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 65-70
2. dentigerous 15-50
3. keratocyst 3-5
4. nasopalatine 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 para-
keratotic 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