CYSTS OF ORAL

CAVITY
Definition of cyst
 Epithelial lined cavity filled with fluid or semi fluid or
gaseous content
 Jaw cysts are "a space within bone lined with epithelium
supported by a fibrous connective tissue wall."
Where does the epithelium lining of jaw cysts come
from?
Cyst epithelium may come from "rests" left over
from tooth development
Cyst epithelium may come from "rests" left over
from face development.
Jaw cysts are found in tooth-bearing
or facial-fissure areas.

 Odontogenic & non odontogenic cysts

Jaw cysts are seen on
radiographs; soft-tissue cysts, on
clinical examination.
Jaw cysts appear as radiolucent areas on
radiographs.
Microscopic Features Common to Most True Jaw
Cysts
 Debris-filled central cavity

 Epithelial lining membrane

 Fibrous connective tissue supporting wall

 Cysts

Epithelial Non- Epithelial

1. Solitary
Non -
Odontogenic 2. Aneurysmal
Odontogenic
3. Stafne’s
 Epithelial
cysts

Non -
Odontogenic
Odontogenic

1. Nasopalatine
Developmental Inflammatory
2. Nasolabial
3. Globulomaxillary
1. Dentigerous 1. Radicular 4. Median
2. OKC 2. Paradental
3. Eruption
4. LPC
5. gingival
Epithelial Cysts
 ODONTOGENIC CYSTS

 Odontogenic cysts arise from tooth development epithelium.

 reduced enamel epithelium, dental lamina, remnants of
Hertwig's epithelial root sheath.
 Inflammatory or Developmental
RADICULAR CYST
RADICULAR
 CLINICAL FEATURES
 Commonest
 Arises from epithelial rests of malassez
 associated with non vital tooth.
 invisible on intraoral clinical examination
 May expand to large sizes – egg shell crackling
 Apical, lateral, residual
Bacterial endotoxins from
necrotic pulp
Release of cytokines including
GFs
Proliferation of epithelial cell rests of
malassez in chronic periapical lesion

Death of central cells

Central cavity lined by

epithelial lining
Cyst expansion
Cyst lumen Cyst wall

Hypertonic contents Semipermeable

membrane

High
Osmotic
gradient

Low

Movement
of water

Hydrostatic
pressure Cyst wall Expansion

Inflammatory exudate
Cell breakdown products
RADIOGRAPHIC FEATURES
 well-demarcated unilocular radiolucency at the tooth apex.
Histopathological features
 central debris-filled cavity
 lined with stratified squamous nonkeratinizing epithelium.
 The outer fibrous c.t. wall shows many chronic
inflammatory cells suggesting the inflammatory origin of this
cyst.
 Mucous metaplasia
PARADENTAL / BUCCAL
BIFURCATION CYST
Buccal Bifurcation Cyst
Paradental Cyst
Dentigerous Cyst
 CLINICAL FEATURES
 commonly arise around impacted teeth
 presumed to arise from the reduced enamel epithelium
 asymptomatic
 Unicystic ameloblastoma
Compression of follicle by
potentially erupting tooth

Increased venous pressure of

follicle

Fluid transudation

Separation of follicle and the

tooth
Cyst expansion
 Same as for radicular cyst
Radiographically
 a well-demarcated, unilocular radiolucency around the
crown of an unerupted tooth
 Types of Dentigerous Cysts

Central
circumferential lateral
HISTOPATHOLOGICAL
 Most dentigerous cysts are lined with stratified squamous
nonkeratinizing epithelium (2-4 cell layer thick) supported
by a fibrous c.t. wall devoid of inflammation
 Mucous metaplasia
Eruption cysts
Odontogenic keratocyst
 Origin
 Asymptomatic
 Mesio distal expansion
 recurrence rates of over 25-62%
radiographic
 Their radiolucencies may be small and unilocular or large and
multilocular
histopathology
 Keratinizing epithelium
 Actively proliferating epithelium
 Palisading of basal layers
 Keratin-filled central cavity
 Thin cyst wall (epithelium and c.t.)
 Flat epithelium-c.t. interface
 Epithelial pouches, satellite cysts
why odontogenic keratocysts are so difficult to
remove completely?

 First, increased mitotic activity

 Second, thin cyst wall – easy tear
 Third, Flat epithelium connective tissue interface
 Fourth, satellite cysts
 Fifth, finger like cyst extensions
Lateral periodontal cyst
 uncommon
 interdental alveolar bone of mandibular premolar area.
 Divergence of adjacent teeth
 Associated with vital tooth
histopathology
 Non keratinized squamous epithelium
 2-3 layers
 Fibrous capsule devoid of inflammation.
 Focal epithelial thickening
Gingival cyst of new born
Palatal cyst of new born
Epstein Pearl
Bohn’s Nodule
Calcifying ghost cell odontogenic
tumour/cyst
NON ODONTOGENIC CYSTS
 Nasolabial
 Nasopalatine
 Median cysts
 Globulomaxillary
 These arises from fissural epithelium, remained after face
development.
NASOPALATINE
 epithelial rests located within the tissues of the incisive canal.
 most common fissural cyst
 Asymptomatic
 heart-shaped radiolucency located just posterior to the
maxillary incisor teeth.
Histopathology
 stratified squamous nonkeratinizing epithelium.
 NPDCs have squamous, columnar, cuboidal, or some
combination of these epithelial types; respiratory epithelium
 The presence of glands, blood vessels, and nerves in the cyst
wall
Cyst of incisive papilla
 Activation of epithelial rests in the incisive papilla may produce a
cyst there.
 This is a soft tissue cyst known as the "papilla palatini cyst"
 This cyst causes a soft-tissue swelling; it is not visible on
radiographs.
NASOLABIAL CYST
 remanents of nasolacrimal duct or epithelial remanents
entrapped along the line of fusion of the maxillary and nasal
processes.
 obliterating the nasolabial fold

 Arising in soft tissues, nasolabial cysts are not visible on radiographs.

 lined by respiratory epithelium, stratified squamous

epithelium, pseudostratified columnar epithelium or a
combination of these.
Globulomaxillary cyst
 An uncommon true jaw cyst appearing as a radiolucency
between the roots of vital maxillary lateral and cuspid
(canine) teeth
 epithelial remnant remained during fusion of the nasal
process and maxillary process.
 Microscopic examination reveals a cyst that is lined with
stratified squamous nonkeratinizing epithelium
Median palatal cysts
 Activation of trapped rests in the palatal midline may cause a medial
palatal cyst.

 radiolucencies in the midline of the palate well posterior to

the incisive canal.

 Median palatal cysts are lined with stratified squamous

nonkeratinizing epithelium
NON EPITHELIAL CYSTS
(PSEUDOCYSTS)

 Solitary bone cysts

 Aneurysmal bone cyst
 Stafne’s idiopathic bone cavity
 Common

History of
Asymptomatic
trauma

Traumatic
bone cyst

Histology –
Radiograph -
fibro vascular
scalloping
CT, giant cells
Traumatic Bone Cyst

Scalloping between the roots

 Uncommon

Trauma
painful
history
Aneurysmal
bone cyst

Fibro
Uni / multi
vascular CT.
locular
multiple
radiolucency
giant cells
 Developmental
anomaly

Concavity on
Stafne Radiograph-
unilocular
lingual side bone radiolucency
mandible
cavity inferior border

Histology –
normal salivary
tissue
SOFT TISSUE CYSTS OF ORAL
CAVITY
 MUCOCELES
 ORAL LYMPHOEPITHELIAL CYST
 EPIDERMOID CYST
 DERMOID CYST
ORAL LYMPHOEPITHELIAL CYST
 Uncommon
 Develops within the oral lymphoid tissue
 Histologically, parakeratinized epithelium with lymphoid
tissue in the cyst wall.
Epidermoid cyst
 Very rare in oral cavity
 Common cyst of skin
 Histologically lined by orthokeratinized stratified squamous
epithelium with prominent granular layer.
Dermoid cyst
 Uncommon
 FOM common site
 Lined by orthokeratinized stratified squamous epithelium,
prominent granular layer.
 Fibrous wall contains skin appendages such as sebaceous
glands, sweat glands and hair follicles.