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Pseudotumors and cysts. Jan Laco, M.D., Ph.D. Causes of swellings of jaws. Cysts odontogenic x non-odontogenic Odontogenic tumors Giant cell lesions Fibro-osseous lesions Non-odontogenic tumors of bone Metastatic tumors Chronic osteomyelitis. Cysts of jaws. - PowerPoint PPT Presentation
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Pseudotumors and cysts
Jan Laco, M.D., Ph.D.
Causes of swellings of jaws
• Cysts– odontogenic x non-odontogenic
• Odontogenic tumors• Giant cell lesions• Fibro-osseous lesions• Non-odontogenic tumors of bone• Metastatic tumors• Chronic osteomyelitis
Cysts of jaws
• = pathological cavity lined by epithelium• RTG: sharply-defined lucencies• ? fluid• slowly growth teeth displacement• asymptomatic x infection painfull• rarely: pathological fracture
Cysts of jaws
• Odontogenic– developmental
• dentigerous• eruption• gingival• lateral periodontal• odontogenic keratocyst• calcifying odontogenic cyst
– inflammatory• radicular• paradental
Cysts of jaws
• Non-odontogenic– nasopalatine duct – nasolabial
• Pseudocysts– solitary bone cyst– aneurysmal bone cyst
Cysts of jaws – frequency (%)
• 1. radicular 65-70• 2. dentigerous 15-50• 3. keratocyst 3-5• 4. nasopalatine 5-10
Odontogenic cysts – radicular cyst
common swelling of jaws and cyst males (M : F … 3 : 2)• 20 - 60 years• maxilla : mandible … 3 : 1• painless sweeling• enucleation
Odontogenic cysts – radicular cyst
• relationship to root of dead tooth• pulpitis periapical granuloma proliferation of
Malassez rests• Mi: hyperplastic squamous epithelium (net-like)
+ hyaline (Rushton) bodieswall: granulation tissue + fibrous tissue mixed inflammation hemosiderin, cholesterol clefts
Odontogenic cysts – residual cyst
= radicular cyst persisting after extraction- spontaneous regress
• lateral radicular cyst– at side of nonvital tooth– lateral branch of root canal– enucleation
Odontogenic cysts – paradental cyst
• inflammation around partially erupted tooth• lower 3. M males, 20 - 25 years• vital tooth with pericoronitis• Mi: ~ radicular cyst• enucleation
Odontogenic cysts – dentigerous cyst
• cystic change of enamel organ after complete enamel formation
• surrounds crown + attached to tooth neck at amelo-cemental junction crown inside (RTG)
• M : F … 2 : 1• 20 - 50 years• 3. M, C prevents eruption• Mi: thin squamous epithelium fibrous wall with scanty inflammation
Odontogenic cysts – eruption cyst
• in soft tissue over tooth about to erupt• from enamel organ (superficial dent. cyst)• children• teeth with no predecessors• soft bluish swelling in gingiva• spontaneously disappear
Odontogenic cysts – gingival cysts
• newborn (Bohn´s nodules) • > 80%• gingiva - proliferation of Serres nests• midline of palate (Epstein pearls)• spontaneously resolve
• adults - rare
Odontogenic cysts – lateral periodontal cyst
• uncommon cyst beside vital tooth• botryoid odontogenic cyst
– lower P and C– > 50 years– Mi: multilocular cyst with fibrous septa squamous epithelium + clear cells (glycogen)– recurrency
• glandular odontogenic cyst– Mi: mucous cells– recurrency
Odontogenic cysts
• odontogenic keratocyst keratocystic odontogenic tumor
• calcifying odontogenic cyst calcifying cystic odontogenic tumor
Odontogenic cysts – odontogenic keratocyst
• uncommon• from enamel organ before tooth formation• (20 – 30) + (50 – 70) years• mandible angle extending in finger-like
fashion in bone marrow spaces• asymptomatic• RTG: multilocular
Odontogenic cysts – odontogenic keratocyst
• Mi: squamous epithelium - basal layer (mitoses) - thin wavy para-
keratotic layer - folded cyst lining
wall - scanty inflammation• complete enucleation - difficult• 60% recurrency in first 5 years !!!
Odontogenic cysts – odontogenic keratocyst
• Gorlin-Goltz syndrome= multiple keratocysts + multiple naevoid
basal cell carcinomas of skin
Odontogenic cysts – calcifying odontogenic cyst
• Gorlin´s• anterior parts of jaws• RTG: cystic cavity + calcifications• Mi: ameloblastoma-like epithelium
ghost cells – large, pale, outlines of nucleus calcification+ odontomas (10% cases)
• enucleation• recurrency
Odontogenic cysts
• wall thickening– cholesterol clefts– carcinoma– ameloblastoma
Odontogenic cysts
• biopsy practice• nonspecific findings – inflammation
• X odontogenic keratocyst• X calcifying odontogenic cyst• X unicystic ameloblastoma
Non-odontogenic cysts – nasopalatine duct cyst
• uncommon• from nasopalatine duct epithelium • midline of palate• position variants (to incisive canal)
– nasopalatine– palatine papilla– median alveolar
• Mi: squamous + respiratory epitheliumwall: mucous glands + neurovascular bundle
• enucleation
Non-odontogenic cysts – nasolabial cyst
• = Klestadt´s, nasoalveolar• very uncommon• from remnants of nasolacrimal duct• in soft tissue deep in nasolabial fold• excision
Cysts of soft tissues
• thyroglossal duct cyst
• lymphoepithelial cyst
• lingual dermoid
• mucocele
Cysts of soft tissues- thyroglossal duct cyst
• uncommom• from remnants of any part of thyroglossal duct• early age• swelling in midline of mouth or neck• Mi: squamous + respiratory epithelium
wall: thyroid tissue, chronic inflammation• removal + part of hyoid bone
Cysts of soft tissues- lymphoepithelial cyst
• branchiogenic cyst ???• cystic change of epithelium entrapped in LN• early age• lateral part of neck + mandible angle + parotid• soft swelling• fistula to skin / oral cavity / pharynx• Mi: squamous + respiratory epithelium
wall: dense lymphoid tissue + germ centres• enucleation
Cysts of soft tissues- sublingual dermoid
• developmental anomaly of branchial arches or pharyngeal pouches
• between hyoid and jaws or beneath tongue• no symptoms• Mi: epidermoid cyst
dermoid cyst – dermal appendages• dissection
Cysts of soft tissues- mucoceles
minor salivary glands lower lip• superficial, 1 cm swellings• extravasation type – damage of duct
– saliva leak inflammation + mucophages – NO epithelium mucofagic granuloma
• retention type – obstruction of duct– epithelium of dilated duct
Cysts of soft tissues- mucoceles
• ranula= mucocele of submandibular or sublingual gland
• unilateral painless swelling, 2-3 cm• floor of mouth