Cysts of the Oral Region Odontogenic Cysts Cysts-pathologic cavity, fluid filled, epithelium lined Cysts of the Oral

Region -majority of cysts found in within max and mand -generally are inflammatory in origin -some are developmental in origin -cysts may be defined as an epithelium lined pathologic cavity that may contain fluid or cellular debris -types: 1. True Cysts-has actual epithelium 2. Pseudo Cysts-not epithelium lined -the epithelial lining of these cysts originates from residues of the tooth forming organ -3 kinds of residue, responsible for the origin of a particular type of lesion 1. Epithelial Rests or Glands of Serres 2. Reduced Enamel Epithelium 3. Rest of Malassez Cysts of the Oral Region -the epithelial rests or glands of serres derived from dental lamina give rise to the ff: 1. Odontogenic Cyst (now considered a tumor) 2. Lateral Periodontal Cyst 3. Gingival Cyst -reduced enamel epithelium is derived from the enamel organ and covers fully formed crown of the unerupted tooth _________ ___________ _________ -rests of malassez formed by fragmentation of the epithelial root sheath of Hertwig --Radicular Cyst Radicular (Periapical Cyst) -the most common cysts of the oral and perioral regions -also called Apical Periodontal Cyst

-an inflammatory cyst derives its epithelium from the proliferation of small odontogenic epithelial residues (rests of malassez) within the periodontal ligament >Etiology -develops with a pre-existing periapical granuloma -periapical represents a discrete focus of chronically inflamed granulation tissue in bone or apex of the tooth -it develops in response to pulpal sheath and subsequent tissue necrosis >pathogenesis -stimulation of the epithelial rests relates to the inflammatory process within the periapical granuloma -cystification occurs as epithelial elements proliferate ultimately forming a lining -remnants of cellular debris are found within cysts lumen -fluids ingress into the lumen ultimately results in outward growth of the cyst -outward growth is enhanced by the osteoclastic bone resorption >clinical feat -most located in max, especially in anterior region followed by max post region, mand post region and finally man ant region -most cases are noted in males -occur at any age but reach its peak at 3rd-6th decades -most radicular cysts are _____________ -often discovered during routine dental radiographic examination -most dont produce bone expansion if present they tend to favor labial or buccal locations -presents in non-vital teeth (__________factor) -______________ -the radiolucency is usually ovoid, with a narrow opaque margin that is contiguous with lamina dura of involved teeth *biopsy-aspirational, yellow fluid means its a cyst >differential dx __________

>tx -extraction and curettage -endo therapy -apicoectomy >prognosis -with _________ recurrence is unexpected -with incomplete removal, a residual cyst may develop from months to years after initial tx Residual Cyst Dentigerous Cyst -Follicular Cyst -2nd most common type of odontogenic cyst -associated with crown of an unerupted or developing tooth -dentigerous means containing teeth -cyst enclosing the crown of unerupted tooth -is attached to cervical region which helps differentiate this cyst from primordial cyst >etiology and pathogenesis -____________ -expansion of dentigerous cyst is related to a secondary increase in cyst fluid osmolarity as a result of passage of inflammatory cells and desquamated epithelial cells into cyst lumen >clin feat -most common sites are 3rd molar regions of mand and max, max canine region -highest incidence during 2nd and 3rd decades -greater frequency in males with a ratio of 1.6-1 -symptoms are generally absent with late frequent indicators of possible ________ -radiographically_________ -the development if crown is generally symmetric with occasional lateral radiolucencies -there is displacement of unerupted teeth -in mand it may extend to the ramus and or the body of mandible

-in maxilla, it may extend into canine regions, max sinus, or to the _______ Paradental Cyst -__________ -these are found adjacent to buccal root surface of mand 3rd molar -radiographically appear well circumscribe radiolucencies over roots of 3rd molar ____ >histopath -stroma is collagenous and its intervening ground substance is rich in acidic glycoprotein and _______ >diff dx -ameloblastoma, especially when it occurs in post region of mand or max in _____ pxs >tx -removal of associated tooth with careful enucleation of soft tissue -if cyst affect ___ Eruption Cyst -separate form of dentigerous cyst -found in children -erupting teeth -epithelium lining this space is REE -a soft tissue cysts results from fluid _________

Lateral Periodontal Cyst -a nonkeratinized, non-inflammatory developmental cyst occurring adjacent or lateral to the root of the tooth >etiology and patho -origin related to proliferation of rests of dental lamina within bone and _______ >clin feat -majority occur in mand pm and cuspid region with ____ incisor area -distinct male predilection -radiographically, presents as a well delineated round or teardrop shaped radiolucency with an opaque margin along the lateral surface of tooth with no associated clinical symtpoms -area of involvement generally between adjacent roots with rare root development -radiographic lesion is most frequent monocystic -if polycystic/multiolocular botryoid ______ >histopath -lined by a thin non keratinized epithelium -cluster of clear cells may be noted as modular thickening within cyst lining >diff diagnosis -cyst forming severe periodontitis -primordial cyst >tx and prognosis -local excision -little tendency for recurrence Glandular Odontogenic Cyst -Sialo-odontogenic cyst -a combined features of both the botryoid odontogenic cyst and a mucus producing salivary gland lumen >clin feat -80% of cases noted in mand -when occurring in mand, most are found in ant region, often crossing the midline -when occurring __________

-jaw expansion is possible in ________ >radiographic feat -multiloculated -lesions exhibits a wide variation in size from some less than 1 cm to those involving most of the mand bilaterally -radiographic margins are well defined and sclerotic >histopath -cystic lining consist of non keratinized epithelium with focal aggregated or nodular thickening within which the epithelial cells assume a swirled appearance -overall histomorphology is reminiscent of a low grade mucoepidermoid ____ >tx -lesions should be considered locally aggressive -surgical tx -when adequate healthy bone remainperipheral curettage or marginal excision >prognosis -poor -long term follow up is essential given the local aggressiveness and recurrence potential Gingival Cyst of the Newborn -Bohns Nodules -dental lamina cyst of newborn -appear typically as multiple nodules along the alveolar ridge in neonate -fragments of dental lamina that remain within alveolar ridge mucosa often tooth formation proliferate to form small keratinized cyst -in vast majority of cases, these cysts degenerate and involute or rupture into the oral cavity -histologically an intact cysts contain keratin debris and a thin epithelial linig (2-3 cell layers thick) >tx -similar in_______ cyst may occur along the midline of palate known as palatine cysts of newborn or epsteins pearls -developmental in origin but didnt derive from odontogenic epithelium -no tx necesary Odontogenic Keratocyst (now considered a tumor)

-any jaw cyst containing keratin -but many other cyst also contain keratin -distinctive entity that is worth of separation ______ >etiology and pathogenesis -origin_______ >clin feat -2nd and 3rd decades -lesion found in children are often reflective of the multiple odontogenic keratocyst as a component of the _______ basal cell carcinoma syndrome -chief site-mand post portion of body and ramus -in max, usually occur in 3rd molar and canine region -radiographiclly with smooth margins and thin radiopaque borders -most lesion are unilocular adjacent to the crown of an unerupted teeth -multilocular _____ -a significant percentage will produce buccal expansion >histopath -fibrous ct component of cyst wall is often _____ of an inflammatory cell infiltrate and is relatively thin -the lumen may contain large amounts of keratin debris or clear fluid similar to serum transudate -2 types 1. Parakeratotic (85-95%) 2. Orthokeratinized (5-15%) 1. Parakeratotic -more aggressive -budding of basla layer of epithelium into supporting CT which may be slightly dysplastic and dyskeratotic -microcysts and satellite _______ 2. Orthokeratinized -less aggressive -lower rate of occurrence -a prominent granular layer is found immediately below a _______ non-____ surface -basal cell layer is less _____ -________ >diff dx

-dentigerous cyst ameloblastoma -traumatic bone cyst, central giant cell granuloma, lat. Periodontal cyst >tx -surgical excision with peripheral osseous _______ osteotomy -follow up is impt >prognosis -high recurrence -poor Calcifying Odontogenic Cyst -a development odontogenic cyst -odontogenic ghost cell tumor -occassional aggressive behavior (neoplastic) >etiology and pathology -derived from odontogenic epithelial remnants within gingiva or within max and mand -char. Microscopic feat is the ghost cell _______ >clin feat -female predilection 70% max -ant to 1st molar region -alveolar bone pressure resorption -radiographically, the central or intraosseous ____ present as an unilocular/multilocular radiolucency with discrete well dermacated margin -variable degrees of opacity -expansion of alveolar bone or soft tissue in 50% of cases -abssence of tenderness and pain are characteristic ____ >histopath -producing the ___ of a solid ____ -epithelial layer irregular and ____ thickness -ghost cells =keratinized cells >diff dx -early stages: dentigerous cyst, odontogenic k____, unicyst ameloblastoma

-later stages: >tx -simple enucleation >prognosis -little risk of recurrence