 Hello everyone, welcome back to another session in dentistry and more. Today's session is about various cysts of the jaws. So this session is about the definition of cyst, the parts and stages of cyst formation, then its classification and the details about relations with regard to pathogenesis clinical features, radiographic features, histopathology, differential diagnosis and management. So the word cyst is derived from a Greek word that is kystis which means bladder or pouch. So we know the cyst looks like a bladder or a pouch with a proper encapsulation or epithelial lining and this is the second most common pathological radiolusincy in the jaw. So we have many definitions for cyst, the most commonly accepted is the Kramer one, it is a pathological cavity having fluid, semi-fluid or gaseous contents and which is not created by accumulation of pus and is often encapsulated or lined by epithelium. So a cyst will be always with encapsulation or epithelial lining. So this part is a crucial part of a cyst which has encapsulation or epithelial lining. So these are the parts of cyst which has lumen surrounding epithelium and further surrounded by a connective tissue capsule. So epithelium would be stratified squamous epithelium or pseudo stratified columnar and the capsule consists of fibroblast, fibrosite, collagen, elastin and other cellular components. So a cyst develops when the stimulation happens then it leads to the proliferation that is the multiplication then there will be the arrangement of cells with the creation of lumen inside. So the final cyst will be a peripherally arranged cells with a lumen at the middle of the cells, aggregation of cells. Theories of cyst enlargement which was summarized by Malcolm Harris in 1975 focusing on three concepts that is mural growth, hydrostatic enlargement and bone reserving factors. The mural growth were focusing on peripheral solution and accumulation of cellular content, hydrostatic enlargement on secretion, transtection and exudation and bone reserving factors on osteoclastic activity. So let's see the classification of cysts. So Robinson as classified as ordentogenic and non-ordentogenic. So in ordentogenic we have periodontal, radicular, lateral, residual, dendritus and primodial cysts whereas non-ordentogenic that is non tooth related tissues. This is tooth related tissues. So non-ordentogenic tissues we have median cyst, incisive, canal cyst and globulo maxillary cyst. In another classification given by WHO it is based on the developmental and inflammatory cell developmental we have ordentogenic and non-ordentogenic just like what we have seen. Some additional classification, the alveolar cyst of infants, gingeral cyst of adults and we have non-ordentogenic mid-palatal cyst of infants. In inflammatory we have follicular cyst, radicular cyst and lateral periodontal cyst. So shear classification is a very simple one, the epithelial line and non-epithelial line. So in epithelial we have development and inflammatory development, ordentogenic and non-ordentogenic. So cysts of maxillary andrum are benign mucosal cyst or surgical ciliated cyst of maxilla and cyst of soft tissues of mouth, face and neck all these cysts will coming under this category. Now let's begin with okc or ordentogenic keratocyst. So ordentogenic keratocyst which has lots of synonyms such as dermoid cyst, colostia derma, primordial cyst, keratocyst derma. So okc was named by Philipson in 1956. So it is arising from dendral lamina or its remnants by proliferation of basal cells of oral epithelium. In clinical features its incidence is 3 to 11 percentage of all ordentogenic cyst and it has a bimodal peak that is third and sixth decade and the predilection is more in males and it is commonly seen in ankle and ascending ramus of mandible and it has got symptoms such as pathological fracture, pain, swelling, discharge, paracetia of lower lipoteat because of the nerve involvement and also since the cyst becomes enlarged and reserves the surrounding bonds and there will be displacement of teeth and anterior posterior expansion. So when we take aspirate we get a odorless, creamy or cheesy content. In radiographic features we see a round or oval well-quarticated radiolucency with large expansile and scaloptor multi-locular lesion which displays uninterrupted, impacted teeth and also the inferior alveolar canal. So there will be perforation of the cortex and the epicenter is above the inferior alveolar canal where the cyst origins and it grows along the internal aspect of jaw with minimal expansion. So I can see a cyst over here. So it expands along the internal aspect of jaw with minimal expansion. So internal aspect of jaw with minimal expansion. You can see this. So it has a few radiological types such as follicle assist which surrounds the crown of an unerupted tooth and is attached to the neck of the tooth which is known as dentisist. Envelopmental type which may envelop an adjacent impacted tooth, replacement type which forms in place of normal teeth, extraneous type which is in the ascending ramus away from the tooth and collateral type is adjacent to root of tooth similar to our lateral periodontal cyst. So in histologic features you can see the satellite cyst which is a unique feature and the term stone appearance of the basal cells. The basal cell has term stone appearance. Then we can see a separation of lining from the capsule, then the big lumen and the parachartinized epithelium. So based on the histology we have two types that is one is parachartinized it is a major one which has aggressive and high rate of recurrence whereas the orthocratinized one which produces only orthocratin which is associated with dentiture assist around third molar which is less aggressive and which is not associated with nevoid basal cell carcinoma syndrome. So there are few syndromes where the O.K.C.E. is reported such as N.B.C.C.S., Murphan syndrome, Ehlers-Dangler syndrome and Noonan syndrome. So we have differential diagnosis one is amyloblastoma, the residual cyst, odendogenic mixoma, traumatic bone cyst and the dentiture assist. So in management we need to go for inoculation, masopilization or peripheral ostectomy, osceous restriction, chemical characterization or decompression. The recurrence rate in O.K.C.E. is comparably high because of the presence of satellite cyst and the thin epithelial lining it has got intrinsic growth potential and proliferation of basal cell. So it has proven that it is a neoplastic change. So it has got neoplastic change because the nevoid basal cell carcinoma syndromes reports the presence of O.K.C. Now we move on to dentiture assist. Dentiture assist encloses the crown of an uninterrupted tooth by expansion of its follicle which is attached to its neck which is also known as follicular cyst or pericoronal cyst. So Brown and Smith named the cyst as dentiture assist which is two-layered enamel epithelium that is reduced enamel epithelium. So it was actually covering the newly formed enamel and it will disintegrate once it erupts into the oral cavity and it merges with the gengeval epithelium and finally it becomes junctional epithelium. But what happens if it is not disintegrates and if it starts collecting fluid between the enamel and this reduced enamel epithelium? This formation happens. So there will be degeneration of stellate reticulum at an early stage of development with associated enamel hyperplasia. So after completion of crown formation by accumulation of fluid between layers of reduced enamel epithelium. So the enamel epithelium will become reduced enamel epithelium when the stellate reticulum collapses and the outer and inner enamel epithelium comes closer. So if there is degeneration of stellate reticulum at very early stage of development with enamel hyperplasia there will be accumulation of fluid between this reduced enamel epithelium. So extra follicular type is appears to be developmental or follicular ordentogenic keratocyst. So how does the cyst expand? So it is by the tooth erupts the pressure on the impacted follicle there will be venous stasis on transudation of serum which increases the hydrostatic pressure and finally the cyst expands. So in clinical features it is commonly seen in second to third decades and in males. The common site is mandibular third molar or maxillary canine areas. Also mandibular primolar and maxillary third molars and it could also be found associated with supernumery and odendoms. Mostly it is asymptomatic unless it is secondly infected and it presents as a slow growing swelling which can cause asymmetry and the aspiration will be thin watery yellowish fluid with occasional blight. So in radiographic features there will be unilocular well-defined radiolusin lesion with sclerotic border around an unirrupted tooth crown. So this is a cyst it is around the tooth crown a radiolusin lesion with sclerotic border you can see a sclerotic border which is around the neck of unirrupted tooth. So cortical plate expansion will be there. So usually CBCT or CT will be used to determine the relationship of the cyst to the mandibular canal prior to the surgery and MRI investigation also will be done. So we have three radiological variations. One is the central variety where the crown is this is a central variety you can see central variety where the cyst is completely encloses the crown from one side to the other side where the tooth is centrally located where the crown is enveloped symmetrically here the pressure is applied to crown pushing it away from its direction of eruption. So the mandibular third molar is a common example which is found at the lower border of mandible or ascending ramus maxillary canal which forced into maxillary sinus maxillary incisors which is forced to the floor of nose whereas a lateral variety which is not symmetrical it is mainly on one side of the tooth so which results from dilation of follicle on one aspect of crown okay not symmetrically on either side which is commonly seen when an impacted mandibular third molar is partially erupted so that its superior aspect is exposed. So you can see the superior aspect is exposed and its partial eruption. The third one is circumferential type in which the entire tooth appears to be enveloped by cyst you can see the entire tooth okay so this is a tooth the entire tooth okay so the entire tooth is enveloped this variety we differentiated from envelopmental type of keratosis. So differential diagnosis we have hyperplastic follicle adenomatode odendogenic tumor calcifying odendogenic cyst ameloblastoma odendogenic keratocyst and finally the radicalocyst so just like the first cyst we have just like our O.K.C. okay we have dentigerocyst associated with few syndromes like cledocranial dysplasia basilsilneva syndrome mortex lame syndrome okay management by inoculation along with the removal of tooth or marsupialization of large cyst and decompression with orthodontic treatment the complications could be after a incomplete surgical removal such as ameloblastoma this lining epithelium or from the rest of odendogenic epithelium ameloblastoma could develop or epidoma or gastronoma from mucoepidoma or gastronoma from lining epithelium from dentigerocyst which contains mucus secreting cells next we have eruption cyst which is also known as eruption hematoma which is nothing but a dentigerocyst occurring in soft tissues occurs when tooth is impeded in its eruption within soft tissues overlaying bone so this is a eruption cyst dilation of tooth follicle by accumulation of tissue fluid or blood clinical features it will be well circumscribed flexuant translucent and commonly seen with mantibular primary incisors and first permanent molars transillumination helps to distinguish eruption cyst and eruption hematoma ok cyst and hematoma is different cyst and hematoma are entirely different on a microscopic feature cyst has a lining it has a lumen with disintegrated content whereas hematoma is just a collection of blood in radiographic which is how we get a shadow of soft tissue with expansion of follicular space without any bone involvement and there will be dilated and open crypt so we can excise the derm of the cyst exposing the tooth crown differential diagnosis it could be misdiagnosed as dentigerocyst or gingival cyst so gingival cyst of newborn it is seen in newborn babies mainly due to this dental lamina epithelial remnants these remnants will become proliferate and around 15 to 20 weeks it will become a cyst so it looks like a small white cream colored cyst in newborns up to three months at the crest of maxilla and mandible so it could be misdiagnosed as abstinibles which is seen on the mid palatine raffae which is derived from entrapped epithelium along the line of fusion or also it could be bonds nodules that is buccal and lingual aspects of maxillary and mandibular ridges derived from remnants of mucus glands so treatment is just a removal of condense the lateral periodontal cyst and vortioid cyst it is also from reduced enamel epithelium or cell rest of molasses or remnants of dental lamina most commonly seen around 50 years and in males the sites are lateral roots of mandibular canine like primolar and anterior maxilla symptoms gingival swelling with normal overlying mucosa and the teeth will be mostly vital so most of the cases when the tooth is associated with cyst the teeth becomes non-vital but this is a lateral periodontal cyst and most of the cases the tooth will be vital so in radiographic features it appears as round or oval or tear drop shaped so you can see and see a tear drop shape and well circumscribed red erosion area with this clearotic margin which has less than 1 centimeter in diameter and there is no resorption of adjacent teeth and unlike many other cysts there will not be any resorption of adjacent teeth so it is lined by non-characterizing layer of squamous or cuboidal epithelium with glycogen rich clear cells differential diagnosis lateral radical assist where the tooth will be non-vital also lateral dentigerosist associated with impactor tooth or lateral periodontal abscess gingival cyst or mental foramen so mental foramen also means diagnosed as our lateral periodontal cyst because of its peculiar location and if it is present between the primolars management commonly by surgical excision without extracting the tooth so gingival cyst of adult this uncommon cyst either in free or attached ginger soft tissue counterpart of lateral periodontal cyst it is due to the cystic transformation of dental amine or glands or rest of sera or also from traumatic implantation of surface epithelium commonly seen between 50 to 60 years but in females and common sites are mandible to canine primolar region so in symptoms it is attached ginger or the interdental papilla of facial aspect to the small soft painless growth which is dome like shaped with well circumscribed which is ranging from less than 1 centimeter in diameter sometimes blue color and radiographic features there will be soft tissue lesion if enlarges to sufficient size then there will be faint round shadow which is indicative of superficial bone erosion and differential diagnosis lateral periodontal cyst peripheral joint cell granuloma traumatic fibroma management just by surgical excision now we have glandular odendogenic cyst it is derived from dental lamina and it is name given by krammer also known as muco epitomoid odendogenic cyst because of the presence of both secretory elements and stratified squamous epithelium so most common in the sixth decade in male groups and site is mandible or anterior which originate as a small painless swelling which has propensity to grow large and recur so radiographic features there will be cortical boundary which is more than scalloped so you can see the radiographic features both unilocular and multilocular appearance expansion of cortical plates with regions of perforation and also displacement of teeth histologic features this will be superficial layer of epithelium or columnar cuboidal cells will be hobnail with cilia or filiform extension of cytoplasm ameloblastoma kot lateral periodontal cyst or butchered cyst or the differential diagnosis we can manage it by local block excision rather than inoculation because of its unpredictable nature of recurrence now we have ceot that is calcifying epithelial odendogenic cyst synonyms are goreland cyst cystic carotinizing tumor then calcifying ghost cell odendogenic cyst calcifying cystic odendogenic tumor so the t was first described by goreland in 1962 which is unusual and rare relation with features of cyst and also that of a solid neoplasm wh now categorizes this entity as a tumor not as a cyst clinical features around the second decade which is a bimodal distribution with second peak around 70 years more common among females site is both joe seen anterior to first molars slow growing pain less willing with cortical plate destruction cystic mass become palpable and the displacement of adjacent teeth and it gives a viscous granular fluid on aspiration so it has few clinical types such as central or intraoschist which is seen within the bone occurs centrally within the bone produces heart bony expansion and may be fairly extensive whereas extra oschist or peripheral type which occurs in the soft tissue overlying the tooth bearing area which is pink in color circumscribed elevated mass which is measuring up to four centimeter and it is associated with odendogenic tumor now radiographic features it is anterior to first molar cuspid sun incisors are involved so the well-defined corticator curve borders with curved cyst like to ill-defined irregular shape with completely reducing with small 4k of calcified material as white flecks or large solid mass can see the large solid mass so which is associated with a tooth and in and it impedes its eruption there will be displacement of teeth then perforation resorption of roots histology features there will be thick layer of basal layer of columbna cells and ghost cells become calcified that is why it has got this name dysplastic bentine which is laid down adjacent to basal layer differential diagnosis dentistry assist aot ossifying fibroma fibrous dysplasia cementoblastoma can be managed by inoculation or cure attached now we have the inflammation cyst or the radical assist which is also known as periapical cyst apical periodontal cyst or root and cyst which is the most common cyst which arises from epithelial cell rest of molasses in the periodontal ligament just stimulated to proliferate and undergo cystic degeneration as a result of inflammation so in pathogenesis there will be caries trauma or periodontal disease which leads to the death of pulp there will be necrotic deprise which stimulate inflammation then apical bone inflammation there will be formation of granuloma then stimulation of epithelial rest of molasses epithelial proliferation the segregation of cells and assist formation finally the periapical cyst so the periapical cyst formation segregation it becomes a cystic cavity so there are three phases first is initiation where the cyst epithelium derived from the epithelial rest of molasses in the periodontal ligament and bacterial endotoxins are the main initiators of the inflammation so there will be local changes in the connective tissue local changes causes decreased oxygen increased carbon dioxide and reduced pH then the cyst forms by the nutritional deficiency theory which says that cavity forms within the proliferating mass in an apical granuloma by degeneration and death of cells in the center so the cells in the center will be deprived of the nutrients and becomes cavity so the abscess theory postulates proliferating epithelium lines and abscess cavity because of the innate nature of the epithelial cells to cover exposed connective tissue surfaces then finally the cyst expansion phase by osmosis and capillary pressure so in clinical features we have the most common cyst of the oral cavity that is a 60 percentage of all cysts could be seen in any age and most commonly in males and most common site is anterior region of maxilla and symptoms that is slowly progressive painless swelling and the tooth will be non vital so you can see a non vital tooth so you can see the non vital tooth here and the cyst the expanded cortical plates okay so this is a symptomatic one it is associated with non vital tooth cortical plate expansion which will be bony heart and axial crackling and also a soft flexuant swelling the aspirate will be straw colored fluid with low protein levels and large amounts of cholesterol so the radiographic features the location is the apex of a non vital tooth that is epi center where it originates can see the apex the periphery will be well defined and if it is secondly infected that well defined border will not be there the outline is usually curved or circular the internal structure it is readily used in occasionally diastrophic calcification which may develop in long standing cyst appearing as partially distributed small particulate radio opacities so if it is affecting the nearby bones it will cause the resorption and displacement of fruits and the cortical plates will be expanded it will become curved or circular pattern and also imagination of the antrum is reported with the case of upper teeth and it may displace the mandibular nerve canal in an inferior direction so you can see the periapical cyst so differential diagnosis could be periapical granuloma scar resurgical defect lateral periodontal cyst or periapical cemental dysplasia traumatic bone cyst or mandibular infected buccal cyst so management we need to do rct it has a potential to heal without surgical intervention sometimes rct plus periodontal surgery and bone graft sometimes extraction curatage and enucleation so untreated radical assist may give rise to amyloblastom or commasal carcinoma next we have residual cyst which is nothing but assist that may persist after the extraction of causative tooth okay which is more common cause of swelling in edendulis jaw in older person now we have non odendogenic cyst the first one is nasopalatine defect assist which is a most common non odendogenic cyst which is one percentage of the population is affected arises from the embryonic remnants of nasopalatine defect or incisive canal defect it is formed due to trauma infection mucus retention spontaneous cystic degeneration of epithelial remnants or it could be due to any of the mentioned reason so clinical features it develops at any stage more common in fourth and fifth decade which shows slight male predilection anterior region is affected like midline of palate and asymptomatic swelling in the anterior palate drainage through tiny fistula pain due to secondary infection or pressure on the nerves and rarely a large cyst produce through and through flexion expansion involving anterior palate and labial alveolar myocosa so radiographic features we have a well circumscribed radius and see between the teeth that is central incisors in or near the midline anterior maxilla between an apical to the central incisors round or oval or inverted pier okay inverted pier or heart shaped can see a heart shaped with sclerotic border we can see a sclerotic border root resorption and bony expansion or rare diameter ranges from 1 to 2.5 centimeter the histology epithelial lining which is highly variable composed of stratified squamous epithelium or pseudo columnar epithelium simple columnar and simple cuboidal and now blood vessels and mucus salivary glands with inflammatory infiltrate ranging from mild to severe form differential diagnosis as incisive fossa radical assist dentistry assist with mesiodense or median palatal assist so we can manage it by surgical inoculation or treatment indicated only in presence of clinical symptoms and before placement of dentures the next one is nasolabial cyst synonyms are naso alveolar or clestate cyst which is a rare developments of tissue cyst occur in the lip beneath the allow of the nose so there are two theories like which develops from entrapped embryonic epithelium at the junction of medial nasal lateral nasal and maxillary process and also it could be arise from remnants of nasal lacrimal duct because of the similar location and histology so it is more common in females at around four to fifth decade in bilateral 10 percentage of the cases mostly asymptomatic and painful if secondary infected it's a fluctuate and obliterate the nasolabial fold so it arises from soft tissues in most of the cases without any radiographic changes and it is lined by pseudo stratified columnar or cuboidal epithelium and goblet cells are seen acute dendro alveolar abscess stick salivary adenoma nasal pharynchal or differential diagnosis and we can surgically excise it so this median palatal cyst or alveolar cyst or mandibular and globular maxillary cyst they were thought to develop from epithelium entrapped in the process of fusion of embryonic process but nowadays believe that they represent the posterior extension of incisive canal cyst in case of median palatal cyst and anterior extension in case of median alveolar cyst okay next we have non-epithelial lined cirrhosis aneurysmal bone cyst which is described by jave in 1942 which is an uncommon lesion seen in most bones of skeleton it is an exaggerated localized proliferative response to vascular tissue okay so it is a misnomer which does not contain vascular aneurysm and is not a true bone cyst which is modified by communication with the large blood vessels or it could be due to the lesions destroyed by hemorrhage or a vascular disturbance it has four stages osteolytic growth phase maturity phase and healing phase so it is commonly under 30 years with no sex predilection and ankle and ramus of mandible is commonly affected with a history of trauma firm swellings which may be painful swelling and malocclusion with enlargement is rapid with limited mouth opening and recent displacement of teeth which are vital axial crackling but not pulsatile ones tissue shows excessive bleeding and blood soaked sponge appearance in radiographic features it has peripheral well-defined circular lesions with multi-locular one septa which is seen in between and ill-defined at right angles to the outer expanded border which gives a soap bubble appearance expanded cortical plates which displace and the reserve the teeth we can managed by curatage and partial resection these are the differential diagnosis joint cell granuloma amyloblastoma cherubism central hemangioma randogenic mixoma stiffens bone cyst now we have solitary bone cyst which is also known as traumatic bone cyst or hemorrhage exist which is basically due to the trauma or the faulty calcium metabolism or local disturbance or ischemic necrosis of fatty marrow it is asymptomatic seen in first two decades of life in males and commonly seen in posterior mandible the teeth are vital aspiration gives a straw colored fluid radiographic features a margin blend with surroundings and scalopy between the roots and radius an internal structure without any sceptre differential agnosis or radical assist cg cg fibrous dysplasia amyloblastoma and the last one is stuffin bone cyst which is also known as lingual bone defect or static bone cavity or latent bone cyst so which is nothing but group of concavities in the lingual surface of the mandible where the depression is lined with an intact outer cortex the pathogenesis is well defined deep depression which is associated with growth of salivary gland adjacent to lingual surface of mandible where the anterior region near apical area of bica spid that is a sublingual gland where it is commonly seen and it is rarely on the ascending ramus where the parotid gland is there fifth to sixth decade is highest incidence with male predilection without any symptoms well defined round avoid or low-bladed radulosity about one to three centimeter in size which is lies below the inferior alveolar canal and anterior to ankle of mandible with well defined margins with a dense cortical border so management no need of treatment unless suspicion of development of neoplasm so that is all about various cysts of oral cavity so we have discussed in detail about the most of the cysts in oral cavity or endogenic and not endogenic varieties so I will come up with a new topic in the industry and more thank you