Fissural cysts of oral cavity

Fissural cysts of oral cavity ppt

1. FISSURAL CYSTS PRESENTED BY N.NARMATHA II YEAR PG

2. CYST- DEFINTION: Kramer(1974) - cyst as a pathological cavity having fluid, semifluid or gaseous contents and which is not created by accumulation of pus. Most cysts but not all are lined by epithelium. CLASSIFICATION OF CYSTS Cysts of the jaws Odontogenic Non-odontogenic

3. Epithelial cysts Classification of the World Health Organization (WHO) 1998 Developmental cysts Inflammatory cysts Odontogenic cysts Non Odontogenic cysts Newborn gingival cyst Odontogenic keratocyst Dentigerous or follicular cyst - Eruptional cyst - Lateral periodontal - Gingival cyst of adult - Sialo-odontogenic cyst - Nasopalatine duct cyst - Naso -alveolar and naso -labial cyst Radicular cyst- Apical Lateral Residual Periodontal cyst- Inflammatoty collateral Infected vestibular mandibular

4. Examination of cysts Inspection: Dermoid cyst – tuft of hairs emanating from midline nasal depression or nodule - Unilateral upper eyelid swelling – first sign Epidermal inclusion cyst – prominent punctum - Foul smell – cheesy like material discharge Thyroglossal cyst – midline of the neck

5. P alpation : Mobility : Freely mobile - Epidermal inclusion cyst , Dermoid cyst Elevates when the patient protrudes the tongue - Thyroglossal cyst Extent: Border : Border of firm dermoid cyst can be readily demonstrated

6. Consistency: Soft If under tension – rubbery Infected – firm Dermoid cyst – cheesy Fluctuancy : Fluctuant , painless, non emptiable

7. Aspiration: Yellowish ,cheesy s ubstance – dermoid cyst Thick, yellow –white , granular fluid – epidermoid cyst Thick, homogeneous yellow to gray – sebaceous cyst Dark, amber coloured fluid – T hyroglossal cyst.

8. Fissural (inclusion, developmental) cysts of oral region: Arise along the lines of fusion of various bones or embryonic process . True cysts – lined by epithelium – derived from epithelial cells entrapped between embryonic process of bones at union lines.

9. Fissural cysts Median anterior maxillary cyst Median palatal cyst Globulomaxillary cyst Median mandibular cysts

10. Developmental cysts derived from embryologic structures or faults which involve the oral or adjacent soft tissue structures. Nasoalveolar cyst Palatal cysts of neonate Thyroglossal tract cyst Benign cervical lympho epithelial cyst Epidermoid cyst Dermoid cyst Heterotrophic oral gastrointestinal cyst.

11. NASOPALATINE DUCT CYST: Most common of the non-odontogenic cyst It is developmental, non neoplastic in nature Location is peculiar and specific Affects the midline anterior maxilla

12. PATHOGENESIS Nasopalatine ducts Progressive degeneration Persistence of epithelial remnants Trauma/infection/mucous retention spontaneous proliferation Nasopalatine duct cyst Mucous glands- secrete mucin – secondary cyst formation

13. CLINICAL DIFFERENTIAL DIAGNOSIS

14. CLINICAL DIFFERENTIAL DIAGNOSIS

15. Radiographic features: Location: Nasopalatine foramen or canal. If it extend posteriorly – median palatal cyst. Anteriorly between central incisors – median anterior maxillary cysts Periphery and shape: Well defined and corticated Circular or oval in shape Heart shape – shadow of nasal spine superimposed on the cyst.

16. Internal structure: Radiolucent Effects on surrounding structures: Divergence of roots Root resorption Expansion of labial /buccal cortex Floor of nasal fossa may be displace in superior direction.

17. Standard occlusal view

18. POST OPERATIVE CT AXIAL AND CORONAL

19. CYSTS OF THE INCISIVE PAPILLA NPDC form within incisive canal – cyst of incisive papilla Etiology : Unknown Trauma, infection, mucous retention Spontaneous cystic degeneration of ductal epithelium Clinical features: Males commonly affected 40-60 years Smaller cysts – asymptomatic Larger cysts – swelling, discharge, pain, salty taste

20. Devitalization ,Bony expansion Translucent/blue in colour,dome shaped Slow and progressive growth > 60 mm in diameter. H/F: On aspiration: A clear or straw coloured fluid

21. Radiographic Differential diagnosis: Large incisive foramen >6 mm Radicular cyst Treatment: Enucleation

22. MEDIAN PALATAL CYSTS Epithelium entrapped Line of fusion of palatal process of maxilla Median palatal cyst C/F: Location – midline of hard palate Clinically visible palatal swelling Etiology : unknown

23. Two main criteria for diagnosis of a median palatine cyst are; Location in the median fissure of the palate behind the incisive canal Presence of epithelium lined sac. Additional criteria Asymptomatic swelling of the midline hard palate, No association with a nonvital tooth, Ovoid, pear or circular shape. CLINICAL DIFFERENTIAL DIAGNOSIS

24. Globulomaxillary cysts Nasoalveolar cysts lateral to the midline . Nasopalatine duct cysts Incisive canal cysts midline , derived from the incisive duct . Median alveolar cyst is also midline - related to the median fissure - appears anterior to the incisive canal, posterior to the maxillary incisors

25. R/G : Well circumscribed radiolucent area - opposite to bicuspid and molar area Sclerotic bordered Differential diagnosis: N asopalatine duct cyst - does not show palatal enlargement H/F

26. TREATMENT: Surgical removal - local anesthesia by infraorbital block injection - Crevicular incision - palatal flap elevated - cystic lining and contents were removed - completely enucleated Curettage - additional removal of surrounding bone to -complete removal - with a sharp curette or a round diamond bur with copious cool irrigation to remove 1 to 2 mm of bone and any pathology remnants

27. GLOBULOMAXILLARY CYST: Embryology: Found at the junction of globular portion of medial nasal process and the maxillary process of the globulomaxillary fissure ,between lateral incisor and cuspid teeth. Suture between premaxilla and maxilla, incisive suture – premaxilla-maxillary cyst

28. C/F Asymptomatic Vitality is preserved Differential diagnosis : Keratotic odontogenic cyst Radicular cyst Lateral periodontal cyst R/G: Inverted , pear shaped radiolucent area between roots of lateral incisor and cuspid Divergence of roots

29. Christ - globulomaxillary cyst are odontogenic rather than fissural in origin. H/F : Treatment : Surgically removed.

30. MEDIAN MANDIBULAR CYST : Rare C/F: Asymptomatic Vitality is preserved Bony expansion Divergence of roots R/F : Unilocular , well circumscribed radiolucency Multilocular

31. Differential diagnosis : Traumatic cyst Sublingual salivary gland depression Apical cysts and granulomas Radicular cyst Treatment : Surgical excision

32. NASOALVEOLAR CYST:( NASOLABIAL CYST,KLESTADT CYST) Rare Embroyolgy : Proliferation of entrapped epithelium along the fusion line Arise at junction of globular process,lateral nasal process, maxillary process

33. C/F: Swelling in nasolabial fold, floor of the nose Superficial erosion of outer surface of maxilla Not visible on radiographs H/F: Differential diagnosis: Treatment : surgical excision Acute dentoalveolar abscess. Large mucous extravasation cyst or a cystic salivary adenoma

34. PALATAL AND ALVEOLAR CYSTS OF NEWBORN: (Epstein pearls , bohn’s nodules, gingival cysts of new born) Embryology: Arises from epithelial remnants of deeply budding dental lamina during tooth development – after fourth month in utero – gingival cyst

35. PALATAL CYST OF NEW BORN: Posterior midline of hard palate Embryology: Epithelial remnants in the stroma after fusion of the palatal process which meet medially to form palate. Epstein pearls: Cysts along the median raphe of palate. Bohn’s nodules : originates from palatal gland structure

36. C/F: Palatal cysts : multiple,1-4 mm, yellow – white sessile mucosal papules Hard palate , anterior soft palate Treatment : No treatment .

37. THYROGLOSSAL DUCTAL CYST: Rare Location: midline of the neck Dilatation of or remnant at site where primitive thyroid descended from its origin Failure of subsequent closure and obliteration of this tract Thyroglossal ductal cyst

38. C/F: Palpable asymptomatic midline neck mass Neck pain, throat pain, dysphagia Infection – cyst dilatation Histology

39. Treatment: Antibiotics - Neosporin, polysporin – 3.5 gm twice daily for 5 days Surgical management – Sistrunk procedure

40. EPIDERMAL INCLUSION CYST: (Epidermal cyst, epidermoid cyst, epithelial cyst, keratin cyst, sebaceous cyst) Implantation of epithelial remnants Cystic transformation Milia – miniature epidermoid cysts

41. ETIOLOGY : Sequestration and implantation of epidermal rests during embryonal period Occlusion of pilo sebaceous unit Iatrogenic or surgical implantation of epithelium HPV infection and eccrine duct occlusion Proliferation of epidermal cells within dermis

42. C/F: Indolent ,asymptomatic Common in third/fourth decades Discharge of foul smelling cheese like material Once infected – pain Firm ,round, mobile, flesh coloured to yellow or white subcutaneous nodules

43. Pigmented Sites: face, trunk, neck , extremities ,scalp Ocular ,oral mucosa ,palpebral conjuctiva ,on the lips ,buccal mucosa ,tongue , uvula Anterior fontanelle

44. Hereditary syndromes associated with epidermoid cysts Gardner syndrome Basal cell nevus syndrome Panchynochia congenita Treatment : surgical removal

45. DERMOID CYST: Contain sebaceous glands, skin adnesia – nails, dental cartilage like and bone like structures, fatty tissues Origin: Sequestration of skin Implantation along the lines of embryonic closure

46. C/F: Face, neck, scalp Can be intracranial, intraspinal,perispinal Common – floor of mouth Congenital Localised on the neck (midline) 1-4 cm

47. Keratin filled lumen Keratinized stratified squamous lining

48. RADIOGRAPHIC FEATURES Best accomplished by CT or MRI. Well defined by more radiopaque soft tissue Radiolucent on conventional radiographs. However, a CT scan of the area may reveal a soft tissue multilocular appearance

49. Congenital mouth cysts Epidermoid (simple)cysts Dermoid (complex) cysts Teratoid cyst(complex) Differential Diagnosis Ranula (unilateral or bilateral blockage of wharton ’s ducts), T hyroglossal duct cysts, Cystic hygromas , Branchial cleft cysts, Cellulitis, Tumors (lipoma and liposarcoma ), and Normal fat masses in the submental areas Treatment: surgical exicision

50. HETEROTROPHIC ORAL GASTROINTESTINAL CYST: C/F: Infants or young children Male predominance Small nodule present within the body of tongue,posterior or anterior floor of mouth, Difficulty in eating or speaking Treatment : Surgical exicision

51. References : 1.Oral radiology,principles,interpretation – white and pharoah 2.Elliott KA , Franzese CB , Pitman KT : Diagnosis and surgical management of nasopalatine duct cysts , Laryngoscope 114 : 1336 - 1340 , 2004 . 3.Mraiwa RJ , Jacobs R , Van Cleynenbreugel J et al : The nasopalatine duct cyst revisited using 2D and 3D CT imaging , Dentomaxillofac Radiol 33 : 396 - 402 , 2004 . 4.Swanson KS , Kaugars GE , Gunsolley JC : Nasopalatine duct cyst: an analysis of 334 cases , J Oral Maxillofac Surg 49 : 268 - 271 , 1991 .