cystic lesions
 Pathological fracture.
 Infection- acute or chronic.
 Post operative wound dehiscence.
 Loss of vitality of the tooth.
 Neuropraxia in infected cysts.
 Recurrence.
 Dysplatic , neoplatic or even malignant changes.

68. ODENTOGENIC CYSTS BASED ON TYPICAL
CLINICAL AND RADIOGRAPHIC FEATURES

69. Periapical cyst
Pathogenesis
*Initiation of epithelial proliferation & cyst
formation
*Cyst growth & enlargement
^ mural growth
^ hydrostatic growth
^ bone resorption
An odontogenic cyst derived from rests of malassez that
proliferates in response to inflammation

70. Clinical features
 non vital tooth (apex)
* involves carious tooth
* males > females
* maxilla > mandible
* 3 – 4 decade of life
* small cyst- asymptomatic <1 cm
* large cyst- “ swelling & mild sensitivity
“ mobility of adjacent tooth

71. Radiographic features
 well circumscribed
radiolucency associated with
apex of non vital tooth
 loss of lamina dura

72. Histopathology
 Non-keratinized stratified squamous epithelium
 Rushton bodies
 Fibrous connective tissue capsule
 Cholesterol crystals
cholesterol crystals
Rushton bodies

73. Treatment
 Extraction of associated non vital tooth and curettage
of epithelium in the apical zone
 Alternatively, a root canal filling may be performed in
association with an apicocectomy to permit direct
curettage of the cystic lesion
 The third and most frequently used option involves
performing a root canal filling only, since most lesions
residue after removal of the inflammatory stimulus
 Surgery is done for persistent lesions

74. Residual cyst
Cyst which develops
subsequent to
extraction or after it
due to left periapical
tissue after removal
of tooth
treatment:
enucleation

75.  Low grade inflammation of parent cyst might
predispose formation of residual cyst.
 Age: older age group
 Sex: male>female
 Site: maxilla>mandible
 Asymptomatic
 It is rarely more than 5 to 10 mm in diameter
 TREATMENT :Enucleation

76. PARA DENTAL CYST
 It is an inflammatory odontogenic cyst which occurs in association with the
root surface of an impacted tooth or partially erupted vital tooth.
 Paradental Cyst is also known as Inflammatory Paradental Cyst, Mandibular
Infected Buccal Cyst, Buccal Bifurcation Cyst.
Origin:
 Rests of malassez
 Reduced enamel epithelium
 Etiology:
 Inflammation due to pericoronitis.
 Pathogenesis:
 Occurs due to unilateral enlargement of dental follicle due to inflammatory
destruction of periodontium and alveolar bone.

77.  Frequency: 2.5—3%
 Age: 1st 3rd decade
 Sex: males>females
 Site: mandibular third molars due to pericoronitis
Radiological findings:
 Well circumscribed radiolucency when it is seen distal to the mandibular
third molar.
 Radiolucency may extend apically
Treatment:
 Surgical enucleation, no recurrence

78. Dentigerous cyst
 It is most common
developmental odontogenic
cyst
 Coined by PAGET 1863
 Origin:
 Derived from the cells of
reduced enamel epithelium
Pathogenesis:-
fluid accumulation b/w the
reduced enamel epith’&
enamel surface resulting in a
cyst in which the crown is
located with in the lumen &
roots outside.
A dentigerous cyst is one that encloses the crown of an unerupted tooth by
expansion of its follicle, and is attached to its neck

79. Clinical features
 Asymptomatic – small
 Pain & swelling- large or
inflamed
 Encloses crown of an
unerrupted tooth( at least 1
missing tooth in arch)
 Cyst attachment at C.E.J
 mand 3 molar > max canines >
max 3 molar
 males > females
 1 & 3 decade of life
 initially bony hard consistency
 egg shell crackling.(later)

80. Radiographic features
 Unilocular ,
well defined
radiolucency
withsclerotic
margins
around the
crown of
unerrupted
tooth.
 3 types of cyst
to crown
relation:
central
lateral
circumferential

81.  CT scan of a maxillary dentigerous cyst extending
to, and impinging on, the floor of the nose.
Radiograph of a central type of dentigerous
cyst.
Note resorption of the root of the first
mandibular molar.

82. CYSTIC FLUID
 Thin watery yellow, straw colored occasionally
blood tinged if infected pus mixed with fluid
 Protein: >5gm/100ml
 Cholesterol crystals if infected

83. TREATMENT
 Removal of associated tooth and enucleation of the
soft tissue component
 Treatment varies depending on size of the lesion
 Smaller lesions; surgical removal of the entire
lesion along with unerrupted tooth.
 Larger cysts; marsupalization -complete removal
of the cyst may cause pathological fracture
 Recurrence is relatively uncommon

84. Eruption cyst
 Soft tissue counterpart of dentigerous
cyst
 Soft ,translucent swelling in the gingival
mucosa over crown of an erupted tooth
Age – 1 month to12 yrs (4.4 yrs)
Site – 1 permanent molar & max incisor
No treatment or excision of portion of sac
An odontogenic cyst with histologic features of a dentigerous cyst that surrounds
a tooth’s crown that has erupted through bone but not soft tissue & is clinically
visible as a soft fluctuant mass on alveolar ridge

85. Odontogenic keratocyst (okc)
 First described by MIKULICZ IN 1876 as dermoid cyst
 Primordial cyst by Robinson 1945
 The term OKC was introduced by PHILIPSEN in 1956
 Pindborg and Hansen in 1963 described the essential
features of this type of cyst.
Origin:
 Remnants of dental lamina (cell rests if serre)
 Primordium of the developing tooth germ or its enamel
organ
 Basal layer of the oral epithelium.
A cyst derived from remnants of dental lamina ,with a biological
behaviour similar to benign neoplasm with a distinctive lining of 6-10 cells
in thickness & that exhibits a basal cell layer of palisaded cells & a surface
of corrugated parakeratin.

86. Clinical features
 Age – 2nd and 3rd decade of life; bimodal age
distribution
 Sex – males > females; black > whites
 Site – Mandible > maxilla
 Varying distance into ascending ramus and
body
 Maxilla – can occur into sinus; globulomaxillary
area
 Patient complains of pain, swelling or
discomfort
 Occasionally parasthesia of lower lip
 Usually symptomless unless infected
 Displacement of adjacent teeth

87.  Bony expansion is minimum in odontogenic
karatocyst -the cyst spreads via the medullary spaces
of bone
 Mostly intraosseous – rarely extraosseous -
peripheral OKC
 Multiple kerato cysts are associated with nevoid
basal cell carcinoma syndrome, marfan syndrome
and Ehlers- Danlos syndrome.

88. Radiological features (OkC)
 Appears small, avoid, or normal radioluscent areas
 Unilocular / multilocular; smooth periphery
 Well demarcated with sclerotic margin
 Rarely expansion of bone seen
 Spread along medullary spaces of bone than
buccolingullay

89. Varieties of odontogenic cyst
Main (1970)
 Envelopmental – cyst embracing an adjacent
Unerupted tooth
 Replacement – cyst which forms in place of normal
tooth of series
 Extraneous – cyst seen in ascending ramus away
from teeth
 Collateral – cyst adjacent to roots of teeth

90. Aspiration
 Keratocyst shows straw colored or thick cheesy material
from the lumen when aspirated.
 Protein estimation : <3.5gms/100ml
 Low quantities of soluble protein rich in albumin and
relatively small quantities of immunoglobulins.

91. Histopathological features
 Lined by 6-8 cells thick thin stratified
squamous epithelium without rete
ridges
 Two types surafce epithelium
 PARAKERATINIZED (80-90%)
 ORTHOKERATINIZED
 Basal layer of cells is made up of tall
columnar cells with basophilic nuclei
which is reverse polarized.
 Palisading arrangemnt of basal cells
with superficial corrugated epithelium.
 Mitotic activity in both the basal and
supra basal cells are seen.
 Desquamated keratin is seen in cystic
lumen.

92.  The junction between the lining and
connective tissue is flat.
 Presence of satellite cyst or daughter
cysts in the connective tissue is
characteristic features..
 The fibrous capsule is thin and is
devoid of inflammatory cells.
 Melanin pigmentation in the basal
cells.
 Daughter cysts are more in OKCs
associated with syndrome.

93. Treatment (OkC)
 Small single lesions can be
completely enucleated
provided access is good
(Intra oral approach)
 Larger cyst – careful
enucleation and done by
extraoral approach; if an
intraoral approach may
lead to blind curettage

94. Treatment (OkC)
 Large multilocular lesions –
excision & immediate bone graft
is treatment of choice at first
operation
 Resection of involved bone and
reconstruction with stainless
steel, vitallium, titanium
 More conservative approach –
enucleation / excision and
cauterization of bone defect with
carnoy’s solution prevents
recurrence
 Composition of carnoys
solution:
 ETHYL ALCOHOL------
----------60ml
 GLACIAL ACETIC
ACID--------10ml
 CHLOROFORM---------
-----------30 ml

95. RECURRENCE
 Pindborg and Hansen (1963) reported a recurrence
of 62% in 16 cysts
 Keratocyst fibrous wall are thin fragile and
particularly when the cysts are large
 The lining is weakly attached to the fibrous wall
 Extension of cyst into cancellous bone increases
the difficulty of removing the lining.

96. Reasons for recurrence of OKCs
 Keratocyst may have in their periphery
satellite/daughter cysts which may be left behind after
enucleation of the main cyst.
 Presence of cell rests of serres may develop into new
cysts formation after enucleation.
 Toller suggested that there may be an intrinsic growth
potential in the epithelial lining which may be
responsible for high recurrence rate.

97. Calcifying Odontogenic Cyst {COC}
 This cyst has many features similar to CEOT.
 First described by Gorlin in 1962.
 Clinical features :
 Rarest of the cysts with a rate of 1%
 Age : common in second decade
 Sex : Equal sex distribution.
 Site : Seen equally in anterior part of mandible and
maxilla.

98. CLINICAL SIGNS AND SYMPTOMS
 Swelling is the most frequent complaint
 Rare occasion there is pain
 Intraosseous lesions produce bony hard expansion and may be fairly extensive
 Lingual expansion may sometimes be observed
 Occasionally the COC may perforate the cortical plate and extend into the soft
tissues.
 Displacement of teeth
 Extraosseous COC are localized sessile or pedunculated gingival masses with no
distinctive clinical features, they can resemble common GINGIVAL FIBROMAS,
PERIPHERAL GIANT CELL GRANULOMAS.

99.  Radiological Features
 Usually unilocular
radiolucency.
 Margins may be well defined or
poorly defined.
 Irregular calcified bodies may
be seen in the lesion.
 Root resorption is a common
feature.

100.  Management
 Surgical enucleation.
 Conservative treatment is adequate if assosiated with
complex odontome.

101. Lateral periodontal cyst
 Designation of LPC restricted
only to those cysts which occur in
PDL region on lateral aspect of
teeth and in which inflammatory
etiology and a diagnosis of
collateral OKC have been ruled
out clinically and histologically
A slow growing , non expansile developmental odontogenic cyst derived
from 1 or more rests of dental lamina, exhibiting a lining 1 to 3 cubiodal
cells & distinctive focal thicknings(plaque)

102. C/F:-
 Uncommon, 20 – 60 yrs, M>F,
Mand. Premolars> Ant. Maxilla
 Asymptomatic . Lateral side of
root.
 Associated teeth are vital
 Size < 1cm (except BOTRYOID)
R/F:-
 well defined ,round, oval,
unilocular radiolucency b/w
roots of tooth. (Multilocular
BOTRYOID)
Histopath:-
 1 to 3 cell thick non keratinized
epithelium glycogen rich clear
cells
Treatment:-
Surgical enucleation.
BOTRYOID varity carefull Follow
up after enucleation

103. Gingival cyst of adult
 Soft tissue counterpart
of lateral periodontal
cyst
 Site – crest of maxillary
& mandibular alveolar
ridge
 Firm, compressible,
painless
 Surface smooth, normal
in color
 * Treatment – surgical
enucleation

104. Gingival cyst of infants
 Bohn’s nodules or Epstein’s pearls.
 Rare after three months of age.
 Seen on the alveolar ridge or along the
mid palatine raphe.
 usually 2 to 3 mm in diametre.
 Pathogenisis : Known to arise from
the remnents of dental lamina {glands
of serres}.
 Those along the mid palatal raphe
arise from the epithilial inclusions at
the line of fusion.
 Treatment : Not indicated.

105. NON ODONTOGENIC CYSTS
 Nasopalatine duct (incisive canal) cyst
 Globulomaxillary cyst
 Nasolabial (naso-alveolar cyst)
 Median cysts

106. Nasopalatine cyst
 Commonest of non odontogenic cysts-Stafne(1969)
 Median anterior maxillary cyst, incisive canal cyst
 Arise from epithelial remnants of nasopalatine duct
 Anywhere in the canal-mostly lower position
 Anterior region of midline of palate

107. Radiographic features
 Well defined round/ovoid/heart shaped
radiolucency
 Usually symmetrical about the midline
 Distinguish from incisive fossa
 TREATMENT: Enucleation

108. Globulomaxillary cyst
 Occurs between roots of maxillary lateral incisor and
canine
 At the junction of maxillary and globular portion of
medial nasal process
 Inverted pear-shaped radiolucency
 TREATMENT: Enucleation

109. NASOLABIAL CYST
 Naso alveolar cyst
 In soft tissues of upper lip below ala of nose
 Slowly enlarging swelling
 Majority unilateral
 Common in women, 3rd and 6th decade
 Etiology unknown
 TREATMENT: Excision of the cyst under GA or LA

110. BONE CYSTS
 SOLITARY BONE CYST
 Also called-simple bone cyst,traumatic bone
cyst,haemorragic bone cyst
 Occurs mainly in children and adolescents
 b/w Canine and 3rd molar regions of the mandible
 Majority are asymptomatic

111. SOLITARY BONE CYST
 Radiographically –irregular radiolucency with
scalloping
 Surgical exploration shows rough bony walled
cavity
 No soft tissue lining
 TREATMENT: Exploration of area and induce
bleeding after evacuating the contents

112. ANEURYSMAL BONE CYST
 Jaffe and Lichtensteiner in 1942
 Most commonly in mandible
 Usually seen in children/young adults
 Presents as a firm painless swelling
 Pathogenesis unknown –trauma?

113. Histopathology
 Non-endothelial lined, blood filled spaces
 Multinucleated giant cells
 RADIOGRAPHICALLY: Usually unilocular
 Can be seen with soap bubble appearance also
 TREATMENT: Surgical excision or curettage

114. REFERENCES
 Textbook of oral and maxillofacial surgery, Daniel M Laskin
 Textbook of Oral & Maxillofacial pathology; Neville,
Damm,Allen,Bouquet:2nd edition
 Textbook on differential diagnosis of oral & maxillofacial
lesions; Norman K. Wood, Paul W. Goaz: 5th edition
 Textbook of Oral pathology; Shafer’s: 5th edition
 Kreidler J F, Raubenheimer E J, Van Heedem WFP. 1993.
A Retrospective analysis of 367 cystic lesions of the jaws-
J.Cranio-Maxillo facial Surg- 21: 339-341.
 Text book of oral maxillofacial surgery, Neelima anil malik