Cyst Types & Treatments PDF

Cyst  Definition Of Cyst A Cyst is a pathological cavity having fluid, semifluid or gaseous contents and which is not created by the accumulation of pus. Most cysts, but not all, are lined by epithelium. True cyst: Pathologic space lined by epithelium filled with f...

Cyst  Definition Of Cyst A Cyst is a pathological cavity having fluid, semifluid or gaseous contents and which is not created by the accumulation of pus. Most cysts, but not all, are lined by epithelium. True cyst: Pathologic space lined by epithelium filled with fluid or semi- solid material. Pseudo-cyst: if the cyst not lined by epithelium. “Odontogenic Cysts”: Cyst Epithelium Derived from “Odontogenic Epithelium Parts Of A Cyst :Cyst has following parts Wall (made of connective tissue) Epithelial Lining Lumen Of Cyst  Pathogenesis Two Stages 1. Cyst initiation 2. Cyst enlargement or expansion Initiation.a Formation.b Enlargement.c Classification  I. Cysts Of The Jaws A. Epithelial-lined Cysts 1 Developmental Origin (a) Odontogenic b) Non-odontogenic i. Dentigerous cyst i. Midpalatal raphé cyst of infants ii. Odontogenic keratocyst ii. Nasopalatine duct cyst iii. Eruption cyst iii. Nasolabial cyst iv. Gingival cyst of adults v. Gingival cyst of infants vi. Developmental lateral periodontal cyst vii. Calcifying odontogenic cyst viii. Glandular odontogenic cyst ix. Botryoid odontogenic cyst 2 Infl ammatory Origin i. Radicular cyst, apical and lateral ii. Residual cyst iii. Paradental cyst B. Non-epithelial-lined Cysts Primary bone cysts 1. Solitary bone cyst 2. Aneurysmal bone cyst  II. Cysts associated with the maxillary antrum 1. Mucocele 2. Retention cyst 3. Pseudocyst 4. Postoperative maxillary cyst  III. Cysts of the soft tissues 1. Dermoid and epidermoid cysts 2. Lymphoepithelial (branchial) cyst 3. Thyroglossal duct cyst 4. Anterior median lingual cyst (intralingual cyst of foregut origin)  Odontogenic cysts  The epithelial lining is derived from the epithelial residues of the tooth-forming organ. They can be subdivided into developmental and inflammatory types depending on their a etiology. Non-odontogenic cysts  The epithelial lining is derived from sources other than the tooth- forming organ. Origin of odontogenic cysts is one of the following sources : a-Enamel organ. b-Reduced enamel epithelium. c-Epithelial rests of Malassez..d-Epithelial rests of Serres Dentigerous Cyst The dentigerous cyst is defined as a cyst that originates by the separation of the follicle from around the crown of an unerupted tooth  The dentigerous cyst encloses the crown of an unerupted tooth and is attached to the tooth at the cementoenamel junction  The pathogenesis :It is essentially due to fluid accumulation between the reduced enamel epithelium and the enamel surface of an impacted or embedded tooth.  Dentigerous Cyst.Gross specimen of a dentigerous cyst Cyst encloses the crown of the tooth and is attached to its neck  Clinical Features Age: 1st to 3rd decades. Gender :more common in males than females.. Site : -  The most common sites are mandibular third molar and maxillary canines areas.  Uncommonly Mandibular premolar, Maxillary 3rd Molar, Supernumerary tooth also can be involved Signs & Symptoms Most cysts grow to a large size before being discovered accidentally while observing a dental x ray to detect the cause of an unerupted tooth. Large lesions can cause cortical expansion, leading to facial asymmetry, teeth displacement, root resorption, even pain, if infected. It is usually asymptomatic but infected dentigerous cyst causes pain and increased swelling  Radiological Features It appears as a well-defined unilocular radiolucent area associated with crown of an impacted or embedded tooth resulting in displacement of the unerupted tooth and resorption of the roots of adjacent erupted tooth.  Radiological Features Central Type: Lateral Type : Circumferential Type :  Histological Features A. Non Inflammed Type: Lining derived from reduced dental epithelium, consists of 2-4 cell layers of non keratinized epithelium, without rete ridges. Wall composed of thin fibrous connective tissue appearing immature, as it is derived from the dental papilla. Non inflamed dentigerous cyst shows a thin. Non keratinized.epithelial lining  Histological Features B- Inflamed type : Lining shows varying degrees of hyperplasia with rete ridges and occasionally even keratinization. Wall is composed of mature connective tissue which shows infiltration by chronic inflammatory cells. Focal areas of mucous cells can be seen in the lining. Small odontogenic epithelial islands can be seen in the wall. Inflamed dentigerous cyst shows a thicker epithelial lining with hyperplastic rete ridges. The fibrous cyst capsule shows a diffuse chronic inflammatory infiltrate Dentigerous cyst. This cyst has been removed together with its associated tooth. The cyst surrounds the crown and is attached at the cementoenamel junction  Complications 1. Recurrence due to incomplete surgical removal. 2. Development of ameloblastoma either from lining epithelium or from odontogenic islands in the connective tissue wall. 3. Development of squamous cell carcinoma from same two sources. 4. Development of mucoepidermoid carcinoma from mucus secreting cells in the lining. 5. Expansion with destruction of the jaw--------fracture..Treatment: Surgical removing of the associated tooth with enucleating the cyst Odontogenic keratocyst  The odontogenic keratocyst is a distinctive form of developmental odontogenic cyst that deserves special consideration because of its specific histopathologic features and clinical behavior. Pathogenesis: It is derived from enamel organ (Abscent tooth) or the epithelial rests of Serres within the jaw.  Clinical Features Age : Occur over a wide age range and cases have been recorded as early as the first decade and as late as the ninth. In most series there has been a pronounced peak frequency in the second and third decades Gender :. More frequently in males than in females. Site : The mandible is involved far more frequently than the maxilla 50% cases occur in angle region and extend to ascending ramus and forwards to body of mandible.  Clinical Features It is usually asymptomatic but the infected odontogenic keratocyst causes pain and increased swelling. Occasionally, paraesthesia of the lower lip or teeth. Some are unaware of the lesions until they develop pathological fractures.  Gorlin- goltz Syndrome, Characterized By Multiple nevoid basal cell epitheliomas Odontogenic Keratocyst of the jaws Bifid ribs– sixth rib Plantar & palmar pits Occular hypertelorism Frontal bossing Ectopic calcifications  Abnormal neck line associated with cervical ribs in a.patient with naevoid basal cell carcinoma syndrome Calcifcacion of falx cerebri in a patient with naevoid basal cell carcinoma.syndrome  Radiographic Features OKC demonstrate a well-defined e radiolucent area with thin radiopaque borders(smooth and often corticated margins.) resulting in displacement of the adjacent teeth. Large lesions, particularly in the posterior body and ascending ramus of the mandible, may appear multilocular An unerupted tooth is involved in the lesion in 25% to 40% of cases; in such instances, the radiographic features suggest the diagnosis of dentigerous cyst  Radiographic Features Radiograph of a small odontogenic Radiograph of an odontogenic.keratocyst.keratocyst with scalloped margins.Radiograph of a multilocular odontogenic keratocyst Radiograph of an odontogenic keratocyst that has enveloped an unerupted tooth to produce a.‘dentigerous’ appearance  Histologic Features The epithelium is stratified squamous epithelium characterized by 6-10 layers in thickness , basal cell layer of palisaded cells and a surface of corrugated parakeratin. The underlying connective tissue contains fibrous tissue, non inflammatory cells and cholestrol clefts are uncommon. The lumen may contain large amounts of keratin debris.  Complications in OKC : 1.Malignant transformation of cyst lining rare, but has been reported. 2.Recurrence – high rate of recurrence. Treatment: Enucleating the cyst with bone chipping.  Eruption Cyst Eruption cysts involving the maxillary.permanent incisors  Eruption Cyst superficial dentigerous cyst. An eruption over the cyst forms over a tooth about to erupt. An eruption cyst is a soft-tissue cyst but probably arises from enamel organ epithelium after enamel formation is complete.  Pathogenesis The circumscribed cavity contains due( blood to surface trauma on biting ) with opposite tooth It imparts purple / deep blue color Hence known as Eruption Hematoma  Clinical Features Age :found in children of different ages, and occasionally in adults if there is delayed eruption. Site :most commonly associated with the first permanent molars and the maxillary incisors The cyst lies superficially in the gingiva overlying the unerupted tooth and appears as a soft, rounded, bluish swelling. The epithelial lining is separated from the alveolar mucosa by a thin layer of fibrous tissue. Radiological Features The cyst may throw a soft-tissue shadow, but there is usually no bone involvement except that the dilated and open crypt may be seen on the radiograph.  Histological Features Show surface oral epithelium on the superior aspect. The underlying lamina propria shows a variable inflammatory cell infiltrate. The deep portion of the specimen, which represents the roof of the cyst, shows a thin layer at nonkeratinizing squamous epithelium Part of an eruption cyst (removed to expose underlying tooth).showing epithelial-lined cyst cavity beneath the mucosa Haemorrhage into the cyst cavity is.common as a result of trauma