the radiology of oral and perioral cysts juan f. yepes, dds, md, mph assistant professor division of...

The Radiology of

Oral and Perioral Cysts

Juan F. Yepes, DDS, MD, MPHAssistant ProfessorDivision of OD, OM, OMFRDepartment of Oral Health PracticeUKCDODM 820 Spring 2009

Cyst

Pathologic cavity filled with fluid, lined by epithelium,and surrounded by a connective tissue wall.

The cyst fluid either is secreted by the cells liningthe cavity or derives from the surrounding tissueFluid.

Cyst

• Cyst occur more often in the jaws because most cysts originate from the rest of odontogenic epithelium that remain after tooth formation.

• Cyst are radiolucent lesions

• Usually asymptomatic **** (infection)

• Related with missing teeth

Cyst

Radiographic Features:

Location

Cyst may occur centrally in any location in the maxilla or mandible

Cyst are rare in the condyle and the coronoid process

A few cyst arise in the soft tissues of the orofacial region

Periphery RadiolucentWell defined and corticatedHowever a secondary infection can change this

CystRadiographic Features:

Shape

Cyst are usually round or oval, resembling a fluid filled ballon

Some cyst may have a scalloped borders

Internal Structure

Cyst are often totally radiolucent

Long standing cyst may have some calcifications inside

Some cyst have septa

Cyst


Effects on Surrounding Structures

Cyst grow slowly

Sometimes displacement and resorption of the teeth

Cyst can expand the mandible

Cyst

Odontogenic Cyst

Non-Odontogenic Cyst

• Radicular Cyst• Residual Cyst• Dentigerous Cyst• Buccal bifurcation cyst• Odontogenic Keratocyst• Basal cell nevus syndrome• Lateral Periodontal Cyst• Calcifying odontogenic Cyst

The Radiology of Oral and Perioral Cysts

Embryonic epithelial precursor Adult epithelial derivative

Surface epithelium

Rests of Serres Gingival Cyst (Dentigerous Cyst if Crown involved)

Reduced Enamel Epithelium

Dentigerous Cyst

Rest of Malassez Radicular cyst


Odontogenic Cysts Nonodontogenic Cysts


Radicular CystDental Cyst


Radicular Cyst

Periapical cyst, Dental cyst

Radicular cyst is a cyst most likely originated when rest of epithelial cells (Malassez) in the periodontal ligament are stimulated toproliferate and undergo cyst degeneration by inflammatory products from a non-vital tooth.

Most common cyst in the jaws

They arise from non-vital teeth

Asymptomatic, unless secondary infection occurs


Radicular Cyst


• In most cases the epicenter of the RC is located at the apex

• 60% are found in the maxilla, especially around incisors and canines

• Well defined cortical border, if secondary infected, the inflammatory• reaction may result in loss of the cortical bone

• Internal structure Radiolucent


Radicular Cyst


Differential Diagnosis

- RO : Granuloma – Cyst – Abscess

- Odontogenic Keratocyst

- Lateral periodontal Cyst

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Dentigerous CystFollicular Cyst


Dentigerous Cyst

A dentigerous cyst is a cyst that forms around the crown ofan unerupted tooth. It begins from accumulation in the layers of reduced enamel epithelium or between the epitheliumAnd the crown of the unerupted tooth.

Second most common cyst in the jaws

They develop around the crown of an unerupted or supernumerarytooth


Dentigerous Cyst

Radiology Features

• The epicenter is just above the crown of the involved tooth

• The cyst is attaches at the CEJ

• Very often are quite big before diagnosis

• Well defined cortex

• Completely radiolucent


Dentigerous Cyst

Radiology Features

- DG often displace and resorb adjacent teeth

- Displaces the associated tooth in a apical direction

Differential Diagnosis - Hyperplastic follicle - OKC: Less likely resorb teeth

Attach more apical

- Cystic ameloblastoma


KeratocystOdontogenic Keratocyst

OKC


OKC

Non-inflammatory odontogenic cyst that arises from thedental lamina.

Unlike other cyst, the epithelium of the OKC appears tohave innate growth potential

The epithelium lining is keratinized and thin

Inside the cyst viscous white material “cheese”


OKC

- OKCs account for above 1/10 of all cyst in the jaws

- Second and third decades with slightly male predilection

- No symptoms until mid size swelling

- High recurrence

- Aspiration Keratin


OKC


- 90% Posterior body of the mandible- Epicenter superior to the inferior alveaolar canal- Looks very similar to dentigerous cyst- Well corticated and radiolucent- MINIMAL EXPANSION- Resorb teeth bust less than DC


Nevoid Basal CellCarcinoma Syndrome

Gorlin-Goltz Syndrome

Basal cell nevus syndrome

Gorlin-Goltz Syndrome

- Multiple basal cell carcinomas of the skin

- Skeletal abnormalities

- Eye abnormalities

- Multiple OKC

Basal cell nevus syndrome

• Usually after 5 years of age and before 30

• Multiples OKC (mandible)

• High recurrence

• Bifid rib

• Polydactyly

• Temporoparietal bossing

• Calcification of the falx cerebri


Residual CystRadicular Cyst

Dentigerous Cyst


Paradental CystInfected Buccal Cyst


Paradental Cyst

~0.5% of odontogenic cysts, histopathologically,but not radiographically.

Daley, T.D., Wysocki, G.P., Pringle, G.A. Relative incidenceOf odontogenic tumors and oral and jaw cysts in a Canadianpopulation. Oral Surg oral med Oral Pathol 1994; 77:276-280.


Lateral PeriodontalCyst


Nonodontogenic Cysts


Incisive CanalCyst

Nasopalatine Canal Cyst


Nasopalatine Duct Cyst

- Remnants of the nasopalatine duct

- 10% of jaw cyst

- Most cases between 40-50 years old

- Asymptomatic or mild symptoms



- + frequent complain: small, well defined swelling just posterior to the palatine papilla

- Sometimes (depending of the size) the cyst produces swelling below the maxillary labial frenum



RADIOGRAPHIC FEATURES:

- Well defined, corticated and is circular or oval in shape. The shadow of the ANS sometimes is superimposed heart shape

- Internal structure: complete radiolucent

- Most common this cyst causes the roots of the central incisors to diverge and occasionally root resorption occurs.



DIFFERENTIAL DIAGNOSIS

-The most common differential diagnosis is a large incisive foramen

- Keep in main: Always compare with old images

- Radicular cyst VIATALITY!!!

58 y.o. male, continuous neuropathic pain upper maxilla

http://www.ukhealthcare.uky.edu/index.htm

http://www.ukhealthcare.uky.edu/index.htm

Periapical Radiolucencies


> 10 mm


Median Mandibular

Cyst


Pseudocystsand Non-Cysts


Mucous RetentionPseudocyst


Serous Retention PseudocystMucous RetentionCystSerous Retention Cyst

Mucosal Cyst


Simple BoneCyst


Traumatic Bone CystHemorrhagic Bone Cyst

Solitary Bone Cyst


Simple Bone Cyst

- SBC is a cavity within the bone that is lined by connective tissue. It may be empty or it may contain some fluid.

-SBC is not a true cyst

- Etiology: unknown, however probably is a abnormality in the bone metabolism


Simple Bone Cyst

- SBC’s are very common

- First or second decade of life

- Male predominance 2:1

- Associated with cemento-osseous dysplasia

- Asymptomatic in most cases

- Expansion of the mandible or maxilla: unusual


Simple Bone Cyst

RADIOGRAPHIC FEATURES

- Almost all SBC’s are found in the mandible

- More often in the posterior body or in the ramus

- Margin: varies, the lesion often scallops between the roots of the teeth

- The borders are better defined in the alveolar process

- Internal structure: Totally radiolucent

- No true septa


Simple Bone Cyst

RADIOGRAPHIC FEATURES

- In most cases these lesions have not effect on the surrounding teeth.

- Lamina dura usually is intact

- Tendency to grow along the long axis of the mandible

DIFFERENTIAL DIAGNOSIS

- OKC (however….)


Salivary GlandInclusion Defect

Stafne Defect


Submandibular Salivary GlandInclusion Defect

Sublingual Salivary GlandInclusion Defect


Submandibular Stafne DefectSublingual Stafne Defect

the radiology of oral and perioral cysts juan f. yepes, dds, md, mph assistant professor division of...

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