CYSTS OF THE JAWS

& ORAL CAVITY

r v subramanyam,mds
LEARNING OBJECTIVES
At the end of this chapter you should be able to:
n Define and classify cysts of the jaws and the
oral cavity
n Describe pathogenesis, features, differential
diagnosis and management of cysts in general
n Explain the aetio-pathogenesis, clinical
features, radiographic appearance, histo-
pathology and management of common cysts.

Etymologically, the word CYST is derived from Eruption cyst

Greek Kystis for sac, bladder, pouch, or bag, Gingival cyst of infants
which in turn is derived from the Greek word Gingival cyst of adults
Kyso for I hold. It can be defined as Developmental lateral periodontal cyst
pathological cavity or pouch, containing fluid or Botryoid odontogenic cyst
semi-fluid material, and which may or may not be Glandular odontogenic cyst
lined by epithelium. Calcifying odontogenic cyst
True cysts are those which have an epithelial lining.
For example Radicular cyst, Dentigerous cyst, and b) INFLAMMATORY
Keratocyst. Radicular cyst, apical and lateral
Pseudocysts is a term given to cysts that do not Residual cyst
possess an epithelial lining. Aneurysmal bone cyst, Paradental cyst and juvenile paradental cyst
Solitary bone cyst, and Mucus escape phenomenon Inflammatory collateral cyst
are examples of pseudocysts.
2. NON-ODONTOGENIC (Developmental)
Cysts can be classified as: Developmental Midpalatal raph cyst of infants
Nasopalatine duct cyst
Sinus Odontogenic Nasolabial cyst

Inflammatory B. Non-Epithelial-lined (PSEUDO) cysts

TRUE
Aneurysmal bone cyst
Solitary bone cyst
CYSTS JAWS Non-Odontogenic
II. CYSTS ASSOCIATED WITH MAXILLARY ANTRUM
So-called Mucocele
PSEUDO Fissural
Cysts Retention cyst
Pseudocyst
Soft
Postoperative maxillary cyst Developmental
Tissues
origin
I. CYSTS OF THE JAWS
A. Epithelial-lined (TRUE) cysts III. CYSTS OF THE SOFT TISSUES OF THE MOUTH, FACE
1. ODONTOGENIC & NECK
a) DEVELOPMENTAL Dermoid & epidermoid cysts
Dentigerous cyst Lymphoepithelial (branchial) cyst
Odontogenic keratocyst Thyroglossal duct cyst

1
 CYSTS OF THE JAWS & ORAL CAVITY: GENERAL FEATURES
Anterior median lingual cyst II. Phase of Cyst Formation
Oral cysts with gastric or intestinal epithelium Cystic degeneration of central cells due to lack of
Cystic hygroma vascularity. There is increase in intercellular
Nasopharyngeal cyst oedema and acid phosphatase activity accompanied
Thymic cyst by formation of microcysts. Gradually these
Cysts of the salivary glands: mucous microcysts coalesce to form a larger cyst.
extravasation cyst; mucous retention cyst; ranula;
polycystic (dysgenetic) disease of the parotid
Parasitic cysts: hydatid cyst; Cysticercus
cellulosae; trichinosis

AETIOPATHOGENESIS:
All true cysts require an epithelial source,

III. Phase of Cyst Enlargement

Cyst may enlarge due to any or more of the
following reasons:
n Attraction of fluid into the cyst cavity Retention
of fluid within the cavity Raised internal
hydrostatic pressure.
which could be one or more of the following: n Bone resorption with increased size of bone
n Reduced Enamel Epithelium cavity - due to MMPs 1, 2, 3 and Prostaglandins
n Rests of Serres E2 & E3
n Cell rests of Malassez n Epithelial proliferation
n Basal layer of oral epithelium
n Tooth primordium
n Cell rests at the line of fusion of developmental
processes
n Nasolabial duct
n Nasopalatine duct
n Maxillary sinus

All true cysts have three phases in their formation:

I. Phase of Initiation
These cells proliferate due to one or more of the
following reasons: To summarize, the aetiopathogenesis can be
schematically depicted as follows:

n
Genetic
n
Loss of immunological surveillance
n
Inflammatory mediators
n
Local factors: ed O2 tension and ed CO2
tension

2
 CYSTS OF THE JAWS & ORAL CAVITY: GENERAL FEATURES
FEATURES OF JAW CYSTS IN GENERAL n Normal anatomic structures (antrum, incisive
canal fossa)
n Slowly enlarging swelling.
n Usually painless, unless secondarily infected or MANAGEMENT OF CYSTS
impinging on a nerve. n Enucleation
n Normally only buccal cortical plate expansion, Separation of the lesion from the bone, with
and not lingual. preservation of bone continuity
n "Eggshell crackling" on palpation of large cysts. n Curettage
Removal by scraping or morcellation (the
n Occasionally pathological fracture.
division of solid tissue, such as a tumour, into
n Displacement of adjacent teeth may occur. pieces, which can then be removed)
n Sometimes resorption of roots of adjacent teeth. n Marsupialization
n Well-circumscribed radioloucency, unilocular Surgical removal of overlying tissue, creating a
(occasionally multilocular) with a radiopaque window in the wall of the cyst decompresses
border. cyst & s intra-cystic pressure promotes
cyst shrinkage & bone fill
FEATURES OF SOFT TISSUE CYSTS IN n Resection without continuity defect
GENERAL Resection of the lesion, including a measurable
perimeter of investing bone, without
n Slowly enlarging swelling interrupting the bone continuity. Procedure
n Painless usually limited to large aggressive, or recurrent, OKCs.
n Fluctuant on palpation n Resection with continuity defect
Resection of the lesion, including a measurable
HISTOPATHOLOGICAL FEATURES OF perimeter of investing bone, with interruption
CYSTS IN GENERAL the bone continuity. Procedure limited to large
All true cysts show: aggressive, or recurrent, OKCs that involve the
inferior border of the mandible. Adjacent soft
n a lumen
tissue may be included in the resection if the
n an epithelial lining, and lesion has penetrated the cortex and involved the
n a connective tissue wall overlying soft tissues.
n Disarticulation
Resection with continuity defect that involves
Lumen TMJ
n Recontouring
Surgical reduction of size, shape, or both of the
surface of the bony lesion.

Epithelial Lining

Connective tissue wall

DIFFERENTIAL DIAGNOSIS
Radiolucent cyst-like features can be seen in
n Odontogenic tumours
n Non-odontogenic tumours
n Giant cell granuloma
n Hyperparathyroidism
n Cherubism
n Stafne bone cavity
3