ODONTOGENIC CYSTS.pptx

ODONTOGENIC CYSTS BY DR. KIRAN KUMAR, NAVODAYA DENTAL COLLEGE, RAICHUR

1. Dr Kiran Kumar K R Professor Dept of Oral Medicine & Radiology Navodaya Dental College 1

2. Odontogenic Cysts 2

3. Definition of the CYST A Pathologic cavity having fluid ,semi fluid, or gaseous contents and which is not created by accumulation of pus.(KRAMER 1974.) 3

4. Classification of Cysts I. Cysts of the Jaws II. Cysts associated with the Maxillary antrum III. Cysts of the soft tissues of the mouth , face, neck and salivary glands 4

5. Classification of Cysts of the Jaws I. Cysts of the Jaws I(A). Epithelial lined II(B). Not epithelial lined 5

6. I(A). Epithelial –lined cysts (a). Developmental origin (b). Inflammatory origin ( i ). Odontogenic (ii).Non- Odontogenic 6

7. I(A)(a) DEVELOPMENTAL ORIGIN:- I(A)(a)( i ) ODONTOGENIC - Gingival cyst of infants Odontogenic keratocyst Dentigerous cyst Eruption cyst Gingival cyst of adults Developmental lateral periodontal cyst Botryoid odontogenic cyst Gandular odontogenic cyst Calcifying odontogenic cyst 7

8. I(A)(a)(ii) NON –ODONTOGENIC :- Mid palatal raphe cyst of infants Nasopalatine duct cyst Nasolabial cyst II ( B)NON-EPITHELIAL –LINED CYSTS Solitary bone cyst Aneurysmal bone cyst 8

9. CYSTS ASSOCIATED WITH THE MAXILLARY ANTRUM:- Mucocele Retention cyst Pseudo cyst Postoperative maxillary cyst 9

10. CYSTS OF THE SOFT TISSUES OF THE MOUTH ,FACE AND NECK:- Dermoid and epidermoid cysts 9. Cyst of the Lymphoepithelial ( Branchial cyst) salivary glands Thyroglossal duct cyst 10. Parasitic cysts Anterior median lingual cyst Oral alimentary tract cyst Cystic hygroma Nasopharyngeal cyst Thymic cyst 10

11. WHO CLASSIFICATION OF CYSTS [1992] :- 11

12. 12

13. 13

14. RADICULAR CYST Definition:- Radicular cysts are the most common inflammatory cysts and arise from the epithelial residues in the periodontal ligament. Synonyms:- 1. Periapical cyst 2. Apical periodontal cyst 3. Dental cyst 14

15. Clinical Features:- 60.3% - all the odontogenic cysts. 3 rd decade , later 4 th -6 th decade. Male predominance. A rises from non-vital tooth. Asymptomatic, until secondarily infected . On palpation- B ony hard Rubbery & fluctuant -if the outer cortex is lost. 15

16. RADIOGRAPHIC FEATURES:- 1. LOCATION:- Epicenter - Apex of non-vital tooth. Location - 60% maxilla - incisors & canines. Non-vital deciduous tooth.( Buccal to developing bicuspid) 16

17. 17

18. PERIPHERY AND SHAPE:- Shape :Round to oval shape. Periphery: Well defined corticated border. If cyst is secondarily infected –border will be lost. INTERNAL STRUCTURE:- Mostly radiolucent. Occasionally dystrophic calcification (in long standing cysts). 18

19. EFFECTS ON SORROUNDING STRUCTURES:- Adjacent teeth - Displacement & resorption of the roots Nonvital tooth - resorption of the root rare. Expansion of outer cortical plates - maxilla / mandible Mandibular canal -displaced inferiorly 19

20. DIFFERENTIAL DIAGNOSIS:- Periapical granuloma Odontogenic keratocyst Lateral periodontal cyst Peripical cemental dysplasia 20

21. RADICULAR CYST PERIAPICAL GRANULOMA Size is ≥ 1cm. Size is ≤ 1cm. Shape- Round Border -Corticated Oval Sclerotic 21

22. RADICULAR CYST ODONTOGENIC KERATOCYST Tooth - Non vital Vital Maxillary anterior teeth . Cortical Expansion Mandibular ramus area No B-L Cortical Expansion 22

23. Dentigerous Cyst Definition :- A dentigerous cyst is one that encloses the crown of an unerupted tooth by expansion of its follicle and is attached to the neck. Browne & Smith - DENTIGEROUS CYST. Dentigerous = tooth bearing. Pathogenesis; Disintegration of Stellate Reticulum epithelial cells Accumulation of fluid in follicular space II 23

24. Clinical Features:- Second most common cyst. Peak - 2 nd & 3 rd decade . M:F :: 2:1 . Site: Mandibular 3 rd molar Maxillary canine & Mandibular Premolars. May be associated with supernumerary tooth. 24

25. Radiological features:- LOCATION:- Epicenter- Just above crown of the involved tooth. Imp- Cyst is attached at the CEJ 3 variants- Central variety- Covering crown 25

26. Circumferential variety- Covers the entire crown without occlusal surface 26

27. Lateral variety- Along lateral surface of root with partially covering the crown. 27

28. Inflammatory DC Spread of periapical infection non-vital deciduous tooth. Multiple DC - Maroteaux - Lamy Syndrome 28

29. 29

30. PERIPHERI & SHAPE:- Well defined - Circular or curved outline. Secondary infected – loss of corticated border. INTERNAL STRUCTURE :- Completely radiolucent. Crown of involved tooth. 30

31. Effects on surrounding structures:- Displaces & resorbs - adjacent teeth Tooth Displacement –apically. Slow growing cyst-expands cortices. If cyst involving maxillary 3 rd molar- Floor of maxillary antrum displaced superiorly mandibular 3 rd molar- inferior alvoelar nerve canal- inferiorly 31

32. DENTIGEROUS CYST HYPERPLASTIC FOLLICLE Follicular space > 5mm Normal Follicular space- 2-3mm 32

33. DENTIGEROUS CYST OKC Expansion of cortical plates Less expansion Adjacent tooth root resorption Less likely resorption Lesion is attached to CEJ of affected tooth Lesion is more apically 33

34. DENTIGEROUS CYST AMELOBLASTIC FIBROMA Associated with unerupted tooth Not associated with u nerupted tooth Molar region Premolar –molar region 34

35. Rx Small- Enucleation Large- Marsupialization Complications SCC Mucoepidermoid carcinoma Ameloblastoma 35

36. ODONTOGENIC KERATOCYST Synonym:- Primordial Cyst The term Odontogenic Keratocyst - Philipsen in 1956. Pathogenesis: 36

37. Clinical features:- Bimodal age . 2 & 5 th decade . Male predominence . Asymptomatic ,until secondarily infected . Less/no cortical expansion. On Aspiration – a thick, yellow, cheesey material of keratin. 37

38. RADIOGRAPHIC FEATURES :- LOCATION:- Posterior body of the mandible -90% Ramus > 50% EPICENTER:- Superior to inferior alveolar canal. SHAPE : Smooth round or oval shape. PERIPHERY :- Corticated border unless secondarily infected. Scalloped outline ( contiguous arcs). 38

39. 39

40. INTERNAL STRUCTURES :- Multilocular radiolucency .- Radiolucent with curved internal septa Effects on surrounding structures:- Grow along medullary cavity of jaws. No/ Slight B-L expansion. Less resorption & displacement of the tooth. 40

41. Differential Diagnosis:- Dentigerous cyst Ameloblastoma Odontogenic myxoma Simple bone cyst. 41

42. Odontogenic Keratocyst Dentigerous cyst Multilocular radiolucency Unilocular radiolucency Less cortical expansion More buccal cortical expansion Not often root resorption present Resorption & displacement 42

43. Odontogenic keratocyst Ameloblastoma Less cortical expansion More cortical expansion 1 st ,2 nd or 3 rd decades Older age Paresthesia absent Paresthesia may be present 43

44. Odontogenic Keratocyst Odontogenic Myxoma Radiolucent – multilocular ,soap bubble appearance Radiolucent- radiopaque , tennis racket or step ladder appearance Thin septa curved ,or cicular Thin etched septa is straight always 44

45. Odontogenic Keratocyst Simple Bone Cyst Scalloped borders mostly towards the inferior border of mandible Scalloping borders towards the crestal bone Resorption or displacement of tooth No resorption or displacement of tooth Loss of lamina dura No loss of lamina dura 45

46. BASAL CELL NEVUS SYNDROME or GORLIN-GOLTZ SYNDROME Syndrome comprises of variety of abnormalities:- B= Multiple nevoid Basal Cell Carcinomas of the skin. S= Skeletal abnormalities . C= Central nervous system abnormalities M= Multiple odontogenic keratocyst . EN= Endocrine system abnormality. 46

47. Clinical features:- After 5 years of age & before 30 years. Skin lesions- small ,flattened, flesh or brown color papules on face, trunk & neck. 47

48. Basal cell carcinoma of the skin 48

49. Skeletal abnormalities –Bifid rib, Synostosis of ribs. 49

50. Multiple OKC in multiple sites of jaws. 50

51. Costal abnormalities as agenesis , deformity, kyphoscoliosis , vertebral fusion, polydactyly , shortening of metacarpals. 51

52. Temporal & temperoparietal bossing. 52

53. Minor hypertelorism . Mild prognathism . Calcification of falx cerebri & duramater in early life. 53

54. 54

55. DIFFERENTIAL DIAGNOSIS:- Multiple myeloma Cherubism Basal Cell Nevus Syndrome Multiple Myeloma Multilocular radiolucencies Multiple punched out radiolucencies with corticated borders. 55

56. 56

57. Basal Cell Nevus Syndrome Cherubism Multiple multilocular radiolucency No jaw expansion, Bilateral multilocular radioluceny . Significant jaw expansion No displacement of the teeth Pushes posterior teeth in anterior direction 57

58. CALCIFYING EPITHELIAL ODONTOGENIC CYST Synonym - Calcifying Odontogenic cyst Gorlin cyst. Clinical features:- 1 st peak is 10-19 years , 2 nd peak is 7 th decade . Slow-growing, painless swelling of jaw. Expansion destroy cortical plate. Advanced lesion--- discharge 58

59. On ASPIRATION :- viscous, granular, yellow fluid. RADIOGRAPHIC INTERPRETATION:- Location– 75% anterior to the 1 st molar. Cuspid and premolar region. Sometimes manifests as pericoronal radiolucencies . Peripheri & Shape – well defined corticated, Ill defined & irregular in cyst like lesions . 59

60. Internal structure :- varies usually… completely radiolucent --- small evidence of foci of calcified material . Effects on supporting structures :- 20%-50% commonly associated with cuspid & impedes its eruption. Displacement & resorption of roots Perforation of cortical plate. 60

61. 61

62. Differential Diagnosis Dentigerous cyst Adenomatoid odontogenic tumour Ameloblastic fibro- odontoma 62

63. CEOC DENTIGEROUS CYST Not evident always pericoronally Always pericoronal radiolucent Tiny fleks of calcification masses are evedent Uniform radiolucent 63