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Epidemiology
Most common odontogenic cyst is periapical /
dentigerus
cyst
Neoplastic : keratocystic odontogenic
tumor
Non-odontogenic cyst: nasopalatine duct cyst
site
Odontogenic cyst,
inflammatory: originate in
tooth bearing areas of
maxilla and mandible;
precise location depends on
cyst type
Odontogenic cyst,
developmental or
neoplastic: variable location
within maxilla or mandible
depending on cyst type
1. Periapical (radicular)
cyst
Inflammatory
odontogenic cyst
Lined by epithelial
cells derived from
rests of Malassez
Also called radicular
cyst, apical
periodontal cyst, root
end cyst, or dental
cyst
Disebut juga
Periapical cyst
Radicular cyst
Terminology
Epithelial rest of Malassez:
Derived from Hertwig's epithelial root sheath
Small spherules of 6-8 epithelial cells with high nuclear to
cytoplasmic ratio
Little or no reverse polarity of cells
Periapical cyst: present at root apex
Lateral radicular cyst: present at the opening of lateral
accessory root canals
Residual cyst: remains even after extraction of offending
tooth
Periapical granuloma: chronic granulomatous inflammation
of periapical tissues
epidemiology
Most common odontogenic cyst (52% of jaw
cystic lesions)
Most common in 4th & 5th decades, but
occurs over wide age range
site
60% in maxilla (vs. mandible)
Most commonly in apex of lateral incisors, but
also along lateral accessory root canals
site
60% in maxilla (vs.
mandible)
Most commonly in
apex of lateral
incisors, but also
along lateral
accessory root canals
Radiology, clinis
appearance
microscopis
Lined by stratified squamous epithelium of variable
Lined by
stratified
squamous
epithelium of
variable
thickness, often
with scattered
ciliated cells
Rushton's hyaline
bodies: amorphic,
eosinophilic, linear
Cholesterol
clefts are
common
within cyst
lining
2. Lateral periodontal
cyst
Non-keratinizing, developmental odontogenic
epidemiologi
Usually 5th to 7th decade of life
Rare in patients less than 30 years of age
Favor males 2:1
Accounts for less than 2% of all jaw cysts
to roots of cuspid or
bicuspid teeth
60-80% occur in
mandibular premolarcanine-lateral incisor
area, but favors
premolar-canine region
When occur in maxilla,
usually involve this
same tooth region but
favors incisor area
Intraoral swelling
Most common adjacent
to roots of cuspid or
bicuspid teeth
60-80% occur in
mandibular premolarcanine-lateral incisor
area, but favors
premolar-canine region
When occur in maxilla,
usually involve this
same tooth region but
favors incisor area
squamous cells
Epithelium is 2-5 cells thick in most areas
Foci of PAS+ glycogen rich clear cells interspersed among
lining epithelial cells
Focal nodular areas of epithelial thickening that may have
a whorled, swirling architecture, and appear in continuity
with the epithelial lining
These mural epithelial plaques extend into the fibrous
connective cyst wall, or may protrude into cyst lumen
Epithelial rests (may or may not be clear cells) can be
seen in fibrous wall
Botryoid odontogenic cyst has more pronounced mural
thickenings/protrusions, comprised of multilocular cysts
with thin fibrous septations and typically has a multilocular,
often larger radiographic appearance
inflamed fibrous
connective tissue wall
Non-keratinized
epithelial lining of
cuboidal to stratified
squamous cells
Epithelium is 2-5 cells
thick in most areas
of epithelial
thickening that may
have a whorled,
swirling
architecture, and
appear in continuity
with the epithelial
lining
terapy
Enucleation, curettage or excision with
3. Dentigerus cyst
Developmental odontogenic cyst that
odontogenic cyst
Most common developmental
odontogenic cyst
Multiple simultaneous
dentigerous cysts uncommon
Represents 20% of epitheliumlined jaw cysts (
Usually seen in
teenagers/young adults,
although can occur over a
wide age range
Clinical appearances
May be small /
asymptomatic, identified
on routine radiographs
taken for unrelated reasons
or for imaging to
investigate delayed tooth
eruption
Can grow large enough to
produce a painless bony
expansion, can displace the
involved tooth, cause
resorption of adjacent teeth
If secondarily infected, may
be associated with pain
CT scan showing
influenced by presence of
inflammation Inflamed
Dentigerous Cyst: Fibrous
connective tissue
Hyperplastic non-keratinized
epithelium, sometimes elongated
interconnecting rete ridges
Chronic inflammatory cells
Cholesterol clefts, possibly
formation of cholesterol
granuloma
Rushton bodies
Scattered mucous, or ciliated or
sebaceous cells uncommon but
possible
Occasional dystrophic
calcifications
Odontogenic epithelial rests,
small, inactive appearing
Non-inflamed Dentigerous
Cyst:
Fibrous to fibromyxoid connective
tissue
No rete ridges, flat interface
Lining epithelium, 2-4 layers of
cuboidal epithelium, devoid of
superficial keratinization
Occasional mucous cells; rare
ciliated cells
Odontogenic epithelial rests,
small, inactive appearing
Some lesions submitted as
dentigerous cysts are partially
lined with a thin, fragmented
layer of eosinophilic columnar
cells/low cuboidal epithelium
representing the postfunctional
ameloblastic layer of the reduced
enamel epithelium
Prognosa
Excellent prognosis, almost never recurs with
Unicyst ameloblastoma
Also called cystic ameloblastoma
Uncommon; 20% of all ameloblastomas
Mean 25 years (younger than classic type), range 8-
micros
Single cystic lesion lined by
lined by
ameloblastic
epithelium that
shows typical
features of
ameloblastoma in
some areas,
including columnar
basal cells in
palisading
arrangement with
vacuolated
cytoplasm,
hyperchromatic
Unicyst ameloblastoma
Therapy
Enucleation or curettage
More aggressive if invasion of fibrous wall
bone
Formerly called odontogenic keratocyst (OKC),
but re-classified as keratocystic odontogenic
tumor (KCOT) due to its potential for
aggressive behavior, recurrence and genetic
abnormalities
Keratocyst
EPIDEMIOLOGY
4-12% of all odontogenic cysts (often
SITE
Mandible most
commonly involved
(65-85% of KCOT)
Most common site:
posterior mandible
Not uncommonly,
but not exclusively
associated with
impacted teeth
Rarely occurs in soft
tissue
PATHOLOGY
Thought to arise from dental lamina
Two-hit mechanism results in bi-allelic loss of
RADIOLOGY
Small lesions often
unilocular
radiolucent lesion,
variable sclerotic
margins
Larger lesions often
multilocular, variable
scalloped margins
MICROSCOPIS
Uniform epithelial lining 6-8 cells thick lacking rete ridges
May have artifactual clefting between epithelium and
Lumen may
contain
keratinaceous
debris
Epithelium
characterized by
palisaded
hyperchromatic basal
cell layer comprised of
cuboidal to columnar
cells May have areas
of budding growth
from the basal cells
TERAPY
Decompression alone
Enucleation with possible curettage
Chemical curettage with Carnoys solution
Marsupialization
Resection
Treatment must balance minimizing
recurrence rate with morbidity associated with
an extensive resection
4. Nasopalatine cyst
Most common intraosseous, non-odontogenic
fifth decades
More common in males (ranges in literature
from slightly more common to up to 3x more
common in males than females)
ETIOLOGY
Two main theories: First: originates from
GENERAL
FEATURE
Usually asymptomatic,
may have swelling of
palate in relation to
maxillary central
incisors
Occasionally produces a
midline anterior
maxillary swelling if
cyst erodes bone of the
anterior maxilla
Can present with painful
swelling or drainage, or
tooth root displacement
radiolucent area
Lined by stratified
squamous epithelium
alone or with
pseudostratified
columnar epithelium
(variable cilia and
goblet cells), simple
columnar epithelium
or simple cuboidal
epithelium
THERAPY
Surgical excision is most common, but
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