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cysts of the jaws

Monday 26 October 2009

cysts of the mandible; cystic anomalies of the jaws

Definition : Cysts derived from odontogenic epithelium are called odontogenic cysts; those that originate from other epithelial structures are known as non-odontogenic cysts.

Within the odontogenic cysts, one discerns between developmental and inflammatory. The inflammatory cysts are thought to arise from inflammation-induced epithelial proliferation with subsequent central liquefaction. The developmental cysts lack a clear-cut aetiology.

Unless stated specifically, all cysts are cured by simple enucleation and do not show any tendency to recur. From a practical view, the radicular cyst, the dentigerous cyst and the odontogenic keratocyst are the most important, as they have the highest incidence. All other cyst types are very rare.

Types

- odontogenic cysts

–* inflammatory

–* developmental

- non-odontogenic cysts

Localization

- mandibular cysts
- maxillary cysts

Diagnostic apporach

- associated with unerupted tooth and no basal layer palisading, no corrugated surface, no parakeratosis

  • dentigerous cyst

- palisaded basal layer, corrugated surface, parakeratosis

  • keratocystic odontogenic tumor

- ameloblastomatous change

- no history or radiographic information

  • "squamous lined cyst" with no features of keratocystic odontogenic tumor or ameloblastoma

Types

- periapical cyst / radicular cyst

  • A periapical cyst, also known as a radicular cyst, is inflammatory, develops from a periapical granuloma, and is associated with the root of a tooth. It is most common in the anterior maxilla. It shows a stratified squamous epithelium and fibrous capsule with mixed (mostly acute) inflammation. It is the most common odontogenic cyst, and most common cyst of the jaw.

- keratocystic odontogenic tumor / keratocyst

  • Keratocystic odontogenic tumor (odontogenic keratocyst), is a neoplastic cyst usually in the posterior jaw, lined by parakeratotic epithelium with a hyperchromatic, palisaded basal layer and wavy surface. It is associated with nevoid basal cell carcinoma syndrome / Gorlin’s syndrome.

- dentigerous cyst - follicular cyst

  • A dentigerous cyst is usually associated with impacted teeth (third molars, maxillary canines).
  • It has stratified squamous epithelium and may or may not be inflamed.
  • It is the second most common odontogenic and jaw cysts , behind periapical cysts.

References

- Lesions of the jaws. Slootweg PJ. Histopathology. 2009 Mar;54(4):401-18. Epub 2008 Jul 11. PMID: 18637149

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