Cysts

Cysts

Epithelial = True Cysts
1. Odontogenic
  1. Inflammatory
    1. Radicular cyst
      1. Non-vital tooth
      2. Pulp necrosis -> Proliferation of Cells of Malassez -> Fluid accumulation
      3. Most common = U2s
      4. Most common cyst
      5. Buccal expansion
      6. If tooth removed --> can recur as Residual cyst
    2. Paradental cyst
      1. History of pericoronitis
      2. Similar to Radicular cyst
      3. Lower 8s - buccal/distal
  2. Developmental
    1. Dentigerous cyst
      1. Unerupted tooth
      2. Derivation = tooth follicle
      3. Eruption cyst
        Extra-alveolar dentigerous cyst
        Often blood filled
        Most common = 6s
        Childen
      4. Most common = L8s & U3s
      5. Buccal expansion
    2. Odontogenic Keratocyst
      1. Vital teeth
      2. No buccal expansion
      3. Gorlin-Goltz syndrome
        BCCs
      4. Posterior mandible
      5. High recurrence rate
      6. Derivation = Dental lamina/Cell rests of Cerres/Enamel organ
      7. Most aggressive cyst
      8. Treatment = Enucleation + Carnoy's solution (modified)
    3. Lateral periodontal cyst
      1. Lateral to tooth
      2. Rare
      3. 3s, 4s, 5s
      4. Small size
      5. Vital teeth
      6. Unknown deriavation
    4. Gingival cyst
      1. Rare in adults
        Interdental papillae
      2. Common in neonates
        Spontaneously resolve
      3. Derivation = Cell rests of Cerres
2. Non-odontogenic
  1. Nasal Palatine duct cyst
    1. Midline palate
    2. Swelling +/- salty discharge, pain
    3. Vital teeth
    4. Heart-shaped
    5. Derivation = remnants of naso-palatine duct
  2. Naso-labial cyst
    1. Swelling in nasolabial fold +/- pain, nasal obstruction
    2. Derivation = embryonic nasolacrimal rod/duct
Primary Bone Cysts
1. Solitary bone cyst
  1. Children
  2. Premolar region, mandible
  3. Fibrous tissue only
  4. Gas or fluid filled
2. Aneurysmal bone cyst
  1. Highly vascularised fibrous tissue, blood, osteoid, osteoblasts
  2. Children, young adults
  3. Angle of mandible
  4. Multi-locular
3. Rare
Features
1. Well-defined, corticaled outline
2. Shape
  1. Uni-locular
    1. Lateral periodontal cyst
    2. Radicular cyst
    3. Paradental cyst
    4. Dentigerous cyst
  2. Multi-locular
    1. Aneurysmal bone cyst
  3. Either
    1. Odontogenic keratocyst
3. Uniformly radiolucent
4. Tooth vitality
  1. Non-vital
    1. Radicular cyst
  2. Vital
    1. Odontogenic keratocyst
    2. Nasal palatine duct cyst
    3. Lateral periodontal cyst
5. Buccal expansion
  1. Radicular cyst
  2. Dentigerous cyst
6. Age
  1. Adults
    1. Radicular cyst
    2. Dentigerous cyst
    3. Lateral periodontal cyst
    4. Nasal palatine duct cyst
  2. Children
    1. Primary Bone cysts
    2. Eruption cyst
    3. Gingival cyst
7. Site
  1. Posterior mandible
    1. Lower 8s
      1. Dentigerous cyst (unerupted)
      2. Paradental cyst
    2. Odontogenic keratocyst
    3. Aneurysmal bone cyst
  2. Premolar mandible
    1. Solitary bone cyst
  3. Upper anterior
    1. Radicular cyst (U2s)
    2. Nasal palatine duct cyst (midline)
Treatment
1. Enucleation
  1. Most common/definitive
2. Marsupialisation
  1. Reduce cyst size
  2. May allow tooth to erupt (Dentigerous cyst)
  3. Shorter/avoid GA
3. Decompression
  1. Reduce cyst size

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	Created by sanna pathy about 5 years ago