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Non Odontogenic Cyst: Dr. Madhusudhan Reddy
Non Odontogenic Cyst: Dr. Madhusudhan Reddy
• Grouped under
• Intro osseous
– Nasopalatine duct cyst
– Median palatal cyst
– Globulomaxillary cyst
– Median mandibular cyst
• Extra osseous/ soft tissue
– Palatal cysts of neonate
– Nasolabial cyst
– Thyroglossal cyst
– Oral lymphoepithelial cyst
– Epidermoid and dermoid cyst
• Intro osseous
– Nasopalatine duct cyst
– Median palatal cyst
– Globulomaxillary cyst
– Median mandibular cyst
Nasopalatine duct cyst
• Also called as
– Nasopalatine canal cyst
– Incisive canal cyst
– Median anterior maxillary cyst
• Most common non odontogenic cyst of oral cavity
• Nasopalatine duct cysts (NPDC) are cysts that originate
from epithelial remnants of the nasopalatine duct, which
become entrapped during fusion of the palate plates
• PATHOGENESIS
• This lesion is considered as a true developmental cyst and
it arises usually due to the proliferation and subsequent
cystic degeneration of the epithelial remnants remaining
after closure of the embryonic nasopalatine duct.
• Initiating factors may be
– Trauma
– Inflammation
– Bacterial infection
• CLINICAL FEATURES
• Age – 4th , 5th and 6th decade
• Sex – male > female ( 4:1)
• Site – usually in anterior region of mid palate near opening
of the incisive foramen
• Small, painful swelling
• Causes pressure sensation on the floor of the nose and
displacement of roots of upper central incisors
• Occasionally, there can be purulent or salty discharge from
the lesion
• Some patient complain of episodic swelling in the soft
tissue between the upper central incisor
• Regional teeth are always vital
• RADIOGRAPHIC FEATURES
• A sharply demarcated symmetrical radiolucency in the
midline of anterior maxilla
• Small round or heart shaped radiolucency between the
roots of the upper central incisor in the midline with
cortical border
• Displacement of roots of the upper central incisor are
commonly seen
• HISTOPATHOLOGY
• Cystic cavity – lined by the ciliated columnar or non
keratinized stratified squamous epithelium and is backed
by a connective tissue capsule
• Mucous secretary cells seen
• Sometimes presence of pigments in the lining
• Lining may be thin or thick and there may or may not be
formation of rete pegs in the lining
• Presence of large nerve and vascular bundle in connective
tissue wall
Histopathology
• DIFFERENTIAL DIAGNOSIS
• Radicular cyst, if it is associated with a pulpally involved
tooth
• Large incisive canal
• TREATMENT
• Surgical enucleation via palatal approach.
Median palatal cyst
• Also called
– Nasoalveolar cyts
– Kelstadts cyst
• Entirely soft tissue cyst, which arises in the nasolabial fold,
just below the ala of nose.
• Occurs in upper lip lateral to the midline.
• Pathogenesis is uncertain.
• 2 theories
• 1st : considers nasolabial cyst to be fissural cyst
• Arising from epithelial remnants entrapped along line of
fusion of maxillary, medial nasal and lateral nasal process
• 2nd : cyst developed from misplaced epithelium of
nasolacrimal duct.
• Due to similar location and similar histologic appearance.
• CLINICAL FEATURES
• Swelling of upper lip lateral to midline
• Result in elevation of ala of nose
• Enlargement often elevates mucosa of nasal vestibule –
obliterates maxillary fold.
• On occasion, expansion may result in: nasal obstruction,
interfere with wearing of denture
• Pain is uncommon
• Cyst may rupture spontaneously or may drain into oral or
nasal cavity
• Commonly seen in adults
• Peak prevalence in 4th -5th decades of life
• Significant predilection for women
• RADIOGRAPHIC FEATURES
• Cyst arises in soft tissues
• Most cases no radiographic changes are seen
• Pressure resorption of underlying bone may occur
• HISTOLOGICAL FEATURES
• May be lined by psuedostratified goblet cells, or by
columnar epithelium which is sometimes ciliated, often
with goblet cells, or by stratified squamous epithelium.
• TREATMENT & PROGNOSIS
• Complete surgical excision of cyst via intraoral approach
• Because lesion is often close to floor of nose
• Sometimes it is necessary to sacrifice portion of nasal
mucosa to ensure total removal
Thyroglossal duct cyst
• Also called as
– Epidermal Cyst
– Epidermoid Cyst
– Epithelial Cyst
– Keratin Cyst
– Sebaceous Cyst
– Milia.
• They are the result of implantation of epidermal elements
and its subsequent cystic transformation.
• CLINICAL FEATURES
• Asymptomatic
• Men = Women, 3rd and 4th decade mostly
• Gardner syndrome is an exception; the
average patient age at onset is 13 years.
• Discharge of a foul smelling cheese-like
material is common.
• Pain and tenderness.
• Oral cysts can cause difficulty in feeding,
swallowing, or even speaking.
• It appears as firm, round, mobile, red to
yellowish white subcutaneous nodules of
variable size.
• It is mainly reported from sites of face,
trunk, neck, extremities, and scalp.
• HISTOLOGICAL FEATURES
• Lined by stratified squamous epithelium with glandular
differentiation and is filled with desquamated keratin
disposed in a laminar pattern.
• Distrophic calcification is seen besides it.
• Pigmented epidermoid cyst have melanin pigment in the
wall and a keratin mass.
• TREATMENT AND PROGNOSIS
• Surgical removal
• No recurrence
Dermoid cyst
• Also Called As
– Dermoid Cystic Tumor
– Cystic Teratoma
– Ovarian Cystic Teratoma
– Cystic Tumor Of Ovary
– Cystic Tumors Of Omentum
– Congenital Cyst Of Spine
– Spinal Dermoid Cysts.
• A hemartomatous tumor containing multiple sabaceous
glands and almost all skin adnexa.
• It may contain nails, teeth, cartilage like and bone like
structures.
• CLINICAL FEATURES
• Common areas of occurance are face, neck, scalp,
intracranial, perispinal, intra-abdominal cysts such as
tumors of the ovary or omentum.
• Seen all ages
• Diameter of the lesion is 1-4 cm.
• Some times can occur in floor of the mouth and tongue too.
• HISTOLOGICAL FEATURES
• Lined by an epidermis, like epidermoid cyst.
• Hair that project into the lumen of the cyst are often
present.
• The dermis of it contains sebaceous glands
• TREATMENT
• Surgical excision
Inflammatory non odontogenic cysts
• Salivary cysts
– Mucous extravasation cyst
– Ranula
– Mucous retention cyst
• Antral cyst
– Retention cyst of maxillary sinus
– Surgical ciliated cyst of maxilla
• Traumatic bone cyst
• Aneursymal bone cyst
• Stafne bone cyst
• Parasitic cyst
Mucocele
• Tissue swelling composed of pooled mucus that escaped
into the connective tissue from a severed excretory duct.
• This mucous escape phenomenon is called as mucocele
(extravasation)
• Occurs secondary to trauma
• 70% occurs in lower lip (minor salivary glands)
• Mucocele of major salivary glands are rare
• Mucocele formed in the floor of the mouth as a
consequence of severence of duct of sublingual
gland(ranula)
• Submandibular duct severence causes massive
extravasation of mucous into submandibular, submental,
sublingual regions causing plunging ranula
• Clinical features:
• Children and young adults
• Male and female are equally affected
• Lower lip is most affected area
• Buccal mucosa>floor of the mouth> ventral tongue>palate
• Mucocele of upper lip are uncommon
• Appears as a fluctuant mass
• Superficial masses show Bluish translucent appearance
• Deep masses – appears as a soft fluctuant submucosal
nodule with normal mucosal color
• After small puncture the swelling heals and re
accumulation of mucin leading to reoccurrence
• Histopathology
• Circumscribed cavity within the connective tissue
• Distended epithelium
• Mucin is walled off by a rim of granulation tissue
• Cavity is not lined by epithelium – false cyst
• Mucin appears basophilic
• Numerous amount of inflammatory cells – neutrophils,
foam cell histiocytes (mucinophages)
• The duct which supply secretions to the cavity is called
feeder duct
• Treatment :
• Excision with removal of associated minor salivary glands
to minimize the chance of reccurence.
• Avoid injury to other glands during primary wound
closure.
ranula