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Pseudotumors and cysts
Jan Laco, M.D., Ph.D.
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Causes of swellings of jaws
• Cysts– odontogenic x non-odontogenic
• Odontogenic tumors• Giant cell lesions• Fibro-osseous lesions• Non-odontogenic tumors of bone• Metastatic tumors• Chronic osteomyelitis
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Cysts of jaws
• = pathological cavity lined by epithelium
• RTG: sharply-defined lucencies
• ? fluid
• slowly growth teeth displacement
• asymptomatic x infection painfull
• rarely: pathological fracture
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Cysts of jaws
• Odontogenic– developmental
• dentigerous• eruption• gingival• lateral periodontal• odontogenic keratocyst• calcifying odontogenic cyst
– inflammatory• radicular• paradental
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Cysts of jaws
• Non-odontogenic– nasopalatine duct – nasolabial
• Pseudocysts– solitary bone cyst– aneurysmal bone cyst
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Cysts of jaws – frequency (%)
• 1. radicular 65-70
• 2. dentigerous 15-50
• 3. keratocyst 3-5
• 4. nasopalatine 5-10
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Odontogenic cysts – radicular cyst
common swelling of jaws and cyst males (M : F … 3 : 2)
• 20 - 60 years
• maxilla : mandible … 3 : 1
• painless sweeling
• enucleation
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Odontogenic cysts – radicular cyst
• relationship to root of dead tooth• pulpitis periapical granuloma proliferation of
Malassez rests• Mi: hyperplastic squamous epithelium (net-like)
+ hyaline (Rushton) bodies
wall: granulation tissue + fibrous tissue
mixed inflammation
hemosiderin, cholesterol clefts
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Odontogenic cysts – residual cyst
= radicular cyst persisting after extraction- spontaneous regress
• lateral radicular cyst– at side of nonvital tooth– lateral branch of root canal– enucleation
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Odontogenic cysts – paradental cyst
• inflammation around partially erupted tooth
• lower 3. M males, 20 - 25 years
• vital tooth with pericoronitis
• Mi: ~ radicular cyst
• enucleation
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Odontogenic cysts – dentigerous cyst
• cystic change of enamel organ after complete enamel formation
• surrounds crown + attached to tooth neck at amelo-cemental junction crown inside (RTG)
• M : F … 2 : 1• 20 - 50 years• 3. M, C prevents eruption• Mi: thin squamous epithelium fibrous wall with scanty inflammation
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Odontogenic cysts – eruption cyst
• in soft tissue over tooth about to erupt
• from enamel organ (superficial dent. cyst)
• children
• teeth with no predecessors
• soft bluish swelling in gingiva
• spontaneously disappear
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Odontogenic cysts – gingival cysts
• newborn (Bohn´s nodules)
• > 80%
• gingiva - proliferation of Serres nests
• midline of palate (Epstein pearls)
• spontaneously resolve
• adults - rare
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Odontogenic cysts – lateral periodontal cyst
• uncommon cyst beside vital tooth• botryoid odontogenic cyst
– lower P and C– > 50 years– Mi: multilocular cyst with fibrous septa squamous epithelium + clear cells (glycogen)– recurrency
• glandular odontogenic cyst– Mi: mucous cells– recurrency
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Odontogenic cysts
• odontogenic keratocyst keratocystic odontogenic tumor
• calcifying odontogenic cyst calcifying cystic odontogenic tumor
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Odontogenic cysts – odontogenic keratocyst
• uncommon
• from enamel organ before tooth formation
• (20 – 30) + (50 – 70) years
• mandible angle extending in finger-like fashion in bone marrow spaces
• asymptomatic
• RTG: multilocular
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Odontogenic cysts – odontogenic keratocyst
• Mi: squamous epithelium - basal layer (mitoses)
- thin wavy para- keratotic
layer
- folded cyst lining
wall - scanty inflammation• complete enucleation - difficult• 60% recurrency in first 5 years !!!
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Odontogenic cysts – odontogenic keratocyst
• Gorlin-Goltz syndrome
= multiple keratocysts + multiple naevoid
basal cell carcinomas of skin
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Odontogenic cysts – calcifying odontogenic cyst
• Gorlin´s• anterior parts of jaws• RTG: cystic cavity + calcifications• Mi: ameloblastoma-like epithelium
ghost cells – large, pale, outlines of nucleus calcification
+ odontomas (10% cases)• enucleation• recurrency
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Odontogenic cysts
• wall thickening– cholesterol clefts– carcinoma– ameloblastoma
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Odontogenic cysts
• biopsy practice
• nonspecific findings – inflammation
• X odontogenic keratocyst
• X calcifying odontogenic cyst
• X unicystic ameloblastoma
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Non-odontogenic cysts – nasopalatine duct cyst
• uncommon• from nasopalatine duct epithelium • midline of palate• position variants (to incisive canal)
– nasopalatine– palatine papilla– median alveolar
• Mi: squamous + respiratory epitheliumwall: mucous glands + neurovascular bundle
• enucleation
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Non-odontogenic cysts – nasolabial cyst
• = Klestadt´s, nasoalveolar
• very uncommon
• from remnants of nasolacrimal duct
• in soft tissue deep in nasolabial fold
• excision
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Cysts of soft tissues
• thyroglossal duct cyst
• lymphoepithelial cyst
• lingual dermoid
• mucocele
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Cysts of soft tissues- thyroglossal duct cyst
• uncommom• from remnants of any part of thyroglossal duct• early age• swelling in midline of mouth or neck• Mi: squamous + respiratory epithelium
wall: thyroid tissue, chronic inflammation• removal + part of hyoid bone
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Cysts of soft tissues- lymphoepithelial cyst
• branchiogenic cyst ???• cystic change of epithelium entrapped in LN• early age• lateral part of neck + mandible angle + parotid• soft swelling• fistula to skin / oral cavity / pharynx• Mi: squamous + respiratory epithelium
wall: dense lymphoid tissue + germ centres• enucleation
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Cysts of soft tissues- sublingual dermoid
• developmental anomaly of branchial arches or pharyngeal pouches
• between hyoid and jaws or beneath tongue
• no symptoms
• Mi: epidermoid cyst
dermoid cyst – dermal appendages
• dissection
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Cysts of soft tissues- mucoceles
minor salivary glands lower lip• superficial, 1 cm swellings• extravasation type – damage of duct
– saliva leak inflammation + mucophages – NO epithelium mucofagic granuloma
• retention type – obstruction of duct– epithelium of dilated duct
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Cysts of soft tissues- mucoceles
• ranula
= mucocele of submandibular or sublingual gland
• unilateral painless swelling, 2-3 cm
• floor of mouth