Transcript Cysts - DENTISTRY 2012

Cystic Lesions Of The Jaws
Radiological Interpretation
Dr ASHRAF ABU KARAKY
Assistant Professor in Oral and
Maxillofacial Surgery
The University of Jordan
Definition
A cyst is defined as a pathological cavity
containing fluid, semi-fluid or gaseous
material other than pus. It is frequently
but not always lined by epithelium.
Diagnosis of Radiolucent Lesions
of the Jaws
Step 1
Systematically describe the RL
. Site
. Size
. Shape
. Outline/ edge or periphery
. Relative radiodensity
. Effects on adjacent
surrounding structures
. Time present
Step 2
Decide whether or not the RL
is:
1- A normal anatomical
structure
2- Artefactual
3- Pathological:
a. Congenital.
b. Developmental
c. Acquired
Step 3
IF acquired RL:
- Infection; Localized to apical
tissue
Spreading within the
jaw
- Traumatic lesions
- Cysts
- Tumours
- Giant cell lesions
- Fibro-cemento-osseous
lesions
- Idiopathic lesions
Step 4
Consider the
classification and
subdivision of cysts and
other RL s within each
of the other main
disease categories
Step 5
Compare the radiological
features of the unknown RL
with the typical RG features
of these possible conditions.
Construct a list showing in order
of likelihood all the
conditions that the lesion
might be (radiological
differential diagnosis)
Classification
Browne 1975 and Main 1985
A- Odontogenic Cysts
1. Inflammatory Odontogenic
Cysts
-Radicular
Residual
Lateral
- Paradental
2. Developmental Cysts
- Odontogenic Keratocyst
- Follicular cyst
Dentigerous
Eruption
- Lateral Periodontal cyst
- Glandular Odonotogenic; Sialoodontogenic cyst
- Gingival cysts of adults
- Gingival Cysts of Infants (Epstein
pearls)
B- Non-Odontogenic Cysts
1. Fissural Cysts
- Nasopalatine duct cyst
- Nasolabial cyst
- Median Madibular Cyst
- Median Palatine Cyst
- Globulo-Maxillary Cyst
2. Bone Cysts
- Solitary bone cyst
- Aneurysmal bone cyst
- Stafne Cyst ( Lingual Salivary
Gland Inclusion Defect)
3. Soft tissue cyst
- Dermoid
- Branchial
- Thyroglossal duct cyst
- Salivary cyst
Inflammatory Odontogenic
Cysts
Radicular
Residual
Lateral
Paradental
Radicular Cyst
Develops from the epithelial remnants of
Hertwig s sheath- the cell rests of Malassez
Age usually adults, 20-50 yrs
Frequency: most common of all jaw cysts
(70%)
Typical radiographic features
Site: Apex of any non-vital
tooth.
Size: Usually 1.5-3cm in
diameter
Shape: Round
Monolocular
Outline: Smooth
Well defined
Well corticated if
longstanding and continuous
with the lamina dura of the
associated tooth
Radiodensity: Uniformly
radiolucent
Cont.// Radiographic Features
Effect: Adjacent teethdisplaced, rarely
resorbed
Buccal expansion
Displacement of
the antrum
Residual Cyst
This term refers to radicular (dental) cyst
remaining after the causative tooth has
been extracted
Age: Adults > 20yrs
Site: Apical regions of tooth bearing
portion of the jaws
Typical radiographic features
Size: Variable, 2-3 cm in
diameter
Shape: Round, Monolocular
Outline: Smooth, Well defined
Usually well corticated
Radiodensity: Uniformly
radiolucent
Effects: -adjacent teeth
displaced, rarely
resorbed
-Buccal expansion
-Displacement of the
antrum
Lateral Radicular Cyst
Form at the side of a
non-vital tooth as a
result of opening of
a lateral branch of
the root canal.
Paradental Cyst
Results from
inflammation around
partially erupted
teeth, particularly
mandibular third
molars.
Age: 20-25yrs
Teeth VitalPericorinitis
Developmental Cysts
- Odontogenic Keratocyst
- Follicular cyst
Dentigerous cyst
Eruption Cyst
- Lateral Periodontal cyst
- Glandular Odontogenic Cyst
- Gingival Cyst of Adults
- Gingival Cyst of Newborn (Epstein
Pearls)
Dentigerous (follicular cyst)
Develop from the remnants of the reduced
dental epithelium
Age: Usually adolescents or young adults (2040yrs), occasionally the elderly.
Frequency: About 20% of all Cysts
Typical radiographic features
Site: Associated with the crown of an
unerupted and displaced tooth,
typically teeth where eruption is
impeded, e.g. upper 3, lower 8
Size: Very variable, cyst suspected if
follicular space exceeds 3 mm but
may grow to several cms in
diameter and extend up into the
ramus
Shape: - Round or oval, typically
enveloping the crown symmetrically
- Monolocular
- 3 varieties are described
depending on the cyst – crown
relationship; central,lateral
circumferential
Cont.// Radiographic Features
Outline: - Smooth
- Well defined
- Often Well Corticated
RD: Uniformly RL
Effects: - Associated tooth;
unerupted and displaced
- Adjacent teeth:
Displaced
Rarely resorbed
- Buccal or medial
expansion, can be extensive
with large cysts causing facial
asymmetry and displacement of
the antrum
Eruption Cyst
dentigerous cyst in the
soft tissue
Odontogenic Keratocyst
Develop from the epithelium of the dental
lamina (the cell rests of Serres)
Age: Very variable, 2nd and 4th decade
Frequency : less than 5% of all odontogenic
cysts
Radiographic Features
Site: Posterior body / angle of
the mandible extending to
the ramus
Anterior maxilla in canine
region
Size: Variable, but often large in
the mandible
Shape: - Oval, extending along
the body of the mandible
with little mediolateral
expansion
- Pseudolocular or
multilocular
Outline: -Smooth
- Well defined
- Often well
corticated
Cont// Radiographic Features
Radiodensity: Uniformly
radiolucent
Effects: - Adjacent teeth-
minimal displacement, rarely
resorbed
- Extensive
expansion
within cancellous bone typically
out of the proportion to the
minimal degree of mediolateral
expansion.
Gorlin s Syndrome (nevoid basal
cell carcinoma syndrome)
Multiple Odontogenic
Keratocysts
Multiple Basal Cell Carcinomas
Skeletal Anomalies, e.g. bifid
ribs and calcification of the
flax cerebri.
Developmental Lateral
Periodontal Cyst
Uncommon developmental intraosseous
cysts form beside a vital tooth.
Age: Variable
Frequency: Uncommon
Radiographic Features
Site: Between roots of
lateral incisor and
canine
Size: Usually small in size
Shape: Round
Outline: Well- demarcated
RD: RL
Effect: Adjacent teethMay be displaced
May erode through
the bone to extend into
the gingiva
Glandular Odontogenic Cyst
Very rare
Age: Middle- aged adults 49yrs
Site: 89% Mandible, anterior
region
many cross the midline
Size: vary up to several cms
RD: Uniformly RL
Shape: multilocular st unilocular
Outline: Well demarcated
Effects: Expansion
Paresthesia
Gingival Cyst
Dental lamina cysts of
the newborn,
(Bohns
nodules;Epsteins
pearls)
Gingival cysts of
adults: st erode the
underlying bone
Non-Odontogenic Cysts
Developmental Cysts
Nasopalatine duct cyst
Nasolabial cyst
Median Palatine Cyst
Globulo-Maxillary Cyst
Median Mandibular Cyst
Nasopalatine Duct / Incisive
Canal Cyst
Develop from epithelial remnants of
Nasopalatine Duct or Incisive Canal.
Age: Variable, but most frequently
detected in middle age (40-60 yrs olds).
Frequency: Most Common of all nonodontogenic cysts, 1% of total
population
Radiographic Features
Site: Midline, anterior maxilla just
posterior to the upper central
incisors
Size: Variable, but usually from
6mm to several cm s in
diameter.
Shape: Round or Oval
Monolocular
Outline: Smooth
Well defined
Well corticated
RD: Uniformly RL but RO shadows
st superimposed
Effects: -Adjacent teeth- distal
displacement, rarely resorbed
-Palatal
expansion
Differentiation between Nasopalatine
Duct Cyst and a large normal
Naopalatine foramen?
. Size
. Outline
. Relative RD
. Shape?
Median mandibular cyst
Develop from embryonic epithelial remnants in
the symphyseal region of the mandible
Median Palatine Cyst
Globulo-Maxillary Cyst
Nasolabial Cyst
Rare fissural cyst, arise at
the junction of the
globular process, the
lateral nasal process
and the maxillary
process as a result of
proliferation of
entrapped epithelium
along the fusion line.
X-ray findings are negative
2. Bone Cysts
- Solitary bone cyst
- Aneurysmal bone cyst
- Stafne Cyst ( Lingual Salivary Gland Inclusion
Defect)
Solitary (simple) bone cyst
Unknown aetiology, may be associated with
trauma.
Age: Children and young adults < 20yrs
Radiographic Features
Site: Premolar and Molar region of the
Mandible
Rarely, anterior Maxilla
Size: Variable, up to several cms
Shape: Monolocular
Irregular, upper border arches
between the roots of the teeth
Outline: - Smooth and undulating
- Moderately well defined
- Moderately well or poorly
corticated
RD: uniformly RL
Effects: - Adjacent Teeth- minimal or no
displacement, v rarely
resorbed
- Minimal or no expansion of
the jaw
Aneurysmal Bone Cyst
More accurately classified as Giant Cell Lesion
Localized non-neoplastic proliferative lesion of
vascular tissue, containing Giant Cells.
Age: Usually < 20yrs old
Frequency: Rare.
Radiographic Features
Site: Body/ posterior mandible
Maxilla occasionally
Size: Variable, up to several cms
Shape: - Mono or Multilocular
- Faint internal trabeculation, may
produce a soap-bubble appearance.
Outline: - Smooth
- Moderately well defined
- Peripheral cortex even when
large
RD: RL with evidence of faint, random
internal
trabeculations
Effects: - Adjacent teeth- displaced, rarely
resorbed
- Buccal and lingual expansion of the
cortex, often marked and described as
Ballooning or Blow-Out
Stafne Cyst ( Lingual Salivary
Gland Inclusion Defect)
Well defined
depression in the
lingual surface of
the posterior body
of the mandible
Usually asymptomatic
and are incidental
RG finding
Radiographic Features
Site: usually near the angle of
the mandible, above the
inferior border, inferior to
the mandibular canal and
posterior to the third molar
Size: can penetrate the
mandible to depths
extending from the lingual to
the buccal cortex
Shape: Ovoid or Rectangular
Outline: - Well defined
RD: Uniformly RL
Effects : Incidental
3. Soft tissue cyst
- Dermoid
- Branchial
- Thyroglossal duct cyst
- Salivary cyst
Dermoid Cyst
Branchial Cyst
Thyroglossal Duct Cyst
Salivary Cysts
Calcifying Odontogenic Cyst
(Gorlin Cyst)
Classified by WHO as odontogenic tumour
Presents typically as radiolucency resembling
other odontogenic cysts
As it develops, a variable amount of calcified
material becomes evident, scattered
throughout the RL. The RO can range from
small flecks to large masses.
Age: Variable, usually adults < 40 yrs old
Radiographic Features
Frequency: rare
Site: Usually mandible (70%)- anterior
or premolar regions, occasionaly
associated with an odontome or
errupted tooth.
Size: Usually small, 1-3 cm in diameter
but can become very large,
involving much of the mandible.
Shape: Variable, but usually
monolocular
Outline: Smooth, well defined
Often corticated
RD: initially RL, in advanced lesions –
variable amount of calcified RO
material
Effects: - Adjacent teeth usually
displaced and / or resobed
- Bony expansion
calcifying
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