SlideShare a Scribd company logo
1 of 54
Download to read offline
 
Data, De Castro, Ghobadyfard, Rohani, Azinfar, Seyed
Arab
Grp. 3
 Radicular cyst is the most common inflammatory odontogenic
cystic lesion. It originates from epithelial residues in
periodontal ligaments, as a consequence to pulpal necrosis
following caries, with an associated periapical inflammatory
response.
 Here, a 55-year-old male patient was presented with a
complaint of painful swelling on the mandibular left 2nd
premolar area.
 The patient management comprised surgical enucleation of
cystic sac under general anesthesia followed by rehabilitation
of the same area.
 Radicular cysts are the most common inflammatory cysts
arising from the epithelial residues in the periodontal ligament
as a result of periapical periodontitis following necrosis of the
pulp, remains asymptomatic and left unnoticed until detected
during routine periapical radiography.
 These cysts comprise about 52% to 68% of all the cysts
affecting the human jaw. Their incidence is highest in third and
fourth decade of life with male predominance. Anatomically
the periapical cysts occur in all tooth-bearing sites of the jaw
but are more frequent in the maxillary than the mandibular
region.
 Caries is the most frequent aetiological factor of radicular
cyst. They also result from the traumatic injuries.
 These cysts are slow growing and asymptomatic unless
secondarily infected. Extraction or endodontic treatment
of the affected tooth is required when clinical and
radiographic characteristics indicate a periapical
inflammatory lesion.
 The normal treatments for radicular cysts include total
enucleation in the case of small lesions, marsupialisation
for decompression of larger cysts, or a combination of
the two techniques. Inflammatory cysts do not recur after
adequate treatment.
General Data:
 A.F.
 55 y/o
 Male
 Married
 Filipino
 Roman Catholic
 Antipolo
 Left mandibular mass
2 years PTC
 patient underwent tooth extraction of a carious left
lower 2nd premolar. At that time no noted movable
tooth beside the 2nd premolar.
4 months PTC
 Gradually enlarging left mandibular mass
 Associated with swelling and tenderness
 Consulted a dentist and was given Amoxicillin
500mg/cap TID x 1week then Co-amoxiclav
625mg/tab TID which offered relief of swelling but
not of the mass
2 months PTC
 Patient was immediately brought to OPD wherein
panoramic xray was requested revealing unilocular
radiolucency on the left side of the mandible
 On follow-up was advised surgery
(-) Hypertension
(-) Diabetes Mellitus
(-) Allergies to food or medication
(-) Hypertension
(-) Diabetes Mellitus
(-) Cancer
 41 pack years
 Drinks occasionally consuming 3-4/week
 Denies illicit drug used

 No cervical
lymphadenopathies
 No mass palpated
Radicular cyst
Radicular cyst
 No gross deformity
 No tragal tenderness
 Intact TM, pearl white
appearance, non-bulging
 No ear discharge
 Non hyperemic canal
 No gross deformity/deviation
 No nasal discharge
 No epistaxis
 (-) congestion
 No polyps
 No masses
 Presence of mass
 Presence of swelling
Radicular cyst
Radicular cyst
Radicular cyst
 Vocal cord equally moving
 No mass noted
 No edema
 Non-hyperemic
 No mass noted

Radicular cyst

 Cyst is a pathological fluid-filled cavity lined by
epithelium.
o Components of a cyst: Lumen (cavity), Epithelial lining, Wall
(capsule)
 Odontogenic Cyst – a cyst in which lining of the lumen
is derived from epithelium involved in tooth development.
 Non-odontogenic Cyst – The epithelial lining is derived
from sources other than the tooth-forming organ.
Radicular cyst
 Also known as Periapical Cyst, Apical Periodontal
Cyst, Root End Cyst or Dental Cyst
 A cyst that most likely results when rests of epithelial
cells (Malassez) in the periodontal ligament are
stimulated to proliferate and undergo cystic degeneration
by inflammatory products from a non-vital tooth.
 Most common odontogenic cystic lesion of inflammatory
origin.
 Radicular cysts are found at root apices of involved
teeth. These cysts may persists even after extraction of
offending tooth, such cysts are called Residual Cysts.
 It is classified as follows:
o 1) Periapical Cyst (70%):
These are the radicular cysts
which are present at root
apex.
o 2) Lateral Radicular Cyst
(20%): These are the
radicular cysts which are
present at the opening of
lateral accessory root canals
of offending tooth.
o 3) Residual Cyst: These are
the radicular cysts which
remains even after
extraction of offending tooth.
 Most common location: (maxilla 3x more affected)
o Maxillary anterior region
o Maxillary posterior region
o Mandibular posterior region
o Mandibular anterior region
 Usually asymptomatic
 Slowly progressing
o If infection enters, the swelling
becomes painful and rapidly
expands
o Initially swelling is round and hard
o Later part of the wall is resorbed
leaving a soft fluctuant
swelling, bluish in color, beneath the
mucous membrane
o When bone has been reduced to
egg shell thickness a crackling
sensation (crepitant) may be felt on
pressure.
Radicular cyst
Radicular cyst
 The main factors in the pathogenesis of cyst formation
are:
o Proliferation of epithelial lining and fibrous capsule
o Hydrostatic pressure of cystic fluid
o Resorption of surrounding bone
 Infection from pulp chamber induces inflammation and
and proliferation of ERM
 Internal pressure is important for growth of cyst
 Hydrostatic pressure within cysts is about 70cm of water
(higher than capillary blood pressure of )
 Net effect is that pressure is created by osmotic tension
within the cyst cavity
 Lumen:
o Cyst fluid (watery & opalescent) but sometimes viscid and yellowish
o Sometimes shimmers with cholesterol crystals (typically rectangular
shaped cholesterol crystals with a notched corner is characteristic)
o Cholesterol crystals are not specific to radicular cysts
o Protein content of fluid – seen as amorphous eosinophilic material often
containing broken-down leucocytes and and cells distended with fat
globules
Radicular cyst
 Epithelial lining:
o Non-keratinized stratified
squamous epithelium
o Lacks a well-defined basal
cell layer
o Thick, irregular, hyperplastic
or net like forming rings &
arcades
o Hyaline bodies (Rushton
bodies) may be found
o Mucous cells – as a result
of metaplasia
Radicular cyst
 Wall/Capsule
o Composed of collagenous fibrous connective tissue
o Capsule is vascular and infiltrated by chronic inflammatory cells
o Plasma cells are prominent or predominate
o Russel bodies are often found
o Pulse or Seed granulomas are often found in cyst wall
 Hyaline bodies (Rushton bodies): characterized by a
hairpin or a slightly-curved shaped, concentric lamination
and occasional basophilic mineralization.
o Are within the epithelium lining
o Origin believed to be previous hemorrhage
o Are of no clinical significance
 Russel bodies: refractile and spherical intracellular
bodies representing Gamma Globulin
 Round/ovoid radiolucency with an opaque border
 Apex of the tooth is within the radiolucency
 Adjacent teeth and structures are displaced
 Infected cyst:
o Poorly demarcated borders
o Background structures become invisible and the defect appears
as tunneling
o PDL space around the involved tooth becomes widened
Radicular cyst
Radicular cyst
 Treatment of a tooth with radicular cyst may include:
o Tooth extraction
o Endodontic therapy – if the involved non vital tooth is to be
retained
o Enucleation – all the cyst tissue will be available for histological
examination; have minimal aftercare. Potentially problematic as
this may deprive adjacent teeth of their blood supply and render
them non vital
o Marsupialisation – partial removal; indicated in large cysts that
involves apices of adjacent teeth; requires considerable
aftercare and good patient cooperation.
• Disadvantage: not all cyst lining is available to histologic
examination which may lead to misdiagnosis
 The patient was subjected to enucleation of the cyst
under general anaesthesia.
 A (crevicular) incision was made from the (distal surface
of the mandibular first premolar until distal surface of the
second molar), the mucoperiosteal flap was raised, the
(mandibular second premolar and the second molar)
were extracted and the cyst was removed in toto along
with the root piece of the first molar. There was an intact
inferior alveolar neurovascular bundle.
 Flaps were repositioned and sutures were taken. The
tissue specimens were sent for histopathologial
examination.

Radicular cyst
 It can develop even after years after tooth extraction and
is responsible for ameloblatomas that develop on
patients older than 30 years.
Patient (A.F.) Radicular Cyst Dentigerous Cyst Ameloblastoma
Location: left body of
the mandible
Non-vital tooth (apex
or lateral part of the
tooth)
Crown of an unerupted
tooth (third molars and
maxillary canines )
Mandible and maxillary
area
Radiologic features:
unilocular radiolucency
unilocular radiolucency
at the apical portion of
a non-vital tooth
unilocular
radiolucency, which is
associated with an
unerupted tooth
radiolucent, unilocular
lesions, with well-
demarcated, corticated
borders;
larger lesions : “soap
bubble” or honeycomb
Microscopic features luminal lining:
nonkeratinized
stratified squamous
epithelium
odontogenic rests are
rarely seen in the cyst
wall
Cholesterol slits,
foreign body giant
cells, and hemosiderin
deposits are common
findings.
luminal lining:
nonkeratinized
stratified squamous
epithelium
Odontogenic rests are
scattered within the
connective tissue
Cholesterol slits and
their associated
multinucleated giant
cells may be present
columnar basilar cells,
palisading of basilar
cells, polarization of
basilar layer nuclei
away from the
basement membrane,
hyperchromatism of
basal cell nuclei in the
epithelial lining, and
subnuclear
vacuolization of the
cytoplasm of the basal
cells

 The radicular cyst is usually symptomless and detected incidentally on
plain OPG while investigating for other diseases. However, as some of
them grow, they can cause mobility and displacement of teeth and once
infected, lead to pain and swelling, after which the patient usually
becomes aware of the problem. The swelling is slowly enlarging and
initially bony hard to palpate which later becomes rubbery and fluctuant.
 The treatment of choice is dependent on the size and localization of the
lesion, the bone integrity of the cystic wall and its proximity to vital
structures.
 Several treatment options are available for a radicular cyst such as
surgical endodontic treatment, extraction of the offending
tooth, enucleation with primary closure, and marsupialization followed
by enucleation. In this case, surgical enucleation was preferred and
was performed uneventfully.
 To conclude, a radicular cyst is a common condition found in the oral
cavity. However, it usually goes unnoticed and rarely exceeds the
palpable dimension. This case illustrates a common condition that
 Department of Otorhinolaryncology, Head and Neck
Surgery, Quirino Memorial Medical Center
 Wikipedia
(http://en.wikipedia.org/wiki/Periapical_cyst#Treatment)
 http://www.slideshare.net/malagha/radicular-
cyst?from_search=3
 http://www.slideshare.net/drabbasnaseem/radicular-cyst-
or-periapical-cyst
 Cawson’s Essentials of Oral Pathology & Oral Medicine
– 7th edition
 Oral and Maxillofacial Medicine (Crispian Scully CBE)
 Contemporary Oral and Maxillofacial Pathology – 2nd
edition

More Related Content

What's hot

Fibro-osseous lesions of the jaws
Fibro-osseous lesions of the jawsFibro-osseous lesions of the jaws
Fibro-osseous lesions of the jawssachidanand giri
 
Diseases of bone manifested in the jaws
Diseases of bone manifested in the jawsDiseases of bone manifested in the jaws
Diseases of bone manifested in the jawsIAU Dent
 
calcifying odontogenic cyst
calcifying odontogenic cyst calcifying odontogenic cyst
calcifying odontogenic cyst Beeula A
 
Abnormalities of the pulp
Abnormalities of the pulpAbnormalities of the pulp
Abnormalities of the pulpChelsea Mareé
 
Fissural cysts of oral cavity
Fissural cysts of oral cavityFissural cysts of oral cavity
Fissural cysts of oral cavityNarmathaN2
 
Radicular cyst or Periapical cyst
Radicular cyst or Periapical cystRadicular cyst or Periapical cyst
Radicular cyst or Periapical cystdrabbasnaseem
 
Chairside investigations
Chairside investigationsChairside investigations
Chairside investigationsrumelaghoshbds
 
PERIAPICAL DISEASES
PERIAPICAL DISEASESPERIAPICAL DISEASES
PERIAPICAL DISEASESAshok Kumar
 
Odontogenic Tumors
Odontogenic TumorsOdontogenic Tumors
Odontogenic TumorsIAU Dent
 
Fibro Osseous Lesions
Fibro Osseous LesionsFibro Osseous Lesions
Fibro Osseous LesionsSanchit Goyal
 
Radiopacities of jaws
Radiopacities of jawsRadiopacities of jaws
Radiopacities of jawsSwati Kalra
 
Diseases of pulp and periapical tissues
Diseases of pulp and periapical tissues Diseases of pulp and periapical tissues
Diseases of pulp and periapical tissues madhusudhan reddy
 
cysts of the oral and maxillofacial region
cysts of the oral and maxillofacial regioncysts of the oral and maxillofacial region
cysts of the oral and maxillofacial regionmadhusudhan reddy
 

What's hot (20)

Fibro-osseous lesions of the jaws
Fibro-osseous lesions of the jawsFibro-osseous lesions of the jaws
Fibro-osseous lesions of the jaws
 
Epithelial dysplasia
Epithelial dysplasiaEpithelial dysplasia
Epithelial dysplasia
 
Diseases of bone manifested in the jaws
Diseases of bone manifested in the jawsDiseases of bone manifested in the jaws
Diseases of bone manifested in the jaws
 
Radicular cyst
Radicular cystRadicular cyst
Radicular cyst
 
Fibro Osseous Lesions
Fibro Osseous LesionsFibro Osseous Lesions
Fibro Osseous Lesions
 
Pindborgs Tumour
Pindborgs TumourPindborgs Tumour
Pindborgs Tumour
 
calcifying odontogenic cyst
calcifying odontogenic cyst calcifying odontogenic cyst
calcifying odontogenic cyst
 
Abnormalities of the pulp
Abnormalities of the pulpAbnormalities of the pulp
Abnormalities of the pulp
 
Fissural cysts of oral cavity
Fissural cysts of oral cavityFissural cysts of oral cavity
Fissural cysts of oral cavity
 
Radicular cyst or Periapical cyst
Radicular cyst or Periapical cystRadicular cyst or Periapical cyst
Radicular cyst or Periapical cyst
 
Chairside investigations
Chairside investigationsChairside investigations
Chairside investigations
 
Odontogenic cyst
Odontogenic cystOdontogenic cyst
Odontogenic cyst
 
PERIAPICAL DISEASES
PERIAPICAL DISEASESPERIAPICAL DISEASES
PERIAPICAL DISEASES
 
Odontogenic Tumors
Odontogenic TumorsOdontogenic Tumors
Odontogenic Tumors
 
healing of oral wounds
healing of oral woundshealing of oral wounds
healing of oral wounds
 
Fibro Osseous Lesions
Fibro Osseous LesionsFibro Osseous Lesions
Fibro Osseous Lesions
 
Radiopacities of jaws
Radiopacities of jawsRadiopacities of jaws
Radiopacities of jaws
 
Dentigerous cyst
Dentigerous cystDentigerous cyst
Dentigerous cyst
 
Diseases of pulp and periapical tissues
Diseases of pulp and periapical tissues Diseases of pulp and periapical tissues
Diseases of pulp and periapical tissues
 
cysts of the oral and maxillofacial region
cysts of the oral and maxillofacial regioncysts of the oral and maxillofacial region
cysts of the oral and maxillofacial region
 

Viewers also liked (12)

Prepare Ur Self 2 Ent Osce
Prepare Ur Self 2 Ent OscePrepare Ur Self 2 Ent Osce
Prepare Ur Self 2 Ent Osce
 
ENT OSPE (1)
ENT OSPE (1)ENT OSPE (1)
ENT OSPE (1)
 
Granuloma nose
Granuloma noseGranuloma nose
Granuloma nose
 
Osce ent
Osce entOsce ent
Osce ent
 
ENT OSPE (2)
ENT OSPE (2)ENT OSPE (2)
ENT OSPE (2)
 
Ent osce
Ent osceEnt osce
Ent osce
 
mmmc ent 7
mmmc ent 7mmmc ent 7
mmmc ent 7
 
My mandibular movement final presentation
My mandibular movement  final presentationMy mandibular movement  final presentation
My mandibular movement final presentation
 
Mandibular Movements
Mandibular MovementsMandibular Movements
Mandibular Movements
 
Mandibular anesthetic techniques
Mandibular anesthetic techniquesMandibular anesthetic techniques
Mandibular anesthetic techniques
 
Benign tumors of jaw
Benign tumors of jaw Benign tumors of jaw
Benign tumors of jaw
 
Cephalometric analysis
Cephalometric analysisCephalometric analysis
Cephalometric analysis
 

Similar to Radicular cyst

Differential diagnoses and management of mandibular radiolucent lesions
Differential diagnoses and management of mandibular radiolucent lesionsDifferential diagnoses and management of mandibular radiolucent lesions
Differential diagnoses and management of mandibular radiolucent lesionsIzhar Ali
 
Cysts of oral regions
Cysts of oral regionsCysts of oral regions
Cysts of oral regionsNaz Dizayee
 
Cysts of the jaw and neck
Cysts of the jaw and neckCysts of the jaw and neck
Cysts of the jaw and neckIAU Dent
 
Odontogenic tumors iii/certified fixed orthodontic courses by Indian dental a...
Odontogenic tumors iii/certified fixed orthodontic courses by Indian dental a...Odontogenic tumors iii/certified fixed orthodontic courses by Indian dental a...
Odontogenic tumors iii/certified fixed orthodontic courses by Indian dental a...Indian dental academy
 
Tumors of the head and neck
Tumors of the head and neckTumors of the head and neck
Tumors of the head and neckIAU Dent
 
Odontogenic Tumors
Odontogenic TumorsOdontogenic Tumors
Odontogenic TumorsDrMuqheem
 
Odontogenic tumours management ih
Odontogenic tumours management  ihOdontogenic tumours management  ih
Odontogenic tumours management ihitrat hussain
 
Management of apical lesions
Management of apical lesionsManagement of apical lesions
Management of apical lesionsVikram Perakath
 
Cysts in orofacial region
Cysts in orofacial regionCysts in orofacial region
Cysts in orofacial regionMohammed Rhael
 
CYSTS OF THE JAWS Part II
CYSTS OF THE JAWS Part IICYSTS OF THE JAWS Part II
CYSTS OF THE JAWS Part IIAbhishek PT
 
Frontal osteoma - HARSH AMIN
Frontal osteoma - HARSH AMINFrontal osteoma - HARSH AMIN
Frontal osteoma - HARSH AMINDr. HARSH AMIN
 
4. cyst & cystlike lesion of the jaw (2) (1)
4. cyst & cystlike lesion of the jaw (2) (1)4. cyst & cystlike lesion of the jaw (2) (1)
4. cyst & cystlike lesion of the jaw (2) (1)qamar olabi
 
Odontogenic Cysts
Odontogenic CystsOdontogenic Cysts
Odontogenic CystsIAU Dent
 

Similar to Radicular cyst (20)

Differential diagnoses and management of mandibular radiolucent lesions
Differential diagnoses and management of mandibular radiolucent lesionsDifferential diagnoses and management of mandibular radiolucent lesions
Differential diagnoses and management of mandibular radiolucent lesions
 
14057080.ppt
14057080.ppt14057080.ppt
14057080.ppt
 
CYSTS OF ORAL AND MAXILLOFACIAL REGION (2).ppt
CYSTS OF ORAL AND MAXILLOFACIAL REGION (2).pptCYSTS OF ORAL AND MAXILLOFACIAL REGION (2).ppt
CYSTS OF ORAL AND MAXILLOFACIAL REGION (2).ppt
 
Cysts of oral regions
Cysts of oral regionsCysts of oral regions
Cysts of oral regions
 
CYSTS OF HEAD AND NECK
CYSTS OF HEAD AND NECKCYSTS OF HEAD AND NECK
CYSTS OF HEAD AND NECK
 
Cysts of the jaw and neck
Cysts of the jaw and neckCysts of the jaw and neck
Cysts of the jaw and neck
 
Odontogenic tumors iii/certified fixed orthodontic courses by Indian dental a...
Odontogenic tumors iii/certified fixed orthodontic courses by Indian dental a...Odontogenic tumors iii/certified fixed orthodontic courses by Indian dental a...
Odontogenic tumors iii/certified fixed orthodontic courses by Indian dental a...
 
Tumors of the head and neck
Tumors of the head and neckTumors of the head and neck
Tumors of the head and neck
 
Odontogenic Tumors
Odontogenic TumorsOdontogenic Tumors
Odontogenic Tumors
 
Odontogenic tumours management ih
Odontogenic tumours management  ihOdontogenic tumours management  ih
Odontogenic tumours management ih
 
Management of apical lesions
Management of apical lesionsManagement of apical lesions
Management of apical lesions
 
Cysts in orofacial region
Cysts in orofacial regionCysts in orofacial region
Cysts in orofacial region
 
CYSTS OF THE JAWS Part II
CYSTS OF THE JAWS Part IICYSTS OF THE JAWS Part II
CYSTS OF THE JAWS Part II
 
Presentation
PresentationPresentation
Presentation
 
Odontogenic tumors iii
Odontogenic tumors iiiOdontogenic tumors iii
Odontogenic tumors iii
 
Benign tumors
Benign tumorsBenign tumors
Benign tumors
 
mixed tumors.pptx
mixed tumors.pptxmixed tumors.pptx
mixed tumors.pptx
 
Frontal osteoma - HARSH AMIN
Frontal osteoma - HARSH AMINFrontal osteoma - HARSH AMIN
Frontal osteoma - HARSH AMIN
 
4. cyst & cystlike lesion of the jaw (2) (1)
4. cyst & cystlike lesion of the jaw (2) (1)4. cyst & cystlike lesion of the jaw (2) (1)
4. cyst & cystlike lesion of the jaw (2) (1)
 
Odontogenic Cysts
Odontogenic CystsOdontogenic Cysts
Odontogenic Cysts
 

Recently uploaded

Microbiology lecture presentation-1.pptx
Microbiology lecture presentation-1.pptxMicrobiology lecture presentation-1.pptx
Microbiology lecture presentation-1.pptxkitati1
 
MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.whalesdesign
 
Mental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil ThirusanguMental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil Thirusangu Medical University
 
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.aarjukhadka22
 
How to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyHow to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyZurück zum Ursprung
 
World-TB-Day-2023_Presentation_English.pptx
World-TB-Day-2023_Presentation_English.pptxWorld-TB-Day-2023_Presentation_English.pptx
World-TB-Day-2023_Presentation_English.pptxsumanchaulagain3
 
AUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsAUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsMedicoseAcademics
 
Female Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before PregnancyFemale Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before PregnancyMedicoseAcademics
 
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfCONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfDolisha Warbi
 
concept of total quality management (TQM).
concept of total quality management (TQM).concept of total quality management (TQM).
concept of total quality management (TQM).kishan singh tomar
 
Role of Soap based and synthetic or syndets bar
Role of  Soap based and synthetic or syndets barRole of  Soap based and synthetic or syndets bar
Role of Soap based and synthetic or syndets barmohitRahangdale
 
Good Laboratory Practice (GLP) in Pharma-LikeWays.pptx
Good Laboratory Practice (GLP) in Pharma-LikeWays.pptxGood Laboratory Practice (GLP) in Pharma-LikeWays.pptx
Good Laboratory Practice (GLP) in Pharma-LikeWays.pptxLikeways
 
High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)kishan singh tomar
 
The Importance of Mental Health: Why is Mental Health Important?
The Importance of Mental Health: Why is Mental Health Important?The Importance of Mental Health: Why is Mental Health Important?
The Importance of Mental Health: Why is Mental Health Important?Ryan Addison
 
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdfSGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdfHongBiThi1
 
blood bank management system project report
blood bank management system project reportblood bank management system project report
blood bank management system project reportNARMADAPETROLEUMGAS
 
introduction to neurology (nervous system, areas, motor and sensory systems)
introduction to neurology (nervous system, areas, motor and sensory systems)introduction to neurology (nervous system, areas, motor and sensory systems)
introduction to neurology (nervous system, areas, motor and sensory systems)Mohamed Rizk Khodair
 
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfSGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfHongBiThi1
 
Physiotherapy Management of Rheumatoid Arthritis
Physiotherapy Management of Rheumatoid ArthritisPhysiotherapy Management of Rheumatoid Arthritis
Physiotherapy Management of Rheumatoid ArthritisNilofarRasheed1
 
Using Data Visualization in Public Health Communications
Using Data Visualization in Public Health CommunicationsUsing Data Visualization in Public Health Communications
Using Data Visualization in Public Health Communicationskatiequigley33
 

Recently uploaded (20)

Microbiology lecture presentation-1.pptx
Microbiology lecture presentation-1.pptxMicrobiology lecture presentation-1.pptx
Microbiology lecture presentation-1.pptx
 
MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.
 
Mental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil ThirusanguMental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil Thirusangu
 
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
 
How to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyHow to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturally
 
World-TB-Day-2023_Presentation_English.pptx
World-TB-Day-2023_Presentation_English.pptxWorld-TB-Day-2023_Presentation_English.pptx
World-TB-Day-2023_Presentation_English.pptx
 
AUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsAUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functions
 
Female Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before PregnancyFemale Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before Pregnancy
 
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfCONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
 
concept of total quality management (TQM).
concept of total quality management (TQM).concept of total quality management (TQM).
concept of total quality management (TQM).
 
Role of Soap based and synthetic or syndets bar
Role of  Soap based and synthetic or syndets barRole of  Soap based and synthetic or syndets bar
Role of Soap based and synthetic or syndets bar
 
Good Laboratory Practice (GLP) in Pharma-LikeWays.pptx
Good Laboratory Practice (GLP) in Pharma-LikeWays.pptxGood Laboratory Practice (GLP) in Pharma-LikeWays.pptx
Good Laboratory Practice (GLP) in Pharma-LikeWays.pptx
 
High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)
 
The Importance of Mental Health: Why is Mental Health Important?
The Importance of Mental Health: Why is Mental Health Important?The Importance of Mental Health: Why is Mental Health Important?
The Importance of Mental Health: Why is Mental Health Important?
 
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdfSGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
 
blood bank management system project report
blood bank management system project reportblood bank management system project report
blood bank management system project report
 
introduction to neurology (nervous system, areas, motor and sensory systems)
introduction to neurology (nervous system, areas, motor and sensory systems)introduction to neurology (nervous system, areas, motor and sensory systems)
introduction to neurology (nervous system, areas, motor and sensory systems)
 
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfSGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
 
Physiotherapy Management of Rheumatoid Arthritis
Physiotherapy Management of Rheumatoid ArthritisPhysiotherapy Management of Rheumatoid Arthritis
Physiotherapy Management of Rheumatoid Arthritis
 
Using Data Visualization in Public Health Communications
Using Data Visualization in Public Health CommunicationsUsing Data Visualization in Public Health Communications
Using Data Visualization in Public Health Communications
 

Radicular cyst

  • 1.   Data, De Castro, Ghobadyfard, Rohani, Azinfar, Seyed Arab Grp. 3
  • 2.  Radicular cyst is the most common inflammatory odontogenic cystic lesion. It originates from epithelial residues in periodontal ligaments, as a consequence to pulpal necrosis following caries, with an associated periapical inflammatory response.  Here, a 55-year-old male patient was presented with a complaint of painful swelling on the mandibular left 2nd premolar area.  The patient management comprised surgical enucleation of cystic sac under general anesthesia followed by rehabilitation of the same area.
  • 3.  Radicular cysts are the most common inflammatory cysts arising from the epithelial residues in the periodontal ligament as a result of periapical periodontitis following necrosis of the pulp, remains asymptomatic and left unnoticed until detected during routine periapical radiography.  These cysts comprise about 52% to 68% of all the cysts affecting the human jaw. Their incidence is highest in third and fourth decade of life with male predominance. Anatomically the periapical cysts occur in all tooth-bearing sites of the jaw but are more frequent in the maxillary than the mandibular region.  Caries is the most frequent aetiological factor of radicular cyst. They also result from the traumatic injuries.
  • 4.  These cysts are slow growing and asymptomatic unless secondarily infected. Extraction or endodontic treatment of the affected tooth is required when clinical and radiographic characteristics indicate a periapical inflammatory lesion.  The normal treatments for radicular cysts include total enucleation in the case of small lesions, marsupialisation for decompression of larger cysts, or a combination of the two techniques. Inflammatory cysts do not recur after adequate treatment.
  • 5. General Data:  A.F.  55 y/o  Male  Married  Filipino  Roman Catholic  Antipolo
  • 7. 2 years PTC  patient underwent tooth extraction of a carious left lower 2nd premolar. At that time no noted movable tooth beside the 2nd premolar. 4 months PTC  Gradually enlarging left mandibular mass  Associated with swelling and tenderness  Consulted a dentist and was given Amoxicillin 500mg/cap TID x 1week then Co-amoxiclav 625mg/tab TID which offered relief of swelling but not of the mass
  • 8. 2 months PTC  Patient was immediately brought to OPD wherein panoramic xray was requested revealing unilocular radiolucency on the left side of the mandible  On follow-up was advised surgery
  • 9. (-) Hypertension (-) Diabetes Mellitus (-) Allergies to food or medication
  • 10. (-) Hypertension (-) Diabetes Mellitus (-) Cancer
  • 11.  41 pack years  Drinks occasionally consuming 3-4/week  Denies illicit drug used
  • 16.  No gross deformity  No tragal tenderness  Intact TM, pearl white appearance, non-bulging  No ear discharge  Non hyperemic canal
  • 17.  No gross deformity/deviation  No nasal discharge  No epistaxis  (-) congestion  No polyps  No masses
  • 18.  Presence of mass  Presence of swelling
  • 22.  Vocal cord equally moving  No mass noted  No edema  Non-hyperemic
  • 23.  No mass noted
  • 27.  Cyst is a pathological fluid-filled cavity lined by epithelium. o Components of a cyst: Lumen (cavity), Epithelial lining, Wall (capsule)
  • 28.  Odontogenic Cyst – a cyst in which lining of the lumen is derived from epithelium involved in tooth development.  Non-odontogenic Cyst – The epithelial lining is derived from sources other than the tooth-forming organ.
  • 30.  Also known as Periapical Cyst, Apical Periodontal Cyst, Root End Cyst or Dental Cyst  A cyst that most likely results when rests of epithelial cells (Malassez) in the periodontal ligament are stimulated to proliferate and undergo cystic degeneration by inflammatory products from a non-vital tooth.  Most common odontogenic cystic lesion of inflammatory origin.  Radicular cysts are found at root apices of involved teeth. These cysts may persists even after extraction of offending tooth, such cysts are called Residual Cysts.
  • 31.  It is classified as follows: o 1) Periapical Cyst (70%): These are the radicular cysts which are present at root apex. o 2) Lateral Radicular Cyst (20%): These are the radicular cysts which are present at the opening of lateral accessory root canals of offending tooth. o 3) Residual Cyst: These are the radicular cysts which remains even after extraction of offending tooth.
  • 32.  Most common location: (maxilla 3x more affected) o Maxillary anterior region o Maxillary posterior region o Mandibular posterior region o Mandibular anterior region
  • 33.  Usually asymptomatic  Slowly progressing o If infection enters, the swelling becomes painful and rapidly expands o Initially swelling is round and hard o Later part of the wall is resorbed leaving a soft fluctuant swelling, bluish in color, beneath the mucous membrane o When bone has been reduced to egg shell thickness a crackling sensation (crepitant) may be felt on pressure.
  • 36.  The main factors in the pathogenesis of cyst formation are: o Proliferation of epithelial lining and fibrous capsule o Hydrostatic pressure of cystic fluid o Resorption of surrounding bone  Infection from pulp chamber induces inflammation and and proliferation of ERM  Internal pressure is important for growth of cyst  Hydrostatic pressure within cysts is about 70cm of water (higher than capillary blood pressure of )  Net effect is that pressure is created by osmotic tension within the cyst cavity
  • 37.  Lumen: o Cyst fluid (watery & opalescent) but sometimes viscid and yellowish o Sometimes shimmers with cholesterol crystals (typically rectangular shaped cholesterol crystals with a notched corner is characteristic) o Cholesterol crystals are not specific to radicular cysts o Protein content of fluid – seen as amorphous eosinophilic material often containing broken-down leucocytes and and cells distended with fat globules
  • 39.  Epithelial lining: o Non-keratinized stratified squamous epithelium o Lacks a well-defined basal cell layer o Thick, irregular, hyperplastic or net like forming rings & arcades o Hyaline bodies (Rushton bodies) may be found o Mucous cells – as a result of metaplasia
  • 41.  Wall/Capsule o Composed of collagenous fibrous connective tissue o Capsule is vascular and infiltrated by chronic inflammatory cells o Plasma cells are prominent or predominate o Russel bodies are often found o Pulse or Seed granulomas are often found in cyst wall
  • 42.  Hyaline bodies (Rushton bodies): characterized by a hairpin or a slightly-curved shaped, concentric lamination and occasional basophilic mineralization. o Are within the epithelium lining o Origin believed to be previous hemorrhage o Are of no clinical significance  Russel bodies: refractile and spherical intracellular bodies representing Gamma Globulin
  • 43.  Round/ovoid radiolucency with an opaque border  Apex of the tooth is within the radiolucency  Adjacent teeth and structures are displaced  Infected cyst: o Poorly demarcated borders o Background structures become invisible and the defect appears as tunneling o PDL space around the involved tooth becomes widened
  • 46.  Treatment of a tooth with radicular cyst may include: o Tooth extraction o Endodontic therapy – if the involved non vital tooth is to be retained o Enucleation – all the cyst tissue will be available for histological examination; have minimal aftercare. Potentially problematic as this may deprive adjacent teeth of their blood supply and render them non vital o Marsupialisation – partial removal; indicated in large cysts that involves apices of adjacent teeth; requires considerable aftercare and good patient cooperation. • Disadvantage: not all cyst lining is available to histologic examination which may lead to misdiagnosis
  • 47.  The patient was subjected to enucleation of the cyst under general anaesthesia.  A (crevicular) incision was made from the (distal surface of the mandibular first premolar until distal surface of the second molar), the mucoperiosteal flap was raised, the (mandibular second premolar and the second molar) were extracted and the cyst was removed in toto along with the root piece of the first molar. There was an intact inferior alveolar neurovascular bundle.  Flaps were repositioned and sutures were taken. The tissue specimens were sent for histopathologial examination.
  • 50.  It can develop even after years after tooth extraction and is responsible for ameloblatomas that develop on patients older than 30 years.
  • 51. Patient (A.F.) Radicular Cyst Dentigerous Cyst Ameloblastoma Location: left body of the mandible Non-vital tooth (apex or lateral part of the tooth) Crown of an unerupted tooth (third molars and maxillary canines ) Mandible and maxillary area Radiologic features: unilocular radiolucency unilocular radiolucency at the apical portion of a non-vital tooth unilocular radiolucency, which is associated with an unerupted tooth radiolucent, unilocular lesions, with well- demarcated, corticated borders; larger lesions : “soap bubble” or honeycomb Microscopic features luminal lining: nonkeratinized stratified squamous epithelium odontogenic rests are rarely seen in the cyst wall Cholesterol slits, foreign body giant cells, and hemosiderin deposits are common findings. luminal lining: nonkeratinized stratified squamous epithelium Odontogenic rests are scattered within the connective tissue Cholesterol slits and their associated multinucleated giant cells may be present columnar basilar cells, palisading of basilar cells, polarization of basilar layer nuclei away from the basement membrane, hyperchromatism of basal cell nuclei in the epithelial lining, and subnuclear vacuolization of the cytoplasm of the basal cells
  • 53.  The radicular cyst is usually symptomless and detected incidentally on plain OPG while investigating for other diseases. However, as some of them grow, they can cause mobility and displacement of teeth and once infected, lead to pain and swelling, after which the patient usually becomes aware of the problem. The swelling is slowly enlarging and initially bony hard to palpate which later becomes rubbery and fluctuant.  The treatment of choice is dependent on the size and localization of the lesion, the bone integrity of the cystic wall and its proximity to vital structures.  Several treatment options are available for a radicular cyst such as surgical endodontic treatment, extraction of the offending tooth, enucleation with primary closure, and marsupialization followed by enucleation. In this case, surgical enucleation was preferred and was performed uneventfully.  To conclude, a radicular cyst is a common condition found in the oral cavity. However, it usually goes unnoticed and rarely exceeds the palpable dimension. This case illustrates a common condition that
  • 54.  Department of Otorhinolaryncology, Head and Neck Surgery, Quirino Memorial Medical Center  Wikipedia (http://en.wikipedia.org/wiki/Periapical_cyst#Treatment)  http://www.slideshare.net/malagha/radicular- cyst?from_search=3  http://www.slideshare.net/drabbasnaseem/radicular-cyst- or-periapical-cyst  Cawson’s Essentials of Oral Pathology & Oral Medicine – 7th edition  Oral and Maxillofacial Medicine (Crispian Scully CBE)  Contemporary Oral and Maxillofacial Pathology – 2nd edition

Editor's Notes

  1. 20/#of sticks per day x duration of smoking habit= __ pack years20/9-10 sticks per day x 20years =