Jaw cysts lab Slide 2 1- Lumen, wall and an epithelial lining 2- True cyst (has an epithelial lining) and

Pseudocyst (Doesn't have epithelial lining) 3- No, lumen is filled with fluid or semi- fluid contents which has NOT been created by the accumulation of pus 4- According to the origin of the epithelium (odontogenic cysts and non-odontogenic cysts) According to where they occur (jaw bone cysts and soft tissue cysts) 5- According to etiology (developmental cysts and inflammatory cysts) 6 Epithelial rests of serres OKC and lateral periodontal cyst Reduced enamel epithelium dentigerous & eruption & paradental cysts Epithelial rests of Malassez radicular cysts 7 Apical radicular cyst Dentigerous cyst OKC Nasopalatine duct cyst Slide 5 1- Round or ovoid well defined radiolucency at the root apex of the tooth 2 Periapical granuloma Chronic periapical abscess Periapical radicular cyst OKC ** On average 40% or more of apical Radiolucencies are cystic Slide 6 1- Periapical radicular cyst (epithelialized odontogenic inflammatory cyst) 2- Epithelial rests of Malassez 3 Associated with apices of non-vital teeth Asymptomatic when small Symptomatic when large or when there's an acute exacerbation
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4- Radicular cysts arise from proliferation of the epithelial rests of Malassez within chronic

periapical granuloma (The environment within the chronically inflamed periapical granuloma which is likely rich in cytokines, inflammatory mediators, bacterial endotoxins, growth factors and others stimulates the rests of Malassez to proliferate) 5- NO

6 Degeneration and death of central cells within a proliferating mass of epithelium Degeneration and Liquefactive necrosis of granulation tissue Slide 7 1- Thick non-keratinized stratified Sequamous epithelium 2- Fibrous capsule is richly vascular and made of inflammatory infiltrate (which are present by default) 3- Yes and change the type of epithelial cells into either mucous or ciliated 4 Black arrow cholesterol clefts Blue arrow Rushton bodies (eosinophilic pinkish bodies present within the epithelium) Red arrow epithelial rests of Malassez 5 Degenerating epithelial and inflammatory cells Serum proteins (hypertonic content) Water and electrolytes

Cholesterol crystals 6- Radicular cysts continue to expand equally in all directions like a unicentric balloon by bone resorbing factors and osmotic gradient 7 Treatment of the involved tooth (RCT or extraction) Surgical removal of the cyst Little or NO tendency for recurrence or neoplastic transformation Slide 8 1- Round or ovoid well defined radiolucency at the extraction site 2 Residual radicular cyst OKC 3- Residual radicular cyst (epithelialized odontogenic inflammatory cyst)
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Slide 9 1- Round or ovoid well defined radiolucency lateral to the tooth 2 Lateral radicular cyst Lateral periodontal cyst OKC 3- Lateral radicular cyst (epithelialized odontogenic inflammatory cyst) Slide 10 1- Unilocular well defined radiolucency associated with crown of unerupted tooth 2 Dentigerous cyst OKC Unicystic ameloblastoma Slide 11 1- Dentigerous cysts (epithelialized odontogenic developmental cyst) 2- Reduced enamel epithelium 3 Occurs as intra-osseous and intra-follicular cyst It is attached to CEJ Affect teeth that are commonly impacted or erupt late (most frequently 3rd molars, upper canines, lower premolars) Asymptomatic when small Symptomatic when large or when there's a secondary infection 4- Mandible 5 Proliferation of outer layer of reduced enamel epithelium (due to unknown stimulus) followed by breakdown of cells within epithelial islands leading to cyst formation Compression of the follicle by an erupting but impacted tooth fluid exudate pooling of this fluid leads to separation of the reduced enamel epithelium from the crown resulting in cyst formation Spread of periapical inflammation from primary tooth to involve the follicle of the permanent successors, accumulation of inflammatory exudate leading to cyst formation
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Slide 12 1- Thin non-keratinized stratified Sequamous epithelium 2- Fibrous capsule is richly vascular and free of inflammatory infiltrate (unless it is secondarily infected) 3- Yes and change the type of epithelial cells into either mucous or sebaceous 4 Degenerating epithelial and inflammatory cells Serum proteins (hypertonic content) Water and electrolytes Cholesterol crystals 5- Dentigerous cysts continue to expand equally in all directions like a unicentric balloon by bone resorbing factors and osmotic gradient 6 Removal of the affected tooth Surgical removal of the cyst Little tendency to recur when completely removed
7-

Dentigerous cysts can cause extensive bone destruction Dentigerous cyst can cause resorption of adjacent roots Dentigerous cysts can cause displacement of teeth Dentigerous cysts may undergo neoplastic transformation into either: Ameloblastoma Sequamous cell carcinoma Central mucoepidermoid carcinoma

Slide 13

1- Soft bluish swelling of the alveolar mucosa 2- Eruption cyst 3- Reduced enamel epithelium 4 Eruption cysts are extra-osseous dentigerous cysts More common in children Asymptomatic If subjected to trauma hemorrhage bluish discoloration

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5- The lining of eruption cysts may be similar to that of dentigerous cysts BUT is usually modified by chronic inflammation and may contain blood (possibly due to trauma) 6- No treatment Slide 14 1- Multilocular well defined radiolucency associated with crown of unerupted tooth 2 OKC Dentigerous cyst Unicystic ameloblastoma Slide 15 1- OKC (epithelialized odontogenic developmental cyst) 2- Epithelial rests of serres 3 OKC occurs in body and ascending ramus of the mandible (in 70-80% of cases) Asymptomatic when small Symptomatic when secondarily infected More growth potential than most other odontogenic cysts Majority of OKCs present as solitary lesions 4- Mandible 5- Thin keratinized stratified Sequamous epithelium 6- Parakeratinization (nucleated keratinocytes) 7 6-10 layers thick Uniform thickness Corrugated surface Polarization of basal cell nuclei High mitotic activity (higher than any other odontogenic cyst) When epithelial lining is secondarily infected, it loses its characteristic histological appearance and gets similar to the lining of radicular cyst Radicular and dentigerous cysts may rarely produce keratin (by Metaplasia) but their epithelial lining is usually orthokeratinized and doesnt show the regular and ordered epithelial differentiation that characterize the odontogenic keratocyst 8 Thin
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 Free of inflammatory infiltrate (unless it is secondarily infected) Ruptures easily resulting in high recurrence rate upon surgical removal Contains small groups of epithelial cells which can give rise to independent daughter cysts around the main lesion Slide 16 1 White cheesy material consisting of keratinous debris Little free fluid Low soluble protein level 2- Growth of odontogenic keratocysts is predominantly in anterio posterior direction (not equally in all directions in a unicentric ballooning pattern) by active epithelial growth, cellular activity in the connective tissue capsule and bone resorbing factors (no role for osmotic gradient) 3- Keratinizing cystic odontogenic tumor 4 Epithelial budding Daughter (satellite) cyst formation Relatively thin fibrous capsule Thin friable epithelium Biological quality of the cyst epithelium 5 Surgical excision Long term clinical and radiographic follow up Tendency to recur even after surgical removal 6- Nevoid basal cell carcinoma syndrome (Gorlin syndrome) 7 Skin (multiple basal cell carcinomas, hyperkeratosis of palms and soles) Oral (multiple OKCs) Skeletal (rib abnormalities, vertebral deformities, cleft lip and palate) CNS (calcified falx cerebri) Ophthalmic (Hypertelorism) Slide 17 1- Daughter (satellite) cysts
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2- Retention of these cysts when the main lesion is removed increases the recurrence rate of the lesion 3- Nevoid basal cell carcinoma Slide 21 1- Nevoid basal cell carcinoma (Gorlin syndrome) 2- Basal cell carcinomas in here can occur anywhere and commonly appear around age of puberty 3- OKCs in here occur throughout life-time and tend to be earlier than solitary OKCs Slide 22 1- Thin orthokeratinized stratified Sequamous epithelium 2- Orthokeratinized odontogenic cyst 3 Orthokeratinzation predominates Orthokeratinized odontogenic cysts do NOT have the characteristic lining of OKC Orthokeratinized odontogenic cysts aren't associated with nevoid basal cell carcinoma syndrome Recurrence is rare Slide 23 1- Unilocular small well defined radiolucency that is lateral to teeth 2 Lateral radicular cyst Lateral periodontal cyst OKC Slide 24 1- Lateral periodontal cyst (epithelialized odontogenic developmental cyst) 2- Epithelial rests of serres 3- F Found lateral to vital teeth Most frequently occur in premolar-canine-lateral incisor area (75-80% of cases) Asymptomatic 4- Mandible 5- Thin non-keratinized stratified Sequamous epithelium
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6- Fibrous capsule is highly vascular and free from inflammatory infiltrate (unless it is secondarily infected) Slide 25 1- Plaque-like thickening 2- Botryoid odontogenic cyst Slide 26 1- Gingival cyst (epithelialized odontogenic developmental cyst) 2- Thin non-keratinized stratified Sequamous epithelium 3- No treatment Slide 27 1- Paradental cyst (epithelialized odontogenic inflammatory cyst) 2- Well defined radiolucency related to the neck of the tooth and the coronal third of the root 3- Reduced enamel epithelium 4 Teeth associated with paradental cysts may show cervical enamel extension Paradental cyst arises alongside a partially erupted molar involved by pericoronitis Almost, all paradental cysts occur in the mandible and most of them are buccally or distobuccally located 5- Thick non-keratinized stratified Sequamous epithelium (resembling radicular cyst) 6- Fibrous capsule is richly vascular and made of inflammatory infiltrate (which are present by default) Slide 28 1- Glandular odontogenic cyst (epithelialized odontogenic developmental cyst) 2- Unilocular well defined radiolucency in the anterior portion of the body of the mandible ** Differential diagnosis OKC 3 Strong predilection for the anterior portion of the jaws, especially the mandible Variable size Pain or paresthesia 4- Glandular epithelium 5- Fibrous capsule is richly vascular and free of inflammatory infiltrate (unless it is secondarily infected)
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Slide 34 1- Nasopalatine duct cyst (epithelialized non-odontogenic developmental cyst) 2- (Round, ovoid or heart-shaped) well-defined radiolucency near the midline of the anterior maxilla between roots of maxillary incisors (which symmetrical about the midline) ** Differential diagnoses: Normal incisive fossa (when radiolucency is less than 6 mm in diameter) Periapical radicular cyst Periapical granuloma Chronic periapical abscess OKC Slide 35 1- Ciliated pseudostratified columnar epithelium with mucous cells (respiratory epithelium) 2- Includes prominent neurovascular bundles 3- Epithelial remnants of the Nasopalatine duct which connects the oral and nasal cavities in the embryo 3 Intra-osseous cyst Asymptomatic Present as a slowly enlarging swelling in the anterior region of the midline of the palate Can produce drainage of pus into the mouth and pain (if secondarily infected) Can be associated with vital or non-vital teeth 4 Surgical enucleation of the cyst Little tendency to recur Routine clinical and radiographic follow up is necessary No neoplastic potential

Slide 36 1- Nasolabial cyst (epithelialized non-odontogenic developmental cyst) 2- Acute periapical abscess 3- Epithelial remnants of the Nasolacrimal duct Slide 37 1- Simple (idiopathic, traumatic, solitary) bone cyst (non-epithelialized non-odontogenic cyst)
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2- Well defined radiolucency of irregular outline and Scalloping around and between the roots of standing teeth ** Differential diagnoses: OKC Aneurysmal bone cyst 3 4 Nothing Blood clot Thin connective tissue membrane ** Remember NO epithelial lining 5- No treatment Slide 38 1- Aneurysmal bone cyst (non-epithelialized non-odontogenic cyst) 2- Well-defined multilocular radiolucency which may have a ballooned out appearance due to the gross cortical expansion ** Differential diagnoses: OKC Simple bone cyst 3 Occurs predominantly in children and young adults Arises in the posterior part of the body or angle of the mandible
It presents as a rabidly developing swelling causing facial deformity and may be associated with pain and paresthesia

Occurs predominantly in children and adolescents Arises in the molar region of the mandible Asymptomatic Some degree of bone expansion (in about 25% of the cases) can be found

4- Pools of blood surrounded by multinucleated giant cells ** Remember NO epithelial lining

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Slide 40 1- Extravasation mucoceles 2- Cheek and floor of the mouth ** Uncommon in the upper lips 3- Rupture in the duct led to Extravasation of mucous 4- History of trauma 5- Pools of mucous with inflamed granulation tissue ** Remember NO epithelial lining Slide 42 1 Extravasation mucoceles Retention mucoceles 2- Extravasation mucoceles Slide 44 1- Ranula ** Extension of Ranula through the mylohyoid muscle and presence in the submandibular area or the neck is called Plunging Ranula 2 Mucous Extravasation cyst Mucous retention cyst Dermoid cyst Epidermoid cyst Lymphoepithelial cyst Thyroglossal duct cyst 3- Extravasation mucoceles Slide 45 1- Ranula 2- Dermoid cyst Slide 46 1 Dermoid cyst Epidermoid cyst 2- Epidermoid cyst
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