**Oral Pathology module** **Odontogenic and non-odontogenic** **cysts** **A/Prof Omar Kujan** **DENT4217** **BDS DipOPath MDSC MFDS RCPS FHEA FRCPath FFOMP(RCPA) PhD**  **Acknowledgement** of country The University of Western Australia acknowledges that its campus is situated on Noongar land, and that Noongar people remain the spiritual and cultural custodians of their land, and continue to practise their values, languages, beliefs and knowledge. **Artist: Dr Richard Barry Walley OAM**  **Learning Outcomes** 1. Describe the different entities of odontogenic and non-odontogenic cysts 2. Outline the pathology features of common odontogenic and non-odontogenic cysts **Definition** A cyst is a pathological cavity filled with fluid, semi-fluid or gaseous contents and is not created by an accumulation of pus. *Kramer 1974.* Cyst Lining Cyst Wall  **Aetiology and pathogenesis** * **Epithelial proliferation** * **Hydrostatic or osmotic factors** * **Keratin formation** * **Bone resorbing factors (prostaglandins,** **collagenase)** **Clinical features** -Noticeable swelling -Discharge into the mouth -Pain due to secondary infection **Diagnosis** •Combination of adequate history, clinical examination and selected investigation (radiographs) **CLASSIFICATION** **Cysts of the jaws** EPITHELIAL CYSTS NON-EPITHELIAL CYSTS (Primary Bone Cysts) Odontogenic Non-odontogenic Inflammatory Developmental **Inflammatory Odontogenic Cysts** ◦ **Radicular (dental) cyst** periapical lateral residual ◦ **Paradental cyst** **<font color="#3366CC">RADICULAR CYSTS</font>** **<font color="#3366CC">Clinical Features</font>** •60-75% of all jaw cysts (Most Common) •Peak in 4th and 5th decades •Non-vital tooth •Upper lateral incisor - most common tooth •Rare in deciduous teeth •Asymptomatic or expansion → springy → egg-shell crackling → fluctuation •Infection → pain Radicular Cyst Apical Lateral Residual     **Radicular** **Cyst**   Radicular cyst Shape: Monolocular Outline: Well defined Well corticated Radiodensity: Uniformly radioucent    No text detected in the image.  Radiographic and clinical image of a radicular cyst.  Clinical images of a radicular cyst.   Panoramic X-ray of jaw with a mandibular fracture and photograph of excised tissue specimen.   **RADICULAR CYST** **Pathogenesis** •INITIATION ◦Cell rest of Malassez activated ◦Activated by products of necrotic pulp •CYST FORMATION ◦Degeneration and death of central cells leads to cavitation   **RADICULAR CYST** **Pathogenesis** •CYST ENLARGEMENT ◦increased osmolality due to breakdown products becoming smaller and more osmotically active ◦wall acts as semi- permeable membrane  **RADICULAR CYST** **Cysts Contents** •Breakdown products of cells •Serum proteins •Water and electrolytes •Cholesterol crystals   - **RADICULAR CYST** - **Histopathology** - •Periapical granuloma with epithelial proliferation - polymorphs in epithelium - •Cyst lined by irregular, non-keratinised stratified squamous epithelium - •Foam cells, lymphocytes, plasma cells, cholesterol clefts, surrounding fibrosis - •Lining becomes thinner and less inflamed - •10% contain hyaline (Rushton) bodies **23**  Histological image showing needle-shaped clefts consistent with cholesterol crystals.  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I need the text from the PDF to effectively combine it with the image OCR and accurately extract and format the text as requested.  and here are the different crops of this image to help you see better, use these only as hints:  **PARADENTAL CYST** * Partially erupted lower 3rd molar usually with pericoronitis * Buccal/Disto-buccal aspect * Enamel spur from bucco-cervical margin of root furcation * Histologically resembles radicular cyst * Derived from reduced enamel epithelium Photograph of extracted tooth with associated paradental cyst and accompanying radiographic image.   **CLASSIFICATION** **Cysts of the jaws** **EPITHELIAL CYSTS** **NON-EPITHELIAL CYSTS** (Primary Bone Cysts) Odontogenic Non-odontogenic *Inflammatory* *Developmental* *Dentigerous cyst* Eruption cyst *Odontogenic keratocyst (primordial cyst)* *Gingival-infants* *Gingival-adults* *Lateral periodontal* **DENTIGEROUS CYST** •Cyst enclosing crown of an unerupted tooth •Attached to cemento-enamel junction •Follicular cyst **PATHOGENESIS** • Intrafollicular fluid accumulates between REE and enamel • Pressure of tooth on impacted follicle - Obstruction of venous outflow - Serum transudation - Exudation **CLINICAL FEATURES** • 10-15% of cyst • Children and young adults • Permanent teeth • Upper canine and lower 3rd molar – teeth likely to be impacted • M:F 1.6:1 • Painless enlargement – missing tooth • Tilting of tooth • Root resorption Radiographic images of dentigerous cysts associated with unerupted teeth.   This document contains images of what appear to be X-rays or radiographic images, likely of a human jaw and surrounding structures. There are two main images presented: - The upper image shows a broader view, possibly a lateral cephalometric X-ray, displaying the profile of the skull, jawbone, and teeth. - The lower image is a closer, more detailed view that highlights a specific area. In this image, several white arrows point to a large, oval-shaped radiolucent (darker) area within the bone, suggesting a cyst or other pathological lesion. To the right of this lesion, several teeth are visible, one of which appears to be wisdom tooth (third molar) that might be impacted or associated with the lesion. Other arrows point to the outlines of this lesion and possibly to associated structures. The images are medical in nature, likely used for diagnostic purposes in dentistry or oral and maxillofacial surgery.   Tooth with associated cystic lesion.  # **PATHOLOGY** * Clear yellow fluid – cholesterol * Purulent if infected * Lined by flattened, non-keratinised stratified squamous epithelium * Continuous with reduced enamel epithelium * Mucous and ciliated columnar metaplasia * Fibrous wall with variable inflammation   **ERUPTION CYST** *Extra-alveolar dentigerous cyst *Deciduous tooth or permanent molar *Fluctuant bluish swelling *Haemorrhage into cyst common *Most spontaneously resolve   **CYSTS** **EPITHELIAL** **ODONTOGENIC** **INFLAMMATORY** Radicular Apical Lateral Residual Paradental **DEVELOPMENTAL** Dentigerous Eruption Odontogenic keratocyst Lateral periodontal Gingival - infants Gingival - adults **NON-ODONTOGENIC** Nasopalatine duct Nasolabial **NON-EPITHELIAL (PRIMARY BONE)** Aneurysmal Solitary **Relative frequency** | Odontogenic (90%) | Non-odontogenic (10%) | |---|---| | **Radicular** 60-75% | Nasopalatine 5-10% | | **Dentigerous** 10-15% | Others 1% | | Keratocyst 5-10% | | | **Paradental** 3-5% | | | Gingival 1% | | | Lateral periodontal 1% | | **ODONTOGENIC KERATOCYST** CLINICAL - 5-10% of all jaw cysts - SITE ◦ 70-80% mandible ◦ 50% angle/ramus - Often asymptomatic - M>F - Swelling, discharge, pain, pathological fracture, tooth displacement, rarely buccal expansion - 10% multiple - High recurrence rate **PATHOGENESIS** - Derived from the dental lamina or it's remnants - cell rests of Serres - Originate from enamel organ (tooth primordium) of a tooth before hard tissues develop: - normal tooth - supernumerary  **RADIOLOGICAL APPEARANCE** * Well demarcated radiolucency * Pseudolocular or multilocular, often with scalloped periphery * Root or tooth displacement There is no text in this image to extract.   **HISTOPATHOLOGY** * Regular stratified squamous epithelium * Thin epithelial layer (5-8 cells thick) * Palisaded basal layer * Corrugated surface which can be parakeratinised or orthokeratininsed * Thin, friable fibrous capsule - little inflammation * Satellite (daughter) cysts Enlargement * Cancellous enlargement antero-posteriorly * Little or no bucco-lingual expansion → large, especially in angle and ramus of mandible   **RECURRENCE** • Up to 60% • Size and infiltrative nature • Tendency to multiplicity and satellite cysts • Intrinsic growth potential • Thin, friable capsule • Genetic - multiple basal cell naevus syndrome (Gorlin-Goltz)   The user wants me to extract text from an image. 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Therefore, I cannot fulfill the request as there is no text in the images to extract.  **GORLIN - GOLTZ SYNDROME** * Multiple keratocysts * Multiple basal cell naevi → carcinomas * Skeletal abnormalities - bifid ribs - spine defects * Frontal bossing and hypertelorism * Calcification of the falx cerebri   Facial images and radiographs showing dermatologic and maxillofacial manifestations.     **LATERAL PERIODONTAL CYST** CLINICAL FEATURES - Canine/premolar area - Rare < 20 years - Adjacent teeth vital NB - Differential diagnosis RADIOGRAPHY - Well defined radiolucent area lateral to tooth **LATERAL PERIODONTAL CYST** **RADIOGRAPHY** - Well defined radiolucent area lateral to tooth   **LATERAL PERIODONTAL** **CYST** **HISTOPATHOLOGY** * Derived from reduced enamel epithelium or cell rests of Malassez * NKSSE 2-6 cells thick * Periodic thickening in luminal surface of epithelium   **GINGIVAL CYSTS** **INFANTS** •Bohn's nodules, Eptein’s pearls •Common in newborns and up to 3 months •Usually rupture or spontaneously involute •2-3 mm keratinising stratified squamous epithelium •Arise from the cell rests of Serres   **GINGIVAL CYST** **ADULT** • Slow -growing, usually < 1cm diameter • Free or attached gingiva or interdental papilla • Tooth vital • Pathogenesis - odontogenic - implantation    <span style="font-size: 32px;">CLASSIFICATION</span> <span style="font-size: 26px;"><u>Cysts of the jaws</u></span> <span style="font-size: 20px;">EPITHELIAL CYSTS</span> <span style="font-size: 20px;">NON-EPITHELIAL CYSTS</span> <span style="font-size: 16px;">(Primary Bone Cysts)</span> <span style="font-size: 16px;">Odontogenic</span> <span style="font-size: 16px;">Non-odontogenic</span> <span style="font-size: 16px;"> Inflammatory</span> <span style="font-size: 16px;"> Developmental</span> **NON-ODONTOGENIC DEVELOPMENTAL CYSTS** * Nasopalatine duct cyst * Nasolabial (naso-alveolar) cyst **\*Median cysts ✗** **\*Globulomaxillary cyst ✗** **NASO-PALATINE DUCT CYST** - Incisive canal cyst - Remnants of nasopalatine duct - M:F 4:1 - 30-60 years - Swelling of midline of palate - Pain and discharge - Mucoid and salty - Vitality of anterior teeth   **NASO-PALATINE DUCT CYST** RADIOLOGY • Well defined radiolucency between roots of central incisors •Roots may diverge •Intact lamina dura HISTOPATHOLOGY •Respiratory type epithelium •Stratified squamous epithelium •Blood vessels and nerves in wall   Histological image of pseudostratified columnar epithelium with cilia.  **NASOLABIAL CYST** * Swelling in nasolabial fold below alae and leading to loss of fold * Sometimes bilateral * Swelling, pain, difficulty in nasal breathing **PATHOGENESIS** - epithelium enclosed at a site of ‘fusion’ of globular, lateral nasal and maxillary processes – unlikely - remnants of embryonic nasolacrimal rod or duct **HISTOPATHOLOGY** - Non-ciliated columnar, respiratory type or stratified squamous epithelium   **SOLITARY BONE CYST** * Also called simple, haemorrhagic, traumatic bone cysts * Rare * Mandible, usually in second decade * Radiolucent area extending between roots (scalloping), usually without expansion * Resolves with minimal intervention   # **SOLITARY BONE CYST** **HISTOPATHOLOGY** * No epithelium * Vascular fibrous tissue in the cyst wall   Radiographic and histological images of a Solitary Bone Cyst.    **ANEURYSMAL BONE CYST** - Radiolucent area bulging into adjacent soft tissue - Mostly in children and young adults - Blood filled spaces - non endothelial lined - Giant cells, haemorrhage, osteoid - Giant cell lesion   Illustration of students confronting red, angry-faced, jellyfish-like creatures on a wall display, with one student pointing to an "ENTER HERE!" sign.