S

S Odontogenic cysts are subclassified as developmental or

inflammatory in origin
S Dentigerous cyst
S Most common, 20% of of all epithelium lined cysts
S Most often in mandibular 3rds (65%). Also max canines, max
3rds, mand 2nd premolar
S Separation of follicle from crown likely 2/2 accumulation of
fluid between the reduced enamel epithelium and the tooth
crown
S Possibly inflammatory, peri-apical inflammation of primary
tooth affects follicle of permanent tooth
S Dentigerous cyst
S Usually asymptomatic  painless bony expansion
S Unilocular radiolucent area that is associated with the crown
of an unerupted tooth
S Radiographic variations
S Central
S Lateral
S Circumferential
S Pathology
S Inflamed
S fibrous wall is more collagenized, with a variable infiltration of
chronic inflammatory cells
S This inflamed dentigerous cyst shows a thicker epithelial lining
with hyperplastic rete ridges. The fibrous cyst capsule shows a
diffuse chronic inflammatory infiltrate
S Pathology
S Noninflamed
S fibrous connective tissue wall is loosely arranged and contains
considerable glycosaminoglycan ground substance
S This noninflamed dentigerous cyst shows a thin, nonkeratinized
epithelial lining.
S Treatment and Prognosis
S Enucleation of the cyst together with removal of the unerupted
tooth. If eruption of the involved tooth is considered feasible,
then the tooth may be left in place after partial removal of the
cyst wall.
S Large dentigerous cysts also may be treated by
marsupialization
S prognosis for most dentigerous cysts is excellent, and
recurrence seldom is noted after complete removal of the cyst
S Complications
S Lining may develop into ameloblastoma, SCC, intraosseous
epidermoid carcinoma
 Eruption Cyst
(eruption hematoma)

S Features
S Soft tissue analogue of dentigerous cyst
S result of separation of the dental follicle from around the
crown of an erupting tooth that is within the soft tissues
overlying the alveolar bone
S most commonly associated with the deciduous mandibular
central incisors, the first permanent molars, and the deciduous
maxillary incisors.
S Treatment
S None
S simple excision of the roof of the cyst generally permits speedy
eruption of the tooth
 Primordial Cyst

S occur in place of a tooth

S originate from cystic degeneration of the enamel organ

epithelium before the development of dental hard tissue

S Later termed OKC in 1992 by WHO

 OKC

S AKA keratocystic odontogenic tumor (KCOT)

S OKC arises from cell rests of the dental lamina

S greater expression of proliferating cell nuclear antigen

(PCNA) and Ki-67, especially in the suprabasilar layer
S PTCH1 mutation - Hedgehog signalling pathway

S Associated with nevoid basal cell carcinoma (Gorlin)

syndrome
 OKC

S Features
S 1. Greater growth potential than most other odontogenic cysts
S 2. Higher recurrence rate
S 3. Possible association with the nevoid basal cell carcinoma
syndrome
 OKC

S Features
S Mandible 60% of cases
 OKC

S Features
S Expand in anteroposterior direction within medullary cavity
without obvious bony expansion
S Multiple OKCs may be present, and such patients should be
evaluated for other manifestations of the nevoid basal cell
carcinoma (Gorlin) syndrome
 OKC

S Radiographic features
S unerupted tooth is involved in the lesion in 25% to 40% of
cases; in such instances
S Resorption of the roots of erupted teeth adjacent to OKCs is
less common than that noted with dentigerous and radicular
cysts
S radiographic findings in an OKC may simulate those of a
dentigerous cyst, a radicular cyst, a residual cyst, a lateral
periodontal cyst ( Fig. 15-16 ), or the so-called
globulomaxillary cyst
 OKC

S Histo
S thin, friable wall, which is often difficult to enucleate from the
bone in one piece
S Filled with clear liquid or cheesy material (Keratin)
S epithelial lining is composed of a uniform layer of stratified
squamous epithelium, usually six to eight cells in thickness
S luminal surface  flattened parakeratotic epithelial cells,
which exhibit a wavy or corrugated appearance
S orthokeratin production may be found in addition to the
parakeratin.
S Treatment and Prognosis
S Complete removal of the cyst in one piece is often difficult
because of the thin, friable nature of the cyst wall
S OKCs often tend to recur after treatment
S Several reports that include large numbers of cases indicate a
recurrence rate of approximately 30%
S Recurrence is encountered more often in mandibular OKCs,
particularly those in the posterior body and ramus
S Recurrence most often within 5 years, but may be greater than
10 years, requires long-term follow up
S Treatment
S peripheral ostectomy of the bony cavity with a bone bur to
reduce the frequency of recurrence
S chemical cauterization of the bony cavity with Carnoy's
solution after cyst removal
S Marsupialization  cyst shrinks and lining becomes thicker
 Orthokeratinized OKC

S microscopically has an orthokeratinized epithelial lining

S prominent palisaded basal layer, characteristic of the typical

OKC is not present
S Treatment and prognosis
S Enucleation with curettage is the usual treatment for
orthokeratinized odontogenic cysts. Recurrence has rarely been
noted, and the reported frequency is around 2%, which is in
marked contrast with the 30% or higher recurrence rate
associated with OKCs
S Nevoid basal cell carcinoma syndrome (Gorlin syndrome)
S Autosomal dominant
S Multiple basal cell carcinomas
S OKCs
S Palmar/plantar pits
S Enlarged head
S Hypertelorism
S Calcified falx cerebri
S Rib anomalies
S Brain CA – medullobastoma
 Gingival Cyst of Newborn

S keratin-filled cysts that are found on the alveolar mucosa of

infants

S Remnants of the dental lamina

S No treatment is indicated for gingival cysts of the newborn

because the lesions spontaneously involute
 Lateral Periodontal Cyst
(Botryoid Odontogenic Cyst)

S occurs along the lateral root surface of a tooth

S arise from rests of the dental lamina, and it represents the

intrabony counterpart of the gingival cyst of the adult

S Occurs later in life, after 50 yrs

S Most often mandibular premolar-canine-lateral incisor area

S Polycystic appearance
S botryoid odontogenic cysts
S variant of the lateral periodontal cyst
S cystic degeneration and subsequent fusion of adjacent foci of
dental lamina rests
S Treatment and Prognosis
S Conservative enucleation
Calcifying Odontogenic Cyst (Calcifying Cystic
Odontogenic Tumor; Gorlin Cyst; Dentinogenic
Ghost Cell Tumor; Ghost Cell Odontogenic
Carcinoma)

S overwhelming majority of intraosseous ghost cell

odontogenic lesions grow as cystic lesions, and less than 5%
of cases can be classified as solid dentinogenic ghost cell
tumors. Therefore, the authors still prefer to use the simpler
designation “calcifying odontogenic cyst”

S may be associated with other recognized odontogenic

tumors, most commonly odontomas
S Features
S About 65% of cases are found in the incisor and canine areas,
equally in maxilla and mandible
S unilocular, well-defined radiolucency
S Radiopaque structures within the lesion, either irregular
calcifications or toothlike densities, are present in about one-
third to one-half of cases
S Extraosseous examples comprise from 5% to 17% of all
cases, appearing as localized sessile or pedunculated gingival
masses

S resemble common gingival fibromas, gingival cysts, or

peripheral giant cell granulomas.
S Histo
S well-defined cystic lesion with a fibrous capsule and a lining of
odontogenic epithelium of four to ten cells in thickness. The basal
cells of the epithelial lining may be cuboidal or columnar and are
similar to ameloblasts. The overlying layer of loosely arranged
epithelium may resemble the stellate reticulum of an
ameloblastoma
S “ghost cells” within the epithelial component. These eosinophilic
ghost cells are altered epithelial cells that are characterized by the
loss of nuclei with preservation of the basic cell outline
S Treatment and Prognosis
S minimal chance of recurrence after simple surgical excision
S When a calcifying odontogenic cyst is associated with some
other recognized odontogenic tumor, such as an
ameloblastoma, the treatment and prognosis are likely to be the
same as for the associated tumor
S Ghost cell odontogenic carcinomas are an unpredictable
variant. May present with uncontrolled local disease and
metastases
Glandular Odontogenic Cyst
(Sialo-Odontogenic Cyst)

S Features
S Occurs in middle age
S Anterior mandible
S unilocular or multilocular radiolucency
S Treatment and Prognosis
S 30% recurrence
S Enucleation and curettage versus en bloc resection