Class: Exam 2 Odontogenic Cysts Flashcards
What is Odontogenesis?
Odontogenesis starts with surface ectoderm (epithelium) growing into jaw (dental lamina) and producing the tooth germ, a portion of which is the enamel organ
Define Odontogenic Cysts
Pathologic cavity lined by odontogenic epithelium and filled with fluid or semisolid material
Etiology of odontogenic cysts
- inflammation
2. Unknown, these are called developmental cysts but are not inflammatory
Which cysts are inflammatory?
Radicular cyst and buccal bifurcation cysts are inflammatory
All the rest are developmental
Define Primordial Cysts
Cyst arising from degeneration of enamel organ prior to tooth formation aborts odontogenesis resulting in radiolucency in place of a missing tooth
- Mandibular 3rd molars
Define Dentigerous Cyst (Follicular Cyst)
Cyst resulting from separation of the follicle from around the crown of developing tooth
Where and within what population is Dentigerous cysts most commonly found?
Any age
Mandibular 3rd molars
Maxillary cuspids
Clinical findings of Dentigerous cysts
Asymptomatic
Usually no expansion
Radiographic findings of Dentigerous Cyst
Well circumscribed pericoronal radiolucency
From CEJ around crown
Histological features of Dentigerous Cyst
Stratified squamous epithelium without keratinization (this was originally the ameloblasts which following odontogenesis becomes reduced enamel epithelium)
Treatment of Dentigerous Cyst
Surgical removal of tooth and cyst if 3M
For Cuspid, may be able to decompress and pull Cuspid in orthodontically
Variants of Dentigerous Cyst
- Eruption Cyst - A dentigerous cyst that gets pushed into oral cavity by erupting tooth, may treat with decompression so tooth can erupt
- Lateral - > Md 3M - Laterally placed
Neoplastic potential of Dentigerous cyst
Exceedingly rare
What three neoplastic lesions may develop from the lining of a dentigerous cyst?
Ameloblastoma
Squamous cell carcinoma
Mucoepidermoid Carcinoma
Name the Periodontal Cysts
Apical Periodontal Cyst (Radicular cyst)
Lateral Periodontal Cyst
Describe the Apical Periodontal Cyst
Most common of all odontogenic cysts
Inflammatory origin secondary to devitalized pulp
- Lateral radicular cyst
- Residual cyst
Describe the Lateral Periodontal cyst
Arises from cystic degeneration of rests of Malassez in PDL
Teeth are vital
Where are Lateral Periodontal cysts most comon?
Mandibular Cuspid and Bicuspids
Radiographic findings of Lateral Periodontal cyts
Small well circumscribed radiolucency along lateral root surface of vital tooth
Histological findings of Lateral Periodontal cysts
Nonkeratinizing stratified Squamous epithelial lining
Treatment of Lateral Periodontal cysts
Excision
Variant of Lateral Periodontal cysts
Botryoid odontogenic cyst
- polycystic, multilocular, may recur after removal
Describe the Newborn (dental lamina cyst)
Soft tissue cysts on gingiva or alveolar ridge from degenerating dental lamina
Very common
When are newborn (Dental lamina cysts) found?
Congenital or early life
Clinical features of newborn (Dental lamina cysts)
Small yellowish elevations
Treatment of newborn (dental lamina cysts)
No treatment
Will self-marsupialize and heal
Define Adult Gingival cysts
Cysts of attached gingiva from degeneration of rests or glands of Serres (Dental lamina)
Soft compressible swellings
Where are Adult gingival cysts commonly found?
Mandibular cuspid and bicuspids
Adult gingival cysts are clinically similar to what?
Clinically similar to mucocele but mucoceles don’t occur on gingiva
Treatment of adult gingival cysts
Excision
Define Odontogenic Keratocyst
Developmental cyst from dental lamina
Odontogenic Keratocysts are classified how?
90% parakeratinized
10% orthokeratinized (orthokeratinized odontogenic cyst)
Where and within what age group are Parakeratinized keratocysts found?
All ages but more common 2-3 & 6-7 decades
Mandibular:Maxillary = 2:1
Increase –> Posterior Mandible
Clinical features of Parakeratinized keratocysts
1/4 exapnsion +- drainage and pain
Clinically aggressive
Radiographic findings of Parakeratinized keratocysts
Unilocular or multilocular radiolucency
Commonly mimics other types of odontogenic cysts
Histologic findings of Parakeratinzied keratocysts
Parakeratotic stratified squamous epithelial lining with well developed palisaded and hyperchromatic basal cells
Often daughter or microcysts in wall
Treatment/Prognosis of Parakeratinized keratocysts
Conservative surgical removal to resection to decompression
*about 1/3 recur
What is Basal cell nevus-bifid rib syndrome
About 5% of patients with keratocyst have
Almost all multiple OKC’s
- Autosomal dominant (mutation of a tumor suppressor gene 9q22)
Clinical features of Basal cell nevus-bifid rib syndrome
basal cell carcinomas (not nevi; not limited to sun-exposed areas or elderly)
- calcification of falx cerebri
- bone anomalies (bifid ribs)
- OKCs usually multiple
- Pits in palms and soles
Keratocysts known for what?
Clinical aggressiveness
Recurrence after removal
Association with basal cell nevus-bifid rib syndrome
Describe orthokeratinized odontogenic cysts
Smaller
Less aggressive
Minimal recurrence
Not associated with syndrome
Where and what age are Calcifying odontogenic cysts (Gorlin Cyst) most common?
Any age
> Mandible
Maybe associated with unerupted teeth or odontomas
Clinical features of Calcifying odontogenic cysts (Gorlin Cyst)
Asymptomatic
Rarely expansion
Occur extraosseously
Radiographic findings of Calcifying odontogenic cysts (Gorlin Cyst)
Radiolucent to mixed radiolucent/opaque
Histologic findings of Calcifying odontogenic cysts (Gorlin Cyst)
Fully or partially cystic
cystic epithelium contains ghost cells (prematurely keratinized) which tends to calcify
Treatment of Calcifying odontogenic cysts (Gorlin Cyst)
Conservative surgical removal - low recurrence
Where are Glandular Odontogenic cysts most common?
Mandible, May be large
Radiographic findings of Glandular Odontogenic cysts
Unilocular to multilocular radiolucency
Histologic findings of Glandular Odontogenic cysts
Cyst showing glandular differentiation (mucus cells, columnar epithelium with cilia, lumina)
Treatment of Glandular Odontogenic cysts
Surgical excision
30-50% recurrence
Define Buccal Bifurcation cyst (Paradental cyst)
Inflammatory cyst occuring on buccal of erupting tooth
Where and within what age group are Buccal bifurcation cysts most common?
Children
Mandibular first molar (often enamel extension into furcation)
Buccal swelling
Radiographic findings of Buccal bifurcation cysts
Unilocular lucency involving furcation of roots
Histologic findings of Buccal bifurcation cysts
Inflamed cyst lined by stratified squamous epithelium
Treatment of Buccal bifurcation cysts
Enucleation of cyst. If you recognize this clinically which you should, you do not have to extract the tooth
