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Radiographic Features
Cysts and Benign Tumors of The Jaws

Odontogenesis
a. Ectodermal : ameloblast and outer tooth

regions b. Ectomesenchymal : odontoblast and dental papilae End process primary and secondary dental laminae disappear any remnants may give benign and malignant lesions later in life

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Overview: Odontogenic cysts & tumors arise from the odontogenic apparatus. The odontogenic apparatus consists of: Epithelium: Remnants of dental lamina Reduced enamel epithelium Odontogenic rests Lining of odontogenic cysts Basal cell layer of oral mucosa Ectomesenchyme: Dental papilla Q: What is a cyst? A: An abnormal space within tissue lined by epithelium. Q: Name some cysts that are not really cysts: A: Aneurysmal bone cyst, Stafne bone cyst, Traumatic bone cyst, Simple bone cyst, Eruption cyst Q: Why are they not cysts? A: No epithelial lining!

Cyst
A Cyst is a benign pathologic cavity filled with fluid, lined by epithelium, and surrounded by a connective tissue wall

A = connective tissue wall B = epithelium

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kista
Penampakan radiografis: Lokasi: 1. dapat muncul dimana saja baik di maksila atau mandibula 2. kista odontogenik sering muncul disekitar regio gigi, di mandibula di atas kanalis nervus alv inf. di maksila di dekat antrum Batas perifer: perifer: mempunyai batas yang jelas ditandai dengan garis radiopak yg tipis Bentuk: Bentuk : bulat atau oval, seperti balon yang berisi air. Struktur bag dlm: dlm: terlihat radiolusen

Effects on adjacent structures

Adapted from: White and Pharoah: Oral Radiology-principles and interpretation, page 380

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Perioral Cysts

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Perioral Cysts

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Perioral Cysts

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Types
Odontogenic NonNon -Odontogenic Pseudocysts

Odontogenic Cysts
Radicular cyst Residual cyst Dentigerous cyst Paradental cysts (Buccal bifurcation cysts) Odontogenic Keratocyst (OKC) Basal cell nevusnevus-bifid rib syndrome (multiple OKC) Lateral periodontal cyst Calcifying odontogenic cyst

Non-Odontogenic cysts
Nasopalatine cyst Nasolabial cyst Dermoid cyst Cysts formerly known as developmental cysts

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Pseudocysts
Simple bone cyst (Traumatic bone cyst) Aneurysmal Bone Cyst Mucous Retention Cyst Stafne Bone Cyst (Stafne Bone Defect)

Radicular cyts
Results from the stimulation of the epithelial cell rests in the PDL by the inflammatory products from the nonnon-vital tooth Most common type of cysts in the jaws

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Periapical cyst or granuloma (chronic localized osteitis)

Impossible to tell radiographically which one it is only histologically, so you must include both in your differential diagnosis. Q: Why does a periapical cyst form instead of just a granuloma? A: If by chance there are Rests of Malassez in the area of inflammation.
The rest cells proliferate due to the inflammation The ball of cells gets too large, cells in the center die, center then has a higher protein concentration, water rushes in to equalize the osmotic pressure. Osmotic pressure can continue to grow the cyst independent of the inflammation.

Other unilocular radiolucencies located periapically: (early) periapical cemento-osseous dysplasia teeth are vital Dentin dysplasia type I teeth are vital, multiple radiolucencies With a periapical cyst or granuloma, the tooth is NON-VITAL Take a vitality test!! Tx for a non-vital tooth is root canal. Must biopsy a radiolucent lesion beneath a vital tooth.

Dentigerous cyst (follicular cyst)

Develops around the crown of an unerupted permanent or supernumerary tooth Second most common type of cyst in the jaws Asymptomatic Internal aspect is completely lucent except for the crown of the involved tooth Either resorbs or displaces the adjacent teeth Follicular spaces >5 >5mm (normal 2-3 mm) should be closely followed for potential development of dentigerous cysts.

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Dentigerous cyst
Radiolucency associated with an unerupted tooth encloses the crown of the unerupted tooth and is attached at the CEJ Most common developmental odontogenic cyst Should be the first differential diagnosis for any radiolucency associated with an unerupted tooth Others: Odontogenic Keratocyst, Ameloblastoma

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Dentigerous cyst

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Paradental cysts (Buccalbifurcation cysts)

Most common in the 6- to 11 11-year year-old age group. Usually associated with the mandibular first molar, occasionally the mandibular second molar. The associated tooth has an altered eruption pattern with buccal tilting of the crown. The associated tooth is vital. Deep periodontal pockets on the buccal aspect of the tooth. +/ +/- swelling +/ +/- pain or tenderness +/ +/- infection.
David LA, Sandor GKB, Stoneman DW, The buccal bifurcation cyst: Is nonsurgical treatment an option? JCDA 64(9) 712-717 1998.

Paradental Cyst

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Buccal Bifurcation Cyst

Odontogenic Keratocyst (OKC)

An OKC is a nonnon-inflammatory odontogenic cyst that arises from the dental lamina. The epithelium in OKC appears to have innate growth potential similar to some benign tumors. Asymptomatic, swelling on occasion Pain from secondary infection Aspiration may reveal thick yellow cheesy material (keratin) High recurrence rate after surgical enucleation

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Odontogenic Keratocyst
(Keratocystic Odontogenic Tumor)
Can be in the location of ANY other type of odontogenic cyst or can be isolated in the jaws! a benign uni-or multicystic, intraosseous tumor of odontogenic origin lining is parakeratinized stratified squamous epithelium potential aggressive, infiltrative behavior solitary or multiple (multiple usually related to Gorlin syndrome) Three important things associated with this diagnosis: 1. High recurrence rate (up to 60%) 2. Highly aggressive (now considered by W.H.O. to be an odontogenic tumor) 3. Relation to Gorlin syndrome Arises from the dental lamina or its remnants PTCH gene is a significant factor in the development of KOT

Odontogenic Keratocyst OKC

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Odontogenic Keratocyst OKC

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Odontogenic Keratocyst OKC

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(Vital teeth)

OKC

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Nevoid Basal Cell Carcinoma Syndrome

GorlinGorlin -Glotz Syndrome/ Multiple OKC

Multiple OKC

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Lateral periodontal cyst

Usually unicystic, it may also appear as a cluster of small cysts "botryoid odontogenic cysts Arise from the epithelial rests in the periodontium lateral to the root 5050 -75 75% % develop in the mandible from lateral incisor to the premolar region In the maxilla, they appear between lateral incisor and canine

Calcifying odontogenic cyst

Calcifying odontogenic cysts have a wide age distribution that peaks at 10 to 19 years of age, with a mean age of 36 years Clinically, the lesion usually appears as a slowgrowing, painless swelling of the jaw. Occasionally the patient complains of pain. In some cases the expanding lesion may destroy the cortical plate, and the cystic mass may become palpable as it extends into the soft tissue. Aspiration often yields a viscous, granular, yellow fluid.

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Residual Cyst

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Residual Cyst

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Nasopalatine duct cyst

incisive canal cyst If it involves the posterior hard palate, termed median palatal cyst Anteriorly, may be called median anterior maxillary cyst, depending on the radiographic features

Nasolabial cysts
Source of the epithelium may be embryonic nasolacrimal duct, which initially lies on the bone surface.

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Pseudocysts
Incisive Canal Cyst Stafne Bone Cyst Traumatic Bone Cyst Surgical Ciliated Cyst (of Maxilla)

Incisive Canal Cyst

Derived from epithelial remnants of the nasopalatine duct (incisive canal) 4th to 6th decades Palatal swelling common, asymptomatic Radiographic findings
WellWell-delineated oval radiolucency between maxillary incisors, root resorption occasional

Histology
Cyst lined by stratified squamous or respiratory epithelium or both

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Incisive Canal Cyst

Stafne Bone Cyst

Submandibular salivary gland depression Incidental finding, not a true cyst Radiographs small, circular, corticated radiolucency below mandibular canal Histology normal salivary tissue Treatment routine follow up

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Stafne Bone Cyst

Traumatic Bone Cyst

Empty or fluid filled cavity associated with jaw trauma (50 (50%) %) Radiographic findings
Radiolucency, most commonly in body or anterior portion of mandible

Histology thin membrane of fibrous granulation Treatment exploratory surgery may expedite healing

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Traumatic Bone Cyst

Surgical Ciliated Cyst

May occur following CaldwellCaldwell-Luc Trapped fragments of sinus epithelium that undergo benign proliferation Radiographic findings
Unilocular radiolucency in maxilla

Histology
Lining of pseudostratified columnar ciliated

Treatment - enucleation

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Mucous retention cyst

Mucous retention cyst Dome shaped opacity in the floor of the maxillary sinus NonNon -epithelial lined Fluid filled Usually asymptomatic

Odontogenic Cysts and Tumors Transition Cyst to Tumor

Quit

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