Odontogenic Cyst

Odontogenic Cysts
9th Semester
Maxillofacial Surgery 3
Dr.Teona Danelia
Prepared by:
Koorosh Arshi
Classification of Odontogenic Cysts
 Developmental:
 Dentigerous cyst Keratocyst
Gingival cyst
 Odontogenic keratocyst
 Calcifying odontogenic cyst

Eruption cyst Dentigerous
 Glandular odontogenic cyst
Radicular
 Eruption cyst Residual cyst
 Gingival cyst
 Inflammatory:
 Periapical (radicular cyst)
 Residual periapical (radicular cyst)

Dentigerous Cyst(follicular cyst)
● Second most common form of benign developmental odontogenic cysts.
● wide age range with a peak frequency in the second to fourth decades.
Etiology:
● Results from accumulation of fluid between reduced enamel epithelium and the crown of an unerupted tooth & unerupted
supernumerary teeth.
Clinical features:
● Asymptomatic , but large cyst result in a palpable mass & displace adjacent teeth , pain.
● The most frequently involved tooth is the mandibular third molar followed by the maxillary canine, and mandibular premolars.
● The most common clinical complication is paresthesia of the inferior alveolar nerve.
Types:
 Central: the radiolucency surrounds just the crown of the tooth.
 Lateral: the cyst develops laterally along the tooth root and partially surrounds the crown.
 Circumferential: the cyst surrounds the crown but also extends down along the root surface.
Radiographic features:
● Dentigerous cysts appear as unilocular well defined pericoronal radiolucencies centered on an impacted tooth. They have a thin
regular sclerotic margin and expand the overlying cortex without cortical breach.
Diagnosis: x-ray , biopsy, CT scan ,
Treatment :
● Enucleation ; Usually large cysts by marsupialization.
surgical exposure and incisional biopsy.
impacted mandibular canines and a well-defined, border of the dentigerous cyst is continuous with both of
radiolucent area around the crown of the impacted the impacted permanent mandibular canines.
mandibular right canine.
Enucleation
Reflection of flap and exposure Removal of bone at the labial

of surgical field aspect respective to the lesion
Operation site after

Removal of cyst from bony cavity, Surgical field after removal of placement of sutures
using hemostat and curette lesion
Marsupialization
Circular incision includes mucosa and periosteum
excess of the cyst lining are removed Packing of cystic cavity with iodoform gauze which is removed a
week later together with the sutures.
Odontogenic Keratocyst
• Rare benign developmental cysts are derived from dental lamina are constituted by a cystic space containing
desquamated keratin.
• Associated with nevoid basal cell carcinoma
• More aggressive & higher rate of recurrence
Clinical features:
• Early odontogenic keratocysts are asymptomatic , typically, clinical signs and symptoms present with bony
expansion, or infection, Swelling, pain and drainage if secondarily infected
• 60% to 80% of cases involve the mandible, particularly in the posterior body and ascending ramus
Types:
1) Sporadic cyst
2) Syndromic cyst associated with nevoid basal cell carcinoma syndrome
Diagnosis: x-ray , biopsy, CT scan ,
• Unilocular or multilocular radiolucency
• Displace or root resorb tooth
Treatment :
 Small cysts can be treated by Enucleation and bony cavity curetted.
 Large cysts have high rate of recurrence that’s why they need surgical resection and reconstruction with a
bone graft.
Nevoid Basal Cell Carcinoma Syndrome
(Gorlin Syndrome)
● Autosomal dominant inherited , uncommon
Etiology:
● Mutation in PTCH tumor suooressor gene
Clinical features:
● Skin: Multiple nevoid basal cell carcinomas ,pitting defects on palms & soles
● Oral: Multiple jaw cysts (odontogenic keratocysts) ,Mandibular prognathism ,cleft palate &lips
● Skeletal sys: bifid ribs, Frontal & temporoparietal bossing ,Hypertelorism
● CNS: lamellar calcification of falx cerebri
Diagnosis: TWO major Criteria or ONE major criteria + more than TWO Minor criteria
 Major criteria: 1) Multiple (>2) BCCs or one under 20 years 2) Odontogenic keratocysts of the jaws in Biopsy
3) Palmar or plantar pits (3 or more) 4) Bilamellar calcification of the falx cerebri 5) Bifid ribs
 Minor criteria :1) Macrocephaly 2) cleft lip or palate, frontal bossing, hypertelorism 3) Sprengel deformity, marked
pectus deformity, marked syndactyly of the digits 4) Radiological abnormalities: vertebral anomalies such as fusion
or elongation of the vertebral bodies, modeling defects of the hands and feet 5) Ovarian fibroma 6)
Medulloblastoma.
Treatment:
● Marsupialization
(a) Multiple KCOTs in the maxilla and mandible a Facial photographs. b Cleft lip and palate. c Palmar
(arrow). (b) calcification of the cerebral falx. pits. d, e Cephalometric radiograph. f Panoramic
(c) anomalies of the ribs characterized by flattening. radiograph. Red arrows show multiple cystic radiolucent
(d) spina bifida. areas, and blue arrows show root hypoplasia
Calcifying Odontogenic Cyst (Gorlin’s cyst)
● Benign developmental cyst of odontogenic origin
● containing ghost cells that may calcify
● Uncommon, mean age of occurrence of approximately 30 years
Etiology:
● COC arise from odontogenic epithelial remnants (remains) that were trapped within the bones of the maxilla and mandible
or gingival tissues.
Clinical features:
● Asymptomatic, painless swelling
● Extraosseous lesions present as a gingival swelling, which may be painful
● bony expansion
● COCs are located most commonly in the anterior regions of jaws
Radiologic features:
● Most COCs appear as unilocular well-defined lesions. The radiopaque structures within the lesions have been described
as either irregular calcifications or toothlike densities.
Diagnosis:
X-RAY , Incisional biopsy or enucleation specimen
Treatment:
● Enucleation & curettage
● COCs with other odontogenic tumor(s): Resection
(A) a vestibular curve from 41 to 43. (B) mandibular frontal section found a hypodense lesion dotted with
hyperdense lesions. Note the presence of tooth 33 included. (C) Intraoperative photograph after elevation of
a vestibular flap and before removal of the lesion. (D) and (E) Pathological anatomical section (arrow) by
keratinization giving ghost cells.
Glandular Odontogenic Cyst
(Sialo-odontogenic cyst)
● Rare developmental cysts can be aggressive & recurrence, less than 0.2% of all odontogenic cysts.
● Most commonly in middle-aged adults
Etiology:
● Cyst developed at a salivary gland or simple epithelium, which undergoes maturation at the glandular.
● Result of a traumatic event
Clinical features:
● Clinically, erupted teeth with GOCs may have mobility or displacement.
● GOCs occur in anterior part of mandible
● Swelling, alveolar expansion, pain, or paresthesia.
● Unilocular or multilocular radiolucency with well-demarcated borders crossing the midline.
Diagnosis:
● X-ray , Biopsy , CT scan
Treatment :
● Enucleation & curettage
● Resection in recurrency
Eruption cyst
● Histologically, an eruption cyst is similar to a dentigerous cyst

● Affects children and involve teeth that have no predecessors (deciduous teeth)Cyst lies
superficially in gingiva overlying the unerupted tooth
Clinical features:
● Clinically visible as a fluctuant mass on the alveolar ridge
● Appears as a soft, rounded, bluish swelling
Treatment:
● Cyst roof may be removed to allow the tooth to erupt, but most eruption cysts burst
spontaneously and require no treatment
Gingival cyst
● Rare developmental cyst derived from the rests of dental lamina, 0.5% of all odontogenic cysts
● peak incidence in fifth to sixth decade of life
Clinical features:
● Solitary, well circumscribed, small painless cyst
● Bluish, smooth surfaced, dome shaped swelling on attached gingiva or unattached alveolar mucosa
● May cause superficial pressure resorption of underlying alveolar bone
● Most common location is facial gingiva of mandibular canines and premolars
Radiologic features:
● Cyst may cause a superficial "cupping out" of alveolar bone, usually not detected on a radiograph
but apparent when cyst is excised.
Treatment:
● Local surgical excision, typically do not recur
Radicular cyst
● Inflammatory odontogenic cyst
● Most common odontogenic cyst
Pathophysiology:
● Dental caries or trauma cause chronic inflammation which eventually forms a periapical inflammation; continued
inflammation stimulates cells of the rests of Malassez, the epithelial cells undergo necrosis to form the cyst which
may be sterile or become secondarily infected
Clinical features:
● Asymptomatic
● Possible swelling (occurs slowly)
● May be painful if infected
● Round to oval radiolucency, often with well defined cortical border
● Can displace or reabsorb roots of adjacent teeth if large
Treatment:
● Extraction or endodontic treatment of the affected tooth
● total enucleation in the case of small lesions, marsupialization for decompression of larger cysts
Residual cyst
● Inflammatory fibrous and granulation tissue at the apex / periapical region of a tooth not
removed / curetted at the time of dental extraction.
Clinical features:
● Variable: range from asymptomatic and only incidentally detected on imaging, to
expansion of affected jaw region, to pain and drainage.
● Round to oval radiolucency of variable size within the tooth bearing regions of jaws at
the site of a previous tooth extraction.
Treatment:
● these lesions should be excised surgically, even in the absence of symptoms.

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Odontogenic Cysts

 Calcifying odontogenic cyst

 Residual periapical (radicular cyst)

Reflection of flap and exposure Removal of bone at the labial

Operation site after

Circular incision includes mucosa and periosteum

● Histologically, an eruption cyst is similar to a dentigerous cyst

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