This document provides information on various cysts that can occur in the oral and paraoral regions. It begins by defining a cyst as a pathologic cavity containing fluid or gas that is not due to pus accumulation and is often lined by epithelium. Various classifications of cysts are described including their epithelial lining, location, origin, and whether they are odontogenic or non-odontogenic. Specific cysts are then discussed in more detail, including odontogenic keratocysts, dentigerous cysts, eruption cysts, lateral periodontal cysts, calcifying epithelial odontogenic cysts, and radicular/periapical cysts. Clinical features, pathogenesis, histopathology,

1. Cysts Of Oral &
Paraoral Region
Dr. Anila K
Reader
Dept of Oral Pathology
NDC, Raichur

2. Derived from Greek word ‘Kystis Sac’
Definition:
“A cyst is a pathologic cavity containing fluid, semi
fluid or gaseous contents, which is not created by
accumulation of pus. It is frequently but not always
lined by epithelium”
Kramer,1974

3. Cystic lining Epithelium
Cystic
capsule/wall
Connective
tissue
Lumen/Cavity
Parts Of Cyst

4. Classification
Epithelial Lining
True Cyst
Pseudo Cyst/False cyst
Location
Intraosseous
Extraosseous

5. Origin
 Intraosseous cyst
• Remnants of dental lamina
• Tooth germ/Enamel organ
• Cell rests of Malassez
• Reduced enamel epithelium
 Soft tissue cyst
• Remnants of epithelium at line of closure
Odontogenic cyst
Non odontogenic cyst/
Fissural cysts
• Salivary gland
• Remnants of thyroglossal duct
• Remnants of embryonic skin Dermoid cyst/ Epidermoid cyst
• Entrapped epithelium in lymphoid tissues Lymphoepithelial cyst

6. Classification
EPITHELIAL CYST NON EPITHELIAL CYST
Odontogenic Non Odontogenic
( Developmental)
Developmental Inflammatory

7. Developmental Odontogenic Cysts
Odontogenic keratocyst/ Primordial cyst
Dentigerous cyst/ Follicular cyst
Eruption cyst
Gingival cyst of infants
Gingival cyst of adults
Lateral periodontal cyst
Calcifying epithelial odontogenic cyst
Glandular odontogenic cyst/ Sialo odontogenic cyst
Botryoid odontogenic cyst

8. Inflammatory Odontogenic Cysts
Radicular cyst/ Periapical cyst
Residual cyst
Mandibular infected buccal cyst
Inflammatory Collateral cyst
Paradental cyst

9. Non Odontogenic Cysts
Nasopalatine duct cyst/ Nasoalveolar cyst
Mid palatine /median palatine raphae cyst
Median mandibular cyst
Globulo maxillary cyst
Nasolabial cyst

10. Non Epithelial Cysts
Aneurysmal bone cyst
Solitary bone cyst
Stafne’s cavity

11. Cysts of Maxillary sinus
Mucocele
Surgical ciliated cyst/ Post operative cyst

12. Soft Tissue Cysts
Cysts Of Salivary Gland
Mucous retention type
Mucous extravasation type
Ranula

13. Other cysts
Dermoid cyst
Epidermoid cyst
Thyroglossal duct cyst
Lympho epithelial cyst/ Branchial cyst

14. Clinical Presentation
Radiographic Features
Diagnosis Of Cysts

15. Aspiration Cytology
Straw coloured fluid periapical cyst & Dentigerous
Cheesy white material Odontogenic keratocyst
Golden yellow fluid Solitary bone cyst
Greenish fluid Infected cyst
Dark brown Haemorrhage in Cyst

16. Biochemical evaluation Of Cyst
Fluid
> 4.89/100ml Inflammatory/non keratinising cyst
< 4.89/100ml Noninflammatory / Keratinising cyst
Proteins
Continuous layer of keratinized epithelium lining the cysts forms
a less readily penetrable barrier than the discontinous
non-keratinized epithelium and thus lower levels of proteins
would accumulate in the cystic fluid

17. Biopsy
Epithelium
 Present/absent
 Keratinised/ Non keratinised
 Thickness
Capsule
 Parallel arrangment of collagen fibers to epithelium
 Cholestrol clefts
 Inflammatory cells
 Daughter cyst
Lumen

18. Odontogenic keratocyst
Synonyms : Primordial Cyst - Enamel organ
Incidence : 5-10%
Importance:
Anteroposterior Growth Pattern
High Recurrence rate

19. Clinical Features
Age : 2nd -3rd decade
Sex : M> F
Site : Mand > Max
Mand : PM-Molar area
Body of mandible
Angle
Ramus
Maxilla: 3rd molar region
canine

20. Clinical Presentation
 Asymptomatic
Pain – Secondary Infection
 Anteroposterior growth
Cancellous bone
 Angle, ramus –Later expansion
Displacement of teeth
Mobility of tooth
Pathologic Fractures

21. Extension into the marrow spaces rather than expansion

22. ODONTOGENIC KERATOCYST – X- RAY
Uni/multi RL with well defined scalloped sclerotic border

23. ODONTOGENIC KERATOCYST – X- RAY
Replacement
Envelopment
Collateral
Extraneous

24. Pathogenesis
 Remnants of Dental Lamina
 Degeneration of stellate reticulum
 Arise from normal tooth series (tooth absent)/
supernumerary teeth
 Basal cell layer of oral epithelium-Posterior

25. Fine Needle Aspiration Cytology
Plasma protein Below 4gm/100ml
• Permeability ↓ due to
keratinisation
• Low / no inflammatory cells
•White cheesy material
• Smear Keratinized epithelial
cells

26. Histopathology

27. Cystic epithelium
 Uniform, 6-10 layers
 Folded
 Surface is corrugated which forms smooth folds
 Usually parakeratinised, occasionally orthokeratinized
 Basal cells are tall, columnar, ovoid darkly
stained well polarised, palisaded nucleus
Tomb stone like or picket fence appearance
 Rete ridge is absent, epi & Ct junction is flat
Lumen – Flakes of Keratin

28. CT capsule is thin & collagen fibers are less dense,
arranged parallely.
 Odontogenic epithelial islands are seen in the capsule
 The basal cells starts proliferating epithelium buds &
separates  lie as island of Daughter cyst / satellite cyst

30. Complications
Pathologic fracture
High Recurrence
Inadequate removal
Presence of daughter cyst
Rapid proliferation of keratocyst lining
Genetic
Tumours – Ameloblastoma, SCC

31. GORLIN-GOLTZ SYNDROME
 Multiple OKC
 Multiple Basal cell carcinomas of skin
 Skeletal abnormalities – Bifid rib & abnormalities of vertebrae
 Cleft lip & palate (5%)
 Intracranial abnormalities
 Calcification of falx cerebri
 Abnormal shape of sella turcica
Basal cell Nevus Syndrome/Nevoid Basal carcinoma syndrome

32.  The term Dentigerous  containing teeth
 Cyst encloses the crown of an unerupted tooth
 It is attached to the neck of the tooth
DENTIGEROUS CYST

33. Dentigerous Cyst

34. CLINICAL FEATURES
 Common developmental odontogenic cyst
 Sex- M > F
 Age - 2nd -4th decade
 Associated with impacted tooth & tooth is
missing/unerupted
 Site – Mand > Max
Mand 3rd M, Max canine,
Max 3rd M & Mand PM

35. Clinical Appearance
 Asymptomatic
 Discovered on X -ray examination/ Retained Deci tooth
 Expansion at the later stage
Egg shell Crackling –Palpation
Mobility/resorption of roots
 Displacement of teeth
*A tooth will be clinically missing/ IMPACTED TEETH

36. DENTIGEROUS CYST – X-RAY
Central Lateral Circumferential
*Cyst Lining attached to CEJ

38. Gross Appearance
Attachment to CEJ
Nodular Thickenings - Ameloblastoma

39. HISTOPATHOLOGY
Non keratinized st sq / flattened/ low cuboidal epi
thin 2-4 cells thick, Resembles reduced enamel epithelium
Thick fibrous wall – capsule
Odo epi islands r seen in the capsule
Metaplasia of the lining, keratin, mucous cells &
occasionally ciliated cells

40. HISTOPATHOLOGY

41. Pathogenesis
 Intra follicular
Fluid accumulation b/w the REE & crown of an unerupted
tooth
Extra follicular
Erupting tooth becomes asso. with cyst formed from the
remnants of dental lamina

42. Complications
Development of tumors
Ameloblastoma
Adenomatoid odontogenic tumor
Mucoepidermoid carcinoma
Squamous Cell carcinoma

43. ERUPTION CYST
 Eruption Heamatoma
 Variant of Dentigerous Cyst
Origin :Derived from Reduced Enamel epithelium
Erupting Decidous teeth/Permanent Molars

44. Eruption cyst

45.  Soft fluctuant swelling  Alveolar ridge  Superficial
to erupting tooth -Painless
 Colour vary  pink to purple 
Type of fluid present within the cyst
 When fluid  Blood tinged  Purple colour 
Eruption hamatoma

46. ERUPTION CYST

48. Histopathological features
 Cyst lining  Thin & non keratinised stratified
squamous epithelium  Cuboidal / flattened epi cells
 Normal oral mucosa on superficial surface
 Chronic inflammatory cell infilterate in CT capsule
 Odontogenic epithelium rests within capsule

49. Treatment
 Cyst - ruptured, discharge its content
 Permits tooth to erupt normally

50. Lateral Periodontal Cyst
Developmental Odontogenic Cyst
Lateral Periodontal Space
ORIGIN
 Cell rests of Dental lamina
Cell rests of malazeez

51. §Asymptomatic, discovered on routine X ray examination
§ Occur in the Mand. canine & Premolar region
§ Associated teeth - Vital
Clinical features
 Uncommon
 Adults

52. Radiologic Features
Well defined unilocular radiolucency with
sclerotic margins – Lateral aspect of tooth
Multilocular RL- Botryoid Odontogenic Cyst

53. Non keratinised epithelial lining – stratified
squamous epithelium
 1-5cell layer thickness
 Cells are often cuboidal
 Nodular thickenings – Epithelial Plaque
Histopathological features

54. Glycogen rich clear cells  Interspersed among
lining epithelial cells
Multilocular LPC  Botryoid  Bunch of grapes

55. Lateral Periodontal Cyst

56. Unicystic & polycystic lateral
Periodontal cyst developing
from rests & respective radiographic
appearance

57. Gingival Cyst of Adults
Uncommon, resembles lateral periodontal cyst

58. Pathogenesis
Derived from cell rests of dental lamina
Traumatic surface implantation of gingival epithelium

59. Usually seen in adult
Mandible gingiva > Maxillary gingiva
 Mandible canine & premolar region  Common site
 Associated teeth  All vital
 present as small well defined painless swelling
on the gingiva, may affect any part of gingiva
Clinical features

61. Histopathology
Similar To LPC
Lining containing focal
thickening (plaque)

62. Gingival Cyst Of Infants/Dental
Lamina Cyst Of Newborn
Developmental Odontogenic cyst
Rests of dental lamina
Bohn’s nodules Alveolar ridge Dental lamina rests

63. Epstein pearls Palate
Histopathology:
Epithelial Lining : Keratinised Str. Squamous
Lumen –Keratin
Capsule –Dense collagen fibres

64. Calcifying Odontogenic cyst
Uncommon lesion, that demonstrates variable
H/P appearance & clinical behavior
Present as cyst or neoplasm
Associated with other odontogenic tumors-
odontome, ameloblastoma
ORIGIN
Odontogenic epithelial rests in the gingiva & jaws

65. Clinical features
Any age but mostly in 2nd & 3rd decades of life
Females > Males
Predominantly intra – osseous, affects both maxillary &
mandible (anterior area)
Asymptomatic slow growth

66. Radiological features
Appears as a unilocular / multilocular well defined
RL with RO within the lesion “salt & pepper appearance”
Displacement & root resorption of involved teeth

67. TYPES
TYPE I  CYSTIC
 Simple cystic
 Odontome producing
 Ameloblastoma producing
TYPE II  NEOPLASTIC TYPE

68. SIMPLE CYSTIC TYPE
Intra osseous or extra osseous
Epithelial lining : 4 -10 cell layers thick
Basal cells - cuboidal / columnar - Ameloblast
Overlying layer of loosely arranged epithelial - SR
Ghost cells
within the CT wall evoke foreign body multinucleated giant
cells
Ghost Cells can undergo calcification

69. ODONTOME PRODUCING TYPE
20% associated with odontomas
Age  10 – 30 years
Intraosseous or extraosseous
H/P  resemble ameloblastomas but also contain
ghost cells & dental hard tissue i.e tooth like
strands in connective tissue

71. Ghost cells present in other lesions like
Craniopharyngioma
Ameloblastic fibroma
Odontoma
COC

72. AMELOBLASTOMA PRODUCING TYPE
Rare
Intraosseous
Ameloblastomatous proliferation in connective tissue
capsule as well as in lumen

73. NEOPLASM TYPE
(DENTINOGENIC GHOST CELL TUMOR)
Occur in later age group
Rare
Intraosseous or extraosseous
H/P  Amelobastomatous epithelium, ghost cells &
calcified bodies
Varying amounts of dentinoid are induced by
odontogenic epithelium

75. RADICULAR CYST
OR
PERIAPICAL CYST

76.  Inflammatory cyst
 Associated with apices of non vital teeth
 Most Common type of odontogenic cyst
Can occur in preexisting Periapical Granuloma
 Sequelae of pulpitis
 Epithelial cell rests of malassez

77. CLINICAL FEATURES
 Age -20 -60yrs
 Sex - M> F
 Site – 60% max ant region, mand post, &
mand ant
Rare in deci dentition
 Causes
 Dental caries
 Pulp death from trauma

78. Clinical appearance
 Tooth - Non vital
- Grossly carious tooth
 When small – asymptomatic
- Discovered on R/E
 As cyst enlarges – Expansion of alveolar bone
 Infected-
Pain
Draining sinus

80. RADIOGRAPHIC FEATURES
•Round/ovoid RL with RO border
*Continuous with Lamina dura
•Root resorption

81. Fine Needle Aspiration Cytology
Straw colored fluid
Cholesterol crystals
Protein levels- 5-11g/dl
Smear -Inflammatory cells

82. Histopathology
Epithelial lining
Non keratinized stratified Squamous epithelium
Variable thickness
Proliferation  Long anastomosing cords of epithelium
forming arcading pattern
Spongiosis/ Intercellular edema
 Infiltrated with inflammatory cells
Metaplasia: Mucous metaplasia /Keratinized epithelium

83. Histopathology

84. Dense bundles of collagen fibres
 Chronic inflammatory cells- lymphocytes, plasma cells
CT capsule

85. RUSSEL BODIES
Aggregates of immunoglobulins produced by plasma cells

86.  Seen within the capsule or lumen
 Few in number or form large mural nodules
 Needle shaped spaces
 These spaces are left by cholesterol dissolved out during
tissue preparation
 Clefts are asso with foreign body giant cells
Cholesterol clefts

87. RUSHTON BODIES/ Hyaline bodies
 Seen in epithelial lining
Hairpin or slightly curved shape
 Hyaline, eosinophilic laminated bodies
 Sometimes undergo mineralization –appear basophilic
Origin:
May be hematogenous
Secretory product of Odontogenic epithelium

88. Pathogenesis of cyst formation
鸎 Cyst Formation &
Proliferation
鸎 Cyst Enlargement
鸎Cyst Expansion :Hydrostatic pressure of cyst fluid
鸎Resorption of surrounding bone
鸎 Cyst Initiation

89. Proliferation of rests of Malassez (due to altered
environment i.e↓O2 &↑CO2) -
periapical granuloma
鸎 Cyst Initiation

90. 1.Degeneration & death of central cells within a
proliferating mass of epithelium
2. Degeneration & liquefactive necrosis of
granulation tissue
3. Epithelization of an abscess cavity
Three main mechanisms
鸎 Cyst Formation &
Proliferation

91. 鸎 Cyst Enlargement
鸎Cyst Expansion :Hydrostatic pressure of cyst fluid
鸎Resorption of surrounding bone

92. HYDROSTATIC PRESSURE
Semi permeable
cyst wall
Hypertonic
Inflammatory exudate
Cell break down products

93. Inflammatory
cells
Prostaglandins
(PGE2, PGF2 &PGI)
Collagenase
Cytokines
Interleukin
BONE RESORPTION
Inflammatory
cells

94. Radicular Cyst

95. RESIDUAL CYST

98. Non-Odontogenic Cysts
FISSURAL CYST

99. Non Odontogenic Cysts
Nasopalatine duct cyst/Incisicive canal cyst
Mid palatine /median palatine raphae cyst
Median mandibular cyst
Globulo maxillary cyst
Nasolabial cyst Nasoalveolar cyst

100. True cysts derived from remnants of
epithelium entrapped between lines of closure of
embryonic facial process
• All are of developmental origin
• Most are intra-osseous except nasolabial cyst
•Each cyst have specific location
General features

101. Most common non-odontogenic cyst
Origin-Epithelium of nasopalatine duct – Incisive
canal
Swelling & Intermittent discharge
NASOPALATINE DUCT CYST
Midline of anterior maxilla
Sometimes cyst occur in soft tissue :cyst of palatine papilla

102. Clinical features
 Age : 4th -6th decade
 M> F
 Swelling –bulge in floor of nose
 Pain – Pressure on nasopalatine nerves
Discharge – Intermittent :Mucoid/Purulent
 Displacement of teeth

104. X-ray - Radiolucency with sclerotic border
Round, ovoid / heart shaped RL

105. Radiological features

106. Histopathology
Stratified Squamous,
Respiratory epithelium,
Mucous Glands
Large BV & nerves - capsule

107. NASOLABIAL CYST
 Naso-alveolar Cyst
 Soft tissue cyst
 Nasolabial folds – Upper lip lateral to midline
* Lesion arises from epithelium included during fusion of
lateral nasal & maxillary process
* From remanants of the nasolacrimal duct

108. Clinical features
 Rare lesion
 Age 4th -5th decade
 Sex  F>M
Site  Maxilla

109.  Slowing enlarging soft tissue swelling obliterating
nasolabial fold & distorting nostril
 May arise bilaterally
 Pain & difficulty in nasal breathing
 Facial deformity if lesion is huge
Clinical presentation
Intra orally
 Bulge in labial sulcus
 Fluctuant on bimanual palpation
 Infected cyst may discharge into the nose

111.  Lined by non ciliated pseudo stratified columnar epithelium
 Mucous sells, ciliated cells, squamous metaplasia
 CT wall fibrous collagen fibers
 Inflammatory infiltrate
Histopathological features

112. Median mandibular cyst
‫שּׂ‬ Midline of the mandible
‫שּׂ‬ Develops from epi entrapped during fusion of the halves
of the mand during embryonic life
Radiological features
 Midline RL found b/w or apical to mand CI
 Cortical expansion is seen

113. Globulomaxillary cyst
Rare lesion
Occurs b/w roots of Max LI & Canine teeth
Epi entrapment b/w globular portion of the
medial nasal process & max process
Radiological features
 Inverted pear shaped RL b/w max LI & C
 Divergence of the roots

114. MEDIAN PALATINE CYST/ MID PALATINE CYST
☼ Midline of palate, Rare
☼ Arising from epithelium entrapped between palatine shelves
☼ Occurs in infants
☼Behind Incisive papilla

115. Young adults
 Firm or fluctuant swelling of midline of hard palate
posterior to palatine papilla
 Asymptomatic, but c/o pain / expansion
Clinical features

116. Occlusal radiograph  Well circumscribed
radiolucency in midline of hard palate
Radiological features
Histopathological features
Stratified Squamous,
Respiratory epithelium,
Mucous Glands
Large BV & nerves - capsule

117. PSEUDOCYSTS

118. ANEURYSMAL BONE CYST
Uncommon lesion
Common in Long bones – Rare in
jaws
Jaffe & Lichenstein -1942

119. Vascular malformation haemodynamic disturbance
Arterio-venous shunt
 Exuberant organisation of hematoma
 History of trauma
 Primary lesions of bone Eg- Fibrous dysplasia & CGCG
Pathogenesis

120. Age-2nd decade, b/w 10 & 20 yrs
Sex- F > M
Site Mand > Max
Post part of mand, angle & ramus
Painless swelling & rapidly progressing
Displacement of teeth
Egg shell crackling
Difficulty in opening of mouth
Clinical Features

121. • Uni/multi RL, ballooned out appearance due to cortical expansion
Displacement of teeth

122.  At the time of surgery dark venous blood wells
up & diffiult to control
 Porous tissue within large spaces contain blood
blood soaked sponge appearance
Cyst content

124.  Non – endothelial lined
 Blood filled spaces – varying size
 Separated by cellular fibrous tissue
 Multinucleated giant cells
 Haemorrhage, haemosiderin
 Trabeculae of osteoid or osseous tissue
HISTOPATHOLOGY

125. Age  predominantly-children, 2nd decade
 Sex  M>F
 Site  Premolar & Molar region of mandible
SOLITARY BONE CYST
Synonyms
TRAUMATIC BONE CYST, HEMORRHAGIC BONE CYST,
SIMPLE BONE CYST , IDIOPATHIC BONE CYST
Clinical features

126. Radiographic features
 RL variable size & irregular outline
 Scalloping around & between roots of teeth
 Well defined margins

127. Unknown
Trauma  intramedullary hemorrhage  fails to
organize clot  lysis of clot / hemolysis & resorption of
the clot  cavitations
Some haemodynamic disturbance in medullary bone
Ischemic necrosis of bone
Low grade infection
Local defect in bone growth
Pathogenesis

128. Cyst Contents
• Cyst cavity
Empty
Golden yellow Fluid
Gaseous contents

129. Histopathology
Similar To ABC
Ct Wall – Capillaries
Giant cells
Osteoid

130. Stafne Bone Cyst

131. Synonyms
Static bone cavity
Latent Bone Cyst
Lingual Mandibular bone Defect
Discovered on R/G
Round to ovoid RL
Below Inf. Alveolar canal
Developmental anomaly – appears as cyst
Lobe of normal submand. Salivary gland

132. Cysts Of Salivary Gland
‫שּׂ‬ Mucocele clinical term which includes
 Mucous extravasation cyst (Pseudocyst)
 Mucous retension cyst (True cyst)
‫שּׂ‬ Ranula

133. MUCOCELE
Mucous extravasation Mucous retention
Common Less common
Age Younger Age  Adults
Etiology-
Trauma
Etiology-
Obstruction/blockage of
salivary flow –sialolith,
periductal scar, impinging
tumor
Site – Minor Sal gland
Lower lip BM, ventral
surface of tongue & floor of
mouth
Site- Both major & minor Sal
gland.
Floor of mouth  Ducts of
SB gland & SL gland. Upper
lip, palate, cheek & max sinus

134. Lesions- painless & smooth
surface.
Superficial Bluish hue /
translucency.
Appear dome shaped
Asymptomatic
On palpation – mobile &
nontender
Lesion situated deep- firm
& more diffuse
Swelling ↑ during meals
Size- Few mm to cm Size- 3mm to 10mm
Pt complain-H/o recurrent
swelling with rupture &
releases its content

136. MUCOCELE
Mucus escapes from severed duct and
accumulates within the submucosal
connective tissue
Lesion is soft and
fluctuant
on palpation

138. MUCUS RETENTION CYST
Hypothesized to arise as ductal
dilatations from obstruction
by mucous plugs
SIALOLITHIASIS

139. HISTOPATHOLOGICAL FEATURES
Mucous extravasation Mucous retention
Pseudocyst  No epithelial
lining
Well lined by granulation
tissue  Free mucin
Mucin  Pale eosinophilic
area of mucus in CT
Ductal epithelial lining.
Lining formed  Epithelial
cells ranges from
pseudostratified to a double
layer of columnar or cuboidal
cells
Lumen contains mucin &
granulation tissue infiltrated by
large numbers of neutrophils,
macrophages, lymphocytes &
occasionally plasma cells
Lumen contains mucus plugs
or sialoliths
Supporting CT  Minimally
inflamed

140. Histopathology

141. Mucus extravasation cyst
Pooled mucin, granulation tissue wall, distended overlying
Epithelium, remnants of severed feeder duct

142. RANULA
 Mucocele of floor of mouth  Ranula
 Derived from Latin word Rana  Frog  Swelling
resemble the bluish appearance of frogs translucent belly
 Mucus extravasation or mucus retention cyst
Etiology
Trauma or ductal obstruction  Responsible for ranulas

144. Bluish appearance
 Large in size  Medial & superior deviation of tongue
 Located in lateral to midline
 Difficulty in speaking & swallowing
 Unusual variant plunging or cervical ranula  Mucus
extravasation  Mylohyoid muscle & along fascial
planes of neck
Clinical features
Unilateral fluctuant painless soft tissue mass in
floor of mouth

147. Other Soft tissue cysts
Dermoid cyst
Epidermoid cyst
Thyroglossal duct cyst
Lympho epithelial cyst/ Branchial cyst

148. DERMOID CYST
 Development
 Contain dermal appendages
Hair follicle,
Sweat or sebaceous gland
 Cause 
Remnants of skin epithelium at lines of closure
Developmental entrapment of multipotential cells

149. Present at birth or in young adults
 Common site  Floor of mouth, submandibular &
 sublingual region
 Midline or lateral to midline
Painless & slow growing
 Generally less than 2cms in diameter
 On palpation soft & doughy owing to keratin & sebum in the lumen
 Yellowish pink colour
Clinical features

150.  If cyst occur above mylohyoid muscles, displace
tongue superiorly & posteriorly, with resultant
difficulties in function (i.e. speech & mastication)
Located below mylohyoid muscle, a midline swelling
of neck occurs / submental swelling
Clinical features vary depending on location of cyst

152. HISTOPATHOLOGICAL FEATURES
 Lined by stratified squamous epithelium & fibrous CT wall
Appendages -hair follicle, sebaceous glands, sweat glands
 lumen filled keratin

153. EPIDERMOID CYST
Traumatic implantation of surface epithelium
Cysts of skin derived from pilosebaceous apparatus
 Present as a small firm subcutaneous mass
Sebaceous Cyst

155. Keratinised stratified squamous epithelium lining with
prominent granulosum
Lumen filled with keratin
Do not contain any dermal appendages in their cyst wall
Histopathology

156. Thyroglossal Cyst
Derived-
Remanants of thyroglossal duct extending from
foramen caecum to cervical region near hyoid
 Inflammation
 Retention of secretion within the duct
 Familial

157. Age  Young, usually before 20 years
 Site  Occurs anywhere from the posterior 1/3rd
of tongue to near hyoid bone in neck
 Size  Varying
 Asymptomatic, Fluctuant
 Dysphagia
 If infected – fistula
 Swelling moves up while swallowing
Clinical features

159. Lining vary depending on
location
Above level of hyoid bone
 St sq keratinized
epithelium
 Below hyoid bone 
Ciliated / columnar type epi
 Respiratory epithelium
Fibrous CT wall
Thyroid follicle  Ovoid to
flattened cells, cuboidal cells with
faintly eosinophilic coagulum
Histopathology

160. BENIGN LYMPHOEPITHELIAL CYST
OR
BRACHIAL CYST
ORIGIN
 Developmental
 Remanants of brachial arch/ Pharyngeal pouch (disputed)
 Entrapment of lymphoid tissue within epithelium of
salivary origin

161. Age  Children & young adult
 Site  Neck, either near angle of mandible or
anywhere along anterior border of
sternocleido-mastoid muscle
 Slowly growing, fluctuant & asymptomatic swelling
 Cystic fluid contains serous gelatin
 2nd brachial arch
Clinical features

162. BRANCHIAL CYST

163. * Epi  Oral cavity or respiratory epithelium
* Cyst wall fibrous –lymphoid follicle with germinal center