CYSTS OF

ORAL REGION
Cysts

 pathological cavity

 often fluid filled lined by

epithelium

 in many instances, exact

pathogenesis of these lesions is
still uncertain
How will a patient present…

• Patient may present with expanding swelling

• Unerupted teeth
• Pain
• Discolored tooth
• History of trauma to teeth
• Pathological fracture of mandible
How will you diagnose a cyst?

• History
• Clinical examination( extraoral/ intraoral)
• Aspiration
• Radiographic: PA, OPG, occlusal view
• CT scan for extensive lesions
• Tooth vitality tests: cold, heat, Laser
doppler flowmetry
• Lab investigations:
1. Fluid cytology
2. Electrophoresis
3. Incisional/ excisional biopsy.
Cysts

 regardless of origin, once

cysts develop in oral +
maxillofacial region,

 tend to slowly increase in

size

 possibly in response to a
slightly elevated
hydrostatic luminal
pressure
CLASSIFICATION
•ODONTOGENIC CYSTS: • NON ODONTOGENIC
Periapical (radicular) cysts CYSTS:
Lateral periodontal cysts
Gingival cyst of newborn Globulomaxillary cyst
Dentigerous cyst Nasolabial cyst
Eruption cyst Median mandibular cyst
Glandular odontogenic cyst
Odontogenic keratocyst
Nasoplatine canal cyst
Calcifying odontogenic cyst • SOFT TISSUE CYSTS OF
•PSEUDOCYSTS: NECK:
Aneurysmal bone cyst Branchial cyst
Traumatic bone cyst
Static bone Cyst Dermoid cyst
Focal Osteoporotic bone Thyroglossal
marrow defect tract cyst
PERIAPICAL (RADICULAR CYST)

• Most common cyst of orofacial region

• Epithelial lining is derived from proliferation rests of
malassez within the PDL
• 60 -75%

INCIDENCE:
One third of all cysts 75% cases

AGE DISTRIBUTION:
Third to sixth decade of life

LOCATION:
Anterior maxilla, posterior maxilla , mandibular
posterior region followed by man anterior region in
descending order
ETIOLOGY/ PATHOGENESIS
Caries/trauma/ periodontal disease

Pulpal necrosis

Apical boneinflammation
Dental granuloma formation

Epithelial proliferation

Periapical cyst formation

CLINICAL FEATURES
• They are usually
asymptomatic except
when they are secondarily
infected
• They cause painless bone
expansion .
• The involved tooth will
be non vital / discoloured
or root canal treated.
• When sufficient bone
expands, egg shell
crackling will be present.
• Cyst may range few
millimeters to a few
centimeters in size
RADIOGRAPHIC VIEW
• Unilocular radiolucency with
narrow opaque margins
continuous with the lamina
dura of the involved tooth

• Differential diagnosis
1. Granuloma
2. Traumatic bone cyst
3. Giant cell lesions
4. Odontogenic tumours
TREATMENT
• 3 Options:
1. Extraction of teeth with
periapical currettage
2. Root canal filling
followed by apicectomy
3. Perform root canal and
wait for periapical lesion
to resolve (if small)
4. If tooth is extracted
and lesion is not
removed, then residual
cyst can form.
DENTIGEROUS CYSTS
• Second most common cyst of the jaw 10 15%
• It is attached to the tooth cementoenamel
junction and encloses the crown of the unerupted
tooth

ETIOLOGY / PATHOGENESIS:
It develops from proliferation of
reduced enamel epithelium
Expansion of cyst occurs from
hydrostatic mechanism and
release of bone resorbing
factors.
RADIOGRAPHIC FEATURES

•Lucency associated with crown

of impacted tooth
•Third molars/canine teeth
most commonly affected.

SIGNS & SYMPTOMS:

Swelling
Pain
Unerupt
ed
tooth
DIFFERENTIAL DIAGNOSIS
• Odontogenic keratocysts
• Ameloblastoma
• Odontogenic tumors

POSSIBLE COMPLICATION:
bone destruction
Resorption of roots
Displacement of teeth
Neoplastic
transformation…
ameloblastoma…
carcinoma rarely
TREATMENT
• Removal of adjacent tooth and enucleation of
cystic content.
• Marsuplization to shrink the lining and allow
eruption of tooth.
ODONTOGENIC KERATOCYST
• They are different from other cyst due to
aggressive nature, high recurrence rate
and their association with basal cell nevoid
syndrome.

ETIOLOGY:
They develop from dental lamina remnants in
the maxilla and mandible
However, an origin from basal cells of the
overlying epithelium
PATHOGENESIS
High proliferation rate

Overexpression of antiapoptotic protein Bcl-2

Overexpression of matrix metalloproteas-es, MMP 2,9

Mutation of PTCH,overexpression of sonic hedgehog

pathway , formation of smoothened protein

SUFU gene mutation

CLINICAL FEATURES

• Age group involved is

second to third decade of
life.
• 5-15%of all cysts.
• Approx 5% of all
OKC patients have
basal cell nevoid
syndrome.
• More common in the
mandible, posterior portion
of body and angle area
most commonly involved.
• Buccal expansion will be
BASAL CELL NEVOID SYNDROME
• Multiple odontogenic cysts
• Basal cell carcinomas on skin
• Frontal bossing, parietal bossing
• Mandibular prognathism
• Spina bifida and bifid ribs
• Kyphoscoliosis
• Calcified falx cerebri
• Palmer/planter keratosis
• Hypertelorism
• Also called gorlin goltz syndrome
RADIOGRAPHIC FEATURES
• Multilocular
radiolucency is present
• With smooth margins
• Resorption of roots may
be seen.
Diagnosis
• Two types of keratocysts:
1. orthokeratinized…. Less common, not
syndrome associated and lower recurrence
rate
2. Parakeratinized… epithelial budding and
daughter cysts, higher recurrence
rate.
TREATMENT
• Surgical enucleation followed by peripheral osseous
currettage or ostectomy.
• Chemical cauterization can also be done with
cornoys
solution/ liquid nitrogen.
• In some larger cysts marsupilization can be done
to reduce the size of the cyst.

RECURRENCE:
10-30% recurrence rate due to;
1. Daughter / satellite cysts
2. Fragile lining
3. Epithelial proliferate rate is very high
4. Production of bone resorbing factors
5. Finger like extension into cancellous bone
6. Inf standard of treatment
7. pseudooccurence