Cysts of the jaws Flashcards by Rachel Sladden

What is a cyst? (2)

A pathological cavity with fluid, semi-fluid or gaseous contents and which is not created by the accumulation of pus
It is usually, but not always, lined by epithelium

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Parts of a cyst (3)

Wall (fibrous connective tissue)
Lumen (space where content of cyst sits)
Lining (usually epithelium)

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Odontogenic cysts of inflammatory origin (3)

Radicuar cyst
Residual cyst
Collateral/ Paradental cysts

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Odontogenic and non-odontogenic developmental cysts (7)

• Follicular cyst
-dentigerous cyst
-eruption cyst
• Odontogenic keratocyst
• Lateral periodontal cyst
• Gingival cyst
• Glandular odontogenic cyst
• Calcifying odontogenic cyst
• Orthokeratinised odontogenic cyst

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Sheffield Oral and Maxfax pathology - cysts % of all cases

13%

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Most common jaw lesions (1)

Odontogenic cysts - 55%

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Classification of cysts of the jaws (4)

Epithelial cysts
-odontogenic: inflammatory or developmental
-non-odontogenic: nasopalatine duct cyst or nasolabial cyst
Cyst-like lesions

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Cysts that are seen quickly in babies (1)

Alveolar cyst

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Gingival cyst (1)

Found in adults

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Most common jaw cysts (2)

Radicular - 65%
Follicular - 20%
Keratocyst - 5%
Nasopalatine - 5%
Others - <5%

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Pathogenesis of jaw cysts: need (3)

Source of epithelium
Stimulus for proliferation
Growth and bone resorption

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Sources of epithelium (3)

Remnants of Hertwigs root sheath –> radicular cysts
Reduced enamel epithelium –> follicular cysts
Remnants of dental lamina –> keratocysts or gingival cysts

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Where does the enamel organ develop from? (1)

The dental lamina

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The PDL contains epithelial remnants of Hertwig’s root heath is called (1)

Rest cells of Malassez

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Stimuli for proliferation - inflammation (3)

Apical granuloma –> radicular cysts
periodontitis –> inferior lateral periodontal cyst
Pericoronitis –> paradental cysts

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Stimuli for proliferation - developmental (3)

Factors largely unknown
Dentigerous cyst
-eruptive force and proliferation?
-hydrostatic pressure?
Keratocyst
-epithelial proliferation
-hydrostatic pressure?
-tumour?

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Cyst growth and expansion

Osmosis and hydrostatic pressure
- inflammation, cell shedding and cell death results in increased osmotic pressure
- water drawn in by osmosis, increasing hydrostatic pressure, resulting in unicentric expansion
- e.g. radicular and dentigerous cysts
Proliferation of the lining e.g. odontogenic keratocyst
Bone resorption
- IL-1 and IL-6
- prostaglandins
- endotoxins
- stimulation and activation of osteoclasts

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Radicular cyst (3)

Arise in the periodontal ligament from the
epithelial rests of Malassez as a result of inflammation following death of the pulp.
Always associated with a non-vital tooth.

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Apical radicular cysts (1)

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at the apex of a tooth associated with

the opening of the root canal

Lateral radicular cysts (1)

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at the side of a tooth associated with

a lateral branch of the root canal

Residual radicular cyst (1)

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a radicular cyst which has persisted after extraction of the associated tooth

Pathogenesis: radicular cyst (3)

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Periapical granuloma (due to caries and non-vital pulp)
Proliferating odontogenic epithelium
Cyst (with non-k SSE lining)

Features of radicular cyst pathology (5)

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Keratin in 2%
Cilia in 10%
Hyaline bodies in 10%
Mucous cells in 15% 
Cholesterol in 30%

Is this a cyst or a granuloma? Cysts ‘tend’ to be (6)

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Larger
More radiolucent
Well defined
Corticated outline
Painless
BUT only 50% are correctly diagnosed pre-operatively

Size vs pathology (3)

90% of lesions >20mm are cysts 65% of lesions 15-19mm are cysts 65% of lesions 5-9mm are granulomas

Collateral cyst: paradental cyst (2)

A cyst which arises on the lateral aspect of a tooth as a result of inflammation in a periodontal pocket. It arises from pocket epithelium. A particular type of paradental cyst arises at the buccal aspect of partially erupted molars

Histology: collateral/ paradental cyst (1)

Similar to radicular cyst

What is a follicular cyst? (3)

A cyst which surrounds the crown of an unerupted tooth and arises from the reduced enamel (follicular) epithelium. • dentigerous - associated with an impacted tooth • eruption - associated with an erupting tooth

Pathogenesis of a follicular cyst (3)

Impacted tooth Follicular epithelium proliferates Cyst forms

Where does an eruption cyst lie? (1)

Just beneath the oral mucosa

Odontogenic keratocyst (3)

• A cyst arising in the tooth bearing area and characterised by a thin lining of parakeratinised epithelium. • It arises from the dental lamina or its remnants • It may replace a tooth

Pathogenesis of keratocyst (3)

Remnants of dental lamina Epithelial proliferation -genetic? trauma? Cyst develops

Lining of odontogenic keratocyst (2)

Parakeratinsed SSE | -often little on no bucco-lingual expansion

Stats about odontogenic keratocyst (4)

* 62% in males * 75% in the mandible * 50% in lower third molar area * 50% associated with unerupted tooth

Recurrence of keratocysts (3)

• % recurrence varies between studies • Fragility of the lining • Daughter cysts

Odontogenic keratocyst - basal cell naevus syndrome (6)

• AKA ‘Gorlin-Goltz syndrome’ • multiple and recurrent odontogenic keratocysts • basal cell carcinomas of skin • frontal bossing • skeletal abnormalities (e.g. bifid ribs) • cranial abnormalities (e.g. calcification of falx cerebri)

Evidence that an odontogenic keratocyst may be a benign neoplasm (4)

High rate of proliferation in the epithelial lining High rate of recurrence ‘Aggressive’ and infiltrative growth Association with basal cell carcinoma in BCNS/ Gorlin-Goltz syndrome • Molecular changes similar to basal cell carcinoma • PTCH (chromosome 9q) mutation in BCC and Gorlin’s syndrome

Lateral periodontal cyst (3)

Occurs on the lateral aspect or between the roots of vital teeth. It is developmental in origin – rests of Serres. Occasionally it is multilocular and called botryoid odontogenic cyst

Gingival cysts of infants (2)

• arises from dental lamina rests in the alveolar mucosa of infants • lined by thin parakeratinised epithelium

Gingival cysts of adults (2)

• arises from dental lamina rests in the attached gingiva • lined by thin non-keratinised epithelium

Glandular odontogenic cyst (2)

A cyst characterised by cuboidal or columnar epithelium with mucous production Forms duct-like or glandular structures

Histology: glandular odontogenic cyst (2)

Epithalial thickenings | Mucous cells and ducts

Nasopalatine duct cyst (2)

Arise in the nasopalatine (incisive) canal from epithelial residues of the nasopalatine duct They are lined by respiratory epithelium or stratified squamous epithelium, or often both

Nasolabial cyst (2)

Arises in the soft tissue overlying the alveolar process at the base of the nostril, deep to the nasolabial fold. It probably arises from remnants of the nasolacrimal duct and is usually lined by pseudostratified columnar epithelium

Cyst-like lesions (3)

Cystic lesions in the jaws, without an epithelial lining: - Solitary (simple) bone cyst - Stafne’s bone cavity

Cysts of the jaws Flashcards

(45 cards)