Dr. Shahzadi Tayyaba Hashmi

Cysts of jaws

DNT 243ORAL PATHOLOGY

CYSTS OF JAWS

DEFINITION:Cysts are pathological fluid-filled cavities lined

by epithelium

Cysts are the most common cause of chronic swellings of the jaws. They are more common in jaws than in any other bone because of many rests of odontogenic epithelium remaining in the tissues.

ODONTOGENIC CYSTS

ODONTOGENIC KERATOCYST(OK

C)

DENTIGEROUS cyst(follicular

cyst)Eruption cyst

Lateral periodontal

cyst

Gingival cysts of Adults

Gingival cysts of Infants

NON-ODONTOGENIC CYSTS

Nasopalatine duct cysts

Nasolabial duct cyst

INFLAMMATORY ODONTOGENIC CYSTS

RADICULAR CYSTS Residual Lateral

PARADENTAL CYSTS

Developmental

Odontogenic

cysts

ODONTOGENIC KERATOCYST

(OKC)

Pathology: Odontogenic Keratocyst is derived

from remnants of dental lamina

Dental lamina:The bands of epithelium that

originates from oral epithelium and remain in the tissues after inducing tooth development

CLINICAL FEATURES OF ODONTOGENIC KERATOCYST

Peak incidence during second or third decade of life

Mandible is usually affected, primarily posterior body of mandible and ramus area

Unilocular or MultilocularMultilocular OKC’s are consistent features of nevoid basal cell carcinoma syndrome( Gorlin Goltz Syndrome )

Exhibits 25% to 60% of recurrence

RADIOGRAPHIC FEATURES

Odontogenic Keratocyst appear as well-defined radiolucent areas with a more or less rounded margins

Some are Unilocular, but majority are Multiloculated

HISTOPATHOLOGY

Microscopic appearance has four major characteristics

1. A thin, uniform lining of Parakeratinized Squamous epithelium, 6 to 10 cell thick

2. A palisaded layer of columnar or cuboidal basal cells

3. Corrugated layer of parakeratin

4. Lack of rete pegs

TREATMENT

Unilocular and small Multilocular cysts can be treated by Enucleation and bony cavity curetted

Large cysts have high rate of recurrence that’s why they need surgical resection and reconstruction with a bone graft

DENTIGEROUS CYSTAn Odontogenic cyst that surrounds the crown

of an impacted tooth.

It is usually derivedfrom Reduced enamelEpithelium (residualEpithelium that surrounds the crown oftooth after enamelformation is complete)

CLINICAL FEATURESUsually remain asymptomatic, but produce swelling

or pain ,If it is large or INFLAMMEDMore common in males as compared to femalesUncommon in children

RADIOGRAPHIC APPEARANCE Appear as well defined radiolucency surrounding the

crown of an unerupted tooth In mandible, cyst may displace the associated tooth

inferiorly into ascending ramus In maxilla, it displaces associated tooth posteriorly

RADIOGRAPHIC APPEARANCE

TREATMENTSurgical ENUCLEATIONIn case of a molar teeth, the

associated tooth is usually extracted at the time when cyst is enucleated

In case of maxillary CUSPID tooth, cyst may be excised by MARSUPILIZATION (surgical curettage of cyst by creating a surgical window in cyst area)

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 as a soft fluctuant mass on the alveolar ridge

CLINICAL FEATURES AND TREATMENT

CLINICAL FEATURES: Affects children and involve teeth that have no

predecessors (deciduous teeth) Cyst lies superficially in gingiva overlying the

unerupted tooth Appears as a soft, rounded, bluish swelling

MANAGEMENT:Cyst roof may be removed to allow the tooth to

erupt, but most eruption cysts burst spontaneously and require no treatment

Eruption cyst ( bluish appearance)