1 intro to cyst, classification & pathophysiology

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2. CystKRAMER-1974Definition :Cyst is defined as a pathological cavity having fluid, semi-fluid orgaseous contents that are not created by the accumulation of pus;frequently, but not always, is lined by an epithelium 3. Killey & Kay -1966 Cyst is an abnormal cavity in hard and softtissues which contain fluid, semifluid, orgas and is often encapsulated and lined byepithelium. 4. CLASSIFICATION OF CYSTS(W.H.O) A. EPITHELIAL1. Odontogenica) Developmental:i ) Primordial cyst (Keratocyst)ii) Gingival cyst of infantsiii) Gingival cyst of adultiv) Lateral periodontal cystv) Dentigerous cyst (Follicular)vi) Eruption cystvii) Calcifying odontogenic cyst 5. b. Inflammatory:i) Radicular cystii) Residual cystiii) Inflammatory collateral cystiv) Paradental cyst2. Non odontogenic Cysts:i) Nasopalatine duct cyst (incisive canal)ii) Median palatine, Median alveolar &Median mandibular cystiii) Nasolabial cyst ( Nasoalveolar cyst)iv) Globulomaxillary cyst 6. B. NON EPITHELIALCYSTS1. Simple bone cyst(Traumatic, Solitary,hemorrhagic bone cyst)2. Aneurysmal bone cyst 7. II) CYSTS ASSOCIATEDWITHMAXILLARY ANTRUM Benign mucosal cyst of maxillary antrum Surgical ciliated cyst of maxilla. 8. III) CYSTS OF THE SOFT TISSUESOF THE MOUTH, FACE & NECK1) Dermoid and epidermoid cysts2) Branchial cyst (Lympho epithelial)3) Thyroglossal duct cyst4) Anterior median lingual cyst5) Oral cyst with gastric and intestinal epithelium6) Cystic hygroma7) Cysts of the salivary glands8) Parasitic cysts: Hydatid cyst: CysticercusCellulosal 9. DIAGRAM OF ODONTOGENIC CYSTS BASED ONCLINICAL AND RADIOGRAPHIC FEATURES 10. CYSTPATHOGENESISINITIATIONCYST FORMATIONENLARGEMENT 11. Initiation Inflammatory cysts infection Other cysts -dental lamina-enamel organ-reduced enamel epithelium-cell rests of malassez 12. ENLARGEMENT1. ATTRACTION OF THE FLUID INTO THE CYST CAVITY2. THE RETENTION OF THE FLUID WITH IN THE CYST3. THE PRODUCTION OF RAISED INTERNAL HYDROSTSTICPRESSURE4. THE RESORPTION OF THE SURROUNDING BONE WITH ANINCREASE IN THE SIZE OF THE BONE CAVITY 13. HARRIS 1974-THEORIES OF CYSTEXPANSION1. MURAL GROWTH THEORY2. HYDROSTATIC ENLARGEMENT3. BONE RESORBING FACTOR 14. MURAL GROWTHPERIPHERAL CELL DIVISIONACCUMULATION OF CELLULAR CONTENT 15. HYDROSTATICENLARGEMENTSECRETIONTRANSUDATION AND EXUDATIONDIALYSIS 16. BONE RESORBING FACTOROSTEOCLASTIC ACTIVITIES 17. DIAGNOSTIC FEATURESWATCH BEFORE THE CATCH CLINICAL FINDINGS Signs and symptoms of a jaw lesion dependon the dimension of the lesion. Small cysts Detected at an early stage as acorollary to routine radiographicexamination. Large cysts Usually in case of a typicalodontogenic cyst expansion of the labial orbuccal aspect of the alveolar bone occurs. 18. Cont Odontogenic cyst in the ramus or thirdmolar region can cause Expansion ofthe lingual aspect alone. Expansion of both the inner and outerbony margins is indicative of a lesion,other than a cyst. 19. EXPANSION Growing cyst causes a locally discerniblebulging of the External bony surface Increase in size Subperiosteal boneformation Early stage Smooth, hard, painlessprominence later expands to make the outer cortex thinwith out micro fractures of the outer cortex PING PONG BALL CONSISTENCY 20. ELASTIC The bone covering centre of theconvexity becomes thinned and can beindented with pressure as the cystgrowth proceeds The term ELASTIC is used todescribe this consistency Micro Fracture Of The Outer CortexSeenEgg shell crackling 21. INCIDENCE OF VARIOUS CYSTS INDIFFERENT PARTS OF THE DENTALARCH Periodontal cyst Anywhere in the dentalarch Dentigerous cyst Associated with impactedmolars, displaced canines, premolars and thirdmolars Fissural cyst Mostly Confined to the upper jaw& in the region of anatomical bony fusion 22. Cont. Solitary bone cyst Present only in themandible Odontogenic Keratocyst Lower thirdmolar area and extending in to the ramusAND mandibular canine regions 23. OTHER CLINICAL FINDINGS Loosening of teeth Involvement of neurovascular bundle Presence of sinus tract 24. SYMPTOMSSmall cysts AsymptomaticInitial symptoms Pain and swelling due to infectionLarge cysts Pathological fracture in the weaker part jawassociated with pain and swelling.Edentulous Displacement of dentureDiscoloration and loosening of tooth 25. INVESTIGATIONSTo see throughRADIOGRAPHICEXAMINATION&ASPIRATION 26. RADIOGRAPHICINVESTIGATIONS Well defined round or oval area of radiolucencycircumscribed by a sharp radiopaque margin Radiographic variations possible depending onthe type of the cyst, its location and the degreeof bone destruction and expansion Certain odontogenic and normal anatomicstructures mimic radiolucencies suggestive ofcyst formation 27. Dentigerous cyst 28. Odontogenic keratocyst 29. Dental cyst 30. Radicular cyst 31. ASPIRATION Aspiration is done with a wide bore needle Aspirated fluid Straw colored fluid containingglary cholesterol crystals, provisional diagnosiswould be a dental cyst Keratin flakes (White cheesy material ) Aspiration of air Penetration in to the antrum Failure to aspirate fluid or air Solid lesion 32. THANK YOU