Odontogenic cysts Types histopathology and management

Talk about odontogenic cysts

1. Dr. Moradzadeh 1

2. Odontogenic Cysts 2

3. Eruption cyst 3

4. Eruption Cyst ( Eruption Hematoma) Clinical Feature Age: 10 years or younger Location: Deciduous mandibular central incisors, the first permanent molars, and the deciduous maxillary incisors. 4

5. 5 (Eruption Hematoma)

6. Histopatholgy oral epithelium Lamina properia cystic epithelium

7. Odontogenic Keratocyst (O.K.C.) 3% to 11% of all odontogenic cysts Origin : Rest of dental lamina 7 specific histopathologic features and potentially aggressive clinical behavior different growth mechanism and biologic behavior from the more common dentigerous cyst and radicular cyst .

8. this lesion is significant for three reasons : 8

9. Immunohistochemical characteristics of OKC Ki67 PCNA 9

10. 93 % of sporadic OKCs, as well as 90% of OKCs associated with the nevoid basal cell carcinoma syndrome, show inactivating mutations of the PTCH1 gene. Genetic studies have shown that several tumor suppressor genes , including p16, p53, MCC, TSLC1, LATS2, and FHIT, are often affected in many odontogenic keratocysts (OKCs ). 10

11. Keratocystic odontogenic tumor(KCOT) 11

12. 12

13. Clinical features Age: 10 - 40 years (60% ) Sex: Slight male predilection. Common site: Mandible (60% to 80% ) , There's marked tendency to involve the posterior body and ramus 13

14. Clinical features Small OKCs are usually asymptomatic Larger OKCs may be associated with pain, swelling , or drainage Some large cysts, however, may cause no symptoms . 14

15. well-defined radiolucent area with smooth and often corticated margins. Large lesions, particularly in the posterior body and ramus of the mandible, may appear multilocular 15 Radiographic features on OKC

16. Tends to grow in an anteroposterior direction within the medullary cavity of the bone without causing obvious bone expansion 16 Radiographic features on OKC

17. An unerupted tooth is involved in the lesion in 25% to 40% of cases 17 Radiographic features on OKC

18. Radiographic features on OKC 18

19. 19 Radiographic features on OKC

20. 20 Radiographic features on OKC

21. 21

22. OKCs of the anterior midline maxillary region can mimic nasopalatine duct cysts . 22 Radiographic features on OKC

23. 23 Odontogenic keratocyst similar to g lobulomaxillary cyst

24. Different presentations of OKC 24

25. 25 Lumen Epithelium Connective tissue Histopathology of OKC Epithelium

26. 26 Histopathology of OKC Corrugation of the surface

27. 27 Histopathology of OKC Detachment of the epithelium from connective tissue

28. 28 Lumen Epithelium Connective tissue daughter or satellite cyst Histopathology of OKC

29. t hin cyst wall 29 Histopathology of OKC Epithelium Connective tissue

30. 30 Histopathology of inflamed OKC

31. Treatment & prognosis Treatment: Enucleation and curettage Recurrence 5-62% ( approximately 21 %–30%.) Recurrence is more often in mandibular OKCs, particularly the posterior mandible. 31

32. Prognosis 32 Partial ostectomy (bone bur) Chemical cauterization ( with carnoy solution) Marsupialization Follow-up Overall prognosis is good .

33. Recurrence due to fragments of the original cyst that were not removed at the time of the operation or a “new” cyst that has developed from dental lamina rests in the general area of the original 33

34. Thank you for your attention 34