cysts lecture

ODONTOGENIC CYSTS OF ODONTOGENIC CYSTS OF THE JAWSTHE JAWS

ODONTOGENIC CYSTS OF ODONTOGENIC CYSTS OF

JAWSJAWS

DEFINITION A cyst is a pathological cavity containing

fluid, semifluid or gaseous contents which may or may not be lined by epithelium and is not created by the accumulation of pus . (Kramer :1974)

ODONTOGENIC CYSTSODONTOGENIC CYSTS

DEVELOPMENTAL Dentigerous cyst Eruption cyst Odontogenic

keratocyst Gingival cyst of

infants Gingival cyst of adults

INFLAMMATORY Periapical(Radicular)

cyst Residual periapical

cyst Buccal bifurcation

cyst

CLASSIFICATION By Kramer, Pindborg and Shear, 1992 in WHO's

publication

ETIOPATHOGENESISETIOPATHOGENESIS Derived from epithelium associated with development of

dental apparatus i.e. tooth germs, reduced enamel epithelium, rests of malassez, remnants of dental lamina, and basal layer of oral epithelium.

3 CONCEPTS OF ORIGIN :-A) Spontaneous origin concept -

Cyst results when epithelium proliferates and organizes to protect exposed or irritated connective tissue elements and in turn connective tissue supports and nourishes epithelium. If it results in intact sac, it is called a cyst.

B)B) Neoplastic origin concept -Neoplastic origin concept -

It implies that the involved tissues materially deviate from normal in their power of proliferation and organization.

C) Pseudo neoplastic origin concept -

The epithelium, a simple cell, nest of cells, entire follicle degenerate under stimulation to basic proliferation resembling a neoplasia. Eventually a lumen is outlined and stratified epithelium membrane may form with organization of connective tissue.

ENLARGEMENT OF CYSTENLARGEMENT OF CYST

A) MURAL GROWTH

(i) Peripheral cell division – peripheral enlargement is attributed to active cell division of lining epithelium in response to an irritant stimulus.

(ii) Accumulation of cellular contents – keratocysts enlarge by accumulation of mural squames as they are cast off the lining epithelium.

(i) Secretion (i) Secretion (ii) Transudation and Exudation(ii) Transudation and Exudation(iii) Dialysis (iii) Dialysis

(C)(C) BONE RESORBING FACTORBONE RESORBING FACTOR

Is mixture of PGEIs mixture of PGE22 and PGE and PGE

33. The . The

source can be capsule and leukocyte source can be capsule and leukocyte content, including a vascular contribution content, including a vascular contribution in vivo. in vivo.

(B) HYDROSTATIC ENLARGEMENT Growth is attributed to distension of cyst wall

by fluid accumulation through following processes:-

-- Paresthesia, displacement of teeth. Paresthesia, displacement of teeth. - Egg shell crackling in large cysts. - Infection results in increased swelling,

pain, discharge tenderness and redness.

RADIOLOGICALFEATURES

Classical appearance - well defined round / oval radiolucent area circumscribed by sharp radiopaque sclerotic margin.

- Range from asymptomatic to incidental finding in radiographs to observable expansion of bone.

CLINICAL CLINICAL FEATURESFEATURES

HISTOLOGICAL FEATURES- Lined by stratified squamous epithelium,

varying in thickness and extent of keratinization depending on type of cyst.

- Lumen may contain keratin, cholesterol crystals and various amount

of protein contents as per the type of cyst.

- Fibrous capsule may be present.

- Ranges from unilocular eg. Radicular cyst to multilocular radiolucency eg Aneurysmal bone

cyst.

Treatment Considerations:-Treatment Considerations:-1) Marsupialization- (Partsch I , Decompression) : Defined as creating

a surgical window in the wall of cyst, evacuating contents of cyst and maintaining continuity between cyst and oral cavity, maxillary sinus or nasal cavity. (Peterson )

Very large cysts . Indications Cysts close to vital structures.

AdvantagesAdvantages

Spares vital structures Spares vital structures Reduces morbidity and neurological loss. Reduces morbidity and neurological loss. Decreased risk of pathological fracture and Decreased risk of pathological fracture and oro-antral fistula. oro-antral fistula.

DisadvantagesDisadvantages Pathological lining left behind can transform Pathological lining left behind can transform

into ameloblastoma or squamous cell into ameloblastoma or squamous cell carcinoma. carcinoma.

Regular post-operative care required. Regular post-operative care required. Infection if saliva and debris accumulates. Infection if saliva and debris accumulates.

. .

Small cystsSmall cysts IndicationsIndications

Potential for neoplastic Potential for neoplastic changes. changes.

2) Enucleation : It is process by which the total removal of cystic lesion is achieved .By Definition,it means shelling out of the entire cystic lesion without rupture.

(Peterson)

No pathological lining left behind No pathological lining left behind

LLesser chances of infection esser chances of infection

No regular follow-up appointments No regular follow-up appointments Uniform healing takes placeUniform healing takes place

Disadvantages

Increased risk to adjacent vital structures

Increased chances of pathological fracture

AdvantagesAdvantages

3) PARTSCH II3) PARTSCH IIMarsupialization followed by EnucleationMarsupialization followed by Enucleation

(For large cysts)

First Marsupialization is done to evacuate the cystic contents.

second stage surgery in the form of enucleation is performed to remove entire cystic lining.

Vital structures sparedAdvantages

No pathological lining left behind

ERUPTION CYST ERUPTION CYST

INTRODUCTION It is the soft tissue analogue of dentigerous cyst

which is the result of seperation of dental follicle from around the crown of an erupting tooth i.e. with in the soft tissues overlying the alveolar bone.

PATHOGENESISIt develops due to accumulation of fluid within the follicular space of an erupting tooth.

CLINICAL FEATURES Age - Children < 10 yrs.

Site - Deciduous and permanent teeth may be involved, frequently anterior to first permanent molar. .

.

Clinical presentation - Appears as soft, translucent swelling in gingival

mucosa overlying erupting tooth. - Painless unless infected - Brief history of 3-4 wks duration during which enlarge to approximately 1.5 cm.- Exposure to masticatory trauma induces hemorrhage

with in the cyst giving rise to eruption hematoma

HISTOPATHOLOGICAL FEATURESHISTOPATHOLOGICAL FEATURES - Superficial aspect covered by oral epithelium. - Underlying lamina propria shows variable

inflammatory cell infiltrate. - Deep portion which represents roof of cyst, shows

a thin layer of non-keratinizing squamous epithelium

Nonkeratinising squamous epithelium

Oral epithelium

TREATMENT AND PROGNOSISTREATMENT AND PROGNOSIS 1) If cyst ruptures - no treatment . 2) If this does not occur – Marsupialization.

RADIOLOGICAL FEATURES- Cyst may throw a soft tissue shadow.- Usually no bone involvement except that dilated and open crypts may be seen.

ODONTOGENIC KERATOCYSTODONTOGENIC KERATOCYST

INTRODUCTION Termed by philipsen (1956)

Very well defined histologic criteria

One clinical feature warranting its recognition and separation as a distinctive entity is its high rate of recurrence (5- 62% Neville)

CLINICAL FEATURES:CLINICAL FEATURES: Frequency : 1% among all types of jaw cysts Age : 2nd and 3rd decades of life Gender : Male > Females Race : White > Black Site : Mandible > Maxilla 50% cases occur at angle of mouth

PRESENTATION: INITIAL STAGES - No signs / Symptoms LARGER LESIONS - Swelling of jaw, facial asymmetry, pain in jaw, mobility and displacement of teeth. Expansion of bone in Anteroposterior direction.

Expansion Maxillary Lesions - Palatal Cortical plate (1/3 Cases) Mandibular Lesions - Buccal cortical Plate (50%) - Lingual Cortical Plate (30%) Extraosseous lesions may develop in relation to gingiva Discharge present if secondarily infected. Larger cysts affecting maxillary sinuses – leads to –

displacement or destruction of floor of orbit and protrusion of eyeball.

NEVOID BASAL CELL CARCINOMA NEVOID BASAL CELL CARCINOMA SYNDROMESYNDROME

– BASAL CELL NEVUS – BIFIDRIB SYNROME– GORLIN AND GOLTZ SYNDROME– MULTIPLE JAW CYST SYNDROME– Given by Binkley and Johnson (1951)– Hereditary disease – Autosomal dominant trait – Mutiple Basal cell epitheliomas – Multiple Basal Cell nevi.– Multiple odontogenic keratocyst ofjaws – Bifid ribs – Ocular hypertelorism– Frontal bossing – CNS disturbances etc. hypogonadism in males – Ovarian tumours

50% cases show multiple cyst formation

Radiological features- Multilocular Radiolucent areas Soap Bubble appearance Crosses mandibular midline oftenly Smooth / scalloped border Displacement of unerupted teeth Expansion and distortion of cortical plates

Types Replacement

Extraneous

ODONTOGENIC

KERATOCYST

Envelopmental

Collateral

1. Replacement type – Cyst develops in place of developing normal tooth 2. Envelopmental type - Entirely enclosing impacted tooth with in the bone.3. Extraneous type - Develops away from tooth bearing areas of jaw 4. Collateral type - Between Roots of a tooth.

Cystic Fluid

- Straw colored fluid contains soluble protein less than 3.5 gm / 100 ml.

- Explained by Taller

- Through electrophonetic studies

- Due to altered degree of keratinisation. Increased Permeability of lining.

- Results in mobility of soluble proteins.

Histopathology

Cystic cavity lined by keratinized Cystic cavity lined by keratinized stratified odontogenic epithelium stratified odontogenic epithelium 6-8 cell 19 years thickness.6-8 cell 19 years thickness.

Basal layer – Tall columnar cells/ Basal layer – Tall columnar cells/ cuboidal cells – palisade arrangement. cuboidal cells – palisade arrangement.

Corrugated epithelial lining Corrugated epithelial lining

Diffuse Chronic inflammatory cellsDiffuse Chronic inflammatory cells

Differential Diagnosis - Ameloblastoma - Dentigerous cyst - Aneurysmal bone eyst - Odontogenic Myxoma - Stafne bone cyst. - Lateral periodontal cyst

Treatment - Surgical enucleation - Marsupialization - Excise overlying oral epithelium - Repeated recurrence - Jaw resection

Prognosis RECURRENCE RATE IS VERY HIGH (5% to 62% - Neville) Possible Reasons: - Retained fragments of thin, delicate cystic lining - Penetration of the original cortex eventually,

also the thin shell of new subperiosteal bone. - Spillage of its contents - Satellite cysts – arising from epithelial residues.

Follicular Cyst Coined by Paget (1963) Definition: Cyst enclosing crown of unerupted tooth by expansion of its

follicle, attached to the neck Clinical Features Frequency : 20-25% Age : Third and forth decades Gender : Male : Female :: 1.6:1 (Brown et al) Race : White > Black Site : Mand 3rd Molar > Max . Canine

>Mand. Premolar > Max 3rd molar

DENTIGEROUS CYSTDENTIGEROUS CYST

Presentation May grow large before diagnosis Slowly enlarging swelling associated with missing

teeth / tooth failed to erupt Painful if infected. Lesions 4-5 cms in 3-4 years . Radiological features Unilocular Radiolucent Associated with crowns of unerupted teeth. Well defined sclerotic margins unless infected

Types Central

Circumferential

Dentigerous cyst

Lateral

Gingival cyst of Newborn Epstein pearls Bohn's Nodules Definition : Multiple, occasionally solitary nodules on alveolar

ridge of new born / very young infants, Representing cyst originating from remnants of dental lamina.

- Epstein Pearls : Cystic Keratin filled nodules. Along midline raphe Derived from entrapped epithelial remnants along line of

fusion. - Bohn's Nodules Keratin filled cysts scattered over palate Numerous along junction of hard and soft palate Derived from palatal salivary gland structures.

Dental Lamina Cyst of newborn:Dental Lamina Cyst of newborn:

CLINICAL FEATURES - Obvious small discrete white swelling of alveolar ridge - Blanched – Internal pressure - Asymptomatic - No discomfort Histologic Features - True cyst with a thin epithelial lining. - Lumen filled with desquamated keratin. - Inflammatory cells present - Dystrophic calcification found - Hyaline bodies of Rushton found Treatment - No treatment required - Lesions disappear By Opening into surface Disruption by erupting teeth

Uncommon cyst of gingiva Etiology and pathogenesis

- Heterscopic glandular tissue.

- Degenerative changes in proliferating epithelial retepeg.

- Remnants of dental lamina, enamel organ or epithelial islands of periodontal membrane.

- Traumatic implantation of epithelium. Clinical features

Frequency : 0.5%

Age : adults over 40 years

Location : Bicuspid–cuspid incisor area (Mandibular)

Representation : Small, well circumscribed painless swelling

of gingiva.

Color : Same as of normal mucosa

Size : Less than 1 cm in diameter may occur in free, attached or interdental gingiva.

Gingival cyst of AdultGingival cyst of Adult

Histological Features : True cyst Stratified squamous epithelial lining In lumen fluid present Glycogen rich clear cells present. Radiological Features Soft tissue lesion – No Radiographic Manifestation Differential Diagnosis - Mucocele - Local periodontal cyst Treatment - Local surgical excision Prognosis - Lesions do not recur.

LATERAL PERIODONTAL CYSTLATERAL PERIODONTAL CYST

INTRODUCTION

This designation is confined to those cysts which occur in the lateral periodontal position and in which an inflammatory etiology and a diagnosis of collateral keratocyst have been excluded

(Shear and Pindborg

1975).

PATHOGENESIS

Arise from reduced enamel epithelium, remnants of dental lamina and cell rests of Malassez

CLINICAL FEATURESCLINICAL FEATURES -- FrequencyFrequency - - 0.7% 0.7% (Mervyn Shear 1989(Mervyn Shear 1989)) - - AgeAge -- 55thth to 7 to 7thth decade decade-- SexSex -- Male > FemaleMale > Female-- SiteSite -- Mandibular premolar areaMandibular premolar area..

Clinical presentation

(a) Asymptomatic and discovered during radiographic examination.

(b) When on labial surface of roots, slight mass obvious, although mucosa is normal.

(c) Tooth is vital.

(d) If infected, it may resemble lateral periodontal abscess.

2

RADIOLOGICAL FEATURESRADIOLOGICAL FEATURES -- Well circumscribed radiolucent area Well circumscribed radiolucent area lateral to root of vital tooth.lateral to root of vital tooth. -- Most cysts < 1 cm diameter. Most cysts < 1 cm diameter.

-- When polycystic, known as When polycystic, known as botryoid botryoid

odontogenic odontogenic cyst.cyst. HISTOPATHOLOGICAL FEATURES

- Hollow sac with connective tissue wall lined on inner surface by stratified squamous epithelium which is single to several cells thick.

- Foci of glycogen rich clear cells in epithelial cells.

-Focal nodular thickenings of lining epithelium Focal nodular thickenings of lining epithelium composed chiefly of clear cells.composed chiefly of clear cells.- Fibrous wall contains clear cell epithelial rests- Fibrous wall contains clear cell epithelial rests

DIFFERENTIAL DIAGNOSISDIFFERENTIAL DIAGNOSIS -- Lateral periodontal abscess/granuloma Lateral periodontal abscess/granuloma -- Radicular cystRadicular cyst-- Lateral dentigerous cystLateral dentigerous cyst

- - Collateral type of primordial cystCollateral type of primordial cyst

TREATMENT AND PROGNOSIS

- Conservative enucleation without damaging the associated tooth.

- Recurrence unusual except in botryoid variant since of polycystic nature.

CALCIFYING ODONTOGENIC CYST CALCIFYING ODONTOGENIC CYST (Gorlin Cyst)(Gorlin Cyst)

INTRODUCTION -Uncommon epithelial lesion characterized by unusual keratin

production and dystrophic calcification.-First described by Gorlin in 1962, who drew attention to an

entity that they described as Calcifying odontogenic cyst likening it to the calcifying epithelioma of Malherbe.

CLASSIFICATION - by Praetorious and co-workers Type I A Simple unicystic type Type I B Odontome producing type Type IC Ameloblastomatous proliferating type II Neoplasm like lesion

PATHOGENESISPATHOGENESIS

Develops from reduced enamel epithelial cells or Develops from reduced enamel epithelial cells or

remnants of odontogenic epithelium in dental remnants of odontogenic epithelium in dental follicle,gingiva or bonefollicle,gingiva or bone..

CLINICAL FEATURES

- Age - 2nd decade

- Sex - Male = Female

- Race - No predilection

- Site - equal frequency in maxilla and mandible

- Common in incisor and canine areas.

Clinical presentationClinical presentation(a) Mostly asymptomatic.(a) Mostly asymptomatic. (b) Swelling is the most frequent complaint.(b) Swelling is the most frequent complaint. (c) Rarely painful(c) Rarely painful(d) Intraosseous lesions may produce a hard(d) Intraosseous lesions may produce a hard bony expansion, may perforate cortex and bony expansion, may perforate cortex and extend into soft tissue.extend into soft tissue. RADIOLOGICAL FEATURES(a)Intraosseous lesions appear as

radiolucent area with well defined margins.

HISTOPATHOLOGICAL FEATURESHISTOPATHOLOGICAL FEATURESWell-defined cystic lesion with

fibrous capsule and a lining of odontogenic epithelium

1 Odontogenic epithelium

a) 4-10 cells thick.

Basal cells may be cuboidal / columnar.

Ghost cells

(b)Irregular calcifications seen in radiolucent area.

(c) Root resorption of adjacent teeth is seen

2 2 Connective tissueConnective tissue -- Consist of ameloblastoma - like strands and Consist of ameloblastoma - like strands and

islands of odontogenic epithelium Infiltrating islands of odontogenic epithelium Infiltrating

into mature connective tissueinto mature connective tissue.. 3. Capsule- - Ameloblastoma - like proliferations in connective tissue of

fibrous capsule and lumen of cyst

- Ghost cells and varying amount of dentinoid in contact with odontogenic epithelium. -

(c) Overlying layer of loosely arranged epithelium resembles stellate reticulum of ameloblastoma

(d) Characteristic feature - "ghost cells" within epithelial component.

(e) Calcified tissues in epithelial cells.

TREATMENT AND PROGNOSISTREATMENT AND PROGNOSIS

Surgical enucleation because of propensity for continued growth.

Lack of recurrence dependent upon completeness of excision.

Carcinomatous transformation into squamous cell carcinoma has been recorded.

GLANDULAR ODONTOGENIC CYST GLANDULAR ODONTOGENIC CYST

(Sialo - odontogenic(Sialo - odontogenic cyst)cyst) The term most descriptive of the lesion is The term most descriptive of the lesion is mucoepidermoid odontogenic cystmucoepidermoid odontogenic cyst because of because of presence of both secretory elements and stratified presence of both secretory elements and stratified

squamous epitheliumsquamous epithelium..

CLINICAL FEATURES - Age - Middle aged adults with a

mean age of 49 yrs.

- Site - Mandibular anterior region.

RADIOLOGICAL FEATURESRADIOLOGICAL FEATURES

Clinical Presentation -

(a) Small cysts – asymptomatic

(b) Large cysts produce clinical expansion, sometimes associated with pain or paresthesia.

(b) Interface between epithelium and fibrous connective tissue wall is flat.

(c) Fibrous cyst wall devoid of inflammatory infiltrate.

(d) Superficial epithelial cells are columnar / cuboidal, occasionally with cilia and epithelium has glandular/ pseudoglandular structure with

HISTOPATHOLOGICAL FEATURES

(a) Squamous epithelium of varying thickness.

(a) Unilocular or commonly multilocular radiolucency.

(b) Margins well defined with a sclerotic rim.

TREATMENT AND PROGNOSISTREATMENT AND PROGNOSIS(a) Enucleation or curettage have been

commonly done.

(b) Because of its propensity for recurrence and aggressive nature, some authors advocate enbloc resection.

intraepithelial crypts or microcysts or pools lined by cells similar to those on surface. Squamous epithelium

with cilia

Microcyst

INFLAMMATORY CYSTSINFLAMMATORY CYSTS PERIAPICAL CYST (RADICULAR CYST; PERIAPICAL CYST (RADICULAR CYST; APICAL PERIODONTAL CYST)APICAL PERIODONTAL CYST) INTRODUCTION INTRODUCTION Epithelium at apex of a non vital tooth can beEpithelium at apex of a non vital tooth can be

presumably stimulated by inflammation to form a presumably stimulated by inflammation to form a

true epithelium-lined cyst or periapical cyststrue epithelium-lined cyst or periapical cysts.. PATHOGENESIS

Occurs in several phases:

- Phase of initiation Pulpal inflammation of nonvital tooth reaches to

periapical region and stimulates epithelial cell rests of Malassez present there.

-- Phase of proliferationPhase of proliferation Stimulation to cell rests of Malassez leads to Stimulation to cell rests of Malassez leads to excessive and exuberant proliferation of these cells, excessive and exuberant proliferation of these cells, which leads to formation of a large mass .which leads to formation of a large mass .

-- Phase of cystificationPhase of cystification. . The centrally located cells become necrosed due to The centrally located cells become necrosed due to lack of nutritional supply giving rise to cyst-like lack of nutritional supply giving rise to cyst-like structure, that contains hollow space inside and structure, that contains hollow space inside and peripheral lining of epithelial cells around it. peripheral lining of epithelial cells around it.

- Phase of enlargementPhase of enlargementSmall cyst formed enlarges by higher osmotic and hydrostatic tension and through bone resorbing factor

CLINICAL FEATURESCLINICAL FEATURES

- Frequency - 60% - 70%

- Age - 3rd to 5th decades

- Sex - Males > Females

- Race - Whites > Blacks

- Site - Maxilla> Mandible

(60%) (40%)

Predilection for maxillary anterior region.

(a) Mostly asymptomatic and discovered on roentgenographic examination of nonvital teeth.

(b) At first enlargement is bony hard but fluctuation results from complete erosion of bone.

(c) In maxillary buccal or palatal enlargement occurs. In mandible buccal enlargement is common.

(d) Pain and infection may be present.

Swelling

Clinical presentationClinical presentation


(a) Round ./ ovoid radiolucency surrounded by a narrow radiopaque margin which extends from lamina dura of involved tooth is seen at apex.

(b) Root resorption is common

HISTOPATHOLOGICAL FEATURESHISTOPATHOLOGICAL FEATURES (a) Stratified squamous epithelium which may

demonstrate Rushton bodies.

(b) Lumen filled with fluid and cellular debris. Dystrophic calcification, cholesterol clefts with multinucleated giant cells, RBCs and areas of hemosiderin pigmentation may be present in lumen wall or both.

(c) Wall consists of dense fibrous connective tissue, often with inflammatory infiltrate containing lymphocytes, neutrophils. plasma cells, histiocytes and (rarely) mast cells and eosinophils.

DIFFERENTIALDIAGNOSIS DIFFERENTIALDIAGNOSIS Periapical granulomaPeriapical granuloma Periapical abscessPeriapical abscess Cementoma (stageI)Cementoma (stageI) Traumatic bone cystTraumatic bone cyst

Bony artifactBony artifact TREATMENT AND PROGNOSIS (a) Extraction and curettage.

(b) Root canal therapy with apicoectomy of involved tooth.

(c) Residual cysts may develop later.

(d) Epidermoid carcinoma develops from lining epithelium.

RESIDUAL PERIAPICAL CYSTRESIDUAL PERIAPICAL CYST

INTRODUCTION When a radicular cyst remains behind in the jaws

after removal of offending tooth , it is referred to as residual cyst.

ETIOLOGY- Develops upon either a deciduous tooth / retained root

that later exfoliates or is extracted.- Tooth associated with dentigerous cyst is removed but

cyst is unrecognized, the residual cyst will persist and increase in size.

Clinical presentation Clinical presentation - Present in edentulous area.- Present in edentulous area.- Majority asymptomatic . - Majority asymptomatic . - Found on routine radiographic - Found on routine radiographic examination. examination.

- Incomplete removal of periapical cyst / granuloma

CLINICAL FEATURESIncidence - less common than radicular

cyst. (Daniel E. Waite)

Age - middle aged / elderly

Sex - Equal

Site - Maxilla > Mandible

RADIOLOGICAL FEATURESRADIOLOGICAL FEATURES- Round to oval radiolucency of variable

size within alveolar ridge at site of a previous tooth extraction.

- As the cyst ages, dystrophic calcification and central luminal radiopacity results from degeneration of luminal cellular contents.

TREATMENT- Same as for apical cyst but preserve

contour of edentulous ridge.

- - Pathologic fracture or encroachment onPathologic fracture or encroachment onassociated structures.associated structures.

BUCCAL BIFURCATION CYSTBUCCAL BIFURCATION CYSTINTRODUCTIONINTRODUCTIONIt is an uncommon inflammatory cyst that It is an uncommon inflammatory cyst that characteristically develops on buccal aspect of characteristically develops on buccal aspect of

mandibular first permanent molar.mandibular first permanent molar. PATHOGENESIS When tooth erupts, an inflammatory response

may occur in surrounding follicular tissues that stimulate cyst formation.

CLINICAL FEATURES

Age - Children from 5-11 yrs

Clinical presentationClinical presentation

(a) Slight to moderate tenderness on buccal aspect of erupting mandibular first molar.

(b) Clinical swelling and a foul tasting discharge present.

(c) Periodontal probing reveals pocket formation on buccal aspect.


Well circumscribed unilocular radiolucency Well circumscribed unilocular radiolucency involving buccal bifurcation and root area of involving buccal bifurcation and root area of involved tooth.involved tooth.

- 1.2 – 2.5 cm in diameter. - 1.2 – 2.5 cm in diameter. -- Occlusal radiograph is helpful. Occlusal radiograph is helpful. - Root apices of molar are tipped towards the - Root apices of molar are tipped towards the lingual mandibular cortex. lingual mandibular cortex. - Many cases associated with proliferative - Many cases associated with proliferative periosteitis of overlying buccal cortex. periosteitis of overlying buccal cortex.

TREATMENT AND PROGNOSISTREATMENT AND PROGNOSIS

(a) Usually enucleation ; extraction unnecessary.

(b) Complete healing with in 1 year.

HISTOPATHOLOGICAL FEATURES

- Non-specific

- Lined by nonkeratinizing stratified squamous epithelium with areas of hyperplasia.

- A prominent chronic inflammatory cell infiltrate in connective tissue wall.

cysts lecture

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