Cyst of the jaw and oral

soft tissues
 Cyst of the jaw
 definition
 Cysts are pathological,fluid filled cavities
lined by epithelium.
 They have not been created by the
accumulation of pus
 They are the commonest cause of major
swelling of the jaws.
 Cyst of the jaw
 Introduction

 Cysts are commoner in the jaws than in

any other bone
 Cysts formed from epithelium remaining
after tooth formation account for all but a
few cysts of the jaws
 The periodontal cyst is the commonest
cyst of the jaws
 Cyst of the jaw
 Classification

 They are divided into two main groups

depending on the suspected origin of the
lining epithelium
 Odontogenic cysts

 Non-odontogenic cysts
 Cyst of the jaw
 Odontogenic cysts
 The epithelial lining is derived from the epithelial
residues of the tooth-forming organ
 Sub-divided into developmental and inflammatory
depending on their aetiology
 Non-odontogenic cysts
 The epithelial lining is derived from sources other than
the tooth-forming organ
 Cyst of the jaw
 The various types may be listed as follows:
 Epithelial cysts

 Odontogenic cysts

 radicular cyst
 primordial cyst
 dentigerous (follicular)cyst
 Odontogenic keratocyst cyst
 Cyst of the jaw
 Non-odontogenic cysts
 globuo-maxillary cyst
 naso-palatine duct(incisive canal)cyst
 median cyst
 naso-labial(naso-alveolar)cyst
 Non-epithelialized primary bone cysts
 solitary bone cyst(simple;traumatic;
haemorrhagic bone cyst)
 radicular cyst
 introduction

 Apical radicular cyst are the most common

cystic lesions in the jaws and are always
associated with the apices of non-vital
teeth
 They account for about 75 percent of all
radicular cysts
radicular cyst
 radicular cyst
 Clinical features
 There are commomer in men than in women
 They are most common between the ages of 20 and 60 years
 More than three times as many cysts effect the maxilla as the
mandible
 There is a particularly high incidence in anterior teeth
 Pain is seldom a feature unless there is secondary inflammation
 radicular cyst
 Clinical features
 When small they are frequently symptomless as
they enlarge they produce expansion of the
alveolar bone and ultimately may discharge
through a sinus
 Radiographically:it presents as a round or ovoid
radiolucency at the root apex well circumscribed
and may be surrounded by a peripheral
radiopaque margin
 radicular cyst
 Clinical features
 Thecyst contents vary from a
watery,straw-coloured fluid through to
semi-solid,brownish material of paste-like
consistency.cholesterol crystals impart a
shimmering appearance
 radicular cyst
 Three main mechanisms of formation
 Degeneration and death of central cells
within a proliferating mass of epithelium
 Degeneration and liquefactive necrosis of
granulation tissue
 Epithelialization of an abscess cavity
 dentigerous cyst
 Introduction
A dentigerous cyst is one which enclose
part of the crown of an unerupted tooth.it
is attached to the amelocemental junction
and arises in the follicular tissues covering
the fully-formed crown of the unerupted
tooth
 The cyst contains proteinaceous,yellowish
fluid and cholesterol crystals are common
 dentigerous cyst
 In order of decreasing
frequency
 The mandibular third
molar
 The maxillary
permanent canines
 Maxillary third molar
 Mandibular premolar
 Supernumerary teeth
 Odontogenic keratocyst
 introduction
 It is now generally accepted that the cysts
most probably arise from remnants of the
dental lamina
 It is a relatively uncommon lesion which
has aroused much interest because of its
unusual growth pattern and tendency to
recur
 Odontogenic keratocyst
 Clinical features
 There is a pronounced peak incidence in
the second and third decades
 More common in males than females
 The third molar region and ascending
ramus of the mandible is the most
common site
 It gives give rise to few symptoms unless it
becomes secondarily inflamed
 Odontogenic keratocyst
 Clinical features
 It enlarge predominantly in an antero-posterior
direction and can reach large sizes without causing
gross bony expansion
 Tendency to recur after surgical treatment is an
important Clinical features.recurrence rates vary
from around 11 percent to over 60 percent
 It contain grey or white cheesy material consisting
of parakeratinized squames.there is little free liquid
 Odontogenic keratocyst
 Retention of epithelial residues or satellite
cysts when the main lesion is enucleated
is one of the factors associated with the
high recurrence rate of keratocysts
 The thinness of the cyst wall and its low
tensile and rupture strength make
enucleation more difficult and recurrence
may thus follow Retention of fragment of
torn lining
 Non-odontogenic cysts
 globuo-maxillary cyst occur between the root of the
maxillary permanent lateral incisor and canine teeth
 naso-palatine duct cyst may arise at any point along
the nasopalatine canal
 naso-labial cyst arises in the soft tissue of the upper
lip just below the ala of the nose
 median cyst arise at any point of the palatine median
posterior to the incisive canal
 Cyst of the soft tissues
 Salivarymucoceles
 mucous extravasation cyst

 mucous retention cyst

 Dermoid and epidermoid cysts

 Lymphoepithelial cyst(branchial cleft cyst)

 Thyroglossal cyst
 Salivary mucoceles

 In order of decreasing frequency

the lower lip the cheek floor of mouth
 A history of trauma can often be elicited from
the patient
 The lesions present as a bluish or translucent
submucosal swelling
 There may be a history of rupture,collapse and

refilling which may be repeated

 Lymphoepithelial cyst
 They are derived from remnants of the
branchial arches or pharyngeal pouchs
 The most common types are those of the
second cleft and ae found at the middle
and lower thirds of the
sternocleidomastoid muscle
 It may enlarge in response to upper
respiratory tract infections
 Thyroglossal cyst
 Itderived from residues of the embryonic
thyroglossal duct
 80 percent occur at or below the hyoid
bone
 The cyst is elevated by protrusion the
tongue because its embryologic origin
from the base of the tongue
 Apporximately 5 percent of the cysts
contain functional thyroid tissue
 Thyroglossal cyst
 location

 80 percent occur at or
below the hyoid bone
 Treatment of cysts
 Enucleation

 It is the commonest mode of treatment

nowadays and in the vast majority of
cases is completely satisfactory
 The affected tooth can be root filled and
preserved
 Marsupialisation
Epithelial tumors of oral mucosa
 Etiological factors
 Smoking

 Chewing habits
 Alcohol

 Industrialhazards
 Dental factors
Epithelial tumors of oral mucosa
 Etiological factors
 Actinic radiation

 Epithelial atrophy

 Viruses

 Immunosuppression

 Candida infection
 Smoking
 Thereis undoubtedly evidence relating
pipe and cigar smoking to oral
carcinoma, particularly on the lip
 Chewing habits
 Pan chewing induces leukoplakia where the pan
is held in the mouth and malignant
transformation is usually evidenced clinically by
the development of a papilliferous, ulcerated
mass.
 (basically a pan consists of betel nut and lime
wrapped in a betel leaf, and tobacco, catechu,
and other spices are often added )
 (pan is normally chewed after meals, its effects
being to satisfy the hunger sensation, to aid
digestion, to produce a slight euphoric effect)
 alcohol
 The risk of developing oral carcinoma is
10-15 times greater in heavy than in
minimal alcohol drinkers
 alcohol drinking and tobacco smoking
appear to have a synergistic effect in the
development of oral carcinoma
 Industrial hazards
 Independent studies have indicated a high
incidence of oral carcinoma in textile
workers, particularly in those exposed to
the dust from raw cotton and wool.
 Dental factors
 Poor oral hygiene, faulty restorations,
sharp edges of teeth and ill-fitting dentures
have all been incriminated in the etiology
of oral cancer
 Actinic radiation
 Sunlight
is probably a factor in causing lip
carcinomas.
 Epithelial atrophy
 Thismay enhance the absorption of
carcinogens through the oral epithelium
and explain the reported association
between oral carcinoma and syphilis, iron,
and vitamin deficiencies, and lichen
planus
 viruses
 Laboratory experiments have shown that
herpes simplex viruses(HSV) can be
carcinogenic or cocarcinogenic under
certain circumstances
 There is evidence that human papilloma
virus, as well as being associated with some
oral squamous cell papillomas, may be
associated with oral carcinoma
 Immunosuppression
 Reports have been published of
carcinoma of the lip developing in patients
with renal transplants
 Candida infection
 Keratoticlesions associated with chronic
candidal infection such as chronic
hyperplastic candidosis are particularly
prone to undergo malignant transformation
 Ameloblastoma
 Potential epithelial
sources include enamel
organ,odontogenic
rests(rests of
malassez,rests of
serres)reduced enamel
epithlium and the
epithelial lining of
odontogenic
cyst,especially the
dentigerous cyst
 Ameloblastoma
 The tumors are appreciated for their
locally aggressive behavior,recurrence
rate and slight metastatic potential.
 Ameloblastoma
 Clinical features
 There appears to be no gender predilection

 It occurs predominantly in the fourth and fifth

decades
 The mandibular molar-ramus area is the most
favored site
 Ameloblastomas are usually asymptomatic

 Tooth movement or malocclusion may be the initial

presenting sign
 Ameloblastoma
 Clinical features
 Rarely,extraosseous peripheral ameloblastomas
are found in the gigiva
 They arise from dental lamina and often are
associated with impacted teeth in young patients
 Radiographically,it appears as osteolytic
processes,may exhibits a unilocular or
multilocular appearance,root resorption may
appear
 Ameloblastoma
 Treatment and prognosis
 The solid-multicystic lesions require at least
surgical excision,since recurrence follows
curettage in 50 to 90% of cases
 Block excision or resection should be reserved
for larger lesions
 Unicystic lesions and peripheral ameloblastomas
require only enucleation
 Resection of the entire lesion with a margin of
bone to prevent local recurrence
 Hemangiomas and vascular
malformations
 Introduction
 Vascular birthmarks,in the past named
“strawberry”or“capillary” hemangioma, “port-wine
stains,” “cavernous hemangiomas,”and “cystic
hygromas,”
 Accurate description is crucial,since the prognosis
and management of vascular birthmarks depend
on their correct classification as hemangiomas or
malformations
 Hemangiomas and vascular
malformations
 Introduction
 Their distinctions have been clarified on the basis of
cellular and clinical characteristics.
 Hemangiomas have an increased mitotic activity and
as such may be considered true neoplasms. they are
typically absent at birth or as a faint vascular
blush.during the first several months of life they may
undergo a rapid proliferative phase, during which they
sometimes grow to large size. The majority of
Hemangiomas undergo spontaneous involution by the
age of seven
 Hemangiomas and vascular
malformations
 Introduction
 vascular malformations have a normal rate of endothelial
cell turnover. They result from congenital errors in
vascular morphogenesis and are classified by their
vessel of involvement–
capillary,venous,arterial,lymphatic, or combined. They
normally grow proportionally with the child and do not
regress spontaneously, unlike Hemangiomas
 Lymphatic malformations(cystic hygromas) classically
occur in the neck or the floor of the mouth.
 Hemangiomas and vascular
malformations
 surgical resection
 Photodynamic laser therapy

 Intralesional steroid injections or

sclerosing agents
 Systemic dexamethasone therapy, or the
intravenous administration of interferon-a
 Treatment of Hemangiomas
 surgical resection
 Indications for early surgical resection
include ulceration and bleeding,
obstruction of the eye with subsequent
amblyopia, nasal airway obstruction
 Treatment of Hemangiomas
 Photodynamic laser therapy
 May be helpful in preventing the onset of
the proliferative phase of Hemangiomas
 Treatment of Hemangiomas
 Intralesional steroid injections or
sclerosing agents
 May be successful in achieving temporary
control of smaller Hemangiomas in certain
locations such as the lip or eyelid
 Treatment of Hemangiomas
 Systemic dexamethasone therapy, or
the intravenous administration of
interferon-a
 For a short course has been found to
arrest the growth of large lesions during
their proliferative phase
 Hemangiomas and vascular
malformations
 Treatment of malformations
 The management of malformations often
is surgical
 Indications for early surgical resection
include recurrent infections, obstructive
symptoms(e.g.,respiratory distress),
hemorrhage,and significant aesthetic
deformities.
 Odontogenic tumors
 Epithelial tumors
 Ameloblastoma

 Squamous odontogenic tumor

 Calcifying Epithelial Odontogenic tumor

 Clear cell Odontogenic tumor

 Odontogenic tumors
 Mesenchymal tumors
 Odontogenic Myxoma
 Central Odontogenic Fibroma
 Cementoblastoma
 Periapical Emental Dysplasia
 Mixed tumors(Epithelial and Mesenchymal)
 Odontoma
 Ameloblastic fibroma and Ameloblastic
fibroodontoma
 Malignant tumors
 Introduction
 Malignant neoplasms that arise in the head and
neck area or upper aerodigestive tract share the
general behavior of most solid tumors:local
growth, locoregional spread, and distant
metastasis.
 Unlike most other solid tumors, 60 percent of
patients with a fatal head and neck malignancy
die without clinical evidence of metastasis
beyond the local (regional) disease.
 Malignant tumors
 Introduction
 Central nervous system invasion, rupture
of the great vessels,airway obstruction,
and invasive local infection are common
causes of death on these patients
 Because of the predominant local and
locoregional natural history of this disease,
significant attention must be paid to local
diagnosis and therapy
 Squamous cell carcinoma
 Introduction
 Accounts for about 90 percent of al oral
malignancies
 Over 90 percent of cases occur in patients
over the age of 40 years
 Oral carcinoma may occur on any part of
the oral mucosa(lip, tongue, the floor of
the mouth, the buccal mucosa, the
alveolar ridge, and the palate)
 Squamous cell carcinoma
 Clinical presentation
 Early lesions are usually asymptomatic
and have a variable appearance
 Common modes of presentation are a
white patch, a small exophytic growth(no
ulceration or erythema), a small indolent
ulcer, or an area of erythroplakia
 Pain is seldom present
 Squamous cell carcinoma
 Clinical presentation
 Persistent ulceration, induration and fixation of
affected tissue to underlying structures, and
underlying bone destruction in the case of
alveolar lesions
 An advanced lesion may present as a broad
based, exophytic mass with a rough nodular,
warty, hemorrhagic or necrotic surface, or as a
deeply destructive and crater-like ulcer with
raised,rolled everted edges
 Squamous cell carcinoma
 Clinical presentation
 Pain may be a feature of an advanced lesion.
 Bone invasion may be detected on
radiographs but may be suggested clinically
by mobility of teeth and in the case of
mandible by altered sensation over the
distribution of the mental nerve, or
pathological fracture
 Squamous cell carcinoma
 Itis important to note that the size of the
surface lesion does not indicate the extent
of underlying invasion
 Premalignant lesions and
condition
A lesion may be said to be premalignant if
it precedes or coexists with a tumor more
frequently than would be expected by
chance alone
 The following may be described as
Premalignant lesions :
 (1)leukoplakia and erythroplakia