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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 cystQ: Why are they not cysts?A: No epithelial lining!

    CystCystA Cyst is a benign pathologic cavity filled withA Cyst is a benign pathologic cavity filled with

    fluid, lined by epithelium, and surrounded by afluid, lined by epithelium, and surrounded by aconnective tissue wallconnective tissue wall

    A = connective tissue wallA = connective tissue wallB = epitheliumB = epithelium

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    kistakistaPenampakan radiografis:Penampakan radiografis:Lokasi:Lokasi:1. dapat muncul dimana saja baik1. dapat muncul dimana saja baik

    di maksila atau mandibuladi maksila atau mandibula2. kista odontogenik sering muncul2. kista odontogenik sering muncul

    disekitar regio gigi,disekitar regio gigi,di mandibula di atas kanalisdi mandibula di atas kanalisnervus alv inf.nervus alv inf.di maksila di dekat antrumdi maksila di dekat antrum

    Batas periferBatas perifer : mempunyai batas: mempunyai batasyang jelas ditandai denganyang jelas ditandai dengangaris radiopak yg tipisgaris radiopak yg tipis

    BentukBentuk : bulat atau oval, seperti: bulat atau oval, sepertibalon yang berisi air.balon yang berisi air.

    Struktur bag dStruktur bag d lm: terlihatlm: terlihatradiolusenradiolusen

    Effects on adjacent structuresEffects on adjacent structures

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

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    Mar 13th, 2007Mar 13th, 2007 77

    MarMar 1313th,th, 20072007 88

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    Mar 13th, 2007Mar 13th, 2007 99

    Mar 13th, 2007Mar 13th, 2007 1010

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    Mar 13th, 2007Mar 13th, 2007 1111

    MarMar 1313th,th, 20072007 1212

    PerioralPerioral C ystsCysts

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    MarMar 1313th,th, 20072007 1313

    PerioralPerioral C ystsCysts

    MarMar 1313th,th, 20072007 1414

    PerioralPerioral CystsCysts

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    TypesTypes

    OdontogenicOdontogenicNonNon--OdontogenicOdontogenicPseudocystsPseudocysts

    Radicular cystRadicular cystResidual cystResidual cystDentigerous cystDentigerous cystParadental cysts (BuccalParadental cysts (Buccalbifurcation cysts)bifurcation cysts)Odontogenic KeratocystOdontogenic Keratocyst(OKC)(OKC)

    Basal cell nevusBasal cell nevus- -bifid ribbifid ribsyndrome (multiple OKC)syndrome (multiple OKC)Lateral periodontal cystLateral periodontal cystCalcifying odontogenicCalcifying odontogeniccystcyst

    NasopalatineNasopalatine cystcystNasolabialNasolabial cystcystDermoidDermoid cystcystCysts formerly known asCysts formerly known asdevelopmental cystsdevelopmental cysts

    Odontogenic Cysts Non-Odontogenic cysts

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    PseudocystsPseudocysts

    Simple bone cyst (Traumatic bone cyst)Simple bone cyst (Traumatic bone cyst)Aneurysmal Bone CystAneurysmal Bone CystMucous Retention CystMucous Retention CystStafne Bone Cyst (Stafne Bone Defect)Stafne Bone Cyst (Stafne Bone Defect)

    Radicular cytsRadicular cytsResults from theResults from thestimulation ofstimulation ofthe epithelial cellthe epithelial cellrests in the PDLrests in the PDLby theby theinflammatoryinflammatoryproducts fromproducts fromthe nonthe non- -vitalvitaltoothtoothMost commonMost commontype of cysts intype of cysts inthe jawsthe jaws

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    MarMar 1313th,th, 20072007 1919

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    Periapical cyst orPeriapical cyst orgranuloma (chronic localized osteitis)granuloma (chronic localized osteitis)

    Impossible to tell radiographically which one it is only histologically, so youmust 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)Dentigerous cyst (follicular cyst)Develops around the crown of an uneruptedDevelops around the crown of an uneruptedpermanent or supernumerary toothpermanent or supernumerary toothSecond most common type of cyst in the jawsSecond most common type of cyst in the jawsAsymptomaticAsymptomaticInternal aspect is completely lucent except forInternal aspect is completely lucent except forthe crown of the involved tooththe crown of the involved toothEither resorbs or displaces the adjacent teethEither resorbs or displaces the adjacent teethFollicular spaces >Follicular spaces >5 5mm (normalmm (normal 22--33 mm) shouldmm) shouldbe closely followed for potential development ofbe closely followed for potential development ofdentigerous cysts.dentigerous cysts.

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    Paradental cystsParadental cysts

    (Buccalbifurcation cysts)(Buccalbifurcation cysts)Most common in theMost common in the 6 6-- toto 1111--yearyear--old age group.old age group.Usually associated with the mandibular first molar,Usually associated with the mandibular first molar,occasionally the mandibular second molar.occasionally the mandibular second molar.The associated tooth has an altered eruption pattern withThe associated tooth has an altered eruption pattern withbuccal tilting of the crown.buccal tilting of the crown.The associated tooth is vital.The associated tooth is vital.Deep periodontal pockets on the buccal aspect of theDeep periodontal pockets on the buccal aspect of thetooth.tooth.+/ +/-- swellingswelling

    +/ +/-- pain or tendernesspain or tenderness+/ +/-- infection.infection.

    David LA, Sandor GKB, Stoneman DW, The buccal bifurcation cyst: Is non-surgical treatment an option? JCDA 64(9) 712-717 1998.

    Mar 13th, 2007Mar 13th, 2007 2828

    Paradental CystParadental Cyst

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    Buccal Bifurcation CystBuccal Bifurcation Cyst

    Odontogenic Keratocyst (OKC)Odontogenic Keratocyst (OKC)

    An OKC is a nonAn OKC is a non- -inflammatory odontogenic cystinflammatory odontogenic cystthat arises from the dental lamina. Thethat arises from the dental lamina. Theepithelium in OKC appears to have innateepithelium in OKC appears to have innategrowth potential similar to some benign tumors.growth potential similar to some benign tumors.Asymptomatic, swelling on occasionAsymptomatic, swelling on occasionPain from secondary infectionPain from secondary infectionAspiration may reveal thick yellow cheesyAspiration may reveal thick yellow cheesymaterial (keratin)material (keratin)High recurrence rate after surgical enucleationHigh recurrence rate after surgical enucleation

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    Odontogenic KeratocystOdontogenic Keratocyst(Keratocystic Odontogenic Tumor)(Keratocystic Odontogenic Tumor)

    Can be in the location of ANY other type of odontogenic cyst or can be isolated inthe 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 i ts remnants

    PTCH gene is a significant factor in the development of KOT

    MarMar 1313th,th, 20072007 3232

    Odontogenic Keratocyst OKCOdontogenic Keratocyst OKC

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    Mar 13th, 2007Mar 13th, 2007 3333

    Odontogenic Keratocyst OKCOdontogenic Keratocyst OKC

    Mar 13th, 2007Mar 13th, 2007 3434

    Odonto genic Keratocyst OKCOdontogenic Keratocyst OKC

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    (Vital teeth)

    OKCOKC

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    Nevoid Basal Cell CarcinomaNevoid Basal Cell CarcinomaSyndromeSyndrome

    GorlinGorlin--GlotzGlotz Syndrome/ Multiple OKCSyndrome/ Multiple OKC

    Multiple OKCMultiple OKC

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    Lateral periodontal cystLateral periodontal cystUsually unicystic, it mayUsually unicystic, it mayalso appear as a clusteralso appear as a clusterof small cysts "botryoidof small cysts "botryoidodontogenic cystsodontogenic cystsArise from the epithelialArise from the epithelialrests in the periodontiumrests in the periodontiumlateral to the rootlateral to the root5050--7575%% develop in thedevelop in themandible from lateralmandible from lateralincisor to the premolarincisor to the premolarregionregion

    In the maxilla, theyIn the maxilla, theyappear between lateralappear between lateralincisor and canineincisor and canine

    Calcifying odontogenic cystCalcifying odontogenic cystCalcifying odontogenic cysts have aCalcifying odontogenic cysts have awide age distribution that peaks atwide age distribution that peaks at 10 10toto 1919 years of age, with a mean ageyears of age, with a mean ageofof 3636 yearsyearsClinically, the lesion usually appearsClinically, the lesion usually appearsas a slowgrowing, painless swelling ofas a slowgrowing, painless swelling ofthe jaw. Occasionally the patientthe jaw. Occasionally the patientcomplains of pain. In some cases thecomplains of pain. In some cases theexpanding lesion may destroy theexpanding lesion may destroy thecortical plate, and the cystic masscortical plate, and the cystic massmay become palpable as it extendsmay become palpable as it extendsinto the soft tissue.into the soft tissue.Aspiration often yields a viscous,Aspiration often yields a viscous,granular, yellow fluid.granular, yellow fluid.

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    2

    MarMar 1313th,th, 20072007 4141

    Residual C ystResidual Cyst

    Mar 13th, 2007Mar 13th, 2007 4242

    Residual CystResidual Cyst

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    Nasopalatine duct cystNasopalatine duct cyst

    incisive canal cystincisive canal cystIf it involves theIf it involves theposterior hard palate,posterior hard palate,termed mediantermed medianpalatal cystpalatal cystAnteriorly, may beAnteriorly, may becalled median anteriorcalled median anteriormaxillary cyst,maxillary cyst,depending on thedepending on theradiographic featuresradiographic features

    Nasolabial cystsNasolabial cystsSource of theSource of theepithelium may beepithelium may beembryonicembryonicnasolacrimal duct,nasolacrimal duct,which initially lies onwhich initially lies onthe bone surface.the bone surface.

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    PseudocystsPseudocysts

    Incisive Canal CystIncisive Canal CystStafneStafne Bone CystBone CystTraumatic Bone CystTraumatic Bone CystSurgical Ciliated Cyst (of Maxilla)Surgical Ciliated Cyst (of Maxilla)

    Incisive Canal CystIncisive Canal CystDerived from epithelial remnants of theDerived from epithelial remnants of thenasopalatine duct (incisive canal)nasopalatine duct (incisive canal)44 thth toto 66 thth decadesdecadesPalatal swelling common, asymptomaticPalatal swelling common, asymptomaticRadiographic findingsRadiographic findings WellWell--delineated oval radiolucency betweendelineated oval radiolucency between

    maxillary incisors, root resorption occasionalmaxillary incisors, root resorption occasionalHistologyHistology Cyst lined by stratified squamous orCyst lined by stratified squamous or

    respiratory epithelium or bothrespiratory epithelium or both

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    Incisive Canal CystIncisive Canal Cyst

    Stafne Bone CystStafne Bone CystSubmandibular salivary gland depressionSubmandibular salivary gland depressionIncidental finding, not a true cystIncidental finding, not a true cystRadiographsRadiographs small, circular, corticatedsmall, circular, corticatedradiolucency below mandibular canalradiolucency below mandibular canalHistologyHistology normal salivary tissuenormal salivary tissue

    TreatmentTreatment routine follow uproutine follow up

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    Stafne Bone CystStafne Bone Cyst

    Traumatic Bone CystTraumatic Bone CystEmpty or fluid filled cavity associatedEmpty or fluid filled cavity associatedwith jaw trauma (with jaw trauma (5050%)%)Radiographic findingsRadiographic findings Radiolucency, most commonly in body orRadiolucency, most commonly in body or

    anterior portion of mandibleanterior portion of mandibleHistologyHistology thin membrane of fibrousthin membrane of fibrousgranulationgranulationTreatmentTreatment exploratory surgery mayexploratory surgery mayexpedite healingexpedite healing

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    Traumatic Bone CystTraumatic Bone Cyst

    Surgical Ciliated CystSurgical Ciliated CystMay occur following CaldwellMay occur following Caldwell- -LucLucTrapped fragments of sinus epitheliumTrapped fragments of sinus epitheliumthat undergo benign proliferationthat undergo benign proliferationRadiographic findingsRadiographic findings Unilocular radiolucency in maxillaUnilocular radiolucency in maxilla

    HistologyHistology Lining of pseudostratified columnar ciliatedLining of pseudostratified columnar ciliated

    TreatmentTreatment - - enucleationenucleation

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