Pseudotumors and cysts

Jan Laco, M.D., Ph.D.

Causes of swellings of jaws

Cysts
odontogenic x non-odontogenic

Odontogenic tumors Giant cell lesions Fibro-osseous lesions Non-odontogenic tumors of bone Metastatic tumors Chronic osteomyelitis

Cysts of jaws
= pathological cavity lined by epithelium RTG: sharply-defined lucencies ? fluid slowly growth teeth displacement asymptomatic x infection painfull rarely: pathological fracture

Cysts of jaws
Odontogenic
developmental
dentigerous eruption gingival lateral periodontal odontogenic keratocyst calcifying odontogenic cyst

inflammatory
radicular paradental

Cysts of jaws
Non-odontogenic
nasopalatine duct nasolabial

Pseudocysts
solitary bone cyst aneurysmal bone cyst

Cysts of jaws frequency (%)

1. radicular 2. dentigerous 3. keratocyst 4. nasopalatine 65-70 15-50 3-5 5-10

Odontogenic cysts radicular cyst

common swelling of jaws and cyst males (M : F 3 : 2) 20 - 60 years maxilla : mandible 3 : 1 painless sweeling enucleation

Odontogenic cysts radicular cyst

relationship to root of dead tooth pulpitis periapical granuloma proliferation of Malassez rests Mi: hyperplastic squamous epithelium (net-like) + hyaline (Rushton) bodies wall: granulation tissue + fibrous tissue mixed inflammation hemosiderin, cholesterol clefts

Odontogenic cysts residual cyst

= radicular cyst persisting after extraction - spontaneous regress
lateral radicular cyst
at side of nonvital tooth lateral branch of root canal enucleation

Odontogenic cysts paradental cyst

inflammation around partially erupted tooth lower 3. M males, 20 - 25 years vital tooth with pericoronitis Mi: ~ radicular cyst enucleation

Odontogenic cysts dentigerous cyst

cystic change of enamel organ after complete enamel formation surrounds crown + attached to tooth neck at amelo-cemental junction crown inside (RTG) M:F2:1 20 - 50 years 3. M, C prevents eruption Mi: thin squamous epithelium fibrous wall with scanty inflammation

Odontogenic cysts eruption cyst

in soft tissue over tooth about to erupt from enamel organ (superficial dent. cyst) children teeth with no predecessors soft bluish swelling in gingiva spontaneously disappear

Odontogenic cysts gingival cysts

newborn (Bohns nodules) > 80% gingiva - proliferation of Serres nests midline of palate (Epstein pearls) spontaneously resolve

adults - rare

Odontogenic cysts lateral periodontal cyst

uncommon cyst beside vital tooth botryoid odontogenic cyst
lower P and C > 50 years Mi: multilocular cyst with fibrous septa squamous epithelium + clear cells (glycogen) recurrency

glandular odontogenic cyst

Mi: mucous cells recurrency

Odontogenic cysts
odontogenic keratocyst keratocystic odontogenic tumor
calcifying odontogenic cyst calcifying cystic odontogenic tumor

Odontogenic cysts odontogenic keratocyst

uncommon from enamel organ before tooth formation (20 30) + (50 70) years mandible angle extending in finger-like fashion in bone marrow spaces asymptomatic RTG: multilocular

Odontogenic cysts odontogenic keratocyst

Mi: squamous epithelium - basal layer (mitoses) - thin wavy parakeratotic layer - folded cyst lining wall - scanty inflammation complete enucleation - difficult 60% recurrency in first 5 years !!!

Odontogenic cysts odontogenic keratocyst

Gorlin-Goltz syndrome = multiple keratocysts + multiple naevoid basal cell carcinomas of skin

Odontogenic cysts calcifying odontogenic cyst

Gorlins anterior parts of jaws RTG: cystic cavity + calcifications Mi: ameloblastoma-like epithelium ghost cells large, pale, outlines of nucleus calcification + odontomas (10% cases) enucleation recurrency

Odontogenic cysts
wall thickening
cholesterol clefts carcinoma ameloblastoma

Odontogenic cysts
biopsy practice nonspecific findings inflammation
X odontogenic keratocyst X calcifying odontogenic cyst X unicystic ameloblastoma

Non-odontogenic cysts nasopalatine duct cyst

uncommon from nasopalatine duct epithelium midline of palate position variants (to incisive canal)
nasopalatine palatine papilla median alveolar

Mi: squamous + respiratory epithelium wall: mucous glands + neurovascular bundle enucleation

Non-odontogenic cysts nasolabial cyst

= Klestadts, nasoalveolar very uncommon from remnants of nasolacrimal duct in soft tissue deep in nasolabial fold excision

Cysts of soft tissues

thyroglossal duct cyst
lymphoepithelial cyst lingual dermoid mucocele

Cysts of soft tissues - thyroglossal duct cyst

uncommom from remnants of any part of thyroglossal duct early age swelling in midline of mouth or neck Mi: squamous + respiratory epithelium wall: thyroid tissue, chronic inflammation removal + part of hyoid bone

Cysts of soft tissues - lymphoepithelial cyst

branchiogenic cyst ??? cystic change of epithelium entrapped in LN early age lateral part of neck + mandible angle + parotid soft swelling fistula to skin / oral cavity / pharynx Mi: squamous + respiratory epithelium wall: dense lymphoid tissue + germ centres enucleation

Cysts of soft tissues - sublingual dermoid

developmental anomaly of branchial arches or pharyngeal pouches between hyoid and jaws or beneath tongue no symptoms Mi: epidermoid cyst dermoid cyst dermal appendages dissection

Cysts of soft tissues - mucoceles

minor salivary glands lower lip superficial, 1 cm swellings extravasation type damage of duct
saliva leak inflammation + mucophages NO epithelium mucofagic granuloma

retention type obstruction of duct

epithelium of dilated duct

Cysts of soft tissues - mucoceles

ranula = mucocele of submandibular or sublingual gland unilateral painless swelling, 2-3 cm floor of mouth