Cystic lesions can be classified in various ways, including by location, tissue of origin, and appearance on imaging. The document discusses the definition, causes, clinical presentation, treatment, and radiographic features of different types of cysts including odontogenic cysts like inflammatory periapical cysts and dentigerous cysts as well as non-odontogenic cysts such as nasopalatine cysts. Cysts are typically asymptomatic but can cause swelling, pain, or discharge and appear on imaging as well-defined radiolucent lesions that may impact surrounding structures. Treatment involves surgical removal of the cyst lining through methods like enucleation, marsupialization, or curettage to prevent recurrence

1. Cystic lesions

2.  Presented by:
Eslam Ahmed (EL TOKTOR)
 Guided by:
• Dr . EMAN ABDEL AZIZ AHMED

3. Content
• Definition
• Causes
• Classification
• Clinical picture
• Treatment
• Radiographic picture
• Examples

4. Definition :
• sac-like pocket of membranous tissue that contains fluid,
air, or other substances.
• Cysts can grow almost anywhere in your body or under
your skin

6. Causes
• tumors
• genetic conditions
• infections
• a fault in an organ of a developing embryo
• a defect in the cells
• chronic inflammatory conditions
• blockages of ducts in the body that cause fluids to build up
• a parasite
• an injury that breaks a vessel

11. Classification :
• There are different
classification as:
 WHO classification
 Shear classification
 Joseph Regezi classifiction
 Shafer’s Classification
 Robinson Classification
 Classification by tissue of origin

12. 1) WHO classification

13. 2) Shear classification

14. Clinical picture
• A symptomatic (painless)
• not associated with the skin but with internal organs
• Bone expansion
• Swelling
• Discharge
• Related to non vital tooth
• May be related to impacted or superneomerory teeth .

15. clinical picture

16. clinical picture

17. Treatment
• Causes of treatment : to avoid
 increase in size
 Get infected
 Jaw weakening
 Malignant changes
 Prevention of teeth eruption
 Involvement of other structures (sinus, nose, adjacent tooth )

18. clinical picture

19. Treatment Methodes
1) Enucleation : remove of cystic lesion totally
 Remove of cyst with out fragmintaion
 Reduce recurrancy
2) Marsupialization :create a surgical window in cyst wall
 Remove only the piece used to form the window
 Remove intracystic preassure and promote cystic shrinkage
 Preliminary step in management

20. Treatment Methodes
3) Enucleation after Marsupialization :
 When bone cover vital teeth
 To prevent fracture in Enucleation
 Accelerate healing process
4) Enucleation and curettage :
 after enucleation bur used to remove 1-2 ml of bone
around cystic cavity
 To avoid recurrency

21. Treatment

24. picture :Radiographic

25. picture :Radiographic
• Techniques : are different as :
I. Occulusal view : show lingual expansion
II. MRI (magnetic resonance image ): for soft tissue lesion
III. C.T : for bony lession
IV. OPG (ortho pentomogram (panorama) ): to assess size and
extent
V. Lateral oblique : assess proximity of lower border
VI. Pa (panorama ): expansion of ramus of the mandible

26. picture :Radiographic

27. picture :Radiographic

28. picture :Radiographic

29. picture :Radiographic

30. picture :Radiographic

31. picture :Radiographic
• Location : according to cyst type may be in the lower or upper jaw or
in the anterior or the posterior
• Shape: may be ovoid, round or pear shape
• Internal structure: may be
 uni or multi locular or both
 radiolucent area or radiolucent surrounded by radiopaque margin
• Affect on structures: may cause
 drifting of teeth
 Tilting of teeth
 Rotation of teeth

32. Examples
1) jaw cyst : may be
A) Epithelial cysts
I) Odontogenic cyst :
It arise from odontogenic epithelium :
1. Dental lamina
2. Enamel Organ
3. Epithelium rests of malassaze or rests of serres
4. Reduce Enamel epithelium

33. Types of odontogenic cysts
• Inflammatory periodontal cyst (periapical –reticular )
• Developmental periodontal
• Dentigerous cyst
• Odontogenic keratocyst(primordial)
• Eruption cyst
• Gingival cyst of adult
• Gingival cyst of young

34. odontogenic cysts

35. odontogenic cysts

36. A) Inflammatory periodontal cyst
• most common cyst
• called periapical cyst or Radicular cyst
i. Clinical pic:
 Common in anterior teeth of maxilla
 egg shell cracking sensation on pressure
 bluish fluctuant swelling
 Related to non vital teeth
 treatment :
 root canal treatment
 Apicoectomy

37. CLINICAL PICTURE
periapical cyst

38. CLINICAL PICTURE
periapical cyst

39. Inflammatory periodontal cyst
 Radiographic pic:
 Location : in periapical region
 Shape: round- or pear-shaped
 Internal structure: radiolucent area surrounded by radiopaque margin
 Affect on structures: Root resorption and displace sinus

40. Radiographic pic:

41. Radiographic pic:

42. Inflammatory periodontal cyst
• IT may be ( central- lateral-Residual )

43. Dentigerous cyst
• Clinical pic :
 Develops around the crown of an unerupted permanent or supernumerary
tooth
 Usually related to impacted canine and third molar
 they are the most aggressive of the cysts.
 treatment :
 Remove of associated teeth
 Enulation of soft tissue

44. Clinical pic :

45. Dentigerous cyst
• It may be :

46. Dentigerous cyst
• Radiographic pic :
• Internal structure : radiolucent area surrounded by radiopaque margin
• Affect on structures : root resorption of adjacent teeth

47. Radiographic pic :

48. C.T for Dentigerous cyst

49. keratocyst
• is a rare locally aggressive developmental cyst
• Clinical pic :
 Swelling is the most common
 in remus ( lower 3rd molar )
 High recurrent rate
 treatment
 Surgical exision with bone curratage
 Osteoectomy (preferred)
 in large cyst : marsupailization then
enucleation

50. Clinical pic :

51. Clinical pic :

52. Clinical pic :

53. treatment

54. Keratocyst
• Rediographic pic :
• Location : mandibular third molar region.
• Shape: solitary, round or avoid
• Internal structure: radiolucent, unilocular lesion with smooth, corticated
borders
• Affect on structures: impede the eruption of adjacent teeth

55. Rediographic pic :

56. Rediographic pic :

57. C.T for OKCs

58. C.T for OKCs

59. C.T for OKCs

60. II) Non odontogenic :
• Types :
 Naso palatine (incisive canal – palatine papilla )
 Fissural cysts : as
 Globulo maxillary
 Naso labial
 Median palatine
 Median mandibular
 Median alveolar

61. Clinical pic :

62. Rediographic pic

63. 1) Nasopalatine Cyst
• Due to cystic degeneration of epithelium of nasopalatine cord
• May be:
1. incisive canal cyst : remnant of nasopalatine cord in incisive canal
2. palatine papilla: remnant of nasopalatine cord in incisive foramen
(outside the canal)
 treatment : surgical removal by palatal approache (enucleationand
currtage )

64. Clinical pic :

65. Clinical pic :

66. incisive canal cyst
• Most common non odontogenic cyst
• Clinical pic :
 related to vital upper centrals
 Swelling In anterior area of the palate
 Salty discharge

67. Clinical pic :

68. Clinical pic :

69. incisive canal cyst
• Rediographic pic :
• Location : between roots of upper two centrals
• Shape: heart shape
• Internal structure: well defined radiolucent with radiopaque margin
• Affect on structures: swelling of anterior part of palate

70. Rediographic pic

71. Rediographic pic

72. palatine papilla cyst
• Clinical pic :
 Soft tissue cyst
 Fluctuant swelling
 Salty test fluids
• Rediographic pic : negative x- rays

73. Clinical pic :

74. 2)Fissural cyst
A) globulomaxillary cyst
• Arise from epithelial remnant at site of fusion between maxillary and
globular(medial nasal) process
• Clinical pic :
 misdiagnosed as periapical cyst
 Between upper lateral and upper canine (vital)
 so it called pre maxillary cyst
 treatment :
 Enucleation to avoid sacrificing
the associated teeth

75. Clinical pic :

76. globulomaxillary cyst
• Redioghraphic pic :
• Location : between upper 2nd and 3rd teeth
• Shape: inverted pear shape
• Internal structure: radiolucent area
• Affect on structures: root divergence of adjacent teeth

77. Rediographic pic

78. Rediographic pic

79. Fissural cysts :
B) Naso labial cyst
• known as a nasoalveolar cyst
• Soft tissue cyst so (its negative x- ray)
• Arise from epithelial remnant at line of fusion between maxillary and
globular process
• Clinical pic:
 At labial vestibule behind the ala of the nose
 Swelling of upper lip
 Distortion of the nostrils
 treatment :
 surgical excision with labial
approach

80. Clinical pic :

81. Fissural cyst :
C) Median palatine cyst :
• Arise from epithelium at line of fusion between two palatine process
• Clinical pic :
 At midline of the palate
 along the median palatal raphe.
 Frequent in young adult
 Hard or flectuant swelling
 treatment : surgical remove

82. Clinical pic :

83. Clinical pic :

84. Median palatine cyst :
• Radiographic pic :
 Location : at palatal mid line
 Shape: rounded
 Internal structure: well defined radiolucent area with radiopaque margin
 Affect on structures: cause centrals divergence

85. Radiographic pic :

86. B) Non epithelial cyst lesion
• Known as pseudo cyst
• Types :
 Traumatic bone cyst
 Aneurismal bone cyst
 Latent bone cyst
 Static bone cyst

87. 1) Traumatic bone cyst
• Known as hemorrhagic or simple or solitary bone cyst
• Pseudo cyst
• Intra bony empty cavity
• Due to failure to form granulation tissue after trauma
• clinical picture :
 In young age
 Lower molar premolar area
 Painless swelling in 20% of patients
 Empty cavity may contain yellow fluid
 May be tender or painful
• treatment : curtatage
• High recurrent rate (19% -50%)

88. Clinical pic :

89. Traumatic bone cyst
• Radiographic pic :
• Location : above inferior alveolar canal
• Shape: upper borders is scalloped to fit molar s roots
• Internal structure: (uni or multi )locular radiolucent area
• Affect on structures : tilting of adjacent roots

90. Radiographic pic :

91. Aneuresmal bone cyst
• Not true cyst
• Pseudo cyst
• Due to vascular abnormalities of the bone
• Clinical pic :
 Site: in lower molar premolar area
 painful with rapid swelling
 Bleeding tendency on operation
 Recurrence rate is high
 treatment :
 curettage
 Enucleation

92. Clinical pic :

93. Aneuresmal bone cyst
• Radiographic pic :
• Location : lower molar premolar area
• Shape: ballone like
• Internal structure: uni or multi locular radiolucent area
• Affect on structures : tilted root of teeth , intact lamina dura

94. Radiographic pic :

95. Static bone cyst))latent bone cyst
• also termed Stafne's idiopathic bone cavity, Stafne bone cavity, Stafne bone
cyst
• is thought to be a normal anatomical variant,
• depression is created by ectopic salivary gland tissue associated with
the submandibular gland
• Clinical pic : (incidental finding)
• seen in middle-aged men
• Usually the defect is unilateral, but occasionally can be bilateral
• appear between the lower 1stmolar and the mandibular angle as a lingual
depression
• destructive bone lesion (localized ,non progressive and non healing (not
treated))

96. Clinical pic :

97. latent bone cyst (Static bone cyst)
• Radiographic pic :
• Location : at the inferior border of the body of the mandible
• Shape: round or oval
• Internal structure: well-defined monolocular radiolucency
• Affect on structures :
• CT : show
 a shallow defect through the medial cortex of the mandible
 with a corticated rim
 no soft tissue abnormalities, except a portion of the submandibular gland

98. Radiographic pic :

99. Referances
• Bánkfalvi A, Piffkó J, Joos U, (2006), Klinische
Oralpathologie, VVerlag MIB Gmbh, Münster
• Oral pathology 301 by prof fahmy abdel-salam
pg (91 -121)
• Cyst of oral and maxillofacial region by Raviraj patel and
Yasin Vaja , guided by DR Tarnjeet Kaur (head of the
departmrnt of oral and maxilla facial surgery , gov dental
collage and hospital , Jamnagar)