Cysts of the oral region / dental implant courses

CYSTS OF THE ORALCYSTS OF THE ORAL
REGIONREGION
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CYSTSCYSTS
 Cyst is an abnormal cavity in hard or softCyst is an abnormal cavity in hard or soft
tissues which contains fluid, semifluid ortissues which contains fluid, semifluid or
gas and is often encapsulated and linedgas and is often encapsulated and lined
by epithelium –by epithelium – KILLEY AND KAY (1966)KILLEY AND KAY (1966)
 A cyst is pathological cavity having fluid,A cyst is pathological cavity having fluid,
semifluid or gaseous contents and whichsemifluid or gaseous contents and which
is not created by accumulation of pusis not created by accumulation of pus
frequently but not always lined byfrequently but not always lined by
epithelium –epithelium – KRAMER (1974)KRAMER (1974)

CLASSIFICATIONCLASSIFICATION
A)ROBINS (1945)A)ROBINS (1945)
Developmental cysts
From odontogenic tissue From non-odontogenic tissue
A) Periodontal cyst
1) Lateral
2) Radicular
3) Residuall
B) Dentigerous cyst
C) Primordial cyst
1) Median cyst
2) Incisive canal cyst
3) Globulomaxillary cyst

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SHEAR 1985SHEAR 1985
Cysts
Epithelial cysts Non- epithelial
Odontogenic Non-odontogenic
Developmental Inflammatory
1) Primordial cyst
) Gingival cyst of newborn
3) Gingival cyst of adults
) Lateral periodontal cyst
Dentigerous cyst (follicular)
6) Eruption cyst
Calcifying odontogenic cyst
1) Radicular cyst
2) Residual inflammatory cyst
3) Collateral cyst
4) Paradental cyst
1) Nasopalatine cyst
2) Median palatine cyst
3) Median mandibular cyst
5) nasolabial cyst

Non- epithelial cysts:Non- epithelial cysts:
1)1) Simple bone cystSimple bone cyst
2)2) Traumatic bone cystTraumatic bone cyst
3)3) Hemorrhagic bone cystHemorrhagic bone cyst
4)4) Aneursymal bone cystAneursymal bone cyst

 Cysts associated with maxillary antrumCysts associated with maxillary antrum
1)1) Benign mucosal cystBenign mucosal cyst
2)2) Surgical ciliated cyst of maxillaSurgical ciliated cyst of maxilla
 Cysts of soft tissue of mouth and neckCysts of soft tissue of mouth and neck
1)1) Dermoid – epidermoid cystDermoid – epidermoid cyst
2)2) Branchial cystBranchial cyst
3)3) Thyroglossal cystThyroglossal cyst
4)4) Anterior median lingual cystAnterior median lingual cyst
5)5) Oral cyst with gastric epitheliumOral cyst with gastric epithelium
6)6) Cystic hygromaCystic hygroma
7)7) Cyst of salivary glandsCyst of salivary glands
8)8) Parasitic hydatid cystParasitic hydatid cystwww.indiandentalacademy.comwww.indiandentalacademy.com

WHO CLASSIFICATION 1971WHO CLASSIFICATION 1971
Epithelial cyst
Developmental Inflammatory
Odontogenic
1) Primordial cyst
2) Gingival cyst
3) Eruption cyst
4) Dentigerous cyst
Non-odontogenic
1) Nasopalatine cyst
3) Nasolabial cyst
Radicular cyst

CLINICAL FEATURESCLINICAL FEATURES
 Depends on the type, location, presenceDepends on the type, location, presence
of infection and adjacent structures.of infection and adjacent structures.
 It causesIt causes
1.1. PainPain
2.2. SwellingSwelling
3.3. Pus dischargePus discharge
4.4. Sinus formationSinus formation
5.5. Paraesthesia / anesthesiaParaesthesia / anesthesia

INVESTIGATIONSINVESTIGATIONS
1)Radiography: Both intraoral and extra oral1)Radiography: Both intraoral and extra oral
2)Aspiration: If pale, straw coloured or fluid with2)Aspiration: If pale, straw coloured or fluid with
cholestrol crystals ( radicular/ dentigerous)cholestrol crystals ( radicular/ dentigerous)
 Blood like/ blood may be central hemangioma orBlood like/ blood may be central hemangioma or
aneursymal bone cyst.aneursymal bone cyst.
 Golden yellow fluid may be solitary bone cyst/Golden yellow fluid may be solitary bone cyst/
 Pale yellow – odourless inspissated whitePale yellow – odourless inspissated white
material mimicking pus may be odontogenicmaterial mimicking pus may be odontogenic
keartocyst.keartocyst.
3) Microscopy eg: rushton bodies3) Microscopy eg: rushton bodies
4) Paper electrophoresis and protein estimation4) Paper electrophoresis and protein estimation

AIMS OF TREATMENTAIMS OF TREATMENT
1.1. To remove the lining or to enable the patientsTo remove the lining or to enable the patients
body to rearrange the position of abnormalbody to rearrange the position of abnormal
tissue so that it is eliminated within the jaw.tissue so that it is eliminated within the jaw.
2.2. To do so with minimum trauma to patient,To do so with minimum trauma to patient,
consistent outcome to the operation.consistent outcome to the operation.
3.3. To preserve adjacent important structuresTo preserve adjacent important structures
such as nerves and healthy teeth.such as nerves and healthy teeth.
4.4. To achieve rapid healing of operation site.To achieve rapid healing of operation site.
5.5. To restore the part to a normal / near normalTo restore the part to a normal / near normal
form to restore normal function.form to restore normal function.

FACTORS INFLUENCIN THEFACTORS INFLUENCIN THE
CHOICE OF OPERATIONCHOICE OF OPERATION
1.1. Age of the patient.Age of the patient.
2.2. Physical status of the patient.Physical status of the patient.
3.3. Patient reservations about anesthesia /Patient reservations about anesthesia /
operation.operation.
4.4. Poor surgical access.Poor surgical access.
5.5. Adjacent structures to be preserved.Adjacent structures to be preserved.
6.6. Presence of large dead space.Presence of large dead space.
7.7. Infections/ fractures.Infections/ fractures.

CLASSIFICATION OFCLASSIFICATION OF
OPERATIONSOPERATIONS
A)A) Decompression / MarsupialisationDecompression / Marsupialisation
1) With incomplete removal of lining either1) With incomplete removal of lining either
opening into the mouth or into the maxillaryopening into the mouth or into the maxillary
sinus.sinus.
2) With complete removal of lining opening2) With complete removal of lining opening
either into the mouth or maxillary sinus.either into the mouth or maxillary sinus.
B) Enucleation with wound closureB) Enucleation with wound closure
1) with bone grafting1) with bone grafting
2) without bone grafting2) without bone grafting
3) secondary closure after primary3) secondary closure after primary
decompressiondecompression

MARSUPIALISATION PARTSCH IMARSUPIALISATION PARTSCH I
ENUCLEATION PARTSCH IIENUCLEATION PARTSCH II
PRINCIPLE OF MARSUPIALISATIONPRINCIPLE OF MARSUPIALISATION
 Surgical opening of cyst cavity.Surgical opening of cyst cavity.
 Conversion into accessory cavity of oralConversion into accessory cavity of oral
cavity.cavity.
 Causative tooth/ teeth endodonticallyCausative tooth/ teeth endodontically
treated or resected.treated or resected.
 Allow wound to epithelialise.Allow wound to epithelialise.
 Packing (medicated).Packing (medicated).

PRINCIPLE OF ENUCLEATIONPRINCIPLE OF ENUCLEATION
 Cyst capsule completely detached fromCyst capsule completely detached from
the bone and shelled out.the bone and shelled out.
 Wound sutured primarily.Wound sutured primarily.
 Cyst epithelium merges with oralCyst epithelium merges with oral
epithelium or removal of cyst epitheliumepithelium or removal of cyst epithelium
with capsule so that healing takes place.with capsule so that healing takes place.

Indications for marsupialisationIndications for marsupialisation
1.1. Extremely large cyst. (M)Extremely large cyst. (M)
2.2. Cyst very large – bone undermining (M) later (E).Cyst very large – bone undermining (M) later (E).
3.3. Vital adjacent teeth are endangered by removalVital adjacent teeth are endangered by removal
(M).(M).
4.4. Risk of opening into maxillary sinus/ nose (M).Risk of opening into maxillary sinus/ nose (M).
5.5. Enucleation of infected cyst leads to infectionEnucleation of infected cyst leads to infection
(M).(M).
6.6. Edentulous mouth(M).Edentulous mouth(M).
7.7. Injury to nerve (M).Injury to nerve (M).
8.8. Patients general condition is poor. (M)Patients general condition is poor. (M)
9.9. Presence of fistula (M).Presence of fistula (M).

INCISIONSINCISIONS
1)1) Curved partsch incisionCurved partsch incision
2)2) ‘‘Pichler’ incision.Pichler’ incision.
3)3) Gingival marginal incision / scalloped trapezoidal incision.Gingival marginal incision / scalloped trapezoidal incision.
4)4) Double incision.Double incision.

TECHNIQUE OFTECHNIQUE OF
MARSUPIALISATION (PARTSCHMARSUPIALISATION (PARTSCH
1892)1892)
 Incision placed in such a way that future edge ofIncision placed in such a way that future edge of
bony opening is covered by mucosa.bony opening is covered by mucosa.
 U shaped incision (partsch incision)U shaped incision (partsch incision)
mucoperioteal flap is raised.mucoperioteal flap is raised.
 Flap dissection in a sub-periosteal plane.Flap dissection in a sub-periosteal plane.
 Bone removal with gouge/ bur & rongeurs.Bone removal with gouge/ bur & rongeurs.
 Bone margins cut back & saucerisation done.Bone margins cut back & saucerisation done.
 Cut away exposed lining.Cut away exposed lining.
 Turn margins of flap into cavity and suture to theTurn margins of flap into cavity and suture to the
lining.lining.
 Cavity irrigated and packed with whiteheadCavity irrigated and packed with whitehead
varnish soaked gauze.varnish soaked gauze.www.indiandentalacademy.comwww.indiandentalacademy.com

 Composition of whitehead varnish:Composition of whitehead varnish:
Benzoin - 10 gramsBenzoin - 10 grams
StoraxStorax - 7.5 grams- 7.5 grams
Balsam of tolu – 5 gramsBalsam of tolu – 5 grams
Iodoform - 10 gramsIodoform - 10 grams
Solvent ether - upto 100 ml.Solvent ether - upto 100 ml.
Pack placed for a period of 10 days.Pack placed for a period of 10 days.
Later construction of a ‘ bung ‘ or obturatorLater construction of a ‘ bung ‘ or obturator

CYST PLUG / BUNGCYST PLUG / BUNG
 Indications:Indications:
1)1) Bony opening which is small in proportion toBony opening which is small in proportion to
size of cystic cavity, either for anatomicsize of cystic cavity, either for anatomic
reasons or because of the need to avoidreasons or because of the need to avoid
damaging adjacent teeth/ important structures.damaging adjacent teeth/ important structures.
2)2) An opening where a substantial part of theAn opening where a substantial part of the
circumference is composed of sulcus mucosacircumference is composed of sulcus mucosa
which is supported on loose connective tissue.which is supported on loose connective tissue.

REQUISITES OF BUNGREQUISITES OF BUNG
1.1. Maintains patency of cyst orifice.Maintains patency of cyst orifice.
2.2. Should be retentive.Should be retentive.
3.3. Should partially extend into cavity.Should partially extend into cavity.
MATERIALS USED:MATERIALS USED:
1)1) Initially gutta percha.Initially gutta percha.
2)2) Acrylic plugs.Acrylic plugs.
3)3) Modified denture.Modified denture.

ADVANTAGES OFADVANTAGES OF
MARSUPIALISATIONMARSUPIALISATION
1)1) No great surgical skill required.No great surgical skill required.
2)2) Conservative methodology.Conservative methodology.
3)3) No risk of creating oro antral fistula orNo risk of creating oro antral fistula or
oronasal fistula.oronasal fistula.
4)4) No damage to adjacent structures.No damage to adjacent structures.
5)5) No risk to adjacent teeth.No risk to adjacent teeth.
6)6) In dentigerous cyst when chances ofIn dentigerous cyst when chances of
eruption of tooth is a distant possibility.eruption of tooth is a distant possibility.

DISADVANTAGES OFDISADVANTAGES OF
MARSUPIALISATIONMARSUPIALISATION
1.1. Pathological tissue is left behind.Pathological tissue is left behind.
2.2. If cavity is large, healing & filling time isIf cavity is large, healing & filling time is
prolonged unduly.prolonged unduly.
3.3. Use of cyst plug/bung with repeatedUse of cyst plug/bung with repeated
cleaning and food debris loading in it.cleaning and food debris loading in it.

TECHNIQUE OF ENUCLEATIONTECHNIQUE OF ENUCLEATION
(PARTSCH II)(PARTSCH II)
 Surgical procedure leaves a surgical openingSurgical procedure leaves a surgical opening
into the cyst cavity covered byinto the cyst cavity covered by
mucoperiosteum and empty space filled bymucoperiosteum and empty space filled by
blood clot which eventually oragnizes to formblood clot which eventually oragnizes to form
healthy bone.healthy bone.
CONTRAINDICATIONS:CONTRAINDICATIONS:
1.1. Large cyst of mandible with fracture, woundLarge cyst of mandible with fracture, wound
breakdown, infection.breakdown, infection.
2.2. Cyst involving apices of more than one toothCyst involving apices of more than one tooth
( vital).( vital).
3.3. Dentigerous cyst in young person whichDentigerous cyst in young person which
prevents tooth from erupting.prevents tooth from erupting.www.indiandentalacademy.comwww.indiandentalacademy.com

PRIMORIDAL KERATOCYSTSPRIMORIDAL KERATOCYSTS
 Embryology :Embryology : derived from cell rests of dentalderived from cell rests of dental
lamina ( cell rests of Serres) and cell rests oflamina ( cell rests of Serres) and cell rests of
mallassez.mallassez.
 Shear’s criteria for keratocysts:Shear’s criteria for keratocysts:
1)1) Regular thin lining of stratified squamousRegular thin lining of stratified squamous
epithelium with no rete pegs.epithelium with no rete pegs.
2)2) Keratinised/ parakeratinised surfaceKeratinised/ parakeratinised surface
epithelium.epithelium.
3)3) Keratin frequently present within cyst cavity.Keratin frequently present within cyst cavity.
4)4) Relative absence of inflamatory cell infiltrate.Relative absence of inflamatory cell infiltrate.
5)5) Columnar basal cells with pyknotic/ vesicularColumnar basal cells with pyknotic/ vesicular
nucleus.nucleus. www.indiandentalacademy.comwww.indiandentalacademy.com

 Types: 1) replacement variety 2)Types: 1) replacement variety 2)
envelopmental/ extraneous/ extrafollicularenvelopmental/ extraneous/ extrafollicular
type.type.
 Site: Most common in the ramus & 3Site: Most common in the ramus & 3rdrd
molar region, lower premolar region, uppermolar region, lower premolar region, upper
molar region, lower incisor region.molar region, lower incisor region.
 More common in mandible than maxilla inMore common in mandible than maxilla in
the ration 5:1.the ration 5:1.

 Clinical features: at a site where a tooth isClinical features: at a site where a tooth is
absent from the dentition, starts betweenabsent from the dentition, starts between
standing teeth/ distal to lower III molar, delayedstanding teeth/ distal to lower III molar, delayed
expansion, symptom less, displacement of teethexpansion, symptom less, displacement of teeth
with a peak incidence in the 2with a peak incidence in the 2ndnd
to 4to 4thth
decade ofdecade of
life.life.
 Radiological examination: unilocular/multilocularRadiological examination: unilocular/multilocular
radiolucencyradiolucency
 Contents: Keratin, inspissated , dirty whiteContents: Keratin, inspissated , dirty white
material resembling pus, smear of keratinisedmaterial resembling pus, smear of keratinised
cells, paucity of plasma protein in fluid oncells, paucity of plasma protein in fluid on
electrophoresis, total plasma established belowelectrophoresis, total plasma established below
4g/100 ml.4g/100 ml.

 Rate of occurrence: upto 60%. TheRate of occurrence: upto 60%. The
reasons are thin friable lining potential forreasons are thin friable lining potential for
tearing, presence of satellite cysts,tearing, presence of satellite cysts,
presence of active epithelial residues.presence of active epithelial residues.
 Treatment : many options depending onTreatment : many options depending on
clinical features and xray, enucleationclinical features and xray, enucleation
(partschII), partsch I and later partsch II(partschII), partsch I and later partsch II
enbloc resection with preservation of boneenbloc resection with preservation of bone
continuity, hemisection / partial resection.continuity, hemisection / partial resection.

 They are the most common and in allThey are the most common and in all
cases pulp is exposed.cases pulp is exposed.
 Etiology: dental caries, fracture of tooth,Etiology: dental caries, fracture of tooth,
thermal, chemical injury to pulp, iatrogenicthermal, chemical injury to pulp, iatrogenic
pulp injury.pulp injury.
 Initiation & progression: Dental cariesInitiation & progression: Dental caries
chronic pulpitis pulp necrosischronic pulpitis pulp necrosis
periapical granuloma epithelial cell restsperiapical granuloma epithelial cell rests
of malassez radicular cyst formationof malassez radicular cyst formation
RADICULAR CYSTSRADICULAR CYSTS

 A tooth is surrounded by its follicle eruptsA tooth is surrounded by its follicle erupts
into a keratocyst cavity in the same wayinto a keratocyst cavity in the same way
as it could erupt into the mouth.as it could erupt into the mouth.

 Expansion of cysts: causes: production of increasedExpansion of cysts: causes: production of increased
internal hydrostatic pressure, attraction of fluid into theinternal hydrostatic pressure, attraction of fluid into the
cyst cavity, retention of fluid within the cavity,cyst cavity, retention of fluid within the cavity,
resorption of surrounding bone with increase in size ofresorption of surrounding bone with increase in size of
bone cavity.bone cavity.
 Theories of cyst enlargement.Theories of cyst enlargement.
A)A) Mural growth theoryMural growth theory
1) Peripheral cell division1) Peripheral cell division
2) Accumulated contents2) Accumulated contents
B)B) Hydrostatic pressure theoryHydrostatic pressure theory
1) Secretion1) Secretion
2) Transudation & exudation2) Transudation & exudation
3) Dialysis3) Dialysis

 Contents: straw colour fluid with cholestrolContents: straw colour fluid with cholestrol
crystals & foam cells.crystals & foam cells.
 Treatment: enucleation with tooth removalTreatment: enucleation with tooth removal
or RCT with apicectomy.or RCT with apicectomy.

DENTIGEROUS CYSTDENTIGEROUS CYST
 Arises from reducedArises from reduced
enamel epithelium.enamel epithelium.
 Associated withAssociated with
missing teeth,missing teeth,
unerupted tooth.unerupted tooth.
 TreatmentTreatment
marsupialisation inmarsupialisation in
children, enucleationchildren, enucleation
in adults.in adults.

SOLITARY BONE CYSTSOLITARY BONE CYST
 Synonyms: extravasation cyst, haemorrahgicSynonyms: extravasation cyst, haemorrahgic
bone cyst, traumatic bone cyst, simple bonebone cyst, traumatic bone cyst, simple bone
cyst, unicameral cyst, progressive bone cavity.cyst, unicameral cyst, progressive bone cavity.
 Etiology: controversial and unknown.Etiology: controversial and unknown.
 Unique features: no epithelial lining, no fluidUnique features: no epithelial lining, no fluid
contents.contents.
 Site: mandible predominantly. In the mandibleSite: mandible predominantly. In the mandible
more common in the ramus and canine-more common in the ramus and canine-
premolar region, similar cysts are found in thepremolar region, similar cysts are found in the
ends of long bones called unicameral cysts.ends of long bones called unicameral cysts.

SOLITARY BONE CYSTSOLITARY BONE CYST
 Clinical features: symptom less, minimal boneClinical features: symptom less, minimal bone
expansion, associated with vital teeth, noexpansion, associated with vital teeth, no
displacement of teeth. Common in 1displacement of teeth. Common in 1stst
and 2and 2ndnd
decades of life.decades of life.
 Xray: unilocular, scalloped upper margins, intactXray: unilocular, scalloped upper margins, intact
alveolar crest and lamina dura, no resorptionalveolar crest and lamina dura, no resorption
and displacement of teeth.and displacement of teeth.
 Treatment: Surgical explorationTreatment: Surgical exploration
 Complications: fracture of mandible, Ca arisingComplications: fracture of mandible, Ca arising
in odontogenic cysts, obliteration of maxillaryin odontogenic cysts, obliteration of maxillary
sinus, Facial/ cervical sinuses, nervesinus, Facial/ cervical sinuses, nerve
involvement leading to paraesthesia.involvement leading to paraesthesia.

ANEURSYMAL BONE CYSTANEURSYMAL BONE CYST
 Uncommon in jaws, seen in first threeUncommon in jaws, seen in first three
decades more common in the posteriordecades more common in the posterior
mandible region.mandible region.
 Clinical findings: Firm and hard bonyClinical findings: Firm and hard bony
swellings, malocclusion, egg shellswellings, malocclusion, egg shell
crackling.crackling.
 Radiology: small radiolucent unilocularRadiology: small radiolucent unilocular
area- may balloon between the cortex.area- may balloon between the cortex.
Honey combed appearance.Honey combed appearance.
 Differential diagnosis: ameloblastoma,Differential diagnosis: ameloblastoma,
odontogenic myxoma.odontogenic myxoma.www.indiandentalacademy.comwww.indiandentalacademy.com

 Pathogenesis: trauma, vascularPathogenesis: trauma, vascular
disturbance, pre existing lesion.disturbance, pre existing lesion.
 Histology: numerous capillaries + bloodHistology: numerous capillaries + blood
filled spaces, small spindle shaped cells,filled spaces, small spindle shaped cells,
separated by loose connective tissue,separated by loose connective tissue,
multinucleated cells, areas of hemorrhagemultinucleated cells, areas of hemorrhage
and hemosiderin.and hemosiderin.
 Aspiration- blood..Aspiration- blood..
 Treatment : curretage. Malignant lesion –Treatment : curretage. Malignant lesion –
radiotherapy.radiotherapy. www.indiandentalacademy.comwww.indiandentalacademy.com

SURGICAL CILIATED CYST OFSURGICAL CILIATED CYST OF
MAXILLAMAXILLA
 Entrapment of epithelial lining of sinusEntrapment of epithelial lining of sinus
during wound closure after caldwell lucduring wound closure after caldwell luc
operation.operation.
 Poorly localised pain / discomfort.Poorly localised pain / discomfort.
 Radiology: well defined to radiolucent areaRadiology: well defined to radiolucent area
closely related to maxillary antrum.closely related to maxillary antrum.

SURGICAL CILIATED CYST OFSURGICAL CILIATED CYST OF
MAXILLAMAXILLA
 Etiology: trauma to salivary gland duct/ partialEtiology: trauma to salivary gland duct/ partial
obstruction.obstruction.
 Type: Extravasation type, retention type.Type: Extravasation type, retention type.
 Clinical features: more common in the lower lip,Clinical features: more common in the lower lip,
palate, cheek, tongue.palate, cheek, tongue.
 In the floor of the mouth descending type calledIn the floor of the mouth descending type called
ranula.ranula.
 Superficial bluish circumscribed raised vesicle.Superficial bluish circumscribed raised vesicle.
 Deeper swelling with normal colour and surfaceDeeper swelling with normal colour and surface
appearance.appearance.

 Histology: Circumscribed – may or mayHistology: Circumscribed – may or may
not be lined by epithelium, connectivenot be lined by epithelium, connective
tissue shows infiltration of polymorphotissue shows infiltration of polymorpho
nuclear cells, lymphoid, plasma cells.nuclear cells, lymphoid, plasma cells.
 Alteration of salivary gland acini adjacentAlteration of salivary gland acini adjacent
to areas of mucocoele. Interstitialto areas of mucocoele. Interstitial
inflamation interlobular + intra lobular ductinflamation interlobular + intra lobular duct
infiltration.infiltration.
 Treatment: excisionTreatment: excision

CALCIFYING ODONTOGENICCALCIFYING ODONTOGENIC
CYST / GORLIN’S CYSTCYST / GORLIN’S CYST
 Age 2Age 2ndnd
decade.decade.
 Males = femalesMales = females
 Maxilla = mandible more common in the anterior part.Maxilla = mandible more common in the anterior part.
 Clinical features: asymptomatic / painless swelling, hardClinical features: asymptomatic / painless swelling, hard
bony expansion, perforation of cortical plate,bony expansion, perforation of cortical plate,
displacement of teeth.displacement of teeth.
 Radiology: unilocular radiolucent area with irregular/ wellRadiology: unilocular radiolucent area with irregular/ well
defined margins. May be associated with unerupteddefined margins. May be associated with unerupted
tooth. Root resorption, irregular calcified bodies oftooth. Root resorption, irregular calcified bodies of
various sizes + opacity in radiolucent areas.various sizes + opacity in radiolucent areas.
 Pathogenesis: from respiratory epithelium/ odontogenicPathogenesis: from respiratory epithelium/ odontogenic
epithelial remnants / gingival tissue/ bone.epithelial remnants / gingival tissue/ bone.

CALCIFYING ODONTOGENICCALCIFYING ODONTOGENIC
CYST / GORLIN’S CYSTCYST / GORLIN’S CYST
 Histology: Type I: simple unicystic/Histology: Type I: simple unicystic/
odontome producing.odontome producing.
 Type II: neoplasm like lesions,Type II: neoplasm like lesions,
dentinogensis ghost cell tumours.dentinogensis ghost cell tumours.
 Ghost cells have pale, eosinophilic,Ghost cells have pale, eosinophilic,
swollen epithelial cells with a faint outlineswollen epithelial cells with a faint outline
of cellular + nuclear membrane.of cellular + nuclear membrane.
 Treatment: enucleationTreatment: enucleation

BRANCHIAL CYST/BRANCHIAL CYST/
LYMPHOEPITHELIAL CYSTLYMPHOEPITHELIAL CYST
 No age groups, sex predilection.No age groups, sex predilection.
 Site: neck close to midline , anterior toSite: neck close to midline , anterior to
sternocleidomastoid, floor of mouth +sternocleidomastoid, floor of mouth +
tongue.tongue.
 Clinical features: Non-ulcerated, freelyClinical features: Non-ulcerated, freely
mobile mass mostly symptomles swelling.mobile mass mostly symptomles swelling.
 On palpation sensation partly filled hotOn palpation sensation partly filled hot
water bottle of their thick wall & fluidwater bottle of their thick wall & fluid
content.content.

BRANCHIAL CYST/BRANCHIAL CYST/
LYMPHOEPITHELIAL CYSTLYMPHOEPITHELIAL CYST
 Etiology: epithelial remnants of branchial clefts +Etiology: epithelial remnants of branchial clefts +
pouches, cyst in cervical lymph nodes, tonsils –pouches, cyst in cervical lymph nodes, tonsils –
plugged crypt opening, salivary gland inclusionsplugged crypt opening, salivary gland inclusions
in parotid lymph nodes, from epithelial remnantsin parotid lymph nodes, from epithelial remnants
of upper portion of branchial apparatus.of upper portion of branchial apparatus.
 Histology: lined by stratified squamousHistology: lined by stratified squamous
epithelium devoid of rete pegs which may beepithelium devoid of rete pegs which may be
keratinised areas of ulceration present lymphoidkeratinised areas of ulceration present lymphoid
tissues encircles epithelium + shows germinaltissues encircles epithelium + shows germinal
centres.centres.
 Treatment: excision if symptomatic.Treatment: excision if symptomatic.

THROGLOSSAL DUCT CYSTTHROGLOSSAL DUCT CYST
 Midline foramen caecum – thyroid duct.Midline foramen caecum – thyroid duct.
 Clinical features : soft movable tender, liftsClinical features : soft movable tender, lifts
on swallowing/ protrusion of tongue,on swallowing/ protrusion of tongue,
dysphonia/dyspnoea.dysphonia/dyspnoea.
 Histology: Pseudostratified columnarHistology: Pseudostratified columnar
epithelium. Mucous glands in wall.epithelium. Mucous glands in wall.
Malignant change leads toMalignant change leads to
adenocarcinoma.adenocarcinoma.
 Treatment: radical surgical excision.Treatment: radical surgical excision.

NASOPALATINE CYSTNASOPALATINE CYST
 Epithelium lined cyst of non-odontogenic origin.Epithelium lined cyst of non-odontogenic origin.
 Arises from the epithelial residues inArises from the epithelial residues in
nasopalatine canal, epithelium included in linesnasopalatine canal, epithelium included in lines
of fusion of embryonic facial processes.of fusion of embryonic facial processes.
 Etiology: trauma/ bacterial infection, mucousEtiology: trauma/ bacterial infection, mucous
glands in association with nasopalatine duct,glands in association with nasopalatine duct,
spontaneously, genetic determinant.spontaneously, genetic determinant.
 Clinical features: a swelling in the anterior regionClinical features: a swelling in the anterior region
of midline of palate and labial apsect of alveolarof midline of palate and labial apsect of alveolar
ridge with pain & discharge.ridge with pain & discharge.
 Differential diagnosis: periapical lesion by testingDifferential diagnosis: periapical lesion by testing
& pulp vitalilty of incisors.& pulp vitalilty of incisors.www.indiandentalacademy.comwww.indiandentalacademy.com

NASOPALATINE CYSTNASOPALATINE CYST
 Radiology: heart shaped radiolucencyRadiology: heart shaped radiolucency
between central incisors.between central incisors.
 Histology: variable epithelium, with bloodHistology: variable epithelium, with blood
vessels in connective tissue.vessels in connective tissue.
 Treatment: enucleationTreatment: enucleation

GLOBULOMAXILLARY CYSTGLOBULOMAXILLARY CYST
 Fissural cyst between maxillary lateralFissural cyst between maxillary lateral
incisor & canine teeth.incisor & canine teeth.
 Inclusion of epithelium at the site of fusionInclusion of epithelium at the site of fusion
of globular process of medial nasalof globular process of medial nasal
process (fronto nasal process) + maxillaryprocess (fronto nasal process) + maxillary
process.process.
 Inverted pear shaped radiolucency- rootsInverted pear shaped radiolucency- roots
of adjacent teeth.of adjacent teeth.

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