CYSTS AND CYSTLIKE
LESIONS OF THE JAWS
Dr. Mariya Guy
Oral Medicine Dept.
• A cyst is a pathologic cavity filled with fluid, lined by epithelium, and
surrounded by a definite connective tissue wall
• Originate from the numerous rests of odontogenic epithelium
• Related to a nonvital tooth
CLINICAL FEATURES
Swelling
No pain
Unerupted tooth
RADIOGRAPHIC FEATURES
• Location
RADIOGRAPHIC FEATURES
• Periphery
• Well-defined
• Corticated
• Shape
• Round or oval
• Scalloped
RADIOGRAPHIC FEATURES
• Internal structure
• RL
• Dystrophic calcifications
• If septa – multilocular appearance
RADIOGRAPHIC FEATURES
• Internal structure
• RL
• Dystrophic calcifications
• If septa – multilocular appearance
RADIOGRAPHIC FEATURES
• Effect on surrounding structures
• Displacement and resorption of teeth
• Expansion of cortical plate
• Displacement of inferior alveolar nerve canal
CYSTS
Odontogenic Nonodontogenic
Inflammatory Developmental Pseudocysts
CYSTS Nasopalatine duct cyst
Odontogenic Nonodontogenic
Inflammatory Developmental Pseudocysts
Periapical cyst and Dentigerous cyst Traumatic bone cyst
granuloma Lateral periodontal cyst Static bone cyst
Residual Odontogenic keratocyst Aneurismal bone cyst
Buccal bifurcation cyst Calcifying odontogenic cyst
Glandular odontogenic cyst
ODONTOGENIC CYSTS
• Radicular cyst • Keratocystic odontogenic tumor
• Residual radicular cyst • Dentigerous cyst
• Buccal bifurcation cyst • Lateral periodontal cyst
• Glandular odontogenic cyst
• Calcifying cystic odontogenic tumor
ODONTOGENIC CYSTS
Inflammatory
RADICULAR CYST
Synonyms
• Periapical cyst
• Apical periodontal cyst
• Dental cyst
Inflammatory
RADICULAR CYST
Clinical features
• Arise from non vital teeth
• 3-6 dec
• Slight M>F
• No sypmptoms unless secondary infection occurs
• Swelling (large)
Inflammatory
RADICULAR CYST
Radiographic features
• RL
• 60% - max, incisor – canine area
• Well-defined, cortical border
• Expansion of cortical plate
• Displacement and resorption of roots
• May displace the mandibular alveolar nerve canal
Inflammatory
RADICULAR CYST
Differential diagnosis
• Apical granuloma (2 cm, histology)
• Early stage of PCD
• Apical scar
• Odontogenic keratocyst
• Lateral periodontal cyst
Inflammatory
RADICULAR CYST
Management
• Endodontic therapy
• Apical surgery
• Extraction
Inflammatory
RADICULAR CYST
Inflammatory
RADICULAR CYST
Inflammatory
RADICULAR CYST
Inflammatory
RESIDUAL RADICULAR CYST
Inflammatory
RESIDUAL RADICULAR CYST
Differential diagnosis
• OKT
• Stafne cyst
Inflammatory
BUCCAL BIFURCATION CYST
Corona-Rodriguez, J Oral Maxillo. Surg 2010
Inflammatory
BUCCAL BIFURCATION CYST
Synonyms
• Mandibular infected buccal cyst
• Paradental cyst
• Inflammatory paradental cyst
Inflammatory
BUCCAL BIFURCATION CYST
Clinical features
• 1-2 dec
• Lack of or delay in eruption of mandibular first or second molar
• Molar may be missing or the L cusp tips
• Vital tooth
Inflammatory
BUCCAL BIFURCATION CYST
Radiographic features
• RL
• Mandibular 1-st or 2-nd molar
• Centered to furcation
• Well-defined cortical border
• Tipping of roots to the lingual cortical plate of mandible
• May displace and resorb the adjacent teeth (large cysts)
Inflammatory
Inflammatory
BUCCAL BIFURCATION CYST
Differential diagnosis
• Periodontal abscess
• Radicular cyst
• LCH
Inflammatory
BUCCAL BIFURCATION CYST
Management : curettage / no treatment
Changes in no need in tooth extraction
treatment
methods Extraction + Enucleation Probing +
over the enucleation irrigation
years
Absorption of cyst
Results No recurrence No recurrence No recurrence
Developmental
DENTIGEROUS CYST
Developmental
DENTIGEROUS CYST
Synonym – follicular cyst
Developmental
DENTIGEROUS CYST
Clinical features
• Around the crown of an unerupted or supernumerary tooth
• No pain or discomfort
• Swelling, facial asymmetry (if large)
Developmental
DENTIGEROUS CYST
Radiographic features
• Epicenter just above the crown of the involved tooth
• Mand or max third molar or max canine
• Cyst attaches CEJ
• Displace and resorb adjacent teeth
• Displace the associated tooth in an apical direction
• Expansion of cortex of the involved jaw
Developmental
DENTIGEROUS CYST
Developmental
DENTIGEROUS CYST
Developmental
DENTIGEROUS CYST
Developmental
DENTIGEROUS CYST
Developmental
DENTIGEROUS CYST
Developmental
DENTIGEROUS CYST
Differential diagnosis
• Hyperplastic follicle (2-3 mm)
• OKT
• Ameloblastic fibroma
• Cystic ameloblastoma
• AOT
• CCOT
• Radicular cyst of primary teeth
Developmental
DENTIGEROUS CYST
Management
• Surgical removal
• Marsupalization + Surgical removal (if large)
• Histologic examination
• Tooth extraction?
Developmental
KERATOCYSTIC ODONTOGENIC TUMOR
Synonyms
• Odontogenic keratocyst
• Primordial cyst
Developmental
KERATOCYSTIC ODONTOGENIC TUMOR
Clinical features
• 10% of all cystic lesions in the jaws
• 2-3 dec
• M>F
• No symptoms or mild swelling
• High propensity for recurrence
Developmental
KERATOCYSTIC ODONTOGENIC TUMOR
Radiographic features
• RL
• If internal septa present – multilocular appearance
• Grow along the internal aspect of the jaws – minimal
expansion – late detection – large size
• Posterior body of mandible
• 90% post to canines
• 50% ramus
• Epicenter superior to the inf alveolar nerve canal
Developmental
KERATOCYSTIC ODONTOGENIC TUMOR
Developmental
KERATOCYSTIC ODONTOGENIC TUMOR
Radiographic features
• May be associated with unerupted tooth
• Round or oval shape
• Scalloped outline
• Can displace and resorb teeth (less than
dentigerous cyst)
• Displace inf alveolar nerve canal inferiorly
Developmental
KERATOCYSTIC ODONTOGENIC TUMOR
Differential diagnosis
• Dentigerous cyst (pericoronal)
• Ameloblastoma
• Odontogenic myxoma Multilocular
• Simple bone cyst
• Basal cell nevus syndrome (multiple)
Developmental
KERATOCYSTIC ODONTOGENIC TUMOR
Management
• Surgical excision
• Curettage or marsupalization
• Resection
• Periodic clinical and radiographic examination 5-10 years
• High propensity for recurrence
BASAL CELL NEVUS SYNDROME
Synonyms
• Gorlin (-Golz) syndrome
• Nevoid basal cell carcinoma syndrome
BASAL CELL NEVUS SYNDROME
Synonyms
• Gorlin (-Golz) syndrome
• Nevoid basal cell carcinoma syndrome
BASAL CELL NEVUS SYNDROME
Clinical featutes
• 5-30 y
• Multiple KOTs
• Multiple BCC of skin
• Skeletal abnormalities (bifid ribs, agenesis, deformity, and synostosis of the
ribs, kyphoscoliosis, vertebral fusion, polydactyly, temporal and
temporoparietal bossing, minor hypertelorism, and mild prognatism)
• Calcifications of falx cerebri
BASAL CELL NEVUS SYNDROME
Clinical featutes
BASAL CELL NEVUS SYNDROME
Radiographic featutes
• Multiple KOTs the same location as that of solitary
• Vary in size mm-cm
BASAL CELL NEVUS SYNDROME
Radiographic featutes
• Multiple KOTs the same location as that of solitary
• Vary in size mm-cm
BASAL CELL NEVUS SYNDROME
Differential diagnosis
• Multiple myeloma
• Cherubism
• Multiple dentigerous cysts
LATERAL PERIODONTAL CYST
• Arise from epithelial rests in periodontium lateral to the
tooth root.
• Usually unicystic, if multicystic – botryoid odontogenic cysts
• Intrabony counterpart of the gingival cyst of adult
LATERAL PERIODONTAL CYST
Clinical features
• 2-9 dec, 5-7 dec (50y)
• M=F
• Asymptomatic
• Vital teeth
LATERAL PERIODONTAL CYST
Radiographic features
• 50-75% mand (lat incisors – second premolar area)
• RL, unilocular or multilocular
• Well-defined, cortical boundary
• Round or oval
• May efface lamina dura
• Displace adjacent teeth and cause expansion (if large)
LATERAL PERIODONTAL CYST
Radiographic features
LATERAL PERIODONTAL CYST
Differential diagnosis Management
• KOT (small) • Excisional biopsy
• Mental foramen • Enucleation
• Neurofibroma • Not tend recur
• Radicular cyst
• Ameloblastoma (multiple)
Epid Location Clinical Teeth Border Inner Histology
Radicular cyst +/- Symp Non Well defined, RL Thin stratified squam
/granuloma(Res Percussion, vital sclerotic, unless…. inflamation, cholesto
idual) swelling, fistule MO cells, non
/ tenderness keratinized
Buccal child Lower 1st M Swelling, Vital Well defined, RL Thin stratified squam
bifurcation c. +-tender sclerotic inflamation, non
keratinized
Dentigerous 10- 3rd molar, Swelling BL Displac From CEJ, well RL Noninflammed,
cyst 30 unerupted e, defined, sclerotic non keratinized,
tooth Resorp. unless…SCC
mucoEp,
ameloblastomq
KOT (Gorlin) You Man>Max Asym. Unerupt Well defined AP RL 6-8 layers. Pallisadin
(orthoker. ng Post>Ant, Orth< aggres. , less expansion, colmn.
parakeratine) adult 3M resorp scalloping Keratininzed
s Uni/Mult
Lateral 5-7 Man Asym <1cm Vital , Well defined, RL Thin epithel, nodula
Periodontal cyst C-PM PDL Uni/Multi thickening
(ging cyst) (botryoid) non keratinized
Histology DD Mang
Radicular cyst Thin stratified Overriding cysts Source
/granuloma(Re squam., inflamation, PCD, apical
sidual) cholestol, MO cells, scar, OKT, LPC
non keratinized
Buccal Thin stratified Rad. cyst Obser, minor
bifurcation squam., inflamation, probing
cysts non keratinized
Dentigerous Noninflammed, Hyper. F, KOT, Surgery
cyst non keratinized, Amelo(Uni), Amelobalst /
AOT, CCOC carcinoma
KOT (Gorlin) 6-8 layers. Dentig., Surgery, high
(orthoker. Pallisading colmn. LatPeriodontal recur.
parakeratine) Keratininzed cyst
Lateral Thin epithel, OKC, mental, Surgery, recur
Periodontal nodular thickening ameloblastoma when multipke
cyst non keratinized
Amelobl Dentigerous CGCG Radicular ABC OKC
astoma cyst cyst COC
55% 55% 40% 18% XX% XX%
GLANDULAR ODONTOGENIC CYST
Synonym
• Sialo-odontogenic cyst
Rare cyst derived from odontogenic epithelium with a spectrum of
characteristics including salivary gland features such as mucous-
producing cells
GLANDULAR ODONTOGENIC CYST
Clinical features
• 46-50 y
• F>M
• Ant mandible
• Aggressive behavior
• Tendency to recur
GLANDULAR ODONTOGENIC CYST
Radiographic features
• Anterior mand and in the max (globullomaxillary region)
• RL, Unilocular/multilocular
• Cortical boundary (smooth or scalloped)
• Expansion and perforating the cortex
• Displacement of teeth
GLANDULAR ODONTOGENIC CYST
Radiographic features
GLANDULAR ODONTOGENIC CYST
Radiographic features
GLANDULAR ODONTOGENIC CYST
Differential diagnosis
• Ameloblastoma
• KOT
• Central mucoepidermoid carcinoma
GLANDULAR ODONTOGENIC CYST
Management
• Resection
• Periodic radiographic examination
CALCIFYING CYSTIC ODONTOGENIC TUMOR
Synonyms
• Calcifying odontogenic cyst
• Calcifying epithelial odontogenic cyst
• Gorlin cyst
CALCIFYING CYSTIC ODONTOGENIC TUMOR
Synonyms
• Calcifying odontogenic cyst
• Calcifying epithelial odontogenic cyst
• Gorlin cyst
Uncommon, slow-growing, benign lesion
CALCIFYING CYSTIC ODONTOGENIC TUMOR
Clinical features
• 2 peaks
• 10-19 y
• 7 dec
• Slow-growing painless swelling
• Sometime expansion
CALCIFYING CYSTIC ODONTOGENIC TUMOR
Radiographic features
• RL, or RL+calcified inclusions
• Uni- or multilocular (rare)
• 75% anterior to the 1-st molar
• Mand = Max
• Well/ill-defined
• 20-50% associated with a tooth
CALCIFYING CYSTIC ODONTOGENIC TUMOR
Radiographic features
• Displacement of the teeth
• Resorption of the roots
• Perforation of cortical plate
CALCIFYING CYSTIC ODONTOGENIC TUMOR
Differential diagnosis
• Dentigerous cysts
(pericoronal no calcification)
• AOT
• Ameloblastic fibro-odontoma
• CEOT
• Long lasting cysts (calcifications)
CALCIFYING CYSTIC ODONTOGENIC TUMOR
Management
• Enucleation and curettage
• Periodic radiographic evaluation
NON ODONTOGENIC CYSTS
• Nasopalatine duct cyst
• Pseudocysts:
• Simple bone cyst
• Aneurismal bone cyst
• Stafne defect
• Mucous retention pseudocyst
NASOPALATINE DUCT CYST
Synonyms
• Nasopalatinal canal cyst
• Incisive canal cyst
• Nasopalatine cyst
• Median palatine cyst
• Median anterior maxillary cyst
NASOPALATINE DUCT CYST
NASOPALATINE DUCT CYST
Clinical features
• 10% of jaw cysts
• 4-6 dec
• M>F 3:1
• Asymptomatic or swelling just posterior to the palatine papilla
• Fluctuant and blue or normal appearing mucosa
• May cause burning sensation or numbness of mucosa
NASOPALATINE DUCT CYST
Radiographic features
• Nasopalatine foramen or canal
• Not always symmetrical
• Well-defined, corticated
• RL (sometimes with dystrophic calcifications)
• Circular or oval, or heart shape
• Labial-palatal expansion
• Divergence of central incisors roots, occasionally – root resorption
NASOPALATINE DUCT CYST
Radiographic features
NASOPALATINE DUCT CYST
Differential diagnosis
• Nasopalatine foramen (6mm)
• Incisive foramen
• Radicular cyst
NASOPALATINE DUCT CYST
Management
• Surgical enucleation
SIMPLE BONE CYST
Synonyms
• Traumatic bone cyst
• Hemorrhagic bone cyst
• Extravasation cyst
• Progressive bone cavity
SIMPLE BONE CYST
• Cavity within a bone that is lined with connective tissue
• May be empty or may contain fluid
• Not a true cyst
SIMPLE BONE CYST
Clinical features
• Common lesion
• 1-2 dec
• M>F 2:1
• Asymptomatic
• Expansion and tooth movement - unusual
SIMPLE BONE CYST
Radiographic features
• Mandible (max –rare)
• Post mand and ramus
• Association with cemento-osseous
and fibrous dysplasia
• Well-/ill-defined
• Round or oval
• Smooth or scalloped border
SIMPLE BONE CYST
Radiographic features
• RL, uni- or multilocular (buy not contain true septa)
• Tooth displacement and resorption – vary rare
• Lamina dura intact
• No or minimal expansion
•
SIMPLE BONE CYST
Differential diagnosis
• KOT
• BM defect
SIMPLE BONE CYST
Management
• Conservative opening and curettage
• Periodic follow-up
• Recurrence rare
ANEURISMAL BONE CYST
Considered to be a reactive lesion of bone rather than cyst or true
neoplasm
ANEURISMAL BONE CYST
Clinical features
• 90% - younger than 30 y
• F>M
• Rapid bony swelling (buccal or labial)
• Pain is an occasional complain
ANEURISMAL BONE CYST
Radiographic features
• Mand > max 3:2
• Molar – ramus region
• Well-defined
• RL, often multilocular (53%), septa
positioned at right angles to the
outer border
• Propensity for rapid extreme
expansion
ANEURISMAL BONE CYST
Radiographic features
• May be associated with other
lesions (20%) such as fibrous
dysplasia, central hemangioma,
giant cell granuloma, and
osteosarcoma
ANEURISMAL BONE CYST
ANEURISMAL BONE CYST
Differential diagnosis
• CGCT
• Ameloblastoma
• Cherubism
Diagnosis is based on biopsy
results
ANEURISMAL BONE CYST
Management
• Surgical curettage (50%
recurrence)
• Partial resection (11%
recurrence)
• Follow-up
Stafne bone cyst
Synonyms
• Lingual salivary gland depression
• Lingual mandibular bone depression
• Developmental salivary gland defect
• Stafne defect
• Stafne bone cyst
• Static bone cavity
Stafne bone cyst
Definition
Lingual mandibular bone depression represent a concavity in the lingual surface of the
mandible where the depression is lined with an intact outer cortex
Not a true cyst
Stafne bone cyst
Stafne bone cyst
Stafne bone cyst
Stafne bone cyst
Jung et al. Korean J Oral Maxillofac Radiol 2005
MUCOUS RETENTION PSEUDOCYST
Synonyms
• Retention pseudocyst
• Retention cyst of maxillary sinus
MUCOUS RETENTION PSEUDOCYST
Clinical features
• Any sinuses, maxillary – most common
• M>F
• Asymptomatic
• Not related to extractions or periapical disease
MUCOUS RETENTION PSEUDOCYST
Radiographic features
• Floor of the sinus
• Unilateral or bilateral
• Vary in size
• Well-defined, noncorticated, smooth, dome-shaped, RO
• No effect on on the surrounding structures – lamina dura intact, PDL in
normal width
MUCOUS RETENTION PSEUDOCYST
Differential diagnosis
• Radicular cyst
• Dentigerous cyst
• KOT
• Antral polips (often multiple)
• Neoplastic mass
MUCOUS RETENTION PSEUDOCYST
Management
• No treatment is required
• May resolve spontaneously
