cyst of the jaw

Cyst of the Jaw

ORAL RADIOLOGY SEMINAR

SHAHIBUL AFZAN WAHABO711498

What is a

cyst ?

A pathologic cavity, lined by epithelium, containing fluid or semisolid material.

** just to recall….

A- connective tissue wall that forms the cyst

B- epithelium that can line a cyst developing within the oral regions.

Classification of Cysts

True cysts

Odontogenic cysts

Non-odontogenic

cysts

Pseudo cysts

Traumatic bone cyst

Aneurysmal bone cyst

Static bone cyst

**p.s:True cysts: possess an epithelial lining.Pseudo cysts: possess NO epithelial lining.

Classification of odontogenic cysts

•Periapical / Radicular cysts

•Residual cysts

Rests of Malassez

•Dentigerous cysts

•Eruption cysts

Reduced Enamel

Epithelium

•Odontogenic keratocysts (OKC)

•Lateral periodontal cysts

•Gingival cysts of the adult

•Dental lamina cysts of the newborn

•Glandular odontogenic cyts

Dental lamina

•Paradental cysts

Unclassified

**do you remember??

Classification of non- odontogenic cysts (developmental cysts)

Non-odontogeni

c cysts

Nasopalatine duct cysts

Nasolabial cysts

TRANSITIONAL

CYSTS AND THEIR RADIOLOGICAL APPEARANCE…

…let’s concentrate on our topic today…

do not sleep…

…and don’t play-play … =)

True cyst> odontogenic cyst>

Periapical / Radicular / Apical periodontal cysts

An odontogenic cyst derived from rests of Malassez that proliferate in response to inflammation.

Age: 20-50 year-old

Frequency: Most common of all jaw cysts (70%)

Site: Apex of any non-vital tooth.

Size: 1.5-3 cm in diameter (if smaller the radiographic distinction between cyst and granuloma cannot usually be made)

Shape: - round - unilocular

Outline: - smooth - well defined - well corticated if long standing and continuous with the lamina dura of the associated tooth.

Radiodensity: Uniformly radiolucent

Effects: - adjacent teeth: displaced, rarely absorbed

- buccal expansion - displacement of the antrum

• This lateral incisor clinically shows a cavity previously occupied by a mesial composite restoration, which was done 4 years ago, and recently fell off.

• The patient relates a history of occasional pain in that tooth as well as tenderness in the periapical area.

• She also states that about 2 years ago she had an episode of marked swelling and intense pain in that area which was treated elsewhere with antibiotics.

• Further treatment at the time, as indicated by the attending dentist, was not performed because the patient failed to maintain the appointment.

• Note the caries on the distal of this tooth and the large periapical radiolucency.

• The lateral incisor was treated endodontically and with a retrofill and on the basis of the biopsy the periapical lesion was diagnosed histologically as a radicular cyst.

CASE REPORT

From our clinic…


Residual cysts

A cyst that remains at the site of a previously extracted tooth

Age: Adults, over 20 years old.

Site: Apical regions of the tooth-bearing portion of the jaws.

Size: Variable, usually around 2-3cm in diameter

Shape: - Round- Unilocular

Outline: - Smooth- Well-defined-Usually well corticated


Effects: - Adjacent teeth displaced, rarely resorbed

- Buccal expansion

- Displacement of the antrum

This cyst was a consequence to caries in the first maxillary molar. That molar was extracted and portions of the cystic

wall were left within bone. Those rests gave

rise to a so-called residual cyst. Therefore,

any cyst must be carefully removed in

order to avoid recurrences.

This large residual cyst has been present for many years in the mandible of a 67 year-old man. Arrow A points to the mandibular canal. Arrow B points to the expansion of the labial cortical plate produced by the cyst. Arrow C points to a radicular rest.

From our clinic…


Dentigerous cystAn odontogenic cyst that surrounds the crown of an impacted tooth; it is caused by fluid accumulation

between the reduced enamel epithelium and the enamel surface, resulting in a cyst in which the crown is located

within the lumen and root or root outside.

Age: Usually adolescents/ 20-40 year-olds, occasionally the elderly.

Frequency: About 20% of all cysts

Site: Usually with the crown of an erupted and displaced tooth, typically teeth where eruption is impeded, e.g. upper 3s and lower 8s.

Size: Very variable

Shape:- Round/ oval, typically enveloping the crown symmetrically - Unilocular

Outline: -smooth -well defined -often well corticated


Effects: - associated tooth unerupted and displaced.

-adjacent teeth: displaced, resorbed in about 50%, enveloped by large cysts.

-buccal/medial expansion facial asymmetry and displacement of the antrum

YOUR TOPIC GOES HERERadiographical appearance:

YOUR SUBTOPIC GOES HERE

Jaw Xray showing a very large dentigerous cyst (yellow dots)(tooth:red dots) on the patient’s lower right jaw.

Varieties of dentigerous cyst

(depending on the cyst/crown relationship)

Central type

Lateral type

Circumferential type


Eruption cystAn odontogenic cyst with the histologic features of a dentigerous cyst that surrounds a tooth’s crown that has erupted through bone but not soft tissue and is clinically visible a s a soft fluctuant mass on the alveolar ridges.

Radiographical appearance:

Enlarged follicular space.

Eruption cyst


Odontogenic keratocyst

A cyst derived from the remnants of the dental lamina, with a biologic behaviour similar to benign neoplasm, with a distinctive lining of six to ten cells in thickness, and that exhibits a basal cell layer of palisaded cells and a surface of corrugated parakeratin.

Site: Post. body /angle of mandible extending into the ramus.

Size: Variable, but often large in the mandible.

Shape: - oval, extending along the body

of mandible with little mediolateral expansion.

- pseudolocular/ multilocular

Outline: -smooth and scalloped-well defined and corticated

Radiodensity: Uniformly radiolucent.

Odontogenic keratocyst prior to treatment

2 years after treatment

4 years after treatment – recurrence of cyst


Lateral periodontal cyst A slow-growing, non-expansile

developmental odontogenic cyst derived from one or more rests of the dental lamina, exhibiting a lining of 1 to 3 cuboidal cells and distinctive focal thickenings (plaque).

Age: Adults over 30 years old

Frequency: Rare

Site: Lateral surface of the roots of vital teeth in the lower canine/ premolar region or upper lateral incisor region.

Size: Small (< 1cm in diameter)

Shape:- Unilocular (very occasionally multilocular) - Round

Outline:- Smooth - Well-defined and corticated


Effects : -Adjacent teeth-displaced if cyst become large, rarely absorbed - Buccal expansion if large


Gingival cyst of the adult

A small development odontogenic cyst of the gingival soft tissue derived from the rests of the dental lamina, exhibiting a lining of squamous to cuboidal epithelium with occasional distinctive focal thickenings similar to those seen in the lateral periodontal cyst.

Clinical distribution, clinical size , age of occurrence and histologic features = lateral periodontal cyst

.: lateral periodontal cyst= intraosseous gingival cyst= extraosseous

Radiographical appearance

• Because they are confined to the gingival soft tissues not apparent on radiograph

• Occasionally they will cause a pressure-induced depression (saucerization) in the underlying alveolar bone apparent on radiograph.


Dental lamina cyst of the newborn

Small, sometimes multiple, raised cystic nodules that occur on the alveolar ridges of infants; they are derived from rests of the dental lamina and consists of a keratin-filled cystic cavity.

Dental lamina cyst of newborn


Glandular odontogenic cyst(sialo-odontogenic cyst)

A unilocular or multilocular odontogenic cyst derived from the rests of dental lamina and characterized by a lining with variable numbers of small intraepithelial glandular structures lined by cuboidal or columnar cells, often including mucus cells.

Clinically,occurs mainly in middle-aged adults,common in mandibular anterior region of the jaw,painless.

Radiographically,Well-defined,Unilocular or more common multilocular radiolucent area.

The radiograph shows the typical multilocular appearance of the glandular odontogenic cyst.


Paradental cyst

A cyst of odontogenic origin commonly located subgingivally on the buccal aspect of an erupted mandibular molar (bifurcation cyst) or the distal surface of a partially erupted mandibular third molar.

True cyst> non- odontogenic cyst>

Nasopalatine duct cyst(incisive canal cyst)

An intraosseous developmental cyst of the midline of the anterior palate, derived from the islands of epithelium remaining after closure of the embryonic nasopalatine duct.


• Well-circumscribed oval / heart-shaped radiolucency.

• Located in the midline of the anterior maxilla between the roots of the central incisors.

True cyst> non- odontogenic cyst>

Nasolabial duct cyst

A developmental cyst of the soft tissue of the anterior muccobuccal fold beneath the ala of the nose, most likely derived from the remnants of the inferior portion of the nasolacrimal duct.

Radiographical appearance

• It is not readily apparent radiographically unless contrast medium is injected into the cystic lumen to facilitate visualization .

• Focal pressure-induced bone resorption (saucerization) of the anterior maxilla can be occasionally demonstrated on radiographs and is most readily seen in the edentulous patient.

Pseudo cyst>

Static bone cyst

An intraosseous pseudocyst, devoid of an epithelial lining and either empty or filled with serous or sanguinous fliud. The etiology is unknown.

Age: Children/ young adults

Frequency: Rare

Site: Mandible, particularly anteriorly and in the premolar/molar region

Size: Variable, up to several centimetres in diameter.

Shape:- -Unilocular- -Irregular, but the upper border arches between the

roots of teeth.

Outline:- -Smooth and undulating- -moderately well-defined- -moderately well or poorly corticated


Effects:-- Adjacent teeth: minimal/no displacement-- Minimal/ no expansion of the jaw

Pseudo cyst>

Aneurysmal bone cyst

A pseudocyst that consists of blood-filled spaces surrounded by multinucleated giant cells and fibrous connective tissue.• Rare cyst of the jaws.

• Arise as primary lesion or secondary to bone disease• Occurs in people less than 20 yrs• post ramus region of the mandible• Firm expansile swelling causes facial deformity

RADIOGRAPHICALLY : • uni or multilocular with ballooned out appearance due to cortical plate expansion

Pseudo cyst>

Traumatic bone cyst

A pathologic cavity in bone that is not lined with epithelium. The cause is uncertain, although an association with trauma has been suggested.


Well-defined unilocular/multilocular radiolucent lesion that characteristically shows scalloping around the roots of teeth.

Traumatic bone cyst in the mandibular premolar region. Note the intact lamina dura and the poor definition inferiorly.

REFERENCE

1.Essentials of Dental Radiography and Radiolgy Fourth Edition, Eric Whaites

(2007)(borrowed from Rafiq)

2. Contemporary Oral and Maxillofacial Pathology, J. Phillip Sapp (2004)

3. General and Oral Pathology for the Dental Hygienist, Leslie DeLong (2008)

4. Oral Pathology for the Dental Hygienist , Ibsen (2009)

Wait!Let’s watch a video about

cyst…

cyst of the jaw

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