CYST -Odontogenic (a) Periodontal/Radicular Cyst (b) Dentigerous Cyst (c) Lateral Periodontal Cyst (d) Odontogenic Keratocyst (e) Calcifying Odontogenic Cyst -Non-Odontogenic (a) Globulomaxillary Cyst (b) Nasolabial Cyst (c) Nasopalatine Cyst ENUCLEATION MARSUPIALIZATION

1. CYSTS OF THE ORAL CAVITY

2. Cyst
-an abnormal cavity in hard or soft tissue, which
contains fluid or semi-fluid and is often
encapsulated and lined with epithelium.

3. Cyst of the Oral Cavity:
 ODONTOGENIC CYST
 NON-ODONTOGENIC CYST
.

4. ODONTOGENIC CYST
 (a) Periodontal/Radicular Cyst
 (b) Dentigerous Cyst
 (c) Lateral Periodontal Cyst
 (d) Odontogenic Keratocyst
 (e) Calcifying Odontogenic Cyst

5. ODONTOGENIC CYST
 Periodontal/Radicular Cyst
-most common type of cystic
lesion
Clinical Features:
-painful condition at initial
stage of inflammation but
eventually becomes
asymptomatic
-associated tooth is non-vital
-slow growing

6. Radiographic Features:
-well circumscribed radiolucency at the apex of the
tooth involved

7. Histological Features:
- contents may be fluid or cheese- like material
-fluid contains inflammatory infiltrates
Treatment:
- enucleation following RCT or extraction of the
tooth

8. ODONTOGENIC CYST
 Dentigerous/Follicular cyst
-a cyst that produces an enlargement of the follicular space around
the crown of a developing or unerupted tooth
Incidence:
-2nd most common type of odontogenic cyst
-Most prevalent among children and adults
-Affects late erupting teeth
 3rd mandibular molars
 Maxillary cuspids
 Maxillary 3rd molars
 Mandibular cuspids

9. Etiology: unknown

10. Clinical Features:
-Painless unless infection sets in
-May result to some degree of deformity or facial
asymmetry
-As result of pressure the tooth involved may
migrate to a considerable distance
-The cyst becomes very large before discovery
-Tooth is missing from the normal series of
dentition

11. Radiographic findings:
-Well defined radiolucency associated with the
crown of an impacted or unerupted tooth
-Generally unilocular

12. RADIOLOGICAL FEATURES:
• CENTRAL TYPE:
• LATERAL TYPE :
• CIRCUMFERENTIAL
TYPE :

13. Radiographic Features:
Radiograph of two dentigerous cysts in the same
patient. The cyst on the right is a lateral type; that on
the left is a circumferential type

14. Radiographic Features:
A central type of dentigerous cyst. Note resorption of
the root of the first mandibular molar

15. Treatment:
-Removal of associated tooth with enucleation
-If cystic lesion is very large, marsupialization may be
done to allow decompression and subsequent
shrinkage.
Gross specimen of a dentigerous cyst.
Cyst encloses the crown of the tooth and is attached to
its neck

16. ODONTOGENIC CYST
 Lateral Periodontal Cyst
Clinical Features:
Age : 20 – 60 years, peak in 6th decade.
Sex : Male predilection.
Site : Lateral PDL regions of mandibular
premolars, followed by anterior maxilla

17. Signs and Symptoms:
• Usually asymptomatic as it occurs on the
lateral aspect of root of tooth.
• Occasionally pain and swelling may occur.
• Associated teeth are vital, unless otherwise
affected.

18. Radiographic Features:
• Round to ovoid
‘lucency with
sclerotic margins.
• Cyst can be present
anywhere between
cervical margin to
root apex.
• Radiographically, it
can be confused
with collateral OKC.
Radiograph of a lateral periodontal cyst
lying between the mandibular premolar
teeth. The margins are well corticated,
indicative of slow enlargement.

19. Radiographic Features:
Lateral periodontal cyst. Radiolucent lesion
between the roots of a vital mandibular
canine and first premolar.
Lateral periodontal cyst. A larger lesion
causing root divergence.

20. Treatment:
-Surgical Enucleation

21. ODONTOGENIC CYST
 Odontogenic Keratocyst
-it has the potential to grow a large cyst and has
a very high recurrence rate.

22. Clinical features:
-usually involves the posterior portion of the mandible
-may be multilocular in larger lesions
-usually produces bone expansion
-may displace teeth but remains vital
Radiographic features:
-well circumscribed radiolucency with smooth margins
and thin radiopaque border

23. Differential diagnosis:
-Ameloblastoma, dentigerous cyst, adenomatoid
odontogenic cyst, tumor, ameloblastic fibroma
Treatment:
-Surgical excision with peripheral osseous
curettage or ostectomy

24. ODONTOGENIC CYST
• Calcifying Odontogenic Cyst
-Also called as Odontogenic ghost cell cyst or Gorlin cyst.
Etiology/Pathogenesis:
-derived from odontogenic epithelial remnants within the gingival
Pathognomonic Feature:
-ghost cell keratinization
Clinical Features:
-occurs more often in females >40 yrs. Old
-usually found in the Maxilla
-may be extraosseous in nature

25. Radiographic Features:
• Intraosseous lesions produce
well defined lucency which is
usually unilocular.
• Irregular calcified masses of
varying sizes may be seen within
the lucency.
• Displacement of root/roots with
or without root resorption and
expansion of cortical plates also
seen-
• Within the radiolucent area
there may be scattered
irregularly sized calcifications
producing variable degrees of
opacity which may be seen as
“salt and pepper” pattern
Radiograph of a calcifying odontogenic
cyst of the maxilla. There is a well-demarcated
margin and calcifications
suggestive of tooth material.

26. Radiographic Features:
Radiograph of a calcifying odontogenic cyst with well-demarcated margins
extending from the right to the left premolar regions of the mandible.
Numerous calcifications are present, some suggestive of small denticles.

27. Histological Features:
- ghost cell keratinization
-examination of ghost cells element will show individual
cells or clusters with dystrophic mineralization
Histological features of a calcifying odontogenic cyst with clusters of
fusiform ghost cells and focal calcifications, lying in a stratified squamous
epithelium.

28. Treatment and Prognosis:
-simple enucleation is sufficient treatment with
little risk of recurrence

29. NON-ODONTOGENIC CYSTIC LESIONS
 (a) Globulomaxillary Cyst
 (b) Nasolabial Cyst
 (c) Nasopalatine Cyst

30. NON-ODONTOGENIC CYST
 Globulomaxillary Cyst
Clinical Features:
-well-defined radiolucency often
producing divergence of the roots
of the maxillary lateral incisor and
the canine
-adjacent teeth are vital
-incidence rate is rare
-pear-shaped radiolucency
Treatment:
-enucleation

31. NON-ODONTOGENIC CYST
 Nasolabial Cyst
Clinical Features:
-rare lesion found among
40-50 year old patients
-predilection for females
-seen as soft tissue swelling
in the canine area
-teeth near the affected
area are vital

32. Treatment:
-surgical excision

33. NON-ODONTOGENIC CYST
 Nasopalatine Cyst
-also known as incisive
canal cyst

34. Clinical Features:
-symmentric swelling in
the anterior region of
the palatal midline is
characteristic of the
lesion
-asymptomatic unless it
reaches considerable
size
-may produce divergence
of the roots of Maxillary
incisors

35. Radiographic Feature:
-heart-shaped
radiolucency
Treatment:
-surgical incision

36. TREATMENT
 Cysts of the jaws are treated in one of the
following four basic methods:
(1) Enucleation,
(2) Marsupialization,
(3) A staged combination of the two procedures,
and
(4) Enucleation with curettage.

37. ENUCLEATION
• Enucleation is the process by which the total removal of a
cystic lesion is achieved.
• By definition, it means a shelling- out of the entire cystic
lesion without rupture.
• Enucleation of cysts should be performed with care, in an
attempt to remove the cyst in one piece without frag-mentation,
which reduces the chances of recurrence by
increasing the likelihood of total removal.
• However, maintenance of the cystic architecture is not
always possible, and rupture of the cystic contents may
occur during manipulation.

38. ENUCLEATION
 TECHNIQUE :
• Aspiration Biopsy of Radiolucent Lesions
• Mucoperiosteal Flaps
• Osseous Window
• Removal of Specimen

39. ENUCLEATION
 Aspiration Biopsy of Radiolucent Lesions :
• Any radiolucent lesion should be aspirated before surgical exploration.
• This provides the dentist with valuable diagnostic information regarding
the nature of the lesion
 Mucoperiosteal Flaps :
• Several varieties of mucoperiosteal flaps are available; the choice
depends chiefly on the size and location of the lesion.
• Access may necessitate extension of the irmcoperiosteal flap. The
location of the lesion dictates where the flap incisions are to be made.
• the flap design should provide 4 to 5 mm of sound bone around the
anticipated surgical margins
• mucoperiosteal flaps for biopsies in or on the jaws she be full thickness
and incised through mucosa, submucosa, and periosteum

40. ENUCLEATION
 Osseous Window :
• once the flap has been elevated, a rotating bur
should be used to remove an osseous window
• The size of the window depends on the size of
the lesion and the proximity of the window to
normal anatomic structures such as roots and
neurovascular bundles.

41. ENUCLEATION
 Technique :
• A dental curette is used to peel the connective tissues wall of
the specimen from surrounding bone.
• The concave surface of the instrument should always be kept
in contact with the osseous surfaces of the bone cavity
• The bony cavity is inspected after irrigation with sterile
saline
• Any residual fragments of soft tissue within the cavity should
be removed with curettes.
• Once the cavity is devoid of residual pathologic tissue, it is
irrigated and the flap is replaced and sutured in its proper
location.

42. ENUCLEATION OF CYST

43. MARSUPIALIZATION
• Marsupialization, decompression, and the Partsch operation
all refer to creating a surgical window in the wall of the cyst,
evacuating the contents of the cyst, and maintaining
continuity between the cyst and the oral cavity, maxillary
sinus, or nasal cavity.
• The only portion of the cyst that is removed is the piece
removed to produce the window. The remaining cystic lining
is left in situ.
• This process decreases intracystic pressure and promotes
shrinkage of the cyst and bone fill. Marsupialtzatron can be
used as the sole therapy for a cyst or as a preliminary step in
management, with enucleation deferred until later.

44. INDICATIONS:
1. Amount of tissue injury : Proximity of a cyst to vital structures can mean
unnecessary sacrifice of tissue if enucleation is used.
2. Surgical access : If access to all portions of the cyst is difficult, portions of
the cystic wall may be left behind, which could result in recurrence.
3. Assistance in eruption of teeth : If an unerupted tooth that is needed in
the dental arch is involved with the cyst (i.e., a dentigerous cyst),
marsupialization may allow its continued eruption into the oral cavity
4. Extent of surgery : Marsupialization is a reasonable alternative to
enucleation, because it is simple and may be less stressful for the patient
5. Size of cyst : In very large cysts, a risk of jaw fracture during enucleation is
possible. It may be better to marsupialize the cyst and defer enucleation
until after considerable bone fill has occurred.

45. MARSUPIALIZATION
 Advantages :
• It is a simple procedure to perform. Marsupiaiization also spare
vital
 structures from damage should immediate enucleation be
attempted.
 Disadvantages :
• Pathologic tissue is left in situ, without thorough histologic
examination.
• Patient is inconvenienced in several respects
• The cystic cavity must be kept clean to prevent infection, because
the cavity frequently traps food debris.
• In most instances this means that the patient must irrigate the
cavity several times every day with a syringe

46. TECHNIQUE OF MARSUPIALIZATION
1) Anaesthesia
2) Aspiration
3) Incision
Circular, oval or elliptic. Inverted U shaped incision with broad base to
the buccal sulcus. Mucoperioteum is reflected in this case.
4) Removal of bone
5) Removal of cystic lining specimen
6) Visual examination of residual cystic lining
7) Irrigation of cystic cavity
8) Suturing
Cystic lining sutured with the edge of oral mucosa.
In U shaped incision the mucoperiosteal flap can be turned into cystic
cavity covering the margin. The remaining is sutured to oral mucosa.

47. 9) Packing-- Prevents food contamination & covers wound margins.
Done with ribbon gauze soaked with WHITEHEAD VARNISH.
COMPOSTION:
Benzoin – 10g
Iodoform – 10g
Storax - 7.5g
Balsam of Tolu – 5g
Solvent ether to 100ml
Pack removed after 2 weeks.
10) Maintenance of cystic cavity
Instruct the patient to clean and irrigate the cavity regularly with oral antiseptic
rinse with a disposable syringe.
11) Use of plug
Prevents contamination. Preserves patency of cyst orifice.
Plug should be stable, retentive and safe design.
Should be made of resilient material ( avoid irritation) like acrylic.
12) Healing
Cavity may or may not obliterate totally. Depression remains in the alveolar
process.