presentation for department of oral medicine and radiology. while presenting make sure to focus more on differential diagnosis and read about each cyst in detail as i havent included the details.

1. Department of Oral
Medicine and
Radiology

2. DEPARTMENT
OF ORAL
MEDICINE
AND
RADIOLOGY
Rayat Bahra Dental College and Hospital

3. CYSTS OF
JAWS
Part - II
Fiza Shameem
Roll no 20
BDS Final year

4. Cyst
 “Pathologic cavity having fluid , semi fluid, or
gaseous content but not always lined by an
epithelium.”
-KRAMER IN 1974

5. GENERAL DIAGNOSTIC
FEATURES OF CYSTS
SIGNS SYMPTOMS
Factors affecting diagnosis Pain and swelling
Expansion Anesthesia or paresthesia
Enlargement Salty taste
Consistency Displacement of denture
Window formation Tooth discoloration
Fluid discharge
Effect on teeth

6. Topics of today’s discussion
Odontogenic cysts
Gingival cyst
Lateral periodontal cyst
Calcifying odontogenic cyst
Radicular cyst

7. Non-odontogenic cysts
Nasopalatine cyst
Nasolabial cyst

8.  Aneurysmal bone cyst
 Paradental
 Solitary bone cyst

9. Gingival cyst
• Uncommon cyst of gingival soft tissue,
occuring either in the free or attached gingiva.
• Regarded as soft tissue counterpart of lateral
periodontal cyst.

10. ETIOLOGY AND PATHOGENESIS :
• It may arise from odontogenic epithelial cell
rests;
• by traumatic implantation of surface
epithelium;
• or by cystic degeneration of deep projections of
surface epithelium

11. CLINICAL FEATURES
Clinical photograph of a gingival cyst of an adult
AGE :5th – 6th decade of life
SITE : mandibular canine and
Pre Molar area; attached
gingiva or I/D papilla
GENDER: male predominance

12.  Signs and symptoms:
• Slowly enlarging, well circumscribed painless
swelling.
• Invariably occurs on facial aspect of free / attached
gingiva.
• Dome shaped soft, fluctuant swelling which is
<1cm in diameter
• Surface of lesion is smooth and of normal color of
gingiva or bluish.
• Fluctuant lesion, adjacent teeth are vital.

13. Radiological features
Radiograph of a gingival cyst in an adult.

14. LATERAL PERIODONTAL CYST
• Uncommon, but well recognized type of odontogenic cyst.
• The designation ‘lateral periodontal cyst’ is confined to those cysts
that occur in the lateral periodontal position and in which an
inflammatory etiology and a diagnosis of collateral OKC have been
excluded on clinical and histological grounds
 (Shear and Pindborg, 1975).

15.  Etiology :
Results from
 an early dentigerous cyst left in place after tooth
eruption
 Okc
 Rests of malassez
 Remanents of dental lamina

16. CLINICAL FEATURES
• Age : 20 – 60 years, peak in 6th decade.
• Sex : Male predilection.
• Site : Lateral PDL regions of mandibular canines and
premolars, followed by anterior maxilla

17. Signs & symptoms
• Usually asymptomatic as it occurs on the lateral aspect of root
of tooth.
• Occasionally pain and swelling may occur.
• Overlying mucosa appears normal in color.
• Associated teeth are vital, unless otherwise affected.
• Cysts rarely < 1cm in size. Except for the BOTRYOID VARIETY.

18. Radiological features
• Round to ovoid ‘lucency
with sclerotic margins.
• Cyst can be present
anywhere between cervical
margin to root apex.
Radiograph of a lateral periodontal cyst lying between the
mandibular premolar teeth. The margins are well corticated,
indicative of slow enlargement.

19. Radiological features
Lateral periodontal cyst. Radiolucent lesion
between the roots of a vital mandibular canine and
first premolar.
Lateral periodontal cyst. A larger lesion causing
root divergence.

20. Differential diagnosis :
 Lateral radicular cyst
 Lateral dentigerous cyst
 Residual cyst
 okc

21. CALCIFYING ODONTOGENIC CYST
• Also called as Odontogenic ghost cell cyst or Gorlin cyst.
• It Has many features of odontogenic tumor, therefore it is
placed in the category of tumors in the latest WHO
classification of odontogenic cysts and tumors.
• In the latest WHO publication on odontogenic tumours
(Prætorius and Ledesma-Montes, 2005) it was classified as a
benign odontogenic tumour and was renamed calcifying cystic
odontogenic tumour (CCOT).

22. Pathogenesis
• COC is a unicystic process and develops from the
reduced dental epithelium or remnants of dental
lamina.
• The cyst lining has the potential to induce formation
of odontoma in adjacent CT wall.

23. Clinical features
• Age : Wide range, peak in 2nd – 3rd decade.
• Sex : slight female predilection
• Site : Anterior segment of both jaws

24. Signs & symptoms
• Swelling is the commonest complaint, seldom
associated with pain.
• Intraosseous lesions can cause hard bony expansion
and resulting in facial asymmetry.
• Displacement of teeth can also occur.

25. RADIOLOGICAL FEATURES
• Intraosseous lesions produce
well defined lucency which is
usually unilocular.
• Irregular calcified masses of
varying sizes may be seen within
the lucency.
• Displacement of root/roots with
or without root resorption and
expansion of cortical plates also
seen
Radiograph of a calcifying odontogenic cyst of
the maxilla. There is a well-demarcated margin
and calcifications suggestive of tooth material.

26. DIFFERENTIAL DIAGNOSIS
Based on radiographic appearance, following lesions
must be included in the provisional diagnosis –
• Ameloblastic fibro odontoma
• Fibrous dysplasia
• Ossifying fibroma

27. RADICULAR CYST
• Also called APICAL PERIODONTAL CYST
• Radicular cysts are the most common inflammatory cysts and
arise from the epithelial residues in the periodontal ligament
as a result of periapical periodontitis following death and
necrosis of the pulp.
• Quite often a radicular cyst remains behind in the jaws after
removal of the offending tooth and this is referred to as a
residual cyst.

29. CLINICAL FEATURES
• Age : peak in 3rd, 4th and 5th decades.
• Sex : Slightly more in males.
• Site : Maxillary anterior region.
• Frequency: Commonest cystic lesion of jaws.

30. Signs & symptoms
• Primarily symptom less.
• Discovered accidentally during routine dental X ray exam.
• Slowly enlarging hard bony swelling initially. Later, if cysts
breaks through cortical plates, lesion becomes fluctuant.
• Diagnostic criteria – associated teeth are non vital
• Rare in deciduous teeth.

31. RADIOLOGICAL FEATURES
• Classically presents as
round / ovoid lucency with
sclerotic borders and
associated with pulpally
affected tooth / teeth.
• If infection supervenes, the
margins become indistinct,
making it impossible to
distinguish it from a
peripaical granuloma.
Radiograph of a radicular cyst. The lesion is a well
defined radiolucency associated with the apex of a non-
vital root filled tooth.

32. DIFFERENTIAL DIAGNOSIS:
 Following lesions must be distinguished from other periapical
radiolucencies–

1. Periapical granuloma
2. Peripaical cemento – osseous dysplasia (early lesions)

33. Nasopalatine Duct
(Incisive Canal) Cyst
• Also classified as “FISSURAL CYSTS”.
• Believed to be derived from epithelial remnants included
during closure of embryonic facial processes.
• Controversy – actual “closure” of embryonic processes does
not occur. Grooves between processes is smoothed by
proliferation of underlying mesenchyme.
• Usually occurs within the nasopalatine canal or in soft tissue
of palate at the opening of canal.

34. PATHOGENESIS
• In lower animals, the NP duct concerned with olfactory
sensation – in humans only vestigial remnants persist in
incisive canal in form of epithelial islands, ducts, cords etc.
• These nests can show central degenration to form cysts.
Etiology for cyst transformation is yet unclear.
• Some believe, it may arise spontaneously like an OKC.

35. CLINICAL FEATURES
• Age : 4th, 5th & 6th decades.
• Sex : More in females
• Frequency: Commonest non odontogenic
developmental cyst

36. Signs & symptoms
• Commonest symptom is swelling,
usually in anterior region of mid
palate.
• Swelling can also occur in midline
on labial aspect of alveolar ridge.
• If pressure on NP nerves – pain
• Exclude possibility of periapical
cyst by testing vitality of incisors.

37. Nasopalatine Duct
(Incisive Canal) Cyst
Small nasopalatine cyst presenting as a soft ovoid
swelling in the midline of the maxilla, posterior to
the central incisor teeth.
Large nasopalatine duct cyst extending laterally and
posteriorly to involve much of the hard palate.

38. RADIOLOGICAL FEATURES
Radiograph of a
nasopalatine duct cyst
showing a pear-shaped
radiolucency in the anterior
maxilla. The lamina dura on
the left is intact although
the apex appears to be in
the cyst.

39. RADIOLOGICAL FEATURES
Shows a large round radiolucency. The roots of the
maxillary incisor teeth are displaced laterally.

40. RADIOLOGICAL FEATURES
• Seen as lucency usually in
incisive canal – DIFFICULT TO
DISTINGUISH FROM A NATURALLY
LARGE INCISIVE CANAL.
• Lucency with AP dimension upto
10 mm considered as enlarged
incisive canal, but if lucency < 14
mm, then NP duct cyst.
• The lucency appears well defined
with sclerotic borders, in midline
of palate between roots of
incisors.

41. DIFFERENTIAL DIAGNOSIS
• Radicular cyst, if it is associated with a pulpally
involved tooth.
• Large incisive canal.

42. NASOLABIAL CYST
• The nasolabial cyst occurs outside the bone in the
nasolabial folds below the alae nasi.
• It is traditionally regarded as a jaw cyst although
strictly speaking it should be classified as a soft
tissue cyst.

43. Clinical features
• Age : Peak incidence in 4th & 5th decades.
• Sex : More in females.
• Frequency: Rare in occurrence.

44. Signs & symptoms
• Commonest complaint –
slowly growing swelling and
occasionally, pain and
difficulty in nasal breathing.
• Extra orally – filling out of
nasolabial fold and may lift
ala of nose.
• Intra orally – bulge in labial
sulcus.
• Fluctuant lesion.
Nasolabial cyst producing a
swelling of the right upper lip,
forming a bulge in the labial
sulcus.

45. RADIOLOGICAL FEATURES
• Difficult to interpret on
radiograph.
• May be seen as localized
increased lucency of
alveolar process above
apices of incisors.
• Lucency results from
pressure resorption on
labial surface of maxilla.
Standard occlusal radiograph of a patient with a nasolabial
cyst. There is a posterior convexity of the left half of the
radiopaque line that forms the bony border of the nasal
aperture.

46. Paradental Cysts
• A cyst of inflammatory origin-
occurring on lateral aspect of
root of partially erupted
mandibular 3rd molar with an
associated history of pericoronitis
• Age : 20-40 years
• Tooth is vital
• Facial swelling
• Facial sinus in some cases

47. Radiographic features
• Affected tooth is tilted
Well demarcated
Radiolucency Distal to
partially erupted tooth
• Lamina Dura is intact
• New bone may be laid
down (a,b) Two cases of bilateral paradental cysts associated with erupting
mandibular third molar teeth. The cysts are distal and buccal to the
involved teeth. Note that the periodontal ligament space is not widened
and that the distal part of the cyst is separate from the distinct distal
follicular space.

48. Aneurysmal Bone Cyst
• Uncommon cyst, found mostly in long bones and spine.
• CLINICAL FEATURES: -
1. Age : First 3 decades.
2. Sex : Mainly females.
3. Site : molar regions of mandible & maxilla.
• Signs & symptoms:
 Hard, rapidly growing swelling which can
cause malocclusion.
 If lesion perforates cortical plates, can cause
“egg shell crackling”.

49. PATHOGENESIS
• Controversy whether lesion arises de novo or from a
vascular disturbance in the form of sudden venous
occlusion or development of an AV shunt occurring
secondarily in a pre existing lesion like central giant
cell granuloma, Osteosarcoma etc.
• Due to the malformation, change in hemodynamic
forces occurs which can lead to ABC.

50. RADIOLOGICAL FEATURES
• Classically seen as a unilocular, ovoid / fusiform lucency which
balloons the cortical plates.
• Teeth displacement and root resorption also observed.
• Lesions are usually unilocular but longer-standing lesions may
show a ‘soap-bubble’ appearance and may become
progressively calcified

51. Radiograph of an aneurysmal bone cyst involving the angle and
ascending ramus of the mandible. There is a ballooning expansion
of the cortex.

52. DIFFERENTIAL DIAGNOSIS
• Conventional ameloblastoma
• CEOT
• Central giant cell granuloma

53. Solitary Bone Cyst
• Also called as Hemorrhagic bone cyst, or Traumatic
bone cyst.
• Commonly seen in mandible, rare in maxilla.
• Identical to solitary bone cyst of humerus in children
and adolescents.

54. CLINICAL FEATURES
• Age : Young individuals
• Sex : Equal
• Site : Body and symphysismenti of mandible.

55. PATHOGENESIS
• None of the theories are certain about exact cause.
• First theory – cyst may follow trauma to bone which causes
intra medullary hemorrhage which fails to organize. This clot
subsequently liquefies - CYST.
• Recent theory osteogenic cells fail to differentiate locally and
thus instead of bone, the undifferentiated cells form synovial
tissue.

56. Signs & symptoms
• Asymptomatic.
• Rarely, swelling and pain may be seen.
• Half of all patients give a history of trauma to the
area.

57. RADIOLOGICAL FEATURES
• Appears as a lucency with
irregular but well defined
edges and slight cortication.
• On occlusal view the
‘lucency is seen to extend
along cancellous bone.
Radiograph of a solitary bone cyst involving an
extensive area in the right body of the mandible. This
example has a well-defined margin with cortication.
Interradicular scalloping is a prominent feature.

58. treatment

59. Principles of Treatment
 REASONS
• Cysts tend to increase in size.
• Cysts tend to get infected.
• Cysts weaken the jaw. ( pathological fracture)
• Some cysts undergo changes. Eg: Ameloblastoma, Mucoepidermoid
carcinoma ( histological study to be done)
• Cysts prevent eruption of teeth. (dentigerous cyst)
• Involvement of neighboring structures.( maxillary sinus, nose,
adjacent tooth)

60. Various Aspirates
PATHOLOGY ASPIRATE Other Findings of Aspirates
Dentigerous Cyst Clear, pale straw colour
fluid
Cholesterol crystals.
Total protein in excess
4 g / 100ml. Resembles serum
Odontogenic Keratocyst Dirty, creamy white
viscoid suspension
Para keratinized squames.
Total protein less than
4 g /100ml. Mostly albumin
Periodontal Cyst Clear, pale yellow straw
colour fluid
Cholesterol crystals.
Total protein 5 — 11g / 100ml
Infected Cyst Pus, brownish fluid Polymorphonuclear leukocytes,
,Cholesterol clefts
Mucocele, Ranula Mucus -----
Gingival Cysts Clear fluid -----

61. Various Aspirates
PATHOLOGY ASPIRATE Other Findings of
Aspirates
Solitary Bone Cyst Serous fluid, blood or
empty cavity
Necrotic blood clot
Stafne’s Bone Cyst Empty cavity – yield air ---
Dermoid Cyst Thick sebaceous material ---
Fissural Cyst Mucoid fluid ----

62. treatment
 Cysts of the jaws are treated in one of the following
four basic methods:
(1) Enucleation,
(2) Marsupialization,
(3) A staged combination of the two procedures, and
(4) Enucleation with curettage.

63. 1. Enucleation
• Enucleation is the process by which the total
removal of a cystic lesion is achieved.
• By definition, it means a shelling- out of the entire
cystic lesion without rupture.

64. ENUCLEATION OF CYST

65. ENUCLEATION OF CYST

66. 2. Marsupialization
• Marsupialization, decompression, and the Partsch operation all
refer to creating a surgical window in the wall of the cyst,
evacuating the contents of the cyst, and maintaining continuity
between the cyst and the oral cavity, maxillary sinus, or nasal cavity.
• The only portion of the cyst that is removed is the piece removed to
produce the window. The remaining cystic lining is left in situ.
• This process decreases intracystic pressure and promotes shrinkage
of the cyst and bone fill. Marsupialization can be used as the sole
therapy for a cyst or as a preliminary step in management, with
enucleation deferred until later.

68. 4. Enucleation with Curettage
• Enucleation with curettage means that after
enucleation a curette or bur is used to remove 1 to 2
mm of bone around the entire periphery of the cystic
cavity
• Any remaining epithelial cells that may be present in
the periphery of the cystic wall or bony cavity must be
removed.
• These cells could proliferate into a recurrence of the
cyst.

69. References :
 Mervyn shear
 Soames and southam
 Wood and goaz
 Shafer