Oral Pathology: Cysts of Oral Cavity (PDF)

Oral pathology by/Nermo Sabry Chapter cysts :. Cysts of oral cavity True cysts...

Oral pathology by/Nermo Sabry Chapter cysts :. Cysts of oral cavity True cysts pseudo cysts Lined by epithelium not lined by epithelium -Traumatic bone cyst Odontogenic non-odontogenic developmental * Haemorrhagic bone cyst - Developmental Cyst - Nasoplatine cyst :. * solitary bone cyst * gingival cyst * Incisive canal cyst - aneurysmal bone cyst * lateral periodontal cyst * Palatine papilla cyst - static bone cyst * dentigerous cyst - Fissural cycts :. * eruption cyst * Median palatal cyst ( Epstein peals ) * odontogenic keratocyst * Median mandibular cyst * gorlin cyst * Nasoladial cyst (keratinizing & calicfing odontogentic cyst ) * Globulomaxillary cyst - inflammatory cyst * median alveolar cyst soft tissue cyst * radicular * thyroglossal tract cyst * residual cyst * cervical lymphoepithelial cyst * lateral periodontal cyst * dermoid and epidermoid cysts * mucous retention cyst * mucous extravasation cyst Definition :. Cyst It is pathological cavity contain fluid or semi fluid and lining by epithelium that surrounded by connective tissue Pseudo cyst It is pathological cavity contain fluid or semi fluid and not lining by epithelium Odontogenic cyst It is pathological cyst that origin from remnants of odontogemic epithelium Non_odontogenic cyst It is pathological cyst that origin from remnants of embryonic structure Rushten bodies Hyaline bodies present in epithelium that have pinky color with variable shaped (hyaline bodies ) Russel bodies Degeneration of plasma cells in connective tissue that have round shaped with pinky colour Marsupialization It is surgical technique of cutting a slit into an cyst and suturing edges of slit to form a contunious surface from external surface into internal surface of cyst Eruption cyst It is soft tissue cyst interfere with erupted teeth Dentigenious cyst It is developmental odontogentic cyst associated with unerupted teeth Primordial cyst It is developmental odontogentic cyst that formed in the place of a tooth Odontogenic keratocyst ( OKC ) IT is developmental odontogentic cyst in which characterized by high recurrence rate 25 % Gingival cyst of adult It is soft tissue cyst present in gingiva Palatine papillary cyst It is soft tissue non_odontogentic cyst that counter part of incisive canal cyst Nasopalatine duct cyst Non odontogenic developmental cyst as origin remants of epith of nasopalatine cord which present in incidive canal 1 Fissural cysts It is cyst which is produced by eith remants at line of fusion betw. Various embryoic processes Premaxillary cyst It is another name of globular maxillary cyst as it appear betw. Upper lateral and canine ( premaxilla & maxilla Traumatic bone ( solitary bone ) It is a case of unknown nature which is characterized by presence of intrabony empty cavity cyst Aneurismal bone cyst It is not ture cyst which characterized by sever bleeding during operation Cyst Origin ( histogenesis ) Site Inflammatory lateral periodontal cyst Epirthelial rests of malassaze In lateral aspect of root of non vital tooth Maxillary ( anterior part ) more mandibular Inflammatory Residual cyst Epirthelial rests of malassaze Apically of removal tooth ( extracted tooth ) Maxillary ( anterior part ) more mandibular Inflammatory apical ( perapical ) Epirthelial rests of malassaze Apically of root of non_vital tooth ( radicular ) ( center ) cyst Maxillary ( anterior part ) more mandibular Gorlin cyst Epirthelial rests of malassaze In upper anterior teeth Developmental laterial periodontal cyst Epirthelial rests of malassaze and serres Bet. Lateral aspects of roots of two adjacent vital teeth Gingival cyst of adult Epirthelial rests of malassaze and serres In gingiva , may be in interdental papillae Gingival cyst of new born Epirthelial rests of serres In alveolar crest of new born Eruption cyst Reduced of enamel epithelial Surround the crown of erupted tooth Dentigenious cyst Reduced of enamel epithelial Surround the crown of unerupted tooth (impacted ) commen in 3 and 8 Odontogenic kertocyst OKC enamel organ before any hard structure Ramus of mandible at angle formed ( from primordial cyst ) Expaned to inferior border of mandible or Reduced of enamel epithelial ( from Dentigenious cyst ) Primordial cyst enamel organ before any hard structure Molar ramus , posterior area of mandible formed Gorlin cyst Epithelial Rests of malasses In upper anterior teeth Incisive canal cyst Epithelial remnants of nasopalatine tract Bet two roots of upper central ( midline ) inside incisal canal Palatine papillary cyst Epithelial remnants of nasopalatine tract At palatine papillary area in incisal foramen Globular maxillaty cyst Epithelial remnants entrapped at line of Bet. Upper lateral and canine fusion of globular processes and maxillary processes Nasolabial cyst Epithelial remnants of nasocrimal duct Labial vestibule behind ale of nose Median mandibular cyst Epithelial remnants entrapped at line of In midline of mandible fusion of 2 mandible processes Median palatine cyst Epithelial remnants entrapped at line of In midline of palate fusion of 2 palatine processes Dermoid and epidermoid cyst Epithelial remnants entrapped at line of In midline above hyoid bone fusion of mandibular and hyoid arches Thyroglossal cyst Epithelial remnants of thyroglossal tract Suprahyoid ( above mylohyoid ) ( floor of mouth ) Below mylohyoid ( neck ) It in tongue , neck , floor of mouth Cervical lymboepithelial cyst Epithelial remnants branical cleft Anterior border of sternomastoid muscles ( branchial cleft cyst ) ( cervical sinus ) Below angle of mandible Traumatic bone cyst Failure of formation granulation tissue Mandibular premolar amd molar area After trauma , blood clot degenerated Leaving empty cavity Aneurismal cyst Unknown Mandible molar area , may be extend to ramus 2 Cyst X-ray appearance (radiograph.) Age and sex :. Inflammatory lateral periodontal cyst Rounded radiolucent area surrounded by radiopaque 20-50 age margin , Appear lateral to tooth non vital , may cause Males more females diverge or displacement of tooth ‘s root Inflammatory Residual cyst Rounded radiolucent area surrounded by radiopaque 20-50 age margin , Appear under socket of removed tooth , may Males more females cause diverge or displacement of tooth ‘s root Inflammatory apical ( perapical ) Rounded radiolucent area surrounded by radiopaque 20-50 age ( radicular ) ( center ) cyst margin , Appear apical to non vital tooth , may cause Males more females diverge or displacement of tooth ‘s root Developmental laterial periodontal cyst Rounded radiolucent area surrounded by radiopaque _ margin , Appear lateral to tooth vital , may cause diverge or displacement of tooth ‘s root Gingival cyst of adult Negative in xray Adult Gingival cyst of new born Negative in xray New born Eruption cyst Negative in xray _ Dentigenious cyst Radiolucent area with radiopaque margin associated with 20-50 age impacted tooth as surround crown of it Males more females Odontogenic kertocyst OKC Well defined Radiolucent area with radiopaque margin In young age May multicular or unilocular Primordial cyst Radiolucent area with radiopaque margin , appear in place In young age of tooth , it multicular or unilocular Gorlin cyst ( keratinizing & calcifing Radiolucent area with radiopaque margin 40 age odontogenic cyst )(ghost cell cyst ) Incisive canal cyst Heart shaped well defined Radiolucent area with _ radiopaque betw. Roots of 2 upper central incisor ( heart shape due to nasal sptam ) Palatine papillary cyst Negative in xray _ Globular maxillaty cyst Inverted shaped Radiolucent area with radiopaque margin _ betw. Upper 2 & 3 Nasolabial cyst Negative in xray Females more than males Median mandibular cyst Radiolucent area with radiopaque margin betw. Roots of _ lower central incisors Median palatine cyst Radiolucent area with radiopaque margin _ Dermoid and epidermoid cyst Negative _ Thyroglossal cyst Negative Old age Cervical lymboepithelial cyst Negative Old age ( branchial cleft cyst ) Mostly female Traumatic bone cyst Well defined Radiolucent area with radiopaque margin Young age With scalloped shaped in upper border of lesion Females more than males It is unilocular Aneurismal cyst Mutiocular radiolucent area soap bubble or honey comp 10 : 20 age appearance Mandibe , molar area extend to ramus 3 Cyst Clinical picture of …. Histology ( microscopic pic ) of. Inflammatory lateral periodontal cyst Site , age , sex , xray + Cyst cavity surrounded by Epithelial tissue then Painless surrounded by C,T Asymptomic Tooth non vital Epithelial linning :. Swelling begin with hard bony Stratified squamous epith. swelling then give eggshell Have hyaline bodies (rushten bodies ) cracking sensation Dystrophic calcification Then give bluish fluctuant swelling May be new form ( thick _ more irregularity _ hyperplasia _ more rete pegs ) May be ( fully )old form ( thin _ more regularity _ flat rete pegs ) May be keratinized May be respiratory epith ( if it in maxillary ) Connective tissue :. Chronic inflammatory cells ( lymphocytes & plasma cell ) Gaint cells Cholesterol cleft Foam cells ( histiocyte ) Fibroblasts Collagen fibers Inflammatory Residual cyst Same Same ,, Inflammatory apical ( perapical ) Same Same ,, ( radicular ) ( center ) cyst Developmental laterial periodontal cyst Site , age , sex , xray + Cyst cavity surrounded by Epithelial tissue then Painless surrounded by C,T Asymptomic Tooth is vital Epithelial lining.. Keratinized or non keratinized 1-2 thickness Show nodular thickness with clear cystoplam due to contain Glycogen Connective tissue :. Collagen fibers Fibroblasts Blood vessels No chronic inflammatory cells Gingival cyst of adult Site , age , sex , xray + Cyst cavity surrounded by Epithelial tissue then Painless surrounded by C,T Asymptomic Swelling attaced to gingiva Epithelial lining.. May appear in interdental Keratinized stratified squamous epith papillae Connective tissue :. Collagen fibers Fibroblasts Blood vessels No chronic inflammatory cells Gingival cyst of new born Painless Cyst cavity surrounded by Epithelial tissue then Asymptomic surrounded by C,T whitish Swelling on alveolar crest of new born Epithelial lining.. Keratinized stratified squamous epith Appear as Muti nodules Connective tissue :. Collagen fibers Fibroblasts Blood vessels No chronic inflammatory cells 4 Eruption cyst Painless Cyst cavity surrounded by Epithelial tissue then Asymptomic surrounded by C,T Swelling on erupted tooth Show bleeding during Epithelial lining.. mastication or extaction Keratinized stratified squamous epith connective tissue :. Collagen fibers Fibroblasts Fill with blood No chronic inflammatory cells Dentigenious cyst Sex , site , xray , age + Cyst cavity surrounded by Epithelial tissue then Painless surrounded by C,T Asymptomic Epithelial lining.. Swelling Non Keratinized stratified squamous epith Associated with impacted teeth 10 % Keratinized stratified squamous epith Show bone swelling if it large 2-10 thickness Have mucous cells Show hyaline bodies Show respiratory epith if it maxillary May Show dysplastic freature ( had premalignant changes ) Connective tissue :. Collagen fibers Fibroblasts Blood vessels Cholersterol clefts may be seen No chronic inflammatory cells Odontogenic kertocyst OKC site , xray , + Cyst cavity surrounded by Epithelial tissue then Painless surrounded by C,T Asymptomic Bonny Swelling Parakeratinized :. No expansion in jaw Epithelial lining… Basal cell layer Corrugated parakeratin Keratin contain remants of nuclei Epithelial buds Connective tissue :. Collagen fibers Fibroblasts Blood vessels No chronic inflammatory cells Daughter cyst orthokeratinized :. Epithelial lining… Cuboidal / flattened cell layer Non Corrugated parakeratin Granular cell layer Weak attachment bet epith and connective t. Connective tissue :. Collagen fibers Fibroblasts Blood vessels No chronic inflammatory cells Primordial cyst site , xray , + Cyst cavity surrounded by Epithelial tissue then Painless surrounded by C,T Asymptomic Epithelial lining… Bonny Swelling statifed squamous epith. associated with missed tooth 30 % keratinized or non keratinized show microcyst connective tissue …. Collagen fibers Fibroblasts Blood vessels No chronic inflammatory cells 5 Gorlin cyst Xray , site. age + Epithelium :. Gorlin syndrome characters by Basal cell layer Multiple basal cell carcinoma Stellate reticulum like cell ( star like cells ) Bifid ribs Ghost cells ( Keratin _ calcification ) Painless Connective :. Asymptomic Fibroblasts Collagen fibers Ghost cells Giant cells Blood vessels Incisive canal cyst site , xray , + Cyst cavity surrounded by Epithelial tissue then Painless surrounded by C,T Asymptomic Epithelial lining … Bonny Swelling in anterior part of Oral epithelial or respiratory ( pesudostratifed palate Columner ciliated epith ) or mixed Numbness sensation Connective tissue.. ( due to pressure in Large arteries sphinopalatine and nasopalatine Mucous glands nerves ) Nerves Produce salty taste fluid Vascular elements Palatine papillary cyst site , xray , + Cyst cavity surrounded by Epithelial tissue then Fluctuant small bluish swelling surrounded by C,T Painless Epithelial lining … Asymptomic Mainly Oral epithelial Produce salty taste fluid Globular maxillaty cyst site , xray + _ Painless Asymptomic Swelling Nasolabial cyst site , xray + Cyst cavity surrounded by Epithelial tissue then Painless surrounded by C,T Asymptomic Epithelial lining … Labial swelling in upper lip Oral epithelial or respiratory ( pesudostratifed Produce distortion of nostrils Columner ciliated epith ) or mixed Non keratinzed connective tissue …. Collagen fibers Fibroblasts Blood vessels No chronic inflammatory cells Median mandibular cyst site , xray + Cyst cavity surrounded by Epithelial tissue then Painless surrounded by C,T Asymptomic Epithelial lining … Oral epithelial or respiratory connective tissue …. Collagen fibers Fibroblasts Blood vessels No chronic inflammatory cells Median palatine cyst site , xray + Cyst cavity surrounded by Epithelial tissue then Painless surrounded by C,T Asymptomic Epithelial lining … Oral epithelial or respiratory connective tissue …. Collagen fibers Fibroblasts Blood vessels No chronic inflammatory cells 6 Dermoid and epidermoid cyst Midline cyst Epithelial :. Painless keratinized Asymptomic epidermoid contain keratin only Present below mylohyoid ( should dermoid contain skin appendages be differentiated from ranula ) ( sweat glands _ hair follical _ sebaceous It appear in neck glands ) If it above mylohyoid connective tissue …. It appear in floor of mouth Collagen fibers Fibroblasts Blood vessels No chronic inflammatory cells Thyroglossal cyst It characterized by lesion move Epithelial :. with tongue movement Stratified columnar epith. Difficult during swallowing and Connective tissue :. eating Thyroid follicles Midline cyst Mucous glands Painless Lymphoid follicles Asymptomic Cervical lymboepithelial cyst Appear at anterior border of Epithelial :. ( branchial cleft cyst ) sternomastoid Stratified squamous epithelum Lateral side of neck Connective :. Painless Lymphoid tissue Asymptomic Collagen fibers Fibroblasts Blood vessels No chronic inflammatory cells Traumatic bone cyst Site , age , sex , xray + Thin wall of loose and c.t lines empty cavity Painless Asymptomic During operation the lesion is an empty cavity which my contain only small amount of yellosh fluid Aneurismal cyst Site , age , sex , xray + Large sinusoidal space filled with blood Thromping painfull Lining by epith. Swelling C.T found in spaceing Sever bleeding during operation 7 Treatment :. Inflammatory lateral periodontal cyst Small … extraction of cyst Large …. Marsupialization of cyst Inflammatory Residual cyst Small … extraction of cyst Large …. Marsupialization of cyst Inflammatory apical ( perapical ) Small … extraction of cyst ( radicular ) ( center ) cyst Large …. Marsupialization of cyst Gorlin cyst Developmental laterial periodontal cyst extraction of cyst Gingival cyst of adult extraction of cyst Gingival cyst of new born Not extraction of cyst , as remove by itselt when teeth is erupted Eruption cyst Not extraction of cyst as it cut during mastication Dentigenious cyst Extraction Odontogenic kertocyst OKC Surgical Primordial cyst Surgical Traumatic bone cyst Open the cavity , refresh bone and by time hematoma and healing will form Compare between :. Two type of OKC :. Point Parakeratinized Orthokeratinized % of cases 88% 12 % Recurrence High low Histology Epithelial lining… Epithelial lining… Basal cell layer Cuboidal / flattened cell layer Corrugated parakeratin Non Corrugated parakeratin Keratin contain remants of nuclei Granular cell layer Epithelial buds Connective tissue :. Connective tissue :. Collagen fibers Collagen fibers Fibroblasts Fibroblasts Blood vessels Blood vessels No chronic inflammatory cells No chronic inflammatory cells Daughter cyst Give reason :. Inflammatory lateral periodontal cyst :. Due to inflammation in accessory root canal Inflammatory odontongenic cysts :. Due to inflammation hyperplasia of epith. Of rest malassaze present in periapical granuloma ( chronic inflammation ) Radiopaque margin in xrays in cyst around radiolucent area Due to deposition of bone around it High reccurence of OKC ? Present of daughter cells Weak attachment between connective tissue and epithelium Cyst grow in finger like processes in cancellous bone High mural growth 8 Enumerate :. Only cyst painful ……. Aneurismal cyst Types of Dentigenious cyst Central Lateral Circumferential Most common cyst is ……………. Inflammatory periodontal cysts High recurrence cyst is ………….. Odontogenic keratocyst ( OKC ) Midline cysts :. Median mandibular Median palatine (Epstein peals ) Median alveolar Incisive canal cyst Dermoid and epidermoid cysts Palatine papillae cyst Thyroglossal tract cyst Cyst are negative in x_ray :. ( soft tissue cysts ) Eruption cyst Gingival cyst of adult Gingival cyst of new born ( bohn’s nodule ) Epstein peals Dermoid cyst Epidermoid cyst Thyroglossal tract cyst Cervical lymphoepithelial cyst Mucous retention cyst Mucous extravasation cyst Nasolabial cyst Palatine papillae cyst Cysts contain blood ( haematoma ) :. Aneurismal cyst Eruprtion cyst ( eruption haematoma ) Haemorrhagic bone cyst Cysts of new born :. Gingival cyst ( bohn’s nodules ) Median palatine cyst ( Epstein peals ) 9 Cysts related to mandibular canal :. Traumatic bone cyst ( above canal ) Static ( latent ) bone cyst ( below canal ) X-rays appearance :. Gorlin cyst ( KCOC ) ……… salt pepper appearance in upper anterior teeth Incisive canal cyst ……….heart shaped appearance bet. Upper cental incisors Aneurismal cyst ………….soap bubbles ( honey comp ) appearance ‫فقاعات الصابون او خليه النحل‬ Globomaxillary cyst…… inverted pear shaped bet. Upper 2 and 3 Odontogenic cysts Arise from Epithelium from :. Epithelial rests of serres in gingiva and jaw ( remants of dental lamina ) Epithelium rests of malassaze ( remants of epithelial root sheath of hertwig in PDL ) Reduce EN epithelium on surface of crown ( remants of enamel organ ) Odontgenic cysts :. Developmental Cyst Inflammatory cyst gingival cyst of adult radicular ( apical ) ( center ) preapical cyst gingival cyst of new born ( bohn’s nodules ) residual cyst lateral periodontal cyst lateral periodontal cyst ( paradental ) dentigerous cyst eruption cyst odontogenic keratocyst gorlin cyst (keratinzing and calcifing odontogenic cyst ) ( KCOC ) Maxillary cysts :. Nasioloabial cyst Palatine papillary cyst Golubomaxillary cyst Incisive canal cyst Median palatine cyst Gorlin cyst Keratinzing cysts :. Developmental lateral cyst Gingival of adult Gingival of new born Demoid & Epidermoid cyst Gorlin cyst Primoidal cyst Theories of rushten bodies ‘s origin :. It was resulted from thrombus in blood vessels has been broken ( refused as it found in epithelium ) It is kind of keratin Complication of dentigerous cyst :. - pathological changes ( due to hollowing jaw bones ) - Mucous cells produce mucoepidermoid change carcinoma - Epithelial lining undergo carcinomatous change ex : squamous cell carcinoma - Ameloblastoma 10 How cyst increase in size ? Complex tissue protein break down into simple protein Lead to increase osmotic pressure inside the cyst Due to increase epithelium in numbers lead to epithelium act as semi permeability membrane Lead to increase hydrostatic pressures inside cyst Fluids will enter from outside to inside of cyst Inc pressure on bone lead to stimulate osteoclasts that cause bone resorption The main difference between primordial cyst and dentigenous cyst Primordial cyst ….. found in place of tooth ……. Origin enamel organ before any hard structure formed Dentiogenous cyst……..found around crown of impacted tooth ……..Reduced of enamel epithelial The main difference between bohn’s nodule and epestian’s pears cysts Bohn’s nodule …. Found on maxillary alveolar crest of new born …… it is odontogentic cyst Epestian’s pear ….found on median palatine raphae …… it is non_odontogenic cyst All true cyst having the following histological features 1_ lined by epithelium 2_ have C.T wall contain collagen fibers , fibroblasts , blood vessels 3_ cavity contain fluid or semi fluid material Main points All cyst are painless except infected cyst and aneursmal cyst All cyst in jaw appear in xray … radiolucent area surround by radioopacity margin ( due to reaction of bone result in slowly action of lesion and well defined round margin All inflammatory cyst …..tooth is non vital , cause due to inflammation , thick epithelium ( hyperplastic epithelim ) in new , thin in old cyst All developmental cyst …tooth is vital , cause it is unknown , epithelium is thin Infected cysts are painful , rapidly growth , hisy margin All cyst begin with hard bony swelling then give eggshell cracking sensation Then give bluish fluctuant swelling ( due to resorption of bone in diff places ) Histological picture in true cyst , epithelium lined surrounded by c.t All cyst discovered by routine xray examination except Aneurismal cyst It is very difficult to differentiated bet. Periapical granuloma and periapical cyst but cyst large in size 11