CYSTS OF HEAD AND NECK

CYSTS OF HEAD AND NECK Karishma S
III MDS

CONTENTS:
1) Introduction
2) Classification of cysts
3) Odontogenic cysts
 Developmental
 Inflammatory
4) Non – odontogenic cysts
 Developmental
 Inflammatory
5) Other cysts
6) Conclusion
7) References

CYST
Cyst is a common pathological lesion and occurs anywhere in the body.
It is defined as a pathological cavity, may or maynot be lined by
epithelium and containing fluid, semisolid or gaseous material.
ODONTOGENIC CYSTS:
These are derived from epithelium associated with the development of
dental apparatus.
The type of epithelium may vary with most common lesions having
Stratified squamous but some developmental or fissural cysts in the
maxilla may have respiratory epithelium.
Several types of cysts may occur , depending chiefly upon stages of
Odontogenesis during which they originate.

ODONTOGENIC CYST
NON-
ODONTOGENIC
CYSTS
INTRAOSSEOUS
• Odontogenic
keratocyst
• Orthokeratinise
d odontogenic
cyst
• Dentigerous
cyst
• Lateral
periodontal cyst
• Glandular
odontogenic
cyst
• Calcifying
epithelial
odontogenic
cyst
EXTRAOSSEOUS
• Eruption cyst
• Botryoid
odontogenic
cyst
• Gingival cyst
of new-born
• Gingival cyst
of adults
INFLAMMATORY
• Apical
periodontal cyst
• Inflammatory
collateral cyst /
Inflammatory
Periodontal
cysts
• Residual cyst
• Paradental cyst
• Buccal
bifurcation cyst
INTRAOSSEOUS
• Nasopalatine
duct cyst
• Median
palatine cyst
• Globulo
maxillary cyst
• Median
mandibular
cyst
EXTRAOSSEOUS
• Palatal cyst
of newborn
• Nasolabial
cyst
• Thyroglossal
duct cyst
• Oral lympho
epithelial cyst
• Epidermiod
cyst
• Dermoid
cyst
TRAUMATIC
• Salivary cyst
• Antral cyst
• Traumatic
bone cyst
• Aneurysmal
bone cyst
INFECTIOUS
• Parasitic
cyst
DEVELOPMENTAL DEVELOPMENTAL INFLAMMATORY
MISCELLANEOUS
• Oral cysts of gastric
/ intestinal
epithelium
• Stafne bone cyst
CLASSIFICATION

CLASSIFICATION BY ETIOLOGY
DEVELOPMENTAL:
Unknown origin but are not a result of inflammatory reaction.
Odontogenic keratocysts
Dentigerous cyst
Eruption cyst
Gingival cyst of new born
Gingival cyst of adult
Lateral periodontal cyst
Calcifying odontogenic cyst
Glandular odontogenic cyst

INFLAMMATORY:
Result of inflammation
 Periapical cyst
 Residual cyst
 Paradental cyst
CLASSIFICATION BY TISSUE ORIGIN
1. DERIVED FROM CELL RESTS OF MALASSEZ
 Periapical cyst
 Residual cyst

2. DERIVED FROM DENTAL LAMINA ( CELL RESTS OF
SERRE)
 Odontogenic keratocysts
 Gingival cyst of new born
 Gingival cyst of adults
 Lateral periodontal cyst
 Glandular odontogenic cyst
3. UNCLASSIFIED
 Paradental cyst
 Calcifying odontogenic cyst

DEVELOPMENTAL
- INTRA OSSEOUS CYSTS

ODONTOGENIC KERTOCYST
Common cystic lesion of jaw, which arises from Remnants of dental lamina,
primordium of the developing tooth germ or enamel organ and sometimes
from the basal layer of the oral epithelium;
It has distinctive clinicopathological character and a higher tendency for
recurrence after treatment.
INCIDENCE: Nearly 1% among all types of cysts.
AGE: Mostly second or third decade of life.
Sex: Males > Females
Site:
•More common in mandible( 75%)
•Among mandibular lesions, 50% of the cases occur at the angle of mandible,
which extend for varying distances into ascending ramus and body of
mandible.

 Maxillary lesions more frequently involve anterior part, however some lesions
can develop from posterior region or in relation to maxillary air sinus.
 On rare occasions, this cyst may occur in gingiva (extraosseous type).
PRESENTATION:
 In initial stages, OKC doesn’t produce any signs or symptoms and the lesion
may be discovered by normal radiographic examination.
 Larger lesions however produce swelling of jaw with facial asymmetry.
 Pain in the jaw along with mobility and displacement of teeth are frequently
seen.
 There is often one tooth missing from the dental arch on clinical
examination, which means the cyst has developed from the developing tooth
germ of particular tooth.
 Bony expansion is minimum because in most of the cases, the cyst spreads
via the medullary spaces of bone and therefore , remarkable bony swelling is
usually absent despite the cyst being very large.

In some cases, completely extraosseous lesions may develop in relation to
the gingiva.
Multiple lesions may also develop in the jaw as a manifestation of the Nevoid
basal cell carcinoma syndrome.
 Paresthesia of lower lip and teeth.
 Pathological fracture
 Discharge of pus if secondarily infected.
 Large OKC’s of maxillary sinus often cause displacement or
destruction of floor of orbit and protrusion of the eyeball.
RADIOLOGICAL FEATURES:
 Multilocular or unilocular radiolucency with a typical “SOAP-BUBBLE”
APPEARANCE.
 On many occasions mandibular lesions enlarge and extend to other side
crossing the midline.

 Displacement of tooth.
 Resorption of root.
 Associated with missing or unerupted tooth.
RADIOLOGICAL TYPES:
1.REPLACEMENT TYPE: When it develops in place of
developing normal tooth. In such cases, there will
be absence of a normal tooth in arch.
2. ENVELOPMENTAL TYPE: When cyst entirely encloses an impacted tooth
within the bone.
3. EXTRANEOUS TYPE: When it develops away from tooth bearing area of the
jaws.
4. COLLATERAL TYPE: When cysts develops in between the roots of a tooth,it
is collateral type of keratocyst.

CYSTIC FLUID:
Straw coloured fluid that contains 3.5gm percent of soluble protein.
HISTOPATHOLOGY:
 Cystic cavity lined by an uniform looking keratinised stratified odontogenic
epithelium having 6-8 layer cell thickness.
 Epithelium and connective tissue interface is flat with no rete peg formation.
 Presence of small microcysts within connective tissue wall; which are also
known as “ DAUGHTER CYSTS” or “ SATELLITE CYSTS.”
KEY POINTS IN RECURRENCE:
 Satellite cyst
 New cyst formation
 Keratinisation pattern
 Nature of cyst lining
 Conservative surgical approach.

DIFFERENTIAL DIAGNOSIS:
 Ameloblastoma
 Dentigerous cyst
 Aneurysmal bone cyst
 Odontogenic myxoma
TREATMENT:
 Treatment is done by either “SURGICAL ENCLEATION” or
“MARSUPIALIZATION”.
 The oral epithelium , overlying cystic lesion , has to be excised to
eliminate the possibility of further recurrence.

DENTIGEROUS CYST
It is common odontogenic cystic lesion, which encloses the crown of an
impacted tooth at its neck portion. Cyst develops due to abnormal
dilation of the dental follicle.
PATHOGENESIS:
 This cyst is derived from the cells of REDUCED ENAMEL EPITHELIUM, which
surrounds crown of impacted or unerupted tooth.
 Cyst enlarges due to accumulation of fluid between REE and crown.
 When cyst develops around crown of impacted permanent tooth, periapical
inflammation in overlying deciduous tooth may be triggering factor.
 Regardless of size, this cyst remains attached to cervical margin (CEJ) of the
involved tooth.
 Crown of tooth is located within the lumen while root remains outside.

INCIDENCE: 16% among all intraoral cysts.
Age: Mostly second and third decade of life.
Sex: Males > Females
Site: Twice as common as Mandible as in Maxilla. Mandibular
third molar is the common site followed by maxillary canine.
PRESENTATION:
 In many cases, smaller cysts remain asymptomatic and are detected
incidentally during routine radiographic examination.
 A cyst can be found occasionally during radiographic examination of
deciduous tooth.
 It normally presents a slow enlarging bony hard swelling of the jaw with
expansion of cortical plates of bone.
 Massive facial swelling, derangement of occlusion, facial asymmetry are seen
in large lesions.

 Severe expansion results in thinning of cortical plates and
on
 palpation the affected area of bone gives “Crepitus- like”
sensation.
 Moreover, if overlying bone is completely lost due to a
growing cyst, FLUCTUATIONS may be felt in that area.
 Paresthesia on the affected part.
 Clinically missing tooth.
 WELL DEFINED, UNILOCULAR, ROUNDED, RADIOLUCENT
AREA
ENCLOSING CROWN OF AN IMPACTED TOOTH.
 Larger cysts may look multilocular due to persistence of
several
residual bony trabeculae within the cystic spaces.
 Interestingly in most of the cases, RESORPTION OF ROOTS of
neighbouring erupted teeth is seen.

CYSTIC FLUID:
Straw coloured fluid that contains 5gm percent of soluble protein.
HISTOPATHOLOGY:
Cystic cavity lined by thin, non-keratinised epithelium of 2-3 layer
thickness.
Lining is supported by a loosely arranged connective tissue stroma that
resembles the odontogenic ectomesenchyme.
Localised area of “ bud-like” proliferations of cystic epithelial cells may be
seen in few areas of cystic wall , known as “ MURAL PROLIFERATIONS.”

 AOT
 Compound odontoma
 Unilocular ameloblastoma
 OKC
 Ameloblastic fibroma
 CEOC
 Ameloblastic fibro- odontoma.
TREATMENT:
MARSUPIALIZATION- If the involved tooth is to be preserved. In other
cases, treatment can be done by surgical enucleation of cyst.

Dentigerous Cyst in a young child: Clinical Insight and
A
Case report RJ Hegde1, SS Khare1, VN Devrukhkar2
Department of Pediatric and Preventive Dentistry, Bharati Vidyapeeth Dental College and Hospital, Navi Mumbai,
Maharashtra, India
A 9-year-old male patient reported to the department of Pedodontics and Preventive dentistry, Bharati
Vidyapeeth Dental College and Hospital, Navi Mumbai, with a chief complaint of swelling and pain on left
lower side of the mandible. The patient was apparently alright one month back, when he noticed a swelling
on left side of face, which gradually increased in size. The patient also gave a history of intermittent pain in
the region of the chief complaint.
On general examination, the patient was healthy, and there was no apparent history of past illness or
hospitalization or trauma to the jaw. On extra-oral examination, a single diffuse swelling was noted on left
side of face with no sinus or active discharge of pus. On intra-oral examination, a hard swelling in 74, 75
regions were found with obliteration of buccal vestibule. The swelling was bony hard with expansion of
buccal cortex in 74, 75 regions with no expansion of lingual cortex. There was a "typical egg shell
cracking" found in 75 region, which was grossly decayed.
Orthopantamograph (OPG) revealed an oval-shaped unilocular radiolucency around the developing second
premolar with sclerotic border. The deciduous second molar was grossly decayed with loss of bone in the
bifurcation area.
Based on clinical and radiographical examination, a provisional diagnosis of dentigerous cyst
was made. The contents of the swelling were aspirated and sent for investigation, which
revealed yellowish, straw-colored fluid. Other routine investigations were within normal limits.

Surgical enucleation of the dentigerous cyst was done, and extraction of unerupted
mandibular second pre-molar with deciduous second molar was done followed by primary
closure of wound. The cyst was seen attached to the neck of the involved tooth.
The specimen was sent for histopathological examination, which revealed cystic wall lined by
2-3 layered thick flattened squamous epithelium with occasional presence of mucosal cells.
Suture removal was done after one week, and the healing was uneventful. The patient was
given functional removable space maintainer till further treatment was advocated.

LATERAL PERIODONTAL CYST
It is an developmental odontogenic cyst that develops in
immediate association with the LATERAL ROOT SURFACE OF
ERUPTED VITAL TOOTH.
CLINICAL FEATURES:
 0.7% of all jaw cysts, common in Males.
 Common site: Maxillary and Mandibular anterior region.
 Clinically the lesion is asymptomatic and detected during
routine
radiographic examinations.
 The tooth with which the cyst is associated is VITAL.
 The cyst is usually less than 1 cm in diameter and it never
causes resorption of the root of affected tooth.
 In few cases there may be small, painless, soft tissue swelling
within or just anterior to interdental papilla.

Small, unilocular, ‘TEARDROP-SHAPED’ radiolucent area on the lateral
aspect of root
( near the crest of alveolar ridge). The lesion is surrounded by a thin,
delicate corticated margin at the periphery.
PATHOGENESIS:
Mainly controversial, but is generally believed that the cyst arises from
the Reduced enamel epithelium or cell rest of Malassez or Serre, all
these cells could be present within PDL.
HISTOPATHOLOGY:
 Lined by non- keratinised stratified squamous epithelium of 2 to 3
cell layer thickness.
 Focal areas of thickening of lining epithelium ( plaques) as well as
some papillary infoldings are commonly seen.
 Cystic epithelium contains cluster of glycogen rich, clear cells, with
vacuolated cytoplasm ( resemble cells of dental lamina).

 Lateral periodontal abscess or granuloma
 Radicular cyst
 Early ameloblastoma
 Collateral type of primordial cyst
 Lateral dentigerous cyst
TREATMENT:
Treatment is done by surgical excision along with the tooth.
Sometimes related tooth can be saved if healthy.

SIALO-ODONTOGENIC CYSTS
(GLANDULAR ODONTOGENIC CYST)
These are large intraosseous odontogenic cysts, which often exhibit an
aggressive course. The cyst consists of stratified squamous epithelium and
areas of numerous mucous secreting cells which often produce pools of
mucin within the cyst.
ORIGIN:
From remnants of dental lamina and are CAPABLE OF GLANDULAR
DIFFERENTIATION.
CLINICAL FEATURES:
Extremely rare and usually seen among adults.

 There is no sex predilection.
 Mandible ( Anterior part ) > maxilla
 Slow growing , asymptomatic, central jaw lesions.
 Some aggressive lesions may attain large size and may cross the
mandibular midline.
 Larger lesions often cause expansion and distortion of the cortical plates,
displacement of teeth with pain and paraesthesia of the affected area.
RADIOGRAPHIC FEATURES:
Appearance is non- specific; most of them present unilocular or sometimes
multilocular , radiolucent area with well defined sclerotic border.

HISTOPATHOLOGY:
 Lined by thin squamous epithelial lining, which may be of uniform
thickness or there can be focal areas of thickening.
 Microcysts are found.
 Organisation of glandular structures may result in formation of acinar
like structures.
 There may be large collection of mucin in cystic lumen.
 Superficial layer of epithelium made up of cuboidal or columnar cells.
TREATMENT:
Surgical excision, the cyst has strong tendency to recur.

CALCIFYING EPITHELIAL ODONTOGENIC
CYST/ GORLIN’S CYST
CLINICAL FEATURES:
Second decade of life, both sexes equally affected.
Common site: Mandibular premolar region. The other common parts are
anterior parts of maxilla and mandible, occasionally extraosseous lesions
develop from gingiva.
PRESENTATION:
It presents as bony hard swelling of the jaw; average size of tumour is 2 to 3
cms in diameter but sometimes more extensive.
Expansion and distortion of cortical plates and displacement of regional
teeth are seen.

 Large bony lesions can cause perforation of cortex.
 Extra-osseous: Circumscribed, sessile or pedunculated gingiva; the associated tooth is
vital.
 Pain is rarely present in larger cysts while the smaller cysts are completely
asymptomatic.
 Unilocular, radiolucent area with a typical cystic appearance; sometimes it can be
multilocular radiolucency with a well corticated margin.
 Some cysts may be associated with unerupted tooth ( mostly canines).
 Root resorption in adjacent teeth is occasionally seen.
 Extraosseous lesion may cause indentation on the overlying bone.
PATHOGENESIS:
From REE or remnants of odontogenic epithelium in the dental follicle.

HISTOPATHOLOGY:
Lined by odontogenic keratinised epithelium of 6 to 8 layer thickness.
Luminal surface shows the presence of “ GHOST CELLS.”
These are swollen, eosinophilic, abnormally keratinised cells devoid of nuclei;
which gradually become paler, leaving only a faint outline hence called ghost
cells.
Connective tissue capsule contains “ satellite microcysts” and there may be
presence of multinucleated giant cells.
 Calcifying epithelial odontogenic tumour
 Adenomatoid odontogenic tumour
 Dentigerous cyst
 Ameloblastoma
TREATMENT:
Surgical enucleation.

DEVELOPMENTAL
- EXTRAOSSEOUS CYSTS

ERUPTION CYST
It is an odontogenic cyst, which surrounds the crown of a tooth that has
erupted through the bone but not soft tissue. ( Soft tissue cyst associated
with erupting crown).
This cyst develops due to accumulation of fluid within the follicular space of
an erupting tooth and hence can be called as ‘SOFT TISSUE VARIANT OF
DENTIGEROUS CYST’.
ORIGIN: From the Reduced enamel epithelial cells.
CLINICAL FEATURES:
 Small, rounded, fluctuant swelling on alveolar
ridge immediately superior to erupting tooth.
 Common in children and it can develop in
relation to deciduous or permanent teeth.

Masticatory trauma may induce haemorrhage within the cyst, which gives
rise to formation of ‘ERUPTION HEMATOMA’ and the lesion appears BLUISH
PURPLE or red in colour.
HISTOPATHOLOGY:
Histologically, cyst is similar to dentigerous cyst and exhibits thin lining of
non-keratinised squamous epithelium.
Cyst may also have numerous epithelial ghost cells within the lumen of
cyst and these cells are derived from the exfoliating lining epithelial cells
of cyst.
TREATMENT:
No treatment is required as it disappears spontaneously once tooth erupts
into oral cavity. In long standing cases, roof of the cyst is excised to allow
the tooth to erupt into oral cavity.

BOTRYOID ODONTOGENIC
CYST
These are rare odontogenic cystic lesions, which resemble cluster of grapes. It is
probably a variant of lateral periodontal cyst.
CLINICAL FEATURES:
Adults over 50 years of age and mandibular canine- premolar region is the common
site.
Clinically, presents as well- defined , painless, expansile central jaw lesion.
RADIOGRAPHIC FINDINGS:
There can be presence of a unilocular or multilocular radiolucent area with well –
corticated margin.
TREATMENT:
Treatment by enucleation.

DENTAL LAMINA CYST ( GINGIVAL CYST)
OF NEW BORN
Gingival cysts of new born are multiple, mall, nodular, keratin-filled, cystic
lesions seen in the oral cavity of new borns or very young infants ( from
birth to 3 months of age).
DEPENDING ON LOCATION:
1. CYSTS OF DENTAL LAMINA: mostly found ALONG THE ALVEOLAR RIDGE
and are odontogenic in origin ( arising from remnants of dental lamina).
2. EPSTEIN’S PEARLS: These small creamy coloured cystic
lesions are found LINEARLY ALONG THE MIDPALATINE
RAPHAE and are probably derived from epithelium,
entrapped along the line of fusion of the palate during
embryogenesis.

BOHN’S NODULES: In this case, small cysts are usually found along
the JUNCTIONOF HARD AND SOFT PALATE and on the buccal and
lingual aspects of ALVEOLAR RIDGE. These are derived from
remnants of mucous glands.
CLINICAL FEATURES:
 All these cysts usually appear as multiple, asymptomatic, small
discrete , white nodules that develop in several parts of oral
cavity.
 Once formed these cysts may discharge the contents by fusion
with
overlying alveolar mucosa or they may undergo spontaneous
regression.
 The size of these cysts are very small and do not exceed 2-3 mm

Gingival cyst of new born involve the maxillary arch more
often than mandibular arch.
HISTOPATHOLOGY:
Microscopic section exhibits a small keratin- filled cystic
cavity, which is line by a thin and flattened squamous
epithelium.
TREATMENT:
No treatment is required.

GINGIVAL CYSTS OF ADULTS
Gingival cyst of adult are small developmental odontogenic cysts of gingival soft tissue.
These are derived from CELL RESTS OF DENTAL LAMINA ( SERRE).
CLINICAL FEATURES:
 Age: 5th-6th decade.
 Sex: more prevalent among females.
 Site: more common in relation to mandible,
 particularly in canine- premolar region.
 Facial side of gingiva is more commonly affected.
PRESENTATION:
 Cyst is located in gingival tissue outside the bone.
 It clinically presents as a firm but compressible, fluid filled, ‘dome-like’ swelling.

 Swelling is often circumscribed, usually less than 1 cm in diameter and it
occurs in attached gingiva or the interdental papilla.
 Surface of lesion is smooth and is of normal colour of gingiva or bluish.
 Adjacent teeth are vital and the cyst is almost always vital unless it is
secondarily infected.
PATHOGENESIS:
Arises from cell rest of dental lamina, interestingly it is the same cell from
which the lateral periodontal cyst also develops. For this reason , it is often
believed that gingival cyst of adult and lateral periodontal cysts, represent
the extraosseous and intraosseous manifestations of the same entity.

Since these cysts are extraosseous they don’t reveal any radiographic change in the
bone.
However in some cases, there may be pressure induced faint round superficial
depression
( cupping out) in the underlying alveolar bone.
HISTOPATHOLOGY:
 Cystic cavity lined by a thin epithelial lining made up of flat or cuboidal cells having
2 to 3 cell layer thickness.
 Epithelium may show pyknotic nuclei with perinuclear cytoplasmic vacuoles.
 Layers of keratin may be present in cystic lumen.
 Like lateral periodontal cyst some clear cells may be seen.
TREATMENT:
Surgical enucleation.

APICAL PERIODONTAL CYST (RADICULAR/
PERIAPICAL/ ROOT END CYST
Radicular cyst or periapical cyst is the most common odontogenic cystic
lesion of inflammatory origin, which occurs in relation to the apex of non-
vital tooth.
PATHOGENESIS:
Cyst develops due to proliferation and subsequently cystic degeneration of
“ epithelial cell rests of Malassez”. The entire process of development of
this cyst occurs in several phases.

INCIDENCE: 50% or more among all types of jaw cysts.
Age: Third, fourth and fifth decade of life.
Sex: More common among males.
Site: Maxilla (60%) is usually more commonly affected than mandible.
CLINICAL PRESENTATION:
The involved tooth is nonvital and it can be easily detected by the presence of
caries, fractures or discolouration's etc. Moreover the affected tooth doesn’t
respond to thermal or electric pulp testing.
Radicular cyst may occur rarely in association with non-vital deciduous tooth (
mostly molars).
Smaller lesions are asymptomatic and are detected only when a radiograph is
taken.

 The larger lesions on the other hand, often produce a slow enlarging, bony
hard swelling of the jaw with expansion and distortion of cortical plates or
disturbance in occlusion mostly of regional teeth.
 Severe bone destruction by the cystic lesion results in thinning of cortical
plates and it may produce “SPRINGINESS” of the jaw bone when digital
pressure is applied.
 There may be presence of fluctuations in case bone is completely eroded by
a large cyst. These lesions clinically appear BLUE as they lie close to the
overlying epithelium since the bone has been completely resorbed.
 Pain may be present if secondarily infected and results in development of
either intraoral or extraoral pus discharging sinuses.
 A radicular cyst may persist in the jaw after the attached tooth has been
extracted; such cyst is often called as RESIDUAL CYST. These cysts frequently
cause swelling in edentulous jaws and they regress slowly and
spontaneously.

In some cases, radicular cysts may develop at the opening of large accessory
pulp canal on lateral aspect of the tooth and these cysts are often termed as ‘
LATERAL RADICULAR CYST’.
If the cyst is secondarily infected it leads to formation of an abscess, which is
called ‘CYST ABSCESS’.
 Well defined , unilocular, round shaped radiolucent areas of variable size.
 Cyst is always found in contact with the root apex of non-vital tooth (
often have a large carious cavity or a fracture on the crown) and bordered at
the periphery by a well-corticated margin. The infected cysts often have hazy
or an ill-defined border.
 Lateral radicular cyst appears as a semi-circular radiolucency on lateral
aspect of root with loss of lamina dura.

Root resorption is often seen in associated non-vital tooth.
Residual cyst appears as round or oval radiolucent area in the alveolar ridge where
from a tooth was extracted previously.
CYSTIC FLUID:
Straw coloured fluid, 5gm percent of soluble protein.
The fluid may contain cholesterol crystals; which can be seen under microscope
once a smear of fluid is prepared.
HISTOPATHOLOGY:
 Cystic cavity lined by thick, non keratinised, stratified squamous epithelium of 6 to
20 cell layer thickness.
 Proliferating cystic epithelium may sometimes grow in peculiar “ arcading pattern.”
 Cyst capsule is made up of vascular connective tissue, which is often infiltrated by
chronic inflammatory cells.
 Cholesterol clefts, Russel bodies, Rushton bodies are seen.

 Periapical granuloma
 Periapical abscess
 Cementoma
 Traumatic bone cyst
 Bony artifact
TREATMENT:
Small cysts are treated by root canal treatments of affected teeth and
apical curettage. Larger cysts are treated by either enucleation or
marsupialization.

CONSERVATIVE MANAGEMENT OF LARGE RADICULAR CYSTS ASSOCIATED WITH
NON-VITAL PRIMARY TEETH: A CASE SERIES AND LITERATURE REVIEW KS Uloopi1, Raju U
Shivaji2, C Vinay1, Pavitra1, SP Shrutha1, R Chandrasekhar1 Department of Pediatric Dentistry, Vishnu Dental College,
Bhimavaram, Andhra Pradesh, India
An 11-year-old male patient reported to the Department of Pediatric Dentistry with the
chief complaint of pain and swelling in the upper left front teeth region since 20 days. The
patient gave a previous history of trauma to the same region for which no treatment was
taken. On extra-oral examination, a diffuse, non-tender, firm swelling measuring 2 × 2 cm
in size was noted on the left cheek. Intraoral examination revealed firm bony hard swelling
with buccal and lingual cortical expansion in the region of retained 61-63. OPG revealed a
well-defined periapical radiolucency involving tooth buds of 21, 22, and displaced 23. Fine
needle aspiration cytology (FNAC) revealed straw-colored fluid. Therefore, based on
patient's clinical findings, radiographic investigations, and FNAC report, the provisional
diagnosis of radicular cyst was made. Marsupialization was performed by creating a
window in the buccal cortical plate, and a drain was positioned followed by extraction of
61, 62, and 63. Histopathological investigation showed the presence of stratified
squamous epithelium with vacuolations and inflammatory cellular infiltration suggesting of
radicular cyst. Regular irrigation with Betadine and saline was carried out for a period of 2
weeks. Eruption of 21 and 22 was noted with a favorable positional change of 23 after 1
year follow-up period, and the patient is undergoing fixed orthodontic treatment for the
further alignment of teeth
(a) Pre-operative intraoral view showing expansion of both cortical plates; (b) Pre-operative orthopantamograph showing periapical
radiolucency involving maxillary left incisor regions; (c) Post-operative intraoral view showing favorable eruption of 21 and 22; (d)
Panaromic radiograph showing bone regeneration after 1 year postoperatively

An 8-year-old male patient visited our Department with
the chief complaint of pain and swelling in the upper right
front teeth region since 1 month. There was a previous history
of trauma to the same region. It was his first dental visit. On
extra-oral examination, a diffuse, non-tender, firm swelling
measuring 2 × 3 cm in size was noticed on the right cheek.
Intraoral examination revealed firm bony hard swelling
extending from the region of 51-54 with 51, 52, and 61 being
non-vital. OPG revealed well-defined radiolucency measuring
about 1.5 × 2 cm in size involving tooth buds of 11, 12, and
13. A light-yellow blood-mixed fluid was collected on
aspiration. Based on clinical findings and laboratory
investigations, the provisional diagnosis of radicular cyst was
made. Conservative treatment of marsupialization was
planned by creating window in the buccal cortical plate, and a
drain was positioned followed by extraction of 51, 52, and 61.
Histopathological examination showed the presence of
arcading pattern of hyperplastic odontogenic cystic epithelium
with subadjacent granular tissue and collagen bundles with
inflammatory cellular infiltration suggesting of radicular cyst.
Regular irrigation with Betadine and saline was carried out for
a period of 1 week. At 8 months recall visit, eruption of 11
(a) Pre-operative intraoral view showing swelling in relation to traumatized 51 and 52; (b) Pre-operative OPG showing
radiolucency involving tooth buds of 11, 12, and 13; (c) Postoperative intraoral view showing eruption of 11 and 12; (d) OPG
after 8 months postoperatively showing the healing of lesion

INFLAMMATORY COLLATERAL
CYST
(INFLAMMATORY PERIODONTAL
CYST)
Arises due to inflammation of periodontal pocket.
A radicular cyst related to the lateral canal of tooth root is
called Inflammatory collateral cyst or inflammatory
periodontal cyst.

PARADENTAL CYST
Inflammatory cyst which occurs in association with the root
surface of an impacted or partially erupted vital tooth, usually
the mandibular third molar.
ORIGIN:
Cell rests of Malassez or REE. Inflammation plays a major role
in development of cyst.
CLINICAL FEATURES:
Males, third decade
Commonly seen on facial or distal aspect of a vital mandibular
third molar tooth.
In all the cases the involved tooth had an associated history of
pericoronitis.

Seen as well circumscribed radiolucent area, may sometimes extend
apically.
HISTOPATHOLOGY:
 Cavity lined by hyperplastic, non keratinised epithelium.
 Intense inflammatory reaction seen in capsule as well as
epithelial lining.
 Pericoronitis
 Radicular cyst
TREATMENT: Surgical enucleation

BUCCAL BIFURCATION CYST ( JUVENILE
PARADENTAL /MANDIBULAR INFECTED
BUCCAL CYST
 Type of paradental cyst.
 It is rare odontogenic cyst of unknown origin.
 Age and site specific.
 Characteristically, it involves mandibular first permanent molars and
occasionally the second molars.
 Children below the age of 15 years are usually affected.
PATHOGENESIS:
It has been postulated that inflammation caused by tooth eruption or
deep periodontal pockets may activate the proliferation of cell rests of
Serre or Malassez, causing hyperplasia of odontogenic epithelium
resulting in cyst formation.

CLINICAL FEATURES:
 Typically affects the buccal aspect of permanent mandibular first or second
molars and involves partially or completely erupted vital tooth.
 Presents as swelling on buccal aspect of the molar and if involved tooth is not
fully erupted, it may be associated with a deep periodontal pocket, pain and
tenderness.
 The lesion invariably involves the furcation area on the buccal surface and may
extend till the root apex.
 Prominence of lingual cusps are seen due to tilting of buccal cusps in many
cases.
Radiolucency, usually semilunar shape on the buccal aspect of the tooth
involving the roots to a variable extent with an occasional periosteal reaction.
Root apices may face the lingual cortical plate due to tilting of tooth.

HISTOPATHOLOGY
 Does not have any specific microscopic appearance and is
similar to that of any inflammatory odontogenic cyst.
 Cyst lining is made up of nonkeratinized stratified
squamous epithelium that may exhibit features of
hyperplasia.
 The underlying connective tissue stroma is densely
infiltrated with lymphocytes and plasma cells.
 Hemosiderine pigment or cholesterol clefts are encountered
in the connective tissue wall frequently.

NON-ODONTOGENIC CYSTS
DEVELOPMENTAL INTRAOSSEOUS CYSTS

GLOBULOMAXILLARY CYST
It is a common type of developmental or fissural cyst that actually arises
in BONE SUTURE, BETWEEN MAXILLA AND PREMAXILLA. Clinically, usual
location is between maxillary lateral incisor and canine teeth.
PATHOGENESIS:
Develops as a result of proliferation of the epithelium, entrapped along
the line of fusion. Now it is considered as a variant of primordial or lateral
periodontal cyst.
CLINICAL FEATURES:
 Asymptomatic, detected during normal radiological examination.
 Cause pain and discomfort when secondarily infected.
 Occasionally there may be a small swelling in between lateral incisor
and canine teeth with elevation of lip.
 Associated teeth are always vital.

INVERTED PEAR SHAPED, radiolucent area between roots of upper
lateral incisor and canine.
Often causes DIVERGENCE OF THE ROOTS.
HISTOPATHOLOGY:
Cystic cavity lined by a stratified or pseudostratified ciliated
columnar epithelium or by a thin squamous epithelium.
The supporting connective tissue capsule often presents chronic
inflamttory cell infiltration.
TREATMENT:
Surgical excision with preservation of involved teeth.

Enucleation after Marsupialization: A case report of
Globulomaxillary Cyst
Mojumder D1 , Chowdhury RU2 , Podder A
A male patient of 18 years reported to a maxillofacial clinic with the complaint of left side of
upper lip swelling for 1 year and it was painless. Swelling was initially small in size, but gradually
enlarged into present condition. Patient has no history of trauma, missing teeth or infection.
Associated symptoms were mobility of the left sided upper lateral incisor and canine and slight
bleeding in the gingival margin of lateral incisor for last 7 days. Extraorally found an ill-defined
spherical swelling anteroposteriorly extending from philtrum to left corner of mouth and from
left ala of the nose to vermillion border of upper lip superoinferiorly. Left nasolabial fold was
obliterated and skin condition was normal. On palpation, local temperature was normal and
swelling was non-tender, bony hard in consistency.
On intraoral examination there was a well-defined, rounded swelling about 3cm× 3cm in size.
Overlying mucosa was normal in appearance. Both 22 and 23 are mobile and spacing was found
in between them, slight bleeding was present in gingival margin of 22. Panoramic view of
radiograph (OPG) revealed a well-defined inverted peer shaped radiolucent lesion with
displacement of the apex of the teeth 21,22,23,24. Chairside vitality test was done and found
adjacent teeth vital. Provisional diagnosis was made as a globulomaxillary cyst and for surgical
procedure.At first left lateral incisor was extracted due to severe mobility. Then a ready-made
plastic obturator was placed through the socket and cyst lining was sutured with obturator and
mucosa. Instruction was given to irrigate the cavity by diluted hydrogen peroxide (H2O2) and 1%

Radiologically, globulomaxillary cyst looks like an inverted pear shaped well-defined
radiolucent lesion in between lateral incisor and canine of maxilla. Histopathologically, lining
composed of stratified squamous epithelium or pseudostratified ciliated columnar epithelium
in globulomaxillary cyst. In our case stratified squamous epithelium found which suggests, it is
a developmental cyst of non-odontogenic origin. In this case, marsupialization was done to
increase bone regeneration and prevent possible involvement into nasal cavity and damage to
adjacent teeth during surgery. After 3 months of enucleation increase radio-opacity is noted in
the lesion in panoramic view indicates bone regeneration.

NASOPALATINE DUCT CYST (
INCISIVE CANAL CYST)
Relatively common nonodontogenic intraosseous, cystic lesion, arising
within the nasopalatine duct or the incisive canal. On rare occasions.
The cyst develops in the soft tissue, near the opening of incisive canal
on palate.
PATHOGENESIS:
It is considered as true developmental cyst; it arises usually due to
proliferation and spontaneous cystic degeneration of the epithelial
remnants remaining after closure of embryonic nasopalatine duct.
Initiating factors:
Trauma, Inflammation, Mucous retention in the nearby minor salivary
gland and bacterial infection etc.

Age: 4th,5th,6th decade of life.
Sex: Males > Females (4:1)
 Small, painful, fluctuant swelling in the midline of anterior part of hard palate
near the opening of incisive foramen.
 Few are asymptomatic and detected by normal radiographic examination.
 Cyst often extends from palate on to labial aspect of upper alveolar ridge.
 In case of extensive labiopalatal swelling typical through and through ‘
fluctuations’ can be elicited during bidigital palpation.
 Often cause pressure sensation on the floor of nose and displacement of roots of
upper central incisors.
 Some patients complain of episodic swelling in the soft tissue between upper
central incisors, however the regional teeth are vital.

 Sharply demarcated symmetrical radiolucency in the midline
of anterior maxilla.
 Most obvious presenting feature is a small ROUND or
HEART- SHAPED (due to radiographic superimposition of
nasal spine) radiolucent area between and apical to the roots
of upper central incisors in the midline.
 Displacement of roots of upper central incisors.
 The cystic lesion doesn’t come in contact with upper incisor
teeth.
 Cyst may be sometimes confused with incisive foramen and
in such cases; a second radiograph should be taken at
different angle, which usually seperates both.
 Cyst is 1-2.5 cms and incisive foramen is 6mm in diameter
only. So, if the suspected lesion is 6mm or less and there is
no clinical symptom; the diagnosis can be incisive foramen

HISTOPATHOLOGY:
Cystic cavity lined by ciliated columnar or non keratinised
stratified squamous epithelium.
Capsule is made up of densely collagenous fibrous
connective tissue, which shows presence of neurovascular
bundles ( Nasopalatine and sphenopalatine nerves and
vessels).
TREATMENT:
Surgical excision.

NON- ODONTOGENIC CYSTS
DEVELOPMENTAL EXTRAOSSEOUS CYS

NASOLABIAL CYST ( KELSTADT’S
CYST)
It is a rare entirely a soft tissue cyst which arises in the upper lip
deep into the nasolabial fold, just below the ala of nose.
ORIGIN:
From the lower part of embryonic nasolacrimal duct. Other theory suggests
that the cyst arises from the epithelial remnants entrapped at line of fusion
of maxillary, median nasal and the lateral nasal processes during the
development of face.
30 to 50 yrs of age
Females
SITE: Soft tissue of the anterior maxillary vestibule below the ala of the
nose and deep in the nasolabial fold area.

CLINICAL FEATURES:
 Cyst produces a small, painless swelling in the upper lip
lateral to midline.
 It often obliterates the nasolabial fold, raises the ala of the
nose and distorts the nostril on one side.
 Usually unilateral but on rare occasions bilateral.
 Sometimes it is massive in size and hence causes nasal
obstruction and difficulty in wearing prosthesis.
RADIOLOGICAL FINDINGS:
Because of its location entirely within soft tissue the cyst
doesn’t show any radiographic change. However sometimes it
may produce focal pressure induced resorption (
Saucerization) of the underlying bone.

HISTOPATHOLOGY:
 It present a small cystic lumen, which is supported by a connective
tissue wall.
 It is lined on inner aspect by pseudostratified ciliated columnar
epithelium with few goblet cells.
 Some degrees of infoldings of cystic lining is seen.
 A narrow zone of dense, homogenous fibrous tissue usually seen
adjacent to epithelial lining.
 Small mucous glands may be present.
TREATMENT:
Surgical excision is recommended treatment and care should be
taken that no ugly scar is formed on lip.

DERMOID CYST
It is a developmental cyst derived from remnants of embryonic skin.
Age: Children and Young adults
Sex: Both are equally affected.
Site: Skin around eyes, anterior upper neck and floor of mouth on midline.
 Painless swelling which often have a doughy and rubbery consistency.
 Always develop on midline of the floor of mouth and thus they differ from
ranulas ; which develop on lateral aspect of midline.
 It develops above the geniohyoid muscle, presents a sublingual swelling in
midline of the floor of the mouth and below the geniohyoid muscle often
produces a midline swelling in the submental region; which often produces a
‘ DOUBLE CHIN APPEARANCE’.

HISTOPATHOLOGY:
 A cystic cavity lined by orthokeratinised stratified squamous
epithelium, which exhibits hair follicles, sebaceous glands etc
 Cavity lumen is often filled with sebum, desquamated
keratin and hair shafts.
 Cyst capsule is composed of narrow zone of compressed
connective tissue.
TREATMENT:
Surgical enucleation

CYST OF SALIVARY GLAND
Cystic lesions developing from salivary glands are commonly
known as “MUCOCELES”; theses lesions develop mostly in
relation to minor salivary glands.
Mucoceles are of two types:
i. MUCOUS RETENTION CYST
ii. MUCOUS EXTRAVASATION CYST

ETIOLOGY AND PATHOGENESIS:
Mucous retention cyst develops as a result of OBSTRUCTION
TO THE DUCT OF THE MINOR OR RARELY MAJOR SALIVARY
GLANDS; WHICH LEADS TO ACCUMULATION OF SALIVA
WITHIN THE GLAND OR WITHIN THE DUCT. Fluid accumulation
causes increased intraluminal pressure which results in
swelling.
Following cause the obstruction of duct:
Calculus formation, scarring, obstruction from mucin plug
crushing the duct ( due to trauma) and atresia.

 Mucous retention cyst is a true cyst since it has a cystic epithelium made up of
glandular epithelial cells of salivary glands.
 Mucous extravasation cyst on the other hand develops as a result of rupture of
the salivary gland duct, which leads to spillage or extravasation of saliva into
connective tissue. Local trauma is considered to be a major etiological factor.
 Mucous retention cyst: Adults, Extravasation cyst: Children
 Both sexes equally affected.
 Mucoceles of minor glands predominantly affect the lower lip, however cheek,
soft palate, floor of mouth and tongue are also frequently involved.
 Cysts of major glands predominantly affect the parotid and these lesions
clinically exhibit slow enlarging, painless soft swelling in the gland.
 Some swellings develop only during meal time and are absent in between
periods.

 Superficial swellings appear as SMALL, RAISED, VESICLE- LIKE, FLUCTUANT
AREAS. Deep seated lesions produce diffuse, relatively firm, painless swellings
in oral cavity.
 Lesions in floor of mouth near submandibular duct area often have AMBER
colour.
 Majority of the mucoceles rupture within a short period of time and result in
pain, ulceration and secondary infection.
HISTOPATHOLOGY:
Mucous retention cyst presents as small cystic cavity, which is filled with
mucous and lined by flattened cuboidal or columnar epithelial cells of salivary
gland duct. Sometimes cyst can be lined by an atrophic stratified squamous
epithelium; moreover in few cases cystic epithelium exhibit papillary folding
which often project into cystic lumen.
TREATMENT:
Surgical excision of lesion along with the involved gland.

RANULA
 Ranula is a form of mucocele that typically causes a large, bluish
fluctuant swelling in the floor of mouth.
 It occurs due to spillage of saliva from the sublingual or rarely
submandibular gland.
 Obstruction, Compression or perforation of the salivary gland duct is the
likely cause for development of ranula.
 Clinically it presents as a dome- shaped, soft, fluctuant, unilateral swelling in
the floor of mouth.
 Ranulas typically have a bluish translucent appearance and they clinically look
like a “distended under belly of a large frog.”
 When ranula herniates through the mylohyoid muscle and produces swelling
in the neck, it is called “ PLUNGING” type of ranula.

HISTOPATHOLOGY:
Large mucous filled area, which is surrounded by a connective tissue or
granulation tissue. Multiple foamy histiocytes are often present in
granulation tissue surrounding the cyst. In many cases, sialoliths may be
found within the duct system of salivary gland.
 Dermoid cyst
 Salivary gland tumour
 Cystic hygroma
TREATMENT:
Surgical excision or marsupialisation. Etiological factor should be removed
to eliminate the possibility of further recurrence. In case of repeated
recurrences, involved gland may have to be excised.

ANEURYSMAL BONE CYST
 It is an uncommon intraosseous cystic lesion, which often affects young
individuals.
 Age: Second decade of life
 Females > Males
 It is believed to develop as a result of cystic transformation of pre- existing
central giant cell granuloma.
 It presents as rapidly enlarging, diffuse, firm, painful swelling of the jaw that
often causes facial asymmetry.
 Severe expansion and thinning of bone causes “ egg shell crackling” and
perforation of cortical plates.
 Affected areas are pulsatile and pathological fractures may occur.

 Radiograph reveals a multilocular radiolucent area with a
typical “HONEY-COMB APPEARANCE.”
 Larger lesions cause “BALOONING” expansion of cortical plates
and also “ BLOW OUT” bulging of lower border of mandible.
HISTOPATHOLOGY:
Multiple blood filled spaces of varying size, lined by spindle shaped cells or flat
endothelial cells.
Multiple multinucleated giant cells, scattered osteoids, areas of hemorrhage and
hemosiderine pigmentations are also seen.
TREATMENT:
Surgical curettage.

SOLITARY BONE CYST ( TRAUMATIC/
HEMORRHAGIC BONE CYST)
Represents a pseudocyst and is characterised by a cavity in the bone
which is lined by fibrous tissue wall and not by an epithelium.
Mandible > Maxilla
Age: Young people (10-20 years of age)
Females > Males
 Asymptomatic and detected by normal radiographic examination.
 Sometimes it produces painful, bony hard swelling of jaw.
 Parasthesia of lip, expansion of cortical plates and displacement of
regional teeth. Overlying teeth are vital.

RADIOLOGICAL FINDINGS:
Unilocular/ multilocular radiolucent area with expansion and distortion
of cortical plates.
Cystic margin from neighbouring bone is well – demarcated; however in
few cases it is ill defined.
Prominent feature: Tendency for scalloping in between teeth.
PATHOGENESIS:
Not clear
Investigators believe that following trauma to the bone and intrabony
hemorrhage occurs which undergoes organisation and repair. However if
the clot forming after hemorrhage does not organise properly or
liquefaction occurs to the clot , then healing of bony wound does not
take place and as a result an intrabony cavity persists, which is later on
called SOLITARY BONE CYST.

HISTOPATHOLOGY:
Cystic cavity lined by loose vascular connective tissue made up of fibrous
tissue, showing areas of hemorrhage, hemosiderine pigmentation and bone
resorption.
Rarely there may be features of myxoid deposition in bone and presence of
multi nucleated giant cells.
TREATMENT:
Surgical exploration of cyst which causes further hemorrhage in the area
with subsequent healing . Some lesions may resolve spontaneously.

RATIONALE BEHIND TREATING A
CYST
 To avoid displacement and loosening of the teeth.
 To avoid pathological fractures of the jaw due to expanding
lesion.
 To avoid displacement of the inferior alveolar canal and
destruction of other vital structures around the cyst.

OBJECTIVES OF TREATING A CYST
 Remove lining entirely
 Preserve teeth
 Protect adjacent structures
 Allow rapid healing
 Restore normal function

OPERATIVE PROCEDURES
Basically two types of procedures:
1.ENUCLEATION
2.MARSUPIALIZATION

MARSUPIALISATION ( PARTSCH I/
CYSTOTOMY)
 In 1892 Partsch described a type of decompression procedure for
treatment of cysts.
 In this procedure, window or a fenestration is made in the bone and
cystic contents are evacuated. The cystic lining is left behind.
 Once contents are evacuated, intracystic pressure reduces.
 Hollow cavity is then packed till it gets obliterated by bone slowly over a
period of time.
 Cystic lining becomes continuous with normal oral mucosa.

ADVANTAGES:
1.Conservative procedure
2.Shrinkage of cyst lining stimulates bone formation
3. No risk of oroantral fistula
4. Adjacent structures unharmed
5. No risk to adjacent vital teeth
DISADVANTAGES:
1.Pathological lining left behind.
2.High chances of recurrence
3.Repeated cleaning
4.Time consuming, Repeated
appointments
5.No tissue for histopathology

INDICATIONS:
 Extremely large cyst
 Risk of cyst opening into maxillary sinus or nose due to
surgical removal of complete lesion.
 In very young patient, where marsupialisation will permit
eruption of enclosed tooth or underlying developing teeth.
 Patients with poor general condition allowing minimal
surgical procedure.
 In cases where there is concern that elaborate surgical
procedure may cause pathological fracture of jaw.

TECHNIQUE:
 Mucosal incision made in such a way that after the procedure when the
mucosa is placed back, it should rest on sound bone.
 Bone is removed with burr or rongers.
 Cystic lining is exposed and incised.
 Cyst lining can be turned over and sutured to periosteum and oral
mucosa or the periosteal flap may be tucked into cystic cavity.

 The wound is allowed to epithelise.
 After cyst contents escape, cavity is irrigated and packed with
gauze impregnated with iodoform or WHITEHEAD’S VARNISH (
BENZOIN- 10g, STORAX- 7.5g, BALSAM OF TOLU- 5g,
IODOFORM-10g, SOLVENT ETHER – up to 100 ml)
 An acrylic plug can be made to block communication of cystic
cavity with the oral cavity.

ENUCLEATION ( PARTSCH II/
CYSTECTOMY)
Enucleation is the surgical removal of entire cystic lining. It leaves behind a
hollow cavity in bone covered by oral mucoperiosteum. This gets filled up
with blood clot which eventually organises to form healthy bone.
ADVANTAGES:
 Entire pathological lining removed
 Tissue available for histopathology
 Less recurrence
 Less appointments for fast healing
 No repeated cleanings
DISADVANTAGES:
 Radical procedure, Requires
surgical skill
 Devitalising adjacent teeth
 Fractures
 Oro antral communication

INDICATIONS:
Treatment of choice for removal of cysts of the jaw and should be
employed with any cyst of the jaw that can be safely removed without
unduly sacrificing the underlying structures.
TECHNIQUE:
1. ENUCLEATION WITH PRIMARY CLOSURE
 Small cysts – Local anesthesia, Larger cysts – General anesthesia.
 Mucoperiosteal incision made such that it rests on sound bone.
 Mucoperiosteal flap is reflected taking care not to perforate cystic
lining.
 If bone is perforated by the cyst, the lining will adherent to the
periosteum and will be difficult to reflect.

 Cystic lining is exposed and now carefully teased away from bone. It is
relatively easy to separate cystic lining from bone because there is a
layer of fibrous tissue between the two which is easily separable.
 In case of infected cysts or an OKC, cystic lining is friable and difficult
to remove.
 Every attempt is made to remove the entire cystic lining without
perforating it. This ensures complete removal.
 The neurovascular bundle and the vitality of adjacent teeth should be
kept in mind during the procedure.
 After cyst is removed completely, cavity is irrigated thoroughly,
hemostasis ensured, sharp bony margins are filed and the flap is
replaced and sutured.

2. ENUCLEATION WITH OPEN PACKING:
In case of large cyst which was previously infected, closure may not be
possible.
After enucleation wound is packed with guaze impregnated with Bismuth
iodoform paraffin paste (BIPP) or Whitehead’s Varnish.
3. ENUCLEATION WITH BONE CURETTAGE:
After enucleation if there is a doubt that a part of lining has been left
behind, it can be curetted out.
A bone curette is used to scrape the bone and remove any remaining lining.

4. ENUCLEATION WITH PERIPHERAL OSTEOTOMY:
In this procedure instead of using curette, a large round bur
may be used to remove 1-2 mm of bone around the entire
periphery of cystic cavity.
This is done to ensure that any remaining epithelial cells
present in cystic wall or bone cavity are removed.
5. ENUCLEATION WITH CHEMICAL CAUTERISATION:
Indicated mainly in case of OKC.
To remove any remaining cystic lining, CARNOY’S SOLUTION (
GLACIAL ACETC ACID, CHLOROFORM, ABSOLUTE ALCOHOL,
FERRIC CHLORIDE) is applied along the cystic cavity.
It is left for 5-7 minutes and irrigated with saline.

6. ENUCLEATION WITH BONE GRAFTING:
Bone grafting with autogenous cancellous bone grafts can be
done in case of large bony defects.
Bone graft obliterates the cavity and stimulates osteogenesis.
There is, however, a risk of wound breakdown and infection
of bone graft that may lead to failure.
7. SEGEMENTAL RESECTION, HEMI-MANDIBULECTOMY:
Only in cases when there is large OKC with massive bone
destruction, segmental resection may be unavoidable.
Also when there is suspected neoplastic transformation of
cyst, segmental resection may be required.

COMPLICATIONS OF CYST
MANAGEMENT
 Injury to Inferior alveolar nerve
 Injury to adjacent teeth
 Fracture of jaw
 Oroantral fistula communication
 Hematoma formation
 Infection
 Dead space
 Incomplete removal
 Recurrence
 Malignant transformation

REFERENCES:
1) Mc Donald and Avery’s Dentistry for the child and adolescent – 9th edition
2) Pediatric Dentistry Infancy Through Adolescence - PINKHAM
3) SHAFER’S Textbook of oral pathology
4) Essentials of oral pathology – PURKAIT – 3rd EDITION
5) Neelima Anil Malik - Textbook of oral and maxillofacial surgery - 3rd
EDITION

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