Cysts of the jaw

Cyst: its a pathological cavity lined by epithelium & filled with fluid or semi fluid material. In the jaw bones & oral tissue there are remnant of epith. come mostly from odontogenic apparatus & most of these remnants are embryonic in origin .for this reason the jaw bone are affected by a large numbers of cysts in comparism to other bones in the body. The epith. remnants that give rise to these cysts are: 1- Reduced enamel epithelium. 2- remnants of dental lamina. 3- epithelial rests of Malassez.

Classification of the jaw cysts I-Epithelial cysts A- odontogenic:

1- developmental cyst (odontogenic keratocyst, dentigerous cyst, eruption cyst, lateral periodontal cyst, gingival cyst, glandular cyst) 2- inflammatory cyst (radicular cyst, paradental cyst)

B- non-odontogenic:
Nasopalatine duct cyst, nasolabial cyst

II-Non epith. (primary bone cysts)

Solitary bone cyst (traumatic, simple), aneurysmal bone cyst, Stafine cyst

III-Soft tissue cysts:

Salivary mucoceles (mucus extravasation, mucus retention) Dermoid & epidermoid cyst Lymphoepithelial cyst Thyroglossal tract cyst

Odontogenic cysts
A cyst in which the lining of the lumen is derived from epithelium produced during tooth development, these include: 1- cysts derived from rests of Malassez: Periapical cyst (radicular) 2- cysts derived from reduced enamel epithelium: reduced enamel epithelium refers to the layer of epith. That remains around the tooths crown after enamel formation is complete. This layer of epith. Is derived from the specialized epith. Components of the enamel organ (inner enamel epith., stratum intermedium, stellate reticulum, & outer enamel epith.)That were active during amelogenesis, & collapse into a thinned dormant membrane of two or three cells in thickness.

A- Dentigerous cyst :

an odontogenic cyst that surrounds the crown of an impacted tooth, caused by fluid accumulation between the reduced enamel epith. & the enamel surface, resulting in a cyst in which the crown is located within the lumen & root outside.

Clinically:
These cysts are commonly associated with unerupted mand. or max. third molars or max. canine. The cyst usually remains asymptomatic but may produce some swelling or pain, particularly if it is large or inflamed.

Radiographically:
Mostly diagnosed by their radiographic appearance. They present as well circumscribed radiolucency surrounding the crown of a tooth.

B- Eruption cyst: Is a variant of the dentigerous cyst that develops in the

alveolar soft tissue around the crown of an erupting tooth.

Clinically, appear as fluctuant swelling of the alveolar ridge, the lesion may bleed during mastication giving rise to the term eruption hematoma Histologically, same as those of a dentigerous cyst. Most of these cysts require no treatment because rupture spontaneously during mastication. But sometime surgical exposure of the crown of affected tooth may be needed.

3- cysts derived from dental lamina:

A- Odontogenic Keratocyst ( okc): A cyst derived from remnants of

the dental lamina. Its less common than the dentigerous cyst but more serous because epith. Lining show high rate of growth.

Clinically:
Occurs in young patient, however, it can occur at any age. The mand. Is affected more commonly than max. in the mand., the cyst occur mostly in the 3rd molar area, while in the max., the 3rd molar & canine areas are usually affected. The cyst is slowly growing & asymptomatic, but later it may cause bone expansion. Although okc is usually present as a single lesion, it can occasionally occur as multiple cysts that sometimes occupy all four quadrants of the jaws as in nevoid basal cell carcinoma.

Radiographically:

appear as a well defined, solitary lesion or as a multilocular radiolucency with a thin cortical margin & displacement of the adjacent tooth.