Pseudotumors and cysts

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Pseudotumors and cysts

• Jan Laco, M.D., Ph.D.

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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

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Cysts of jaws

• pathological cavity lined by epithelium
• RTG sharply-defined lucencies
• ? fluid
• slowly growth ? teeth displacement
• asymptomatic x infection ? painfull
• rarely pathological fracture

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Cysts of jaws

• Odontogenic
• developmental
• dentigerous
• eruption
• gingival
• lateral periodontal
• odontogenic keratocyst
• calcifying odontogenic cyst
• inflammatory
• radicular
• paradental

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Cysts of jaws

• Non-odontogenic
• nasopalatine duct
• nasolabial
• Pseudocysts
• solitary bone cyst
• aneurysmal bone cyst

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Cysts of jaws frequency ()

• 1. radicular 65-70
• 2. dentigerous 15-50
• 3. keratocyst 3-5
• 4. nasopalatine 5-10

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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

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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

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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

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Odontogenic cysts paradental cyst

• inflammation around partially erupted tooth
• lower 3. M
• ? males, 20 - 25 years
• vital tooth with pericoronitis
• Mi radicular cyst
• enucleation

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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 F 2 1
• 20 - 50 years
• 3. M, C ? prevents eruption
• Mi thin squamous epithelium
• fibrous wall with scanty inflammation

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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

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Odontogenic cysts gingival cysts

• newborn (Bohns nodules)
• gt 80
• gingiva - proliferation of Serres nests
• midline of palate (Epstein pearls)
• spontaneously resolve
• adults - rare

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Odontogenic cysts lateral periodontal cyst

• uncommon cyst beside vital tooth
• botryoid odontogenic cyst
• lower P and C
• gt 50 years
• Mi multilocular cyst with fibrous septa
• squamous epithelium clear cells
  (glycogen)
• recurrency
• glandular odontogenic cyst
• Mi mucous cells
• recurrency

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Odontogenic cysts

• odontogenic keratocyst
• ? keratocystic odontogenic tumor
• calcifying odontogenic cyst
• ? calcifying cystic odontogenic tumor

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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

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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 !!!

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Odontogenic cysts odontogenic keratocyst

• Gorlin-Goltz syndrome
• multiple keratocysts multiple naevoid
• basal cell carcinomas of skin

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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

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Odontogenic cysts

• wall thickening
• cholesterol clefts
• carcinoma
• ameloblastoma

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Odontogenic cysts

• biopsy practice
• nonspecific findings inflammation
• X odontogenic keratocyst
• X calcifying odontogenic cyst
• X unicystic ameloblastoma

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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

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Non-odontogenic cysts nasolabial cyst

• Klestadts, nasoalveolar
• very uncommon
• from remnants of nasolacrimal duct
• in soft tissue deep in nasolabial fold
• excision

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Cysts of soft tissues

• thyroglossal duct cyst
• lymphoepithelial cyst
• lingual dermoid
• mucocele

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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

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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

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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

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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

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Cysts of soft tissues- mucoceles

• ranula
• mucocele of submandibular or sublingual gland
• unilateral painless swelling, 2-3 cm
• floor of mouth