Introduction To Introduction To Cyst Classification Cyst Classification

& & PathophysiologyPathophysiologyDr V.RAMKUMAR

CONSULTANT DENTAL &FACIOMAXILLARYSURGEON

REG NO: 4118 TAMILNADU- INDIA(ASIA)

Cyst Cyst

KRAMER-1974KRAMER-1974Definition :

Cyst is defined as a pathological cavity Cyst is defined as a pathological cavity having fluid, semi-fluid or gaseous having fluid, semi-fluid or gaseous

contents that are not created by the contents that are not created by the accumulation of pus; frequently, but not accumulation of pus; frequently, but not

always, is lined by an epitheliumalways, is lined by an epithelium

Killey & Kay -1966

• Cyst is an abnormal cavity in hard and soft tissues which contain fluid, semifluid, or gas and is often encapsulated and lined by epithelium.

CLASSIFICATION OF CYSTS CLASSIFICATION OF CYSTS (W.H.O)(W.H.O)

• A. EPITHELIAL

1. Odontogenic

a) Developmental: i ) Primordial cyst (Keratocyst) ii) Gingival cyst of infants iii) Gingival cyst of adult iv) Lateral periodontal cyst v) Dentigerous cyst (Follicular) vi) Eruption cyst vii) Calcifying odontogenic cyst

b. Inflammatory: i) Radicular cystii) Residual cystiii) Inflammatory collateral cystiv) Paradental cyst

2. Non odontogenic Cysts: i) Nasopalatine duct cyst (incisive canal)ii) Median palatine, Median alveolar & Median mandibular cystiii) Nasolabial cyst ( Nasoalveolar cyst)iv) Globulomaxillary cyst

B. NON EPITHELIAL CYSTS

1. Simple bone cyst (Traumatic, Solitary, hemorrhagic bone cyst)

2. Aneurysmal bone cyst

II) CYSTS ASSOCIATED WITH

MAXILLARY ANTRUM• Benign mucosal cyst of maxillary antrum

• Surgical ciliated cyst of maxilla.

III) CYSTS OF THE SOFT TISSUES OF THE MOUTH, FACE & NECK 1) Dermoid and epidermoid cysts 2) Branchial cyst (Lympho epithelial) 3) Thyroglossal duct cyst 4) Anterior median lingual cyst 5) Oral cyst with gastric and intestinal epithelium 6) Cystic hygroma 7) Cysts of the salivary glands 8) Parasitic cysts: Hydatid cyst: Cysticercus Cellulosal

DIAGRAM OF ODONTOGENIC CYSTS BASED ON CLINICAL AND RADIOGRAPHIC FEATURES

CYST CYST PATHOGENESISPATHOGENESIS

INITIATIONINITIATION

CYST FORMATION CYST FORMATION

ENLARGEMENT ENLARGEMENT

Initiation Initiation

• Inflammatory cysts – infection

• Other cysts –

-dental lamina

-enamel organ

-reduced enamel epithelium

-cell rests of malassez

ENLARGEMENTENLARGEMENT 1.1. ATTRACTION OF THE FLUID INTO ATTRACTION OF THE FLUID INTO

THE CYST CAVITYTHE CYST CAVITY

2.2. THE RETENTION OF THE FLUID WITH THE RETENTION OF THE FLUID WITH IN THE CYST IN THE CYST

3.3. THE PRODUCTION OF RAISED THE PRODUCTION OF RAISED INTERNAL HYDROSTSTIC PRESSURE INTERNAL HYDROSTSTIC PRESSURE

4.4. THE RESORPTION OF THE THE RESORPTION OF THE SURROUNDING BONE WITH AN SURROUNDING BONE WITH AN INCREASE IN THE SIZE OF THE BONE INCREASE IN THE SIZE OF THE BONE CAVITYCAVITY

HARRIS 1974-HARRIS 1974- THEORIES OF CYST THEORIES OF CYST

EXPANSIONEXPANSION 1. MURAL GROWTH THEORY 1. MURAL GROWTH THEORY

2. HYDROSTATIC 2. HYDROSTATIC ENLARGEMENT ENLARGEMENT

3. BONE RESORBING FACTOR3. BONE RESORBING FACTOR

MURAL GROWTHMURAL GROWTH

PERIPHERAL CELL DIVISION PERIPHERAL CELL DIVISION

ACCUMULATION OF CELLULAR ACCUMULATION OF CELLULAR CONTENTCONTENT

HYDROSTATIC HYDROSTATIC

ENLARGEMENTENLARGEMENT SECRETIONSECRETION

TRANSUDATION AND EXUDATIONTRANSUDATION AND EXUDATION

DIALYSISDIALYSIS

BONE RESORBING FACTOR

OSTEOCLASTIC ACTIVITIES

DIAGNOSTIC FEATURES WATCH BEFORE THE

CATCH• CLINICAL FINDINGS• Signs and symptoms of a jaw lesion depend

on the dimension of the lesion.• Small cysts – Detected at an early stage as a

corollary to routine radiographic examination.

• Large cysts – Usually in case of a typical odontogenic cyst “expansion” of the labial or buccal aspect of the alveolar bone occurs.

Cont……Cont……

• Odontogenic cyst in the ramus or third molar region can cause Expansion of the lingual aspect alone.

• Expansion of both the inner and outer bony margins is indicative of a lesion, other than a cyst.

EXPANSION

• Growing cyst causes a locally discernible bulging of the External bony surface

• Increase in size – Subperiosteal bone formation

• Early stage – Smooth, hard, painless prominence

• later expands to make the outer cortex thin with out micro fractures of the outer cortex

• “ PING PONG BALL” CONSISTENCY

ELASTIC• The bone covering centre of the

convexity becomes thinned and can be indented with pressure as the cyst growth proceeds

• The term “ELASTIC” is used to describe this consistency

• Micro Fracture Of The Outer Cortex Seen

Egg shell crackling

INCIDENCE OF VARIOUS CYSTS IN DIFFERENT PARTS OF THE DENTAL

ARCH

• Periodontal cyst – Anywhere in the dental arch

• Dentigerous cyst – Associated with impacted molars, displaced canines, premolars and third molars

• Fissural cyst – Mostly Confined to the upper jaw & in the region of anatomical bony fusion

Cont….Cont….

• Solitary bone cyst – Present only in the mandible

• Odontogenic Keratocyst – Lower third molar area and extending in to the ramus

AND mandibular canine regions

OTHER CLINICAL FINDINGSOTHER CLINICAL FINDINGS……

• Loosening of teeth

• Involvement of neurovascular bundle

• Presence of sinus tract

SYMPTOMS

Small cysts – AsymptomaticInitial symptoms – Pain and swelling due to infection

Large cysts – Pathological fracture in the weaker part jaw associated with pain and swelling.Edentulous – Displacement of denture Discoloration and loosening of tooth

INVESTIGATIONSTo see through

RADIOGRAPHIC EXAMINATION

& ASPIRATION

RADIOGRAPHIC INVESTIGATIONS

• Well defined round or oval area of radiolucency circumscribed by a sharp radiopaque margin

• Radiographic variations possible depending on the type of the cyst, its location and the degree of bone destruction and expansion

• Certain odontogenic and normal anatomic structures mimic radiolucencies suggestive of cyst formation

Dentigerous cystDentigerous cyst

Odontogenic keratocystOdontogenic keratocyst

Dental cystDental cyst

Radicular cystRadicular cyst

ASPIRATION

• Aspiration is done with a wide bore needle• Aspirated fluid – Straw colored fluid containing

glary cholesterol crystals, provisional diagnosis would 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

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