jaw bone cyst

Jaw bone cysts DR: Mazen Abood Bin Thabit. M.D, FRCPathAssistant Prof Of Pathology Senior lecturer of Oral pathology and oral histology

Copyright 2003, Elsevier Science (USA). All rights reserved.

Introduction Definition : Cyst is pathological fluid , simi-fluid or gas filled cavity lined

by epithelium . Most common lesion . Most common casus of jaw swelling . Often destructive and produce signs and

symptoms . True cyst Vs Pseudo-cyst


General feature of cyst Sharpe radiolucent with well defined margin . Fluid may be aspirated . Tran-illuminated . Grow slowly Displacing rather than resorbing . Symptomless . Rarely cause pathological fracture Forms compressible and fluctuant swelling . Appears plush close to the mucosa . Cystic epithelium some time undergo neoplastic

transformation.


Approach of diagnosis Complete history: Pain , duration , tooth mobility or loss ,

occlusion ,swelling , delay eruption Physical examination : Inspection , palpation , percussion . Radiology: Plan X-ray ,panoramic, dental radiograph, CT. FNAC: Biopsy:


Classification I. Odontogenic cysts : Developmental cysts 1. Dntigerous cyst . 2. Eruption cyst . 3. Odontogenic keratocyst 4. Gingival cyst 5. Lateral periodontal cyst 6. Botryoid odontogenic cyst . 7. Gandular Odontogenic cyst 8. Calcifying odontognic cyst


Classification Inflammatory cysts 1. Radicular cyst . 2. Paradental cyst . 3. Residual cyst 4. Inflammatory collateral cyst . Neoplastic cyst 1. Cystic ameloblstoma 2. Calcifying odontogenic cyst II. Non odontogenic cyst : 1. Nasopalatine cyst . 2. Nasolabial cyst


Classification III. Cysts without epithelial lining ( Pseudocyst) : 1. Solitary ( Simple ) bone cyst 2. Aneurysmal bone cyst IV. Cyst of soft tissue: 1. Dermoid and epidermoid cyst 2. Lympho-epithelial cyst . 3. Thyro-glossal cyst


Embryological origin of cyst Rest Of Malassez . Reduced Enamel

epithelium Remnant of dental

lamina


Radicular ( Periapical ) cyst The most common

odontogenic cyst of inflammatory origin.

65-70% Related to apex of non-vital

tooth.

Pathogenesis


Periapical ( Radicular ) cyst: Clinical feature : 3rd -4th decades Male . More common in anterior

maxilla . Tooth is non vital Small cyst asymptomatic . Large cyst may produce slow

growing hard bony swelling Springiness . Fluctuation if bone is eroded Pain if infected with sinus Paresthesia and pathological

fracture Lateral radicular cyst .

Radicular csyt


Radicular ( Periapical ) cyst

Radicular cyst

Well defined ,unilocular radio-lucent with well defined cortical margin


Radicular ( Periapical ) cyst Histopathology: Stratified squamous 6-20cell

thick . Surrounded C.T shows

chronic inflammation . Cholesterol cleft. Russel bodies . Multinucleated giant cells Epithelium may undergo

malignant transformation


Radicular ( Periapical ) cyst Differential diagnosis: Periapical granuloma. Periapical abscess . Cementblastoma. Traumatic bone cyst .

Treatment: Small cyst : Root canal treatment Large cyst : Enaculation or marsupialization


Residual cyst Cystic lesion may present

at the site of tooth extraction

Residual cyst

Edentulous region


Dentigerous cyst 2nd most common . Enclose part or all the

crown Caused by accumulation of

fluid between REE and Enamel

CEJ


Dentigerous cyst

Attached to CEJ Forming cyst in which the

crown located within it’s lumen and the root out side

CEJ


Dentigerous cyst Clinical presentation: 1. Asymptomatic . 2. swelling or pain . 3. Common in mandible 4. Mandibular 3rd molar , maxillary

permanent canine and mandibular premolar .

5. More common in adult male 6. 20-50 years . 7. Permanent dentition may be

missed 8. Large cyst may cause bone

expansion and tooth displacement 9. may associated with

supernumerary teeth or odontomas


Dentigerous

Radiograph : Unilocular radiolucent area Well circumscribed Contains crown Surrounded by sclerotic bone

outline

Radiolucent space around the crown


Dentigerous cyst Types : The cyst attached to CEJ and

the crown related to cyst in three ways:

1.Central type . 2.Lateral type . 3.Circumferential

type


Histopathology Non keratinized squamous epithelium 2-10 cell thick . May be atrophic or ulcerated . Wall dense fibrous and no inflammation . Islands of odontogenic epithelium may

seen. Cyst filled proteineous material and

cholisterol cleft Long standing cyst may shows dysplasia Neoplastic tumors may arise from cyst


Dentigerous cyst Treatment: Marsupialization . Enaculation Differential diagnosis: 1.Adenomatoid odontogenic

tumor . 2. Unilocular cystic

ameloblastoma. 3. primordial cyst . 4. Ameloblastic fibroma 5. CEOC


Eruption cyst Odontogenic cyst

similar to dentigerous cyst with teeth about to erupt.

Tooth crown has erupt through the jaw bone


Eruption cyst Clinical feature : 1. Affect children in both

dentition 2. Superficial appears as soft ,

bluish fluctuant swelling on the alveolar ridge .

3. Repetitive trauma may induce hemorrhage with the cyst ( Eruption hematoma) .

No treatmentOccasionally surgical removal of cyst roof


Odontogenic keratocyst Also called Primordial

cyst and arises mainly from remnant of dental lamina

Jaw bone

Cyst cavity


Primordial cyst Clinical feature: 1. 1st peak 20- 30 years and

the 2nd peak 50-70 years . 2. Male predominance . 3. 2/3 in the mandible in the

posterior alveolar ridge . 4. In the maxilla , the 3rd

molar region is more affected .

5. Cyst have remarkable growth potentiality .

6. Grow in antero-posterior direction


Primordial cyst Clinical feature: 7. Usually single , occasionally

multiple ( Golin –Gottz syndrome ).

8. Small cyst discovered incidentally by X-ray .

9. Large cyst cause bone swelling

10 . Pain , mobility and displacement of teeth .

11. Occasional paresthesia of lower lips and teeth .

12. In some cases extraosseous extension to gingiva.

13. Pus discharge and sinus


Primordial cyst Radiography : 1. High and remarkable growth

potential . 2. May attain a large destructive

size. 3. High recurrence rate after

enaculation 25-60% 4 . Recent WHO classification

designate this cyst as Keratocystic adontogenic tumor .


Primordial cyst Clinical behavior : 1. High and remarkable growth

potential . 2. May attain a large destructive

size. 3. High recurrence rate after

enaculation 25-60% 4 . Recent WHO classification

designate this cyst as Keratocystic adontogenic tumor .


Histopathology: The cyst lined by thin

parakeratinized odontogenic squamous epithelium of 6-10 cell layer .

Palisaded layer of columnar or cuboidal basal layer with reverse polarity .

Corrugated layer of parakeratin on it’s luminal surface .

The junction between cyst and connective tissue is weak with focal separation.

Cyst contains desquamated parakeratin , and cheesy material

Inflammation absent . Thin fibrous wall .

Basal layer

Parakeratin layer


Primordial cyst

Causes of recurrence:1. Thin fragile lining .2. Budding or finger like cyst .3. Daughter cyst .4. Other dental lamina5. Focal separation of the

epithelium


Primordial cyst

Daughter cyst


Primordial cyst Treatment :1. Small : Simple enaculation

.2. Large: Enaculation with or

without peripheral osteomy.

3. Complete resection with 1cm margin .

4. Long term follow up .


Lateral periodontal cyst

Uncommon intra-osseous odontogenic cyst similar to gingival cyst of adult

It’s derived from rest of dental lamina

Lateral to the root surface of erupted tooth


Lateral periodontal cyst Clinical feature: 0.7% of jaw bone cyst . Middle age patient .Both mandible and maxilla Canine and premolar of mandible .Near the crest of ridge Asymptomatic. May produce bone expansion and

pain Tooth is vital . Cyst less than 1 cm .

X-ray: Tear or drop shape radiolucency

Differential diagosis


Lateral periodontal cyst : Histopathology: Thin non keratinized

squamous epithelium One or two cell thick . Some cells are of clear

cystoplasm The cyst separate from PDL.

Clear cells

Surgical excsion of cyst along with the tooth


Gingival cyst of adult An extra-osseous

odontogenic cyst of the gingival tissue

Arise from rest of dental lamina

Gingival cyst


Gingival cyst of adult Clinical feature: Rare 4o years Firm , compressible and dome

shape swelling less than 1cm Facial gingiva of incisor or

premolar

Gingival cyst

Histopathology :Very thin flat non keratinized squamous epithelium


Gingival cyst of newbornCalled Dental lamina cyst of

newbornUncommon .Multiple superficial nodules . Resolve without treatment .Thin keratinized squamous

epithelium

Gingival cyst

Varient :1. Epstein’s pearls: Mid palatine

raphe.2. Bohn’s nodules: Junction of hard

and soft palate


Botryoid odontogenic cyst Rare odontogenic cyst

resembles the cluster of grapes .

Cystic changes of multiple adjacent dental lamina

Polycystic variant . Expensile , painless central

swelling . Multilocular cysts with fine

septa. Flat nonkeratinized

epithelium with clear cells Strong tendency to

recurrence


Glandular cyst Also called sialo-odontogenic

cyst . Intra osseous from dental

lamina . Rare . Large single unilocular or multi Anterior mandible . Uni or multilocular radio-luncent

. Thin stratified squamous with

small glandular or microcyst ( Pseudo-duct like )

High tendency to recurrence


Solitary bone cyst Traumatic bone cyst ,

unicameral bone cyst or hemorrhagic bone cyst.

Children and adolescent. Mandibular premolar and

molar Painless swelling . Round radio-lucent and less

sharply defined . Bony wall lined by thin loose

C.T , RBCs or hemosedrin laden macrophages

Unknown

Unicameral cyst X-Ray

C.T.Scan


Aneurysmal bone cyst Rare in the jaw . Posterior part of body or

angle of the mandible 10-20 years Firm and painless swelling

. Numerous non endothelial

lining spaces , filled with blood , fibrous septa with giant cells


Aneurysmal bone cyst Uni or multilocular radio-

lucent Balloon like

Aneurysmal bone cyst


Nasopalatine ( Incisive canal ) cyst The most common

nonodntogenic Remnant of nasopalatine duct. Slow growing swelling in the

anterior region of midline palate .

Intermittent salty discharge . Should differentiated from

palatine fossa Incisive papillae

Well defined ovoid or heart shape radio-lucent

Pathology:1. Pseudo-stratified columnar .2. Stratified squamous The wall has nerve and small macular arteries

and veins


Globulomaxillay cyst Common . Bone fusion between

maxilla and premaxilla Cyst between maxillary

lateral incisor and canine Asymptomatic unless

infected. Pseudo- stratifeid

columnar or squamous Pathogenesis .

Inverted pear shaped radiolucent cyst .


Naso-labial cyst : Uncommon . Female of 4th decade Upper lip Remnant of nasolacrimal

duct Swelling obliterate the

naso-labial fold and nostrils .

Pseudo-s stratified columnar

Pseudo-startified columnar with mucus cells

1. Median cyst :2. Median mandibular cyst


Lympho-epithelial cyst : Deep to sternomatoid

muscles or at the level of mandibular angle

Rarely intra-oral . Remnant of brachial arches

. Stratied squamous and the

wall coantins lymphoid follicles

Thyro -glossal duct cyst In the region of hyoid bone .Rarely intra-oral at the midline of tongue or floor


Residual cyst


Glandular odonto


Trumatic bone cyst

jaw bone cyst

Documents