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Cyst Final-1
Cyst Final-1
Cyst Final-1
1.Lumen of cyst
Lumen of
cyst epithelial lining
Cystic
Fibrous capsule
Microscopic examination:
Most of th epithelial cysts are lined by stratified
squamous epithelium
May be lined by “Pseudostratified ciliated columnar
epithelium” when cyst is in contact with Nasal cavity
& Maxillary sinus cavity.
1.Phase of initiation
2.Phase of proliferation
3.Phase of cystification
4.Phase of enlargement
Clinical features-
Age- Mostly third, fourth & fifth decade of life.
Sex- More common among males.
The cyst can occur in relation to any tooth of
either jaw but maxilla ( 60%) is usually more commonly
affected than mandible ( 40%).
1.The occurrence of more caries in the upper
anterior teeth.
2. the occasional presence of dense-in-dente in the
upper lateral incisors
are usually responsible for the higher incidence of
this cyst in the maxilla.
Clinical presentation-
The involved tooth is always nonvital & it
can be easily detected by the presense of caries,
fractures or discoloration, etc.
Occur rarely in association with nonvital deciduous
tooth.
Smaller cystic lesions are asymptomatic, detected
only by a radiograph.
Larger lesions, often produce a slow enlarging, bony
hard swelling of the jaw with expansion & distortion of
the cortical plates and disturbance in occlusion.
Enlargement=
Increased osmolatity of the cystic fluid(in comparison
to the blood serum) often causes more & more fluid
accumulation in the lumen of the cyst.
Treatment:
Clinical features:
Clinical presentation-
1. In the initial stages odontogenic keratocyst does
not produce any signs or symptoms & the lesion
may be discovered only during routine
radiographic examinations.
2. Larger lesions of odontogenic keratocyst however
produce swelling of the jaw with facial asymmetry
and pain in the jaw along with mobility &
displacement of the teeth.
3.Bony expansion is minimum in odontogenic
keratocyst because in most of the cases the cyst
spreads via the medullary spaces of the bone &
therefore remarkable bony swelling is usually absent.
Paper Electrophoresis:
Electrophoretic treatment reveals that the
cystic fluid of OKC has soluble protein levels,which is
below 3 - 5gram/100ml whereas in case of non-
keratinizing cysts,the level is about 5 - 11gram/100ml.
Treatment:
Treatment is done by either “surgical enucleation”
or “marsupiazation” of the cyst.
Causes of Recurrence:
OKC may recur after treatment in about 60%
cases, the causes of this are
Treatment-
Treatment by enucleation.
Lateral Periodontal cyst
Is an uncommon cyst that develops in immediate
association with the lateral root surface of an
erupted tooth.
Pathogenesis:
Mainly controversial, but it is generally believed that
the cyst arises from the cell rest of malassez or from
the cell rests of serres or from the reduced enamel
epithelial cells.
Clinical Features:
Age and Sex - Commonly occurs in adult males.
Common Site- Maxillary & mandibular anterior
regions are common sites.
Clinical presentation-
Clinically the lesion is mostly asymptomatic & in few
cases there may be a small,painless soft tissue
swelling within or just anterior to the interdental
papillae.
-The overlying mucosa is generally normal in
color,but in few cases,there may be a bluish
discoloration.
-The cyst is usually less than 1cm in diameter.
Radiological features:
-Radiographically,lateral periodontal cyst presents as a
small,unilocular,”teadrop-shaped” radiolucent area on
the lateral aspect of the root.
Histopathology:
Cyst presents a small cystic cavity lined by non-
keratinized stratified squamous epithelium of 2-3 cell
layers thickness supported by a connective tissue wall.
Pathogenesis:
The cyst probably develops from the reduced
enamel epithelial cells or remnants of odontogenic
epithelium.
Clinical Features:
Age-Mostly the cyst develops in the second
decade of life.
Sex- Both sexes are equally affected.
Pathogenesis:
The gingival cyst of adult arises from the cell rests of
the serres.
Clinical Features:
Globulomaxillary cyst
Pathogenesis:
Treatment:
By surgical excision, with preservation of the involved
tooth.
Nasolabial cyst
Nasolabial cyst is entierly a soft tissue cyst, which arises in
the nasolabial fold, just below the ala of the nose.
Clinical Presentation:
Treatment:
Surgical enucleation.
Nasopalatine Duct Cyst
Pathogenesis:
It arises usually due to the proliferation & subsequent
cystic degeneration of the epithelial remnants remaining
after closure of the embryonic nasopalatine duct.
Clinical Presentation:
-The cystic lesion clinically presents as a
small, painful swelling in the midline of the anterior part of the
hard palate near the opening of the incisive foramen.
Histopathology:
cystic cavity is lined by ciliated
columnar or nonkeratinized stratified squamous
epithelium & is supported by a connective tissue capsule.
Treatment:
Surgical excision
Pseudo cysts / Non- epithelialised
bone cysts
Solitary Bone Cyst / Traumatic,
Haemorrhagic, Simple bone cyst,
Ideopathic bone cavity
Solitary bone cyst represents a pseudo cyst.
Clinical features:
Age - Common among young people.
Sex – Males > Females.
Site – Mandibular body, symphysis or ramus
& maxillary anterior regions, etc are the common sites.
Presentation:
In most of the cases, the cyst is asymptomatic but in few
cases ,it produces a painful, bony hard swelling of the jaw.
Pathogenesis:
The exact pathogenesis of solitary bone cyst
is not clearly known, but it is believed that the condition
develops due to trauma in the jawbone.
Histopathology:
cystic cavity surrounded by a
loose vascular connective wall.
Treatment:
The treatment is done by surgical exploration of the
cyst; it helps in causing further hemorrhage in the area
with subsequent healing.
Aneurysmal Bone Cyst
Aneurysmal bone cyst is an uncommon cystic
lesion.
Clinical features:
Age – Usually second decade of life(10 to 19 yrs.)
Sex – Females are more commonly affected.
Site – Mandibular molar -ramus area, maxillary
posterior region.
Pathogenesis:
Pathogenesis of ABC is controversial & it
is believed that the cyst arises as a result of
trauma with subsequent venous occlusion inside
the bone.
It is also believed that the lesion occurs as
a result of cystic transformation of a preexisting
pathology,especially the central giant cell
granuloma.
Clinical Presentation :
- ABC clinically presents a rapidly enlarging, diffuse,
firm, painful swelling of the jaw causing facial asymmetry.
- the affected area of the jaw may be pulsatile in some
cases.
-Severe expansion & thinning of the bone often
results in “egg-shell crackling” & perforation of the
cortical plates.
-Pathological fracture of the affected jawbone
may occur .
-Accidental injury or perforation of the cyst may result in
profuse bleeding.
Treatment:
Surgical Curettge.
Cysts of The Salivary Gland
Cystic lesions developing from the salivary glands
are commonly known as “mucocele” and these lesions
develop mostly in relation to the minor salivary glands
& rarely in relation to the major salivary glands.
Etiology:
-Obstruction to the duct by calculus(sialolith)
formation.
- Compression of the duct by trauma or a
growing tumor in the vicinity.
- Perforation of the duct due to injury.
- Absence of the duct itself(atresia)
-Scar or stricture formation to the duct,
specially after surgery.
Clinical Features:
-Clinically “ranula” presents a soft,fluctuant,
unilateral swelling in the floor of the mouth,which
often causes deviation of the tongue.
-The lesion typically has a bluish translucent
appearance & it often resembles the distended
“frog's belly”(for which the name ranula has
developed).
-If the lesion is a deep-seated one,the bluish
coloration is usually absent & when such lesion
herniates through the mylohyoid muscle,they are called the
“plunging” type of ranula.
-In many cases,ranula can cross the midline of the
floor of the mouth & can even obstruct air-way.
Histopathology:
The extravasation type of ranula
microscopically presents large mucous -filled area
which is surrounded by a connective tissue wall.
The retention type of ranula reveals the
mucous filled area which is lined by an epithelial
lining of the salivary gland.
In both the cases,sialoliths may be found
within the duct systems.
Clinical features:
Age – Young adults
Sex - Male = Female
Site – Skin around the eyes,anterior upper
neck & the floor of the mouth.
Presentation:
- A pain less swelling,which is often having a
doughy consistency.
- The cyst,which develops above the
myelohyoid muscle,presents a sublingual swelling in
the midline.
- It often causes elevation of the tongue
with difficulty in eating & speaking.
-The cyst below the myelohyoid muscle often
produces a midline swelling in the submental or
submandibular region.
-Size varies from few milimeters upto 2
centimeters.
Histopathology:
- A cystic cavity lined by orthokeratinized
stratified squamous epithelium,which exhibits
hair follicles,sebaceous glands & erector pili muscles
etc.
- The cavity lumen is often filled with sebum,
descuamated keratin & hair shafts.
-The cyst capsule is composed of a narrow
zone of compressed connective tissue.
Treatment:
Surgical enucleation.
Surgical Cilliated Cyst Of Maxilla
It is an iatrogenic cyst, which develops as result of
surgery involving maxillary sinus.
Clinical Features:
Age – Middle aged to old aged adults.
- Pain & tenderness in the maxilla is present.
- There is history of previous surgery in the
maxilla.
Radiographic Features:
X- ray reveals a well-circumscribed radiolucency
in close proximity of the maxillary sinus.
Histopathology:
-The cyst is lined by a pseudostratified ciliated
columnar epithelium.
-The surrounding connective tissue is either
normal or inflamed.
Treatment:
Surgical enucleation.