Chapter 10:

Cysts of the Jaws and Neck

WIL DUSTIN P. SINLAO

• Cyst is a pathological fluid-filled cavity lined by
epithelium.

Component of cyst:
1. Lumen (cavity)
2. Epithelial lining
3. Wall(capsule)
ODONTOGENIC CYSTS

 Periapical (radicular) Cyst

 Lateral Periodontal Cyst
 Gingival Cyst of the Newborn
 Dentigerous Cyst
 Eruption Cyst
 Glandular Odontogenic Cyst
 Odontogenic Keratocyst / Keratocyst
odontogen
NON ODONTOGENIC CYST

 Globulomaxillary cyst/lesion
 Nasolabial Cyst
 Median Mandibular Cyst
 Nasopalatine Duct (incisive) Canal Cyst
PSEUDOCYST

 Aneurysmal Bone Cyst

 Traumatic (Simple) Bone Cyst
 Static Bone Cyst (Stafne’s Bone Defect)
 Focal Osteoporotic Bone Marrow Defect
SOFT TISSUE CYST OF THE NECK

Branchial cyst/cervical Lymphoepithelial Cysts

Dermoid Cysts
Thyroglossal tract Cyst
ODONTOGENIC CYST:
Periapical(Radicular) cyst

Most common odontogenic cyst seen in non-vital tooth.

ETIOLOGY
• Develops from a pre-existing periapical granuloma.
• Proliferation of odontogenic epithelial residues of rest of
Malassez within the periodontal ligament.
• Cyst expands because of increasing osmotic pressure in
lumen
CLINICAL FEATURES

• Age distribution peaks in 3rd to 6th decades

• Most cyst are located in the maxilla, especially the
anterior region
• Asymptomatic

RADIOGRAPHIC FEATURES

• The radiolucency associated with a periapical cyst is

generally round to ovoid, with a narrow, opaque margin
that is contiguous with the lamina dura of the involved
tooth.
HISTOPATHOLOGY
 Lumen:
Contains cyst fluid; which is usually watery and
opalescent. Sometimes more viscid and yellowish

 Epithelial lining:
Nonkeratinized stratified squamous epithelium. Hyaline
bodies (rhuston bodies) may be found.

 Wall:
Composed of collagenous fibrous connective tissue.
Capsule is vascular and infiltrated by chronic inflammatory
cells. Pulse (seed) granuloma and Russel bodies are often
found.
TREATMENT

 Root canal filling

 Extraction of the involved non-vital tooth and
curettage of apical zone
 If incompletely removed residual cyst may
develop. Continued cyst growth can cause
significant bone resorption and weakening of the
maxilla and the mandible
ODONTOGENIC CYST:
Lateral Periodontal Cyst

ETIOLOGY
• the origin of this cyst is related to proliferation of
rests of dental lamina

CLINICAL FEATURES
 Associated with vital tooth
 Mostly occurs in the mandibular premolar and
cuspid regions.
 LPC presents as an asymptomatic and well-
delineated
RADIOGRAPHIC FEATURES
• Round or teardrop-shaped unilocular (and
occasionally multilocular) radiolucency with
opaque margin along lateral surface of vital
tooth root

TREATMENT
Local incision
Follow-up is suggested for treated multilocular
odontogenic cyst
ODONTOGENIC CYST:
GINGIVAL CYST OF THE NEWBORN

• BOHN’S NODULE

ETIOLOGY
• It is believed that fragments of the dental lamina
that remain within the alveolar ridge mucosa
after tooth formation proliferate to form these
small keratinized cyst
CLINICAL FEATURES
 Self-limiting
 Degenerate
 They involute or rupture into the oral cavity
within few weeks to few months

HISTOPATHOLOGY
This cyst is lined by a bland stratified squamous
epithelium

TREATMENT
Not necessary because nearly all of these cysts
involute spontaneously or rupture before the
patients is 3 months of age
ODONTOGENIC CYST:
DENTIGEROUS CYST

• 2ND most common type of odontogenic cyst

ETIOLOGY
Proliferation of enamel organ remnant of reduced
enaml epithelium

RADIOGRAPHICALLY
Well defined unilocular radiolucency with
corticated margin within the crown of unerupted
tooth
ODONTOGENIC CYST:
ERUPTION CYST

ETIOLOGY
• Result from fluid accumulation
within the follicular space of an
erupting tooth.
• Dentigerous cyst in children

CLINICAL FEATURES
• With trauma, blood may
appear within the tissue forming
an eruption hematoma.
HISTOPATHOLOGY
The epithelium lining this space is simply
reduced enamel epithelium.

TREATMENT
NO treatment is needed because the tooth
erupts through the lesion. Subsequent to eruption,
the cyst disappears spontaneously without
complication.
ODONTOGENIC KERATOCYST/
KERATOCYSTIC ODONTOGENIC TUMOR (OKC)

ETIOLOGY
Develop from dental lamina remnants in the mandible and
maxilla. However, the origin of this cyst from extension of
basal cells of the overlying oral epithelium.

CLINICAL FEATURES

 They occur at age and have peak incidence within the 2nd
to 3rd decades
 In the mandible, the posterior portion of the body and
ramus region are most common affected.
 In the maxilla, the third molar region is commonly affected
TREATMENT

 Surgical excision with peripheral osseous

curettage or ostectomy is the preferred method
of management.
 Some have advocate surgical decompression
and marsupialization to permit cyst shrinkage,
followed by enucleation as an alternative.
ODONTOGENIC CYST:
CALCIFYING ODONTOGENIC CYST

Ghost cell keratinization, “ghost cell tumor”

ETIOLOGY
Due to abnormal keratinization of spindle cells.

TREATMENT
 More aggressive than simple curettage.
 Patients should be monitored following treatment
because recurrence are not common.
NONODONTOGENIC CYST:
GLOBULOMAXILLARY CYST

ETIOLOGY
• Due to epithelial entrapment between lateral incisors and
canine.

CLINICAL FEATURE
• Causes root divergence

RADIOGRAPHIC FEATURES
• Inverted pear shaped radiolucency
NONODONTOGENIC CYST:
NASOLABIAL CYST

ETIOLOGY
• this lesion represents cystic change in the solid cord
remnants of cells that form the nasolacrimal duct

CLINICAL FEATURES
• Peak incidence noted in the fourth and fifth decades.
Mostly in female
• Chief clinical sign is a soft tissue swelling that may
present in the soft tissue over the canine region or the
mucobuccal fold.
NONODONTOGENIC CYST:
MEDIAN MANDIBULAR CYST

ETIOLOGY
• Epithelial entrapment in the midline of mandible

CLINICAL FEATURES

 Found symmetrically in the midline of the mandible

 Small in size
 Associated with vital tooth
 Teeth maybe divergent due to the swelling
RADIOGRAPHIC FEATURE
 Small generally well defined circular or ovoid in shape
 Lamina dura of involved teeth is intact

TREATMENT
cyst should be enucleated carefully without involvement
or damaged to the apices of the incisors
NONODONTOGENIC CYST:
NASOPLATINE DUCT (INCISIVE CANAL) CYST

• Located within the nasopalatine canal or within

the palatal soft tissues at the point of opening of
the canal

ETIOLOGY
• Proliferation of epithelial remnants of paired
ambryonic nasopalatine ducts within the insive
canal
CLINICAL FEATURES
 Most common nonodontogenic oral cyst
 Symmetrical swelling in the anterior region of the
palatal midline.
 Most cases occur between the 4th to 6th decades of life
 Men are affected than women
 May induce internal root resoption

RADIOGRAPHIC FEATURE
• Heartshaped due to anterior nasal spine

TREATMENT
• Surgical enucleation
PSEUDOCYST: ANEURYSMAL BONE CYST

ETIOLOGY
• Unknown, may be related to altered hemodynamics or
abnormal healing of bone hemorrhage

RADIOGRAPHIC FEATURES

 Presence of a destructive or
osteolytic process with slight
irregular margins.
 A multilocular pattern is
noted in some instances
HISTOPATHOLOGY
• Blood-filled spaces lined by connective tissue and
multinucleated giant cells

TREATMENT
 Excision: no bleeding hazard
PSEUDOCYST:
TRAUMATIC BONE CYST

ETIOLOGY
• Unknown
• Trauma sometimes suggested maybe related to bleeding in
the jaw with clot resorption

RADIOGRAPHIC FEATURE
• Radiolucent area with
scalloping borders between
the roots of the teeth
TREATMENT

• Surgical entry to initiate bleeding and stimulate

healing. Some may heal spontaneously.
PSEUDOCYST:
STATIC BONE CYST (STAFNE’S BONE DEFECT)

ETIOLOGY
• Due to enclavement of salivary gland parenchyme
(submandibular)

RADIOGRAPHIC FEATURES
Appears sharply circumscribe
oval radiolucency beneath the
level of the inferior alveolar canal.
TREATMENT
• The appearance of a static bone cyst is usually
pathognomonic, and no treatment is required.
PSEUDOCYST:
FOCAL OESTEOPOTIC BONE MARROW DEFECT)

ETIOLOGY

3 theory
1. abnormal healing following tooth extraction maybe
responsible

2. Residual remnants of fetal marrow may persist into

adulthood, thus presenting as a focal lucency.

3. This tissue may merely represent a focus extramedullary

hematopoiesis that becomes hyperplastic in adult life.
CLINICAL FEATURES
 Asymptomatic
 Mostly female are affected
 Site is at the angle or posterior of the mandible

RADIOGRAPHIC FEATURE
Poorly defined radiolucency , multilocular

TREATMENT
No further treatment is necessary
SOFT TISSUE CYST OF THE NECK: CERVICAL
LYMPHOEPITHELIAL CYST

ETIOLOGY
• Before the theory of origin is incomplete obliteration of the
branchial clefts, with epithelial remnants ultimately undergo
cystic change. But the current theory of origin is that
epithelium is entrapped in cervical lymph node during
embryogenes

CLINICAL FEATURES
 Located lateral portion of the neck, usually anterior to
the sternomastoid muscle
 Asymptomatic cysts usually become clinically apparent
in late childhood to young adulthood as a result of
enlargement.
TREATMENT
• Surgical excision
SOFT TISSUE CYST OF THE NECK:
DERMOID CYST

ETIOLOGY
• developmental entrapment of multipotential cells or possibly
implantation of epithelium

CLINICAL FEATURES
– Located above the mylohyoid muscle, displace the
tongue superiorly and posteriorly
– When located below the mylohyoid muscle, midline
swelling of the neck occurs.
– Painless and slow growing; no gender predilection has
been noted
– On palpation, the cyst are soft and doughy because
keratin and sebum in the lumen
HISTOPATHOLOGY
• Lined by stratified squamous epithelium
supported by a fibrous connective tissue wall

TREATMENT
• Treatment is surgical excision. Most lesion can
be removed through the mouth with little risk of
recurrence
SOFT TISSUE CYST OF THE NECK:
THYROGLOSSAL DUCT CYST

ETIOLOGY
• Due to failure of embryonic thyroglassal duct to become
obliterated after descent of analge of median lobe to its
normal position

Clinical Features:
 30% found in patients older than 30 y/o; 30% found in
patients younger than 10 y/o
 Most cyst occur at the midline, with 60% occurring in
the thyrohyoid membrane and only 2% in the tongue
itself
 When attached to the bone and tongue, they may
retract on swallowing in extension of the tongue.
HISTOPATHOLOGY
• Cyst lining with ciliated or columnar
epithelial lining. Thyroid tissue might
be seen within CT

TREATMENT
• Treatment is surgical excision. It is
often recommended that the central
portion of the hyoid bone be removed
in an effort to eliminate any residual
thyroglossal tract epithelium from the
site.
Thank you