24. Cysts of soft tissues in the maxillofacial region. Classification, etiology, pathogenesis, clinical features, , diagnosis, differential diagnosis and treatment Flashcards
Soft tissue cyst types
*Nasolabial cysts
* Sublingual dermoid and dermoid cysts
* Branchial lymphoepithelial cysts
* Thyroglossal cysts
Nasolabial cysts and where they are commonly located
- True soft tissue fissural cysts => do not occur within bone
- Located above the buccal sulcus under the ala of the nose=>at junction of the globular, lateral nasal, and maxillary processes
- Usually unilateral
-Uncommon lesions with a wide age distribution, predominantly occurring in the third, fourth, and fifth decades of life
-More frequently observed in females.
Clinical features of nasolabial cysts
- Unilateral swellings
- Swelling lifts nasolabial fold and obliterates the labial sulcus=> may cause difficulty in breathing
- Fluctuant and painless unless secondarily infected=>
- May discharge into the nose or mouth
Proposed hypotheses for the pathogenesis of nasolabial cysts
- Remnants of the nasolacrimal duct.
- Mucous cysts=> from the epithelium lining the floor of the nose
- Mucous cysts=> within the mucous glands in the labial sulcus
- Sequestered epithelium
Treatment for nasolabial cysts
Surgical removal
Sublingual dermoid and epidermoid cysts, and how they differ
- Sublingual dermoid cysts => cystic teratoma lined by epithelium
- Contains skin appendages=> hair, sebaceous glands, or teeth
- Epidermoid cysts => also lined by epithelium
- Do not contain skin appendages
Incidence and pathogenesis of sublingual dermoid and epidermoid cysts
- Uncommon
- Usually in young adolescents
- Non-odontogenic =>from epithelial rests
- In 5% of cases=> can become malignant.
Typical site and clinical features of sublingual dermoid cysts
- Occur in the midline of the floor of the mouth=>
- Above or below the geniohyoid muscle
- Midline or rarely lateral swellings
- If above the geniohyoid muscle=>elevate the tongue, causing difficulty with mastication and speech
- Below=> submental swelling (double chin)
- Small in infancy => several centimeters in diameter
- Dough-like on palpation
Treatment approach for sublingual dermoid cysts
Surgical removal
Branchial lymphoepithelial cysts and where they commonly located
- Cystic lesions=>from remnants of the branchial arches
- More commonly => in cervical region than intraorally
- Angle of the mandible
- Anterior to the sternocleidomastoid muscle, or in the parotid region
- Less common=> floor of the mouth
- Ventral surface of the tongue, soft palate, buccal vestibule
Incidence and demographic distribution of branchial lymphoepithelial cysts
- Rare
- Any age but=>frequently young adults between 20 and 40 years old
Clinical features of branchial lymphoepithelial cysts
- Up to 10 cm in size
- Soft, fluctuant masses
- May develop a fistulous tract and drain externally
- Intraoral cysts=> 1 to 10 mm
- Submucosal, and freely mobile
They can be confused with mucoceles, lipomas, or irritation fibromas
Proposed pathogenesis for branchial lymphoepithelial cysts
- Epithelial remnants => branchial clefts and pouches
- Residual cervical sinus epithelium
- Salivary gland inclusions=> parotid lymph nodes undergoing cystic changes
Treatment for branchial lymphoepithelial cysts
Surgical excision
Thyroglossal cysts and where are they commonly located
- Occur=> midline course of the embryonic thyroglossal duct=>
- Extend from foramen cecum of the tongue to the thyroid gland
- Common sites => floor of the mouth
- Area around the hyoid bone
- Thyroid cartilage region
-rare
-most commonly seen in infancy and the second decade of life
