DEFINATION

A Cyst is defined as a pathological cavity or sac with in the hard or soft tissue filled with fluid or semi-fluid or gas and lined by epithelium (in most cases), fibrous tissue or even some times by neoplastic tissue. If get infected may contain pus. They are the most common cause of the chronic swelling of jaws.

INCIDENCE
Odontogenic Cysts- 90%, among these, Radicular cysts-65-75%; Follicular cysts14-18%; Kerotcysts-3-11%. Non-Odontogenic cysts-Naso-Palatine cyst (Most common)- 5% while other are very rare.

MECHANISM OF CYST FORMATION

The cysts are formed from the epithelium Odontogenic or non-Odontogenic in the jaw bones. Two phases of cyst formation;
Cyst initiation Cyst enlargement or expansion

Cyst Initiation a
Exact phenomenon for stimulation is not known. Except inflammation as in Radicular Cyst. In some people there is predisposition for developing cyst from developing odontogenic Epi like Dental lamina or its remnants, enamel organ etc.

Cyst Initiation b
The 3 main factors in the development of cyst are; 1. Proliferation of the epithelial lining and of connective tissue capsule. 2. Accumulation of fluid with in the cyst. 3. Resorption of the surrounding bone and new bone formation.

Cyst Enlargement or Expansion

Once cyst formation has been initiated, it continues to enlarge, irrespective of its type or origin by;
Increase in the volume of its contents. Increase area of the sac or Epi proliferation. Resorption of the surrounding bone. Displacement of the surrounding soft tissues.

RADICULAR CYSTS1
Apical cysts are most common and are associated with apices of non-vital teeth. Residual cyst is Radicular cyst remained after the involved tooth has been removed usually found in edentulous jaws. Lateral type is very uncommon form at the side of the tooth and is the result of inflammation from pulp in to the lateral periodontium.

RADICULAR CYSTS2
Pathogenesis: PHASE OF INITIATION It arises by the proliferation of rest of Malassez with in chronic peri apical granuloma and their proliferation is initiated by persistent inflammatory stimuli from the necrotic pulp. PHASE OF CYST FORMATION As this mass of proliferated epithelium, grow in size the central cells away from the surrounding vascularity die and central liquefactive necrosis occur.

RADICULAR CYSTS3
PHASE OF ENLARGEMENT Mural growth proliferation of Epi Accumulation of fluid and raised intra static pressure-Because of the increased osmotic pressure more water is drawn in from out side the periphery and cyst expands in size. This is because of difference between serum and cystic fluid and presence of proteins in the cystic fluid such as large molecules of globulins, albumin, fibrinogen and fibrin degradation products. Bone resorption bone resorbing factors released from capsule which stimulate OSTEOCLAST FUNCTION. These are prostaglandins like PGE2, and PGE1 and certain leucotrienes.

RADICULAR CYSTS4
The boney wall become thinner though there is also reactionary subperiosteal deposition of bone causing alveolar bone expansion but in large cysts resorption is faster than deposition ,the bone become thinner and thinner giving eggshell sensation and progressively bone is lost cyst lining is directly exposed under the mucosa as a bluish swelling. The rate of Radicular cyst expansion is 5mm/yr.

Kerato Cysts

PATHOGENESIS Developmental lesions arising from remnants of dental lamina, not inherited (except the case of M B Cell nevi). Stimulus of cyst formation is not known. Cyst expansion-Growth is rapid and multicentric, and along with hydrostatic pressure, other features also involved;
1. Hydrostatic forces- same. 2. Active epithelial Growth-- High activity of the epithelial lining of these cysts responsible for the rapid growth. Local groups of epithelium proliferate rapidly producing folds in the lining which projects in to the cancellous spaces resulting in antero-posterior expansion or multicentric growth pattern.

Kerato Cysts
3. Bone resorbing factors-Capsule of K cysts release prostaglandin but in less amounts as compare to other cysts and are poor bone resorber and extends only antero-posterior direction in the cancellous bone. The lining of the k cyst also release collagenase cause bone resorption. 4. Squames of keratin-Accumulation of these varied areas produces localized areas of increased pressure resorption of bone.

Follicular Cyst
Pathogenesis Dentigerous cyst develop from the follicular tissues of un erupted teeth, but only 1% of such teeth develop cysts, and the mechanism of their formation is unclear. The fluid is accumulated either between R.E. Epi. and crown of tooth or between

 the space of Internal and the External layer of R.E. Epi and the proliferation of the major part of the External R.E. Epi forms the cyst lining. The exact cause for this is not known but it is suggested that compression of the follicle by potentially erupting but impacted tooth obstructs the venous flow, increasing

the venous pressure and thus causing the transudation across the capillary walls The increased pressure accumulation of fluid cause separation of the follicle from the crown with between two layers of R.E. Epi the outer layer proliferate to form the cyst lining and inner layer remains as a very thin fragile Epi lining. Expansion It is same as of Radicular cyst.

Follicular Cyst (Canine)