 CYSTS OF THE JAWS AND

ORAL SOFT TISSUES

A cyst is a pathological cavity which may or

may not be lined by an epithelium and
having fluid or semifluid contents.
( which has not been created by the
accumulation of pus).

Cysts of the jaws are more common than

in any other bone.
 – Clinical significance of Cyst
– 1.May be mistaken as benign tumors
especially the intra bony cyst.
– 2. Bone destruction
– 3. Enlargement causes

Disfigurement
– 4. Pathologic fractures
– 5.Secondary infection – Osteomyelitis
COMPLICATIONS
– 1.Root Resorption - Loosening &
migration of teeth
– 2.Lining of cysts may give rise to
Neoplasms(Ameloblastoma,Squamouscell
carcinoma,Mucoepidermoidcarcinoma)
Classification of the cysts of the jaw-
1)Epithelial cysts(True cysts)
2)Non-epithelialized primary bone cysts(False
or Pseudo cysts)
EPITHELIAL CYSTS(True cysts)
Odontogenic cysts
i) Developmental type
-Odontogenic keratocyst( Primordial
cyst)
-Dentigerous (Follicular) cyst
-Eruption cyst
-Lateral periodontal cyst
-Gingival cyst
- Glandular odontogenic cyst
 ii) Inflammatory type
- Radicular cyst (dental cyst)
a) apical
b) Lateral
c) residual
- Paradental cyst

Non- Odontogenic cysts

-Nasopalatine duct ( incisive canal) cyst
-Nasolabial ( Nasoalveolar cyst)
-Globulomaxillary cyst
-Median cysts
2) Non- epithelialized primary bone
cysts(False or Pseudo cysts)
- Solitary bone cyst(simple,
traumatic, haemorrhagic bone
cyst)
- Aneurysmal bone cyst
- Stafne's idiopathic bone cavity
 They are divided into two main groups depending
on suspected origin of the epithelium.
1.Odontogenic cyst-
The epithelial lining is derived from the
epithelial residues of the tooth forming organ.
They can
be subdivided into
developmental & inflammatory types
depending upon their aetiology.
2.Non- Odontogenic cyst- The epithelial lining is derived
from sources other than the tooth-forming organ.
ODONTOGENIC CYSTS-
There are three kinds of residues, each
primarily responsible for the origin of a
particular type of lesion.

1) The epithelial rests of Serres

persisting after dissolution of the dental
lamina-Odontogenic keratocyst
2)The reduced enamel epithelium which is
derived from the enamel organ & covers
the fully formed crown of an unerupted
tooth- Dentigerous , eruption cysts,
paradental cysts.

3) The rests of malassez formed by

fragmentation of the epithelial root sheath
of Hertwig- Radicular cysts
 Incidence of cysts of the jaws-
Odontogenic cysts Non-odontogenic cysts
(90%) (10%)
Radicular cyst 60-75% -Nasopalatine cyst
(Most common cyst) 5-10%

Dentigerous cyst 10-15% -Other non-odontogenic

Odontogenic Keratocyst 5-10% & primary bone cysts 1%
Paradental cyst 3-5%
Gingival cyst <1%
Lateral periodontal
cyst <1%
 Parts of a cyst or Macroscopic examination:
Macroscopically

 1.Lumen of cyst


 2.Cystic epithelial lining

 3. Fibrous capsule
Microscopically


Lumen of

cyst epithelial lining
Cystic


 Fibrous capsule
Microscopic examination:
Most of th epithelial cysts are lined by stratified
squamous epithelium
May be lined by “Pseudostratified ciliated columnar
epithelium” when cyst is in contact with Nasal cavity
& Maxillary sinus cavity.

– May contain keratin, fluid or pus (cysts secondarily

infected).

Cyst fluid contains varying amount of serum proteins,

proteases and Inhibitors (collagen fibrinolysis),
Keratins, glycosaminoglycans & Proteoglycans,
Lipids: 1 Lipoprotein & Cholesterol forming 
Lipoprotein
PATHOGENESIS

a Initiation b Cyst formation c Cyst enlargement

12
6. Pathogenesis of cysts
 RADICULAR CYST

Apical periodontal / periapical cyst / root end cyst is

the most common odontogenic cystic lesion of
inflammatory origin.

In a radicular cyst if the involved tooth is

exfoliated or extracted and the cystic lesion
remains within the bone, the condition is known
as RESIDUAL CYST.
 Pathogenesis-

 The entire process of development of this cyst occurs in

several phases.

 1.Phase of initiation
 2.Phase of proliferation
 3.Phase of cystification
 4.Phase of enlargement

Develops due to the proliferation & subsequent

cystic degeneration of the “ epithelial cell rests of
Malassez” , in the periapical region of a nonvital
tooth.
Some people are more prone to develop radicular cyst as
compared to others. THIS COULD BE BECAUSE
Some kind of immune mechanism may prevent the cyst
formation in few people
while on the other hand
defective immunity may cause the development of cyst
in other people.

Clinical features-
Age- Mostly third, fourth & fifth decade of life.
Sex- More common among males.
The cyst can occur in relation to any tooth of
either jaw but maxilla ( 60%) is usually more commonly
affected than mandible ( 40%).
1.The occurrence of more caries in the upper
anterior teeth.
2. the occasional presence of dense-in-dente in the
upper lateral incisors
are usually responsible for the higher incidence of
this cyst in the maxilla.

Clinical presentation-
The involved tooth is always nonvital & it
can be easily detected by the presense of caries,
fractures or discoloration, etc.
Occur rarely in association with nonvital deciduous
tooth.
Smaller cystic lesions are asymptomatic, detected
only by a radiograph.
Larger lesions, often produce a slow enlarging, bony
hard swelling of the jaw with expansion & distortion of
the cortical plates and disturbance in occlusion.

Maxillary lesions may cause either buccal or palatal

cortical expansions whereas the mandibular lesions
often cause buccal or labial expansions & rarely the
lingual expansions.

Severe bone destruction by the cystic lesion results in

thinning of the cortical plates.
 If it is secondarily infected it may result in the
development of either intraoral or extraoral pus
discharging sinuses.
Occasionlly radicular cysts can be multiple in numbers,
occuring in relation to several teeth or in relation to
several roots of a multirooted tooth.

In some cases radicular cyst may develop at the opening

of a large accessory pulp canal on the lateral aspect of
the tooth root. These cysts are termed as lateral
radicular cysts.
Radiological features-
On radiographs, radicular cysts present
well defined, unilocular, radiolucent areas of
variable size ( few millimeters to several centimeters).
The radiolucent area is always in contact with the apex
portion of a nonvital tooth.
Aspiration of the cystic contents reveal a straw
coloured fluid, which may be sometimes blood
tinged. Paper electophoresis indicates the presence
of about 5gm% of soluble protein in it.
Histopathology-
Histologically, lined by a nonkeratinised
stratified squamous epithelium of about 6 to 20 cell
layers thickness. The lining epithelium is backed by a
well- vascularized, connective tisue stroma.
 Ciliated columnar epithelium or respiratory epithelium may also
be present due to metaplastic change in the cystic lining.
The proliferating cystic epithelium may sometimes grow in a
peculiar fashion, by enclosing or encircling a mass of
connective tissue capsule from all sides. This pattern of growth
is called “ arcading pattern”
Multiple small, ribbon shaped, cleft like spaces are seen
either in the cystic lumen or in the connective tissue, which
are known as “cholesterol clefts”
”Multiple laminated :crescent” shaped or “
hairpin” shaped hyaline structures are present in
the cyst. “Rushton bodies” are also found within the
cystic lining or in the connective tissue.
Russel bodies which are nothing but a plasma cell
being surrounded by immunoglobulins are sometimes
seen.

Multinucleated foreign body type of gaint cells may be

seen within the connective tissue.
Mechanism of Bone Resorption
Treatment-
Small cysts are treated by root canal treatments of the
affected teeth & apical curettage. The larger cysts are
treated either by enucleation & marsupialization.
 Dentigerous Cyst

Dentigerous cyst is the second common odontogenic

cystic lesion, which encloses the crown of an impacted
tooth at its neck portion.

The word “dentigerous” means tooth bearing.

 Pathogenesis:

*Dentigerous cyst is derived from the cells of the

reduced enamel epithelium,which surrounds the
crown of an impacted or unerrupted tooth.

*The cyst enlarges due to accumulation of the fluid in

between the reduced enamel epithelium & the tooth
crown.

*The stimulus is not known.

 Clinical features
Age: Second & Third decade of life

Sex-More common in Males.

Site-Twice common in Mandible as compared to

maxilla.

-Mandibular third molar area is the most common site

of occurance of dentigerous cyst, although the
maxillary canine, mandibular premolar & maxillary
third molar areas are also common.

-The cyst also frequently occurs in relation to the

supernumerary teeth or odontomes,etc.
 Clinical Presentation :

Smaller cystic lesions are asymptomatic & are

detected incidentally during the routine radiographic
examination for a missing tooth.

Larger lesions, often produce a slow enlarging, bony

hard swelling of the jaw with expansion & distortion of the
cortical plates, derangement of occlusion and
occassional facial asymmetry.
.
Occasionally pain may be present if the cyst is
secondarily infected & pus discharging sinus may also be
present.

Paresthesia & anesthesia or even pathological

fractures may be seen in some cases.
 Radiographic features:

The cyst presents as a well defined ,unilocular

radiolucent area, enclosing the crown of an impacted
tooth (and sometimes impacted supernumerary tooth or an
odontome) & the periphery of the lesion is bordered by
corticated or sclerotic margins.

-Expansion & distortion of the cortical plates with

displacement of the regional teeth (sometimes to a large
degree)are commonly observed.

-In most of the cases cyst shows resorption of the roots

of the neighbouring normal teeth.
Radiological Types of Dentigerous cyst=

1.Central type-When the cystic cavity envelops the crown of

the impacted tooth symmetrically from all sides.

2.Lateral type- In this case the cystic cavity is located on one

side of the involved crown.

3.Circumferential type-When the cystic cavity radiographically

appears to enclose the entire tooth.
 Histopathology :

-Cyst is lined by nonkeratinised stratified

squamous epithelium of uniform thickness of about 2-3
cell layer thickness(resembling reduced enamel
epithelium).
The cystic epithelial cells are usually flat or cuboidal in
nature
The lining epithelium is supported by a connective tissue
stroma which consists of young fibroblast cells which are
widely separated by a ground substance rich in
muccopolysaccharides & collagen bundels.

Nests, islands & strands of odontogenic epithelium are

sometimes seen within the capsule.
Cystic Fluid:
The cyst is usually filled with a straw coloured
fluid that contains about 5gm percent of soluble protein.

Enlargement=
Increased osmolatity of the cystic fluid(in comparison
to the blood serum) often causes more & more fluid
accumulation in the lumen of the cyst.

Thus the increased intracystic hydrostatic pressure may

result in bone resorption with subsequent expansion of
the cyst.
 Causes of Root resorption of adjacent normal tooth:

The cystic epithelial cells release some chemical substances,

which can cause resorption of the roots similar to that of the
normal reduced enamel epithelial cells in a developing
permanent tooth.

Treatment:

Treatment of dentigerous cyst is done by “marsupilization” &

by “surgical enucleation”of the cyst.
 Eruption cyst
Eruption cyst is an odontogenic cyst, which
surrounds the crown of a tooth that has erupted through
the bone, but not the soft tissue.
It is derived from the reduced enamel epithelial
cells.
Cyst enlarges due to accumulation of fluid within the
follicular space of an erupting tooth.
Clinical Features:
-Clinically the cyst presents a small ,fluctuant
swelling on the alveolar ridge,immediately
superior to an erupted tooth.
-Common among the children & it contains
either a clear fluid or a blood- tinged fluid.
-Mastication may induce haemorrhage
within the cyst, which gives rise to the formation of
“erruption haematoma.”
-Histologically the cyst is lined by nonkeratinised
stratified squamous epithelium of uniform thickness of
about 2-3 cell layer thickness of flat or cuboidal cells
(resembling reduced enamel epithelium).

The lining epithelium is supported by a connective

tissue stroma which consists of young fibroblast cells
which are widely separated by a ground substance rich
in muccopolysaccharides & collagen bundels.
Treatment
-No treatment is required for eruption cyst as it
disappears spontaneously once the the tooth
erupts into the oral cavity.
 Odontogenic Keratocyst
(Primordial cyst)

Odontogenic keratocyst has distinctive

clinicopathologic character and higher tendency
for recurrence.

Odontogenic keratocyst s often have a more

aggressive course than any other cystic lesion of jaw
& for this reason these are sometimes known as
“benign cystic neoplasms”.
-The cyst often presents as a solitary lesion in the angle
of the mandible.

However in some cases multiple such cysts may occur

in association with a syndrome called
“Nevoid basal cell carcinoma syndrome.”
Pathogenesis :
Odontogenic keratocyst arises mainly from
the-
1.Dental lamina or its remnants.
2.Primordium of the developing tooth germ or
enamel organ.
3.Sometimes from the basal layer of the oral
epithelium.

Clinical features:

Age- Mostly second & third decade of life

sex- Males are affected more often than

females
Site- Majority of the cases develop in relation to
mandible (75%) as compared to
maxilla (Intraosseous type).
Among the mandibular lesions, 50% of the cases
occur at the angle of mandible, which extend for
varying distances into the assending ramus & the
body of mandible.
Maxillary lesions more frequently involve the
anterior part of the jaw.
On rare occasions this cyst may occur in the gingiva
( extraosseous type)

Clinical presentation-
1. In the initial stages odontogenic keratocyst does
not produce any signs or symptoms & the lesion
may be discovered only during routine
radiographic examinations.
2. Larger lesions of odontogenic keratocyst however
produce swelling of the jaw with facial asymmetry
and pain in the jaw along with mobility &
displacement of the teeth.
 3.Bony expansion is minimum in odontogenic
keratocyst because in most of the cases the cyst
spreads via the medullary spaces of the bone &
therefore remarkable bony swelling is usually absent.

4.One third of the maxillary

wwww lesions cause expansion of the
buccal cortical plate while Mandibular lesions exhibit
buccal expansion in about 50%cases.

5.Excessive expansion & thinning of the bone may result

in pathologic fracture in some cases.

6.Discharge of pus may be seen in case the cyst is

secondarily infected.
 Radiographic Features
1.Keratocysts often radiographically present
multilocular radiolucent areas, with typical
“soap-bubble”appearance.
-In few cases, the lesion is unilocular .
-Displacement of unerupted teeth & deflection of their
roots are often seen.
2.Sometimes multiple cysts may be seen in the jaw
(when associated with the “Nevoid basal cell carcinoma
syndrome.” )
.
Radiological Types of Keratocysts:

1.Replacement type -When keratocyst develops in

place of a developing normal
tooth.

2.Envelopmental type- When a cyst entirely encloses

an impacted tooth within the
bone.

3.Extranneous type- When keratocyst develops

away from the tooth bearing
areas of the jaws.

4.Collateral type- When a cyst develops between the

roots of a tooth.
 Histopathology

1.A cystic cavity,which is lined by kertinized

stratified odontogenic epithelium of 6-8 cell
layers thickness.
 2.A cystic cavity,which is lined by kertinized
stratified odontogenic epithelium of 6-8 cell
layers thickness.
3.The lining epithelium is flat & there is no rete peg
formation.
4.In almost 80-90% cases the cystic lining exhibits
parakeratinized epithelium & in few cases it exhibits
orthokeratinized epithelium.
The cystic lining often shows a folded or corrugated
appearance ,which could be due to unequal pattern
of the lining at different places.
The basal layer of the epithelium is made up of tall
columnar cells or cuboidal cells.
The cells contain intensely basophilic nuclei,
which are situated away from the basement
membrane. Reverse polarity of basal cell
nuclei could be seen in some cases.
➲ Sometimes the basal layer of the epithelium is made up of
cuboidal cells these cells are often seen in association with
orthokeratotic linings.
➲ Large amounts of desquameted keratin is often found in the
cystic lumen.
➲ The junction between the cystic lining & the connective
tissue capsule is weak & in many cases the cystic epithelium
may be detached from underlying connective tissue.
➲ .”
➲ One of the most interesting histopathological feature is the
presence of multiple small micro cysts within the connective
tissue wall of this cyst. These small cysts are often known as
“daughter cyst” or “satellite cysts.”
➲ The fibrous capsule is usually
➲ thin & is devoid of
➲ inflammatory cells.

Paper Electrophoresis:
Electrophoretic treatment reveals that the
cystic fluid of OKC has soluble protein levels,which is
below 3 - 5gram/100ml whereas in case of non-
keratinizing cysts,the level is about 5 - 11gram/100ml.
Treatment:
Treatment is done by either “surgical enucleation”
or “marsupiazation” of the cyst.

Causes of Recurrence:
OKC may recur after treatment in about 60%
cases, the causes of this are

1.could be due to enlargement of the satellite cysts

following treatment.
2. The cells of OKC have an aggressive potential for
multiplication.

3. If any part of the cyst capsule remains within the bone

during surgery, the retained part (containing remnants
of epithelial islands)may lead to recurrence due to
subsequent multiplication & cystification of the
epithelial remnants.
4. if some portion of lining which is thin & fragile is left behind
within the bone, it could result in further cyst formation.

5. Cystic epithelium with narrow infoldings or finger like

projections left behind during surgery could result in
recurrence.

6. In an attempt to save a vital structure(a tooth, a nerve or a

blood vessel,etc.)adjacent to the cyst, sometimes
conservative surgical approach is undertaken. This may
result in incomplete removal of the cyst leading to
recurrence.
 Botryoid Cyst

Botryoid odontogenic cysts are rare odontogenic cystic

lesions,which resembles cluster of grapes.
-Clinically the cyst presents a well-
defined,painless,expensile central jaw lesion.
-Radiographically there can be presence of a unilocular
or multilocular radiolucent area with well corticated margin.
-Histologically botryoid odontogenic cyst reveals multiple
cystic cavities separated from one another by fibrous septa.
-The cystic cavities are lined by cuboidal or squamous
epithelium, which are of 1-2 cell layer thickness
- Focal areas of clear cell clusters are often found
along the lining.

Treatment-
Treatment by enucleation.
 Lateral Periodontal cyst
Is an uncommon cyst that develops in immediate
association with the lateral root surface of an
erupted tooth.

Pathogenesis:
Mainly controversial, but it is generally believed that
the cyst arises from the cell rest of malassez or from
the cell rests of serres or from the reduced enamel
epithelial cells.
Clinical Features:
Age and Sex - Commonly occurs in adult males.
Common Site- Maxillary & mandibular anterior
regions are common sites.

Clinical presentation-
Clinically the lesion is mostly asymptomatic & in few
cases there may be a small,painless soft tissue
swelling within or just anterior to the interdental
papillae.
 -The overlying mucosa is generally normal in
color,but in few cases,there may be a bluish
discoloration.
-The cyst is usually less than 1cm in diameter.

Radiological features:
-Radiographically,lateral periodontal cyst presents as a
small,unilocular,”teadrop-shaped” radiolucent area on
the lateral aspect of the root.
Histopathology:
Cyst presents a small cystic cavity lined by non-
keratinized stratified squamous epithelium of 2-3 cell
layers thickness supported by a connective tissue wall.

Treatment : Cyst is enucleated and the related tooth can be

retained if healthy.
 Calcifying Epithelial Odontogenic
Cyst(CEOC) Or Gorlin's cyst

Is a relatively uncommon odontogenic cyst .

Pathogenesis:
The cyst probably develops from the reduced
enamel epithelial cells or remnants of odontogenic
epithelium.
Clinical Features:
Age-Mostly the cyst develops in the second
decade of life.
Sex- Both sexes are equally affected.

Site- Mandibular premolar region, Other common

sites are the anterior part of maxilla and mandible; also
occasionally develops from the gingiva.
Clinical presentation-

Cyst presents a bony hard swelling of the jaw, which can be

extensive.
-Most of the cysts are completely asymptomatic.
Radiological features:
Cyst presents as a unilocular or
multilocular radiolucent area.
Histopathology:
1.Cystic lumen is lined by an odontogenic keratinized
epithelium of about 6-8 cell layer thickness.
2.The basal cells of the lining epithelium are columnar
or cuboidal in nature often showing a palisading
arrangement (ameloblast like cells).
3. The spinous cells of the lining epithelium often
resemble stellate reticulum.
4. surface epithelium often shows the presence of many
“ghost cells” which are eosinophilic, keratinized cells
devoid of nuclei. These cells undergo calcification.

Treatment: By surgical enucleation.

 Dental Lamina cyst(Gingival cyst) of
The Newborn

Are the cystic lesions seen in the oral cavity of newborn or

very young infants(from Birth-upto 3 months of age).

Depending upon their locations in the oral cavity ,these cysts

are divided into several types.

1.Cysts of the dental lamina - These lesions are mostly

found along the alveolar ridge & are odontogenic in
origin(arising from the remnants of dental lamina).
2.Epstein's pearls – These small cystic lesions are found
linearly along the midpalatine raphe & are probably
derived from the epithelium, entrapped along the line of
fusion of the palate during embryogenesis.

3.Bohn's nodule – In this case,small cysts are usually found

along the junction of the hard & soft palate & on the
buccal & lingual aspects of the alveolar ridge.
These cysts are derived from the remnants of mucus
glands.
.
Clinical Features: All these types of cysts in the newborn
usually present as multiple, asymptomatic, small
discrete, white nodules.
Once formed the dental lamina cysts may
discharge the contents by fusion with the overlying
alveolar mucosa or they may undergo spontaneous
regression.

Histopathology: Microscopic section exhibits a small

keratin filled cystic cavity which is lined by a thin &
flattened squamous epithelium.

Treatment: No treatment is required.

 Gingival cyst of the adult

Is a small developmental odontogenic cyst of the gingival

soft tissue.

Pathogenesis:
The gingival cyst of adult arises from the cell rests of
the serres.
Clinical Features:

Age- Fifth & sixth decade of life

Sex- More prevalent among females.
Site- Mandible > Maxiila
Particularly in canine-premolar region.
Clinical presentation:
- Cyst is located in the gingival tissue outside the
bone.
-Clinically cyst presents as a firm, well-circumscibed,
usually less than 1 cm in diameter but compressible, fluid
filled swelling on the mandibular or maxillary facial gingiva of
canine-premolar area.

-Surface of the lesion is smooth & is of normal color as

of gingiva or bluish.

-The adjacent teeth are vital.

Radiographic features:
Since gingival cysts of adult are entirely
extraosseous lesions they do not reveal any
radiographic change in the bone.
Histopathology:
cystic lumen is lined by a thin epithelial lining made up
of flat or cuboidal cells of 2 to 3 cell layer thickness
supported by conective tissue stroma.
Treatment:
Surgical enucleation.
 Non-Odontogenic cysts

Globulomaxillary cyst

Is a cyst that arises in the bone suture, between the maxilla

& premaxiila.
Clinically the usual location of the cyst is between maxillary
lateral incisor & canine teeth.

Pathogenesis:

Earlier it was believed that the cyst develops as a result of

proliferation of the epithelium, entrapped along the line of
fusion between the maxilla & premaxilla.
Clinical features:
-The cyst is usually asymptomatic & is detected
during routine radiological examination.

- On rare occasions, there may be a small swelling in

between the upper lateral incisor & canine teeth, with
elevation of the lip.

-The associated teeth are always vital.

-It can cause pain & discomfort, etc. only when

secondarily infected.
Radiographic features:
Radiograph reveals an inverted pear-shaped radiolucent
area between the roots of the upper lateral incisor & canine.

It often causes divergence of the roots of these teeth.

In many cases, the lesion is present bilaterally.

Histopathology:

cystic cavity is lined either by a stratified or

pseudostratified ciliated columnar epithelium or by a
thin squamous epithelium and supported by connective tissue
capsule.

Treatment:
By surgical excision, with preservation of the involved
tooth.
 Nasolabial cyst
Nasolabial cyst is entierly a soft tissue cyst, which arises in
the nasolabial fold, just below the ala of the nose.

Clinical Presentation:

-The cyst produces a small, painless, swelling of the

upper lip, which often obliterates the nasolabial fold &
distorts the nostrils on one side.

-It is usually unilateral but sometimes it can be

bilateral.
-Sometimes it can be massive in size.
-It may project into the floor of the nose.
 Radiological finding Because of its location entirely within
the soft tissue,the lesion does not exhibit any radiographic change.
 Histopathology:
small cystic lumen is lined by a pseudo- stratified
ciliated columnar epithelium supported by a connective tissue
capsule.

Treatment:
Surgical enucleation.
 Nasopalatine Duct Cyst

Nasopalatine duct cyst is a relatively common, intraosseous,

cystic lesion, arising within the nasopalatine duct or the
incisive canal.

Pathogenesis:
It arises usually due to the proliferation & subsequent
cystic degeneration of the epithelial remnants remaining
after closure of the embryonic nasopalatine duct.

The initiating factors for the development of the cyst may be

trauma, inflammation & bacterial infection,etc.
Clinical Features:
Incidence- Common cyst & affects about 1% of
the population.
Age- Fourth,fifth & sixth decade of life.
Sex- Males > Females ,the ratio is 4 :1.

Clinical Presentation:
-The cystic lesion clinically presents as a
small, painful swelling in the midline of the anterior part of the
hard palate near the opening of the incisive foramen.

-It often extends onto the labial aspect of upper

alveolar ridge.
 Radiology:
Cyst presents as a small round or heart shaped radiolucent
area between the roots of upper central incisors in the midline
of the anterior maxilla.

Histopathology:
cystic cavity is lined by ciliated
columnar or nonkeratinized stratified squamous
epithelium & is supported by a connective tissue capsule.

Treatment:
Surgical excision
Pseudo cysts / Non- epithelialised
bone cysts
 Solitary Bone Cyst / Traumatic,
Haemorrhagic, Simple bone cyst,
Ideopathic bone cavity
Solitary bone cyst represents a pseudo cyst.

Clinical features:
Age - Common among young people.
Sex – Males > Females.
Site – Mandibular body, symphysis or ramus
& maxillary anterior regions, etc are the common sites.
Presentation:
In most of the cases, the cyst is asymptomatic but in few
cases ,it produces a painful, bony hard swelling of the jaw.
Pathogenesis:
The exact pathogenesis of solitary bone cyst
is not clearly known, but it is believed that the condition
develops due to trauma in the jawbone.

Investigators believe that

following trauma to the bone,
intrabony hemorrhage occurs &
if the clot does not organize properly or
liquefication occurs to the clot,
the healing of the bony wound does not take place
& as a result an intrabony cavity persists, which is called as
solitary bone cyst.
Macroscopy:
Once the cystic cavity is opened an empty space is
found in the bone, which is containing very little
blood, blood pigments & serous fluid. A thin fibrous tissue
membrane may line the cavity.

Histopathology:
cystic cavity surrounded by a
loose vascular connective wall.

Treatment:
The treatment is done by surgical exploration of the
cyst; it helps in causing further hemorrhage in the area
with subsequent healing.
 Aneurysmal Bone Cyst
Aneurysmal bone cyst is an uncommon cystic
lesion.

Clinical features:
Age – Usually second decade of life(10 to 19 yrs.)
Sex – Females are more commonly affected.
Site – Mandibular molar -ramus area, maxillary
posterior region.
Pathogenesis:
Pathogenesis of ABC is controversial & it
is believed that the cyst arises as a result of
trauma with subsequent venous occlusion inside
the bone.
It is also believed that the lesion occurs as
a result of cystic transformation of a preexisting
pathology,especially the central giant cell
granuloma.
 Clinical Presentation :
- ABC clinically presents a rapidly enlarging, diffuse,
firm, painful swelling of the jaw causing facial asymmetry.
- the affected area of the jaw may be pulsatile in some
cases.
-Severe expansion & thinning of the bone often
results in “egg-shell crackling” & perforation of the
cortical plates.
-Pathological fracture of the affected jawbone
may occur .
-Accidental injury or perforation of the cyst may result in
profuse bleeding.

-Paresthesia may be present on the affected side & regional

teeth are often displaced,r esulting in derangement of the
occlusion. The displaced teeth are always vital.

-There may be difficulty in mouth opening if the cyst causes

impingement on the capsule of TMJ.
 Radiology:
-Radiograph reveals a multilocular radiolucent area in
the bone,with a typical “honey-comb” appearance.
- “Balloning” expansion of the cortical plates,
displacemant of teeth & resorption of the roots of the
adjoining teeth are also commonly seen.
- A prominent feature of the cyst is the “blow -out”
bulging of the lower border of the mandible.
Histopathology:
-Microscopically ABC present multiple blood
filled spaces of varying size, which are lined by many
spindle shaped cells or flat endothelial cell s.
-Epithelial lining is absent in this cyst & the
cystic spaces are separated from one another by
connective tissue stroma.
-Multiple multinicleated giant cells,scattered
osteoid ,areas of hemorrhage & hemosiderine
pigmentations etc.are commonly present in the
hypercellular connective tissue stroma of the cyst.

Treatment:
Surgical Curettge.
 Cysts of The Salivary Gland
Cystic lesions developing from the salivary glands
are commonly known as “mucocele” and these lesions
develop mostly in relation to the minor salivary glands
& rarely in relation to the major salivary glands.

Mucoceles are basically of two types:

1.Mucous retention cyst (True cyst).
2.Mucous extravasation cyst(pseudo cyst).
 Etiology & Pathogenesis:
1.The mucous retention cyst develops as a result of
obstruction to the minor salivary gland, which leads to
accumulation of saliva within the gland or its duct, thereby
causing its expansion.

This happens in case of obstruction to the salivary gland

duct due to:
Calculus formation, Scarring, Crushing of the
duct(as a result of trauma) & atresia (congenital
absence of duct in the salivary gland), etc.
2.Mucous extravasation cyst on the other hand, develops as a
result of damage to the salivary gland duct, which leads to
the extravasation of the saliva into the connective tissue.

Trauma is the most important etiological factor in this cyst.

 Clinical Features:
-Mucoceles occur at any age & both sexes are
almost equally affected.
-Lower lip is the most common site for their
occurrence, followed by cheek, palate & tongue.
- Some swellings develop only during
mealtime & these are absent in between.
- The superficial lesions appear as
- -small, raised, vesicle-like areas, measuring from few
millimeters to few centimeters in diameter & they
have bluish appearance.
- These swellings often recur & are usually
round or oval shaped, smooth & fluctuant.
- The deep-seated lesions usually cause small
but diffuse swellings, with no color change in the
overlying mucosa.
Histopathology:
1. Mucous retention cyst
a small cystic cavity filled with mucous is
lined by flattened epithelial cells of the salivary gland
duct and supported by connective tissue , which is
containing multiple macrophages,PMN, eosinophils &
specially lymphocytes.
In the vicinity of the lesion a minor salivary gland is almost
always present.

2. Mucous extravasation cyst

a cystic cavity filled with mucous is surrounded by a
compressed connective tissue, which is containing
multiple macrophages,PMN, eosinophils & specially
lymphocytes.
Treatment:
Surgical excision of the lesion along with involved
gland.
 Ranula
Ranula is a form of mucocele that specifically occurs in
the floor of the mouth, in association with the duct of the
sublingual salivary glands or rarely the submandibular
gland.
The ranula represents either as an extravasation or
a retention cyst.

Etiology:
-Obstruction to the duct by calculus(sialolith)
formation.
- Compression of the duct by trauma or a
growing tumor in the vicinity.
 - Perforation of the duct due to injury.
- Absence of the duct itself(atresia)
-Scar or stricture formation to the duct,
specially after surgery.

Clinical Features:
-Clinically “ranula” presents a soft,fluctuant,
unilateral swelling in the floor of the mouth,which
often causes deviation of the tongue.
-The lesion typically has a bluish translucent
appearance & it often resembles the distended
“frog's belly”(for which the name ranula has
developed).
-If the lesion is a deep-seated one,the bluish
coloration is usually absent & when such lesion
herniates through the mylohyoid muscle,they are called the
“plunging” type of ranula.
 -In many cases,ranula can cross the midline of the
floor of the mouth & can even obstruct air-way.

Histopathology:
The extravasation type of ranula
microscopically presents large mucous -filled area
which is surrounded by a connective tissue wall.
The retention type of ranula reveals the
mucous filled area which is lined by an epithelial
lining of the salivary gland.
In both the cases,sialoliths may be found
within the duct systems.

Treatment: Surgical excision or marsupialization

along with elimination of etiological factor.
Excision of involved gland in case of recurrence
 Dermoid Cyst
It is a developmental cyst derived from the remnants
of the embryonic skin.

Clinical features:
Age – Young adults
Sex - Male = Female
Site – Skin around the eyes,anterior upper
neck & the floor of the mouth.
Presentation:
- A pain less swelling,which is often having a
doughy consistency.
- The cyst,which develops above the
myelohyoid muscle,presents a sublingual swelling in
the midline.
- It often causes elevation of the tongue
with difficulty in eating & speaking.
-The cyst below the myelohyoid muscle often
produces a midline swelling in the submental or
submandibular region.
-Size varies from few milimeters upto 2
centimeters.
 Histopathology:
- A cystic cavity lined by orthokeratinized
stratified squamous epithelium,which exhibits
hair follicles,sebaceous glands & erector pili muscles
etc.
- The cavity lumen is often filled with sebum,
descuamated keratin & hair shafts.
-The cyst capsule is composed of a narrow
zone of compressed connective tissue.

Treatment:
Surgical enucleation.
 Surgical Cilliated Cyst Of Maxilla
It is an iatrogenic cyst, which develops as result of
surgery involving maxillary sinus.

Clinical Features:
Age – Middle aged to old aged adults.
- Pain & tenderness in the maxilla is present.
- There is history of previous surgery in the
maxilla.

Radiographic Features:
X- ray reveals a well-circumscribed radiolucency
in close proximity of the maxillary sinus.
 Histopathology:
-The cyst is lined by a pseudostratified ciliated
columnar epithelium.
-The surrounding connective tissue is either
normal or inflamed.

Treatment:
Surgical enucleation.