1. Prepared by:Nazatun Fameiza
binti Kamarudin
:NU09DL055

2. INDEX
 1)Definition of cyst
 2)Classification of cyst
 3)Radicular cyst
 4)Residual cyst
 5)Dentigerous cyst
 6)Odontogenic Keratocyst
 7)Basal Cell Nevus Syndrome
 8)Calcifying cystic Odontogenic tumor
 9)Nasopalatine Duct cyst
 10)Nasolabial cyst.

3. DEFINITION OF CYST
 Cyst is defined as pathologic cavity,
 having fluid,semifluid, or gaseous contents and
 which is not created by accumulation of pus.
 It is frequently but not always lined by epithelium.
cyst
Lining epithelium
lumen
Wall of fibrous
connective tissue

4. CLASSIFICATION OF CYST
Cyst of the jaw
Epithelial (true Non Epithelial (pseudo cyst)
cyst)
Odontogenic Non odontogenic
Based on etiology Based on site of origin
Inflammatory
Developmental unclassified
Reduced enamel
epitelium Cell rest of
Malassez
Cell rest of Serre

5. EPITHELIAL/TRUE CYST
ODONTOGENIC NON ODONTOGENIC
FISSURAL CYST DEVELOPMENTAL CYST
-median anterior -palatal cyst of neonate
maxillary cyst -thyroglossal tract cyst
-nasopalatine duct cyst -benign cevical
-nasolabial cyst lymphoepithelial cyst
-globulomaxillary cyst -epidermoid and dermoid
cyst
-median mandibular
cyst Heterotopic oral
gastrointestinal cyst

6. ODONTOGENIC
BASED ON SITE OF ORIGIN
BASED ON ETIOLOGY
1)REDUCED ENAMEL EPITHELIUM
DEVELOPMENTAL -dentigerous cyst
CYST INFLAMMATORY
-eruption cyst
-gingival cyst of infants -periapical cyst
2)CELL REST OF SERRE
-gingival cyst of adults -residual cyst
-odontogenic keratocyst
-odontogenic keratocyst -paradental cyst
-gingival cyst of newborn
-dentigerous cyst
-gingival cyst of adults
-eruption cyst
-lateral periodontal cyst
-lateral periodantal cyst
-glandular odontogenic cyst
-botryoid odontogenic
cyst 3)CELL REST OF MALASSEZ
-glandular odontogenic -periapical cyst
cyst -residual cyst
-calcifying odontogenic 4)UNCLASSIFIED
cyst
-calcified odontogenic cyst
-paradental cyst

7. NON EPITHELIAL (PSEUDO
CYST)
-solitary bone cyst
-aneurysm bone cyst

8. RADICULAR CYST
 synonyms:periapical cyst,apical periodontal cyst,dental cyst
 Definition:
 Cyst that results when cell rest of Malassez in periodontal ligament are
stimulated to proliferate and undergo cystic degeneration by inflammatory
products from NON VITAL tooth.
 Clinical Features:
 The most common type of cyst in the jaw
 Age:3rd-6th decade
 Sex:MALE predominance
 Arise from NON VITAL TOOTH ;
 -due to extensive caries,large restorations,trauma
 Asymptomatic
 Larger cyst may cause swelling

9.  On palpation,the swelling may feel
 A)bony and hard if cortex is intact
 B)crepitant as the bone thins
 C)rubbery and fluactuant if the outer cortex is lost
 Radiographic Features;
 1)location:
 -approximately at the apex of a
 non vital tooth,
 -60% are found in MAXILLA
 -Especially around INCISORS and CANINES
 -(mesial/distal surface of tooth root at the opening of accessory canal or in
deep periodontal pocket)
 -because of distal inclination of the root,cyst that arise from the maxillary
lateral incisor may invaginate the antrum
 -may associated with NONVITAL DECIDUOS MOLAR which is situated
buccal to developing bicuspid.


10.  Periphery and Shape:
 -well-defined cortical border
 -if the cyst is secondarily infected,the
 inflammatory reaction surrounding the
 bone may result in loss of this cortex or
 alteration lead to sclerotic border.
 -outline:curved or circular

11.  Internal Structure:
 -radiolucent
 -in long standing cyst,dystrophic calcification may developed,appearing
as sparsely distributed small particulate radiopacities.
 Effects on surrounding structures:
 -large cyst lead to displacement and resorption of adjacent teeth.
 -resorption patern have curved outline
 -the cyst may invaginate the antrum,but there should be evidence of
cortical boundaries between the contents of the cyst and the internal
structure of antrum.
 -cyst may displace mandibular alveolar canal in an inferior direction.

12.  -the outer cortical plates of maxilla or mandible may expand in curved or
circular shape

13.  Differential Diagnosis:
 1)Apical granuloma
 -cyst characterized by round shape,well-defined cortical border,and size
greater than 2cm in diameter.
 2)early stage of periapical cemental dysplasia,an apical scar or surgical defect
 -patient’s history helps with the differentiation
 3)Odontogenic keratocyst or Lateral Periodontal cyst
 -vitality of involved tooth should be test.
 -non vital tooth have large pulp chamber due to lack of secondary dentin.
 4)Benign fibro-osseous lesion
 -a larger radicular cyst that invaginated maxillary antrum may collapse and
start filling in with the new bone.with biopsy,the histologic analysis may
result in ossifying fibroma or benign fibro-osseous
lesion.Radiographically,the new bone will form first at the periphery of the
cyst as the cyst shrinks and not in the center of cyst.(this is different pattern
from benign lesion)

15.  Management:
 -extraction
 -endodontic theraphy
 -Apical surgery
 Larger cyst
 -surgical removal
 -marsupialization

16. RESIDUAL CYST
Definition:
Cyst that remains after incomplete removal of the original cyst.
Clinical Features:
-Asymptomatic
-associated with EDENTULOUS AREA

17. Radiographic Features:
1)Location
Site:mandible
-epicenter is positioned in the former periapical region of involved or
missing tooth
-in mandible,the epicenter is above the inferior alveolar nerve canal

18.  2)Periphery and shape
 -cortical margin with oval or circular shape
 3)Internal structure
 -radiolucent
 --dystrophic calcification in long standing cyst

19. 4)Effect on surrounding structure:
-tooth displacement or resorption
-outer cortical plate of jaw may expand
-cyst may invaginate maxillary antrum or depress the inferior alveolar canal.
Differential Diagnosis:
1)Odontogenic keratocyst
-residual cyst has greater expansion than OKC
2)Stafne developmental salivary gland defect
-the defect is located below mandibular canal,thus is unlikely to be
odontogenic in nature.
Treatment:
-surgical removal
-marsupialization

20. DENTIGEROUS CYST
 Synonym:follicular cyst
 Definition:
 A cyst that forms around the crown of UNERUPTED tooth.It begins when
fluid accumulates in the layers of REDUCED ENAMEL EPITHELIUM or
between the epithelium and the crown of unerupted tooth.
 Clinical Features:
 -2nd most common cyst in the jaw
 -associated with UNERUPTED or
 SUPERNUMERARY TOOTH.
 (mesiodens in anterior maxilla)
 -no pain or discomfort
 -clinical examination shows:
 @>missing tooth with hard swelling
 resulting in facial asymmetry

21.  Radiographic Features:
 1)Location:
 -mandibular or maxillary THIRD MOLAR
 -MAXILLARY CANINE
 -this cyst attaches at CEMENTOENAMEL junction
 -types of radiographic presentation:
 a)central type

22.  b)lateral type
 c)circumferential type

23.  2)Periphery and shape
 -well defined cortex with a curved or circular outline
 3)Internal structure
 -radiolucent except the crown of involved tooth
 4)Effect of surrounding structure
 -displacement and resorption of adjacent tooth

24.  -it displaces the associated tooth in apical direction
 -maxillary third molar or cuspid may be pushed to the floor of orbit
 -mandibular third molar may be moved to condylar or coronoid region or
to the inferior cortex of mandible

25.  -the floor of maxillary antrum may be displaced as the cyst invaginates
the antrum
 -The cyst may displace the inferior alveolar nerve canal in an inferior
direction
 Differential Diagnosis
 1)hyperplastic follicle
 -size of normal follicle space is 2-3mm
 -If the folicular space exceed 5mm assaciated with tooth displacement
and bone expansion,a dentigerous cyst is more likely.
 2)odontogenic keratocyst
 -OKC does not expand the bone to the same degree as dentigerous
cyst,less likely to resorb tooth,may attach further at apically on the root
instead of CEJ.

26.  3)ameloblastic fibroma or ameloblastoma
 -dentigerous cyst contain internal structure(tooth)
 4)adenomatoid odontogenic tumor and calcified odontogenic cyst
 -evidence of a radiopaque internal structure in these two lesion.
 5)radicular cyst at the apex of primary tooth
 -occasionally surrounds the crown of the developing permanent tooth
positioned apical to it,giving false impression of dentigerous cyst
associated with permanent tooth.
 -occur most often in MANDIBULAR DECIDUOUS MOLAR and the
developing BICUSPIDS
 -thus,clinician should look for extensive caries or large restoration in
primary tooth to indicate radicular cyst.

27.  Management
 1)surgical removal including the tooth
 2)large cyst should be treated with marsupialization before surgical
removal
 3)cyst lining should be submitted for histologic examination because
many lesion might be arise from cyst lining eg;
 a)AMELOBLASTOMA
 b)SQUAMOUS CELL CARCINOMA
 c)MUCOEPIDERMOID CARCINOMA

28. ODONTOGENIC KERATOCYST
Synonyms:
-KERATOCYSTIC ODONTOGENIC TUMOR(KOT)
-primordial cyst
Definition:
The WHO has reclassified this cystic lesion into a unicystic or multicystic
odontogenic tumor on the basis of TUMORLIKE CHARACTERISTIC of
the lining epithelium.The epithelium in the KOT appear to have innate
growth potential,consistent with benign tumor.The epithelial lining is
DISTINCTIVE because it is KERATINIZED (hence the name)and thin (4-8
cells thick).Occasionally,budlike proliferations of epithelium grow from
the basal layer into the adjacent connective tissue wall.Islands of
epithelium in the wall may give rise to SATELLITE MICROCYST.Inside
the cyst contain a viscous or cheesy material derived from epithelial
lining.

29. Clinical Features:
-KOT account for about one tenth (1/10) of all cystic lesion in jaws
-age:20-30
-sex:male predominance
-may associated with UNERUPTED tooth
-asymptomatic
-aspiration reveal a thick yellow cheesy material(KERATIN)
Have high properties of RECCURENCE ,because of small satellite cyst or
epithelium fragments left behind after surgical removal of epithelium.
Radiographic Features:
1)Location
-most common:POSTERIOR BODY OF MANDIBLE
(90% occur posterior to canine)
:RAMUS (more than 50%)
-the epicenter located superior to inferior alveolar nerve canal

30. -has same pericoronal position as dentigerous cyst.
2)Periphery and shape
-well-defined cortical border
-smooth round or oval shape
-or might have scalloped outline

31. 3)Internal Structure:
-radiolucent
-in some case curved internal septa may be present giving a multilocular
apppearance.

32. 4)Effect on surrounding structure:
-a very characteristic feature that its PROPENSITY TO GROW ALONG THE
INTERNAL ASPECT OF THE JAW CAUSING MINIMAL EXPANSION.
-this occur throughout the mandible except for the upper ramus and
coronoid process.

33.  -the relatively slight expansion contributes to their late detection,which
allow them to reach a large size.
 -KOT can displace and resorb teeth but to a slightly degree than
dentigerous cyst.
 -the inferior alveolar nerve canal may be displaced inferiorly.
 -this may invaginate and occupy the maxillary antrum.

34.  – RADIOGRAPHIC VARIETIES
1. REPLACEMENTAL –
Cyst forms in place of normal tooth
by degeneration of dental
lamina.
2. EXTRANEOUS –
OKC occurs in ascending ramus, away
from tooth bearing areas

35. 3. COLLATERAL –
OKC occurs adjacent to root of tooth,
mimicking a lateral periodontal cyst.
4. ENVELOPMENTAL –
This is an odontogenic keratocyst
which embraces or envelopes an
adjacent unerupted tooth.

36.  Differential Diagnosis:
1)dentigerous cyst
-it is KOT if the cystic outline is connected to the tooth at the point apical to
CEJ,and if no expansion of the cortical plate.
 -although KOT can develop occlusal to developing tooth ,the follicle of
involved tooth is not enlarged as dentigerous cyst.
2)Ameloblastoma
-scalloped margin and multilocular appearance of KOT may resemble
ameloblastoma but ameloblastoma has greater propensity to expand.
3)Odontogenic myxoma
-have similar characteristic of mild expansion and multilocular appearance.
4)Simple bone cyst
-have similar characteristic of scalloped margin and minimal bone expansion
-however the margins of simple bone cyst are more delicate and difficult to
detect.
5)4-5% of KOT cases may constitute part of BASAL CELL NEVUS SYNDROME.

37. Management:
-referral to radiologist for a complete radiologic examination is advisable.
-resection,curretage,or marsupialization to reduce the size of large lesion
before surgical excision.
-complete removal of the cystic walls to reduce the chance of recurrence
-after surgical treatmant,it is important to make periodic posttreatment
clinical and radiographic examination to detect any recurrence.
-recurrent lesion usually develop within the first 5 years but may delayed as
long as 10 years.

38. BASAL CELL NEVUS SYNDROME
 Synonyms:Nevoid basal cell carcinoma, GORLIN-GOLTZ syndrome
 Definition:
 Comprises a number of abnormalities as multiple nevoid basal cell carcinomas of
the skin,skeletal abnormalities,central nervous system abnormalities,eyes
abnormalities and multiple KOTs.it is inherited autosomal dominant trait with
variable expressivity.

39.  Clinical Features:
 age:5-30 years
 A) multiple KOTs-appearing in multiple quadrant
 -early in life
 -high RECURRENT RATE

40.  B) skin lesion-small,flattened,flesh-colored or brown papules
 -prominent on face,neck, and trunk

41.  C)Skeletal anomalies
 -BIFID RIB (most common)
Frontal chest radiograph shows
bilateral bifid ribs (arrows).
 -costal abnormalities eg 1) vertebral fusion

42.  2)kyphoscoliosis
 3)polydactyly

43.  4)temporal and temporoparietal bossing
 5)minor hypertelorism- abnormally increased distance between two
 organs or bodily parts.

44. 6) calcification of Falx cerebri
Skull CT showing calcification of the falx

45.  Radiographic features:
 1) location:same as solitary KOTs,may develop bilaterally
 2)other radiographic features:
 Radiopaque line of the calcified falx cerebri may be prominent on the
posterior anterior skull projection

46. CALCIFYING CYSTIC ODONTOGENIC TUMOR
Synonyms:Calcifying odontogenic cyst,Calcifying epithelial odontogenic cyst,
Gorlin cyst
Definition :
-uncommon slow growing,benign lesions.occupy a spectrum ranging from a
cyst to an odontogenic tumor.It may manufacture calcified tissue (dysplastic
dentin) or associated with an odontoma.when it contains a more solid
component ,it gives appearance resembling ameloblastoma although it
does not behave like one.

47.  Clinical features:
 Mean age:36 years
 first peak:10-19 years
 second peak:seventh decade
 Appearance:slow –growing,painless swelling in jaw
 Radiographic features:
 1) location:
 - 75% occur in bone anterior to first molar especially associated with cuspids
and incisors

48.  2) periphery and shape:
 -vary from well-defined and corticated with a curved, cystlike shape to ill-
defined and regular
 3) Internal structure:
 -a)completely radiolucent
 -b)evidence of small foci or calcified material that appear as white flecks or
small smooth pebbles
 -c)larger,solid,amorphus masses
 -d)multilocular

49.  4) effect on surrounding structure:
 -20-50% of cases is associated with tooth(cuspid) and impedes it eruption
 -displacement of teeth and root resorptions
 -perforation of cortical plate may be seen with enlarging lesion.
 Management:
 Enucleation and curettage.

50. NASOPALATINE DUCT CYST
 Synonyms:Nasopalatine canal cyst, Incisive canal cyst, Nasopalatine cyst,
 Median palatine cyst, Median anterior maxillary cyst.
 Definition:
 Nasopalatine canal usually contains remnants of the nasopalatine duct, a
primitive organ of smell, and the nasopalatine vessels and nerves.
Occasionally, a cyst forms in the nasopalatine canal when these embryonic
epithelial remnants of the nasopalatine duct undergo proliferation and
cystic degeneration.

51.  Clinical Features:
 10% of jaw cysts
 Age:4th-6th decades
 Sex:male predilection
 Asymptomatic
 Small,well-defined swelling just posterior to palatine papilla
 Fluactuant and blue swelling if near the surface.
 May penetrate labial plate and produce swelling below maxillary labial
frenum.
 May bulge into nasal cavity and distort nasal septum
 Pressure of cyst on adjacent nasopalatine nerve may cause burning
sensation or numbness over palatal mucosa.

52.  Radiographic Features:
 1) location
 -a) found in the nasopalatine foramen or canal
 -b) If extends posteriorly involving hard palate MEDIAN PALATAL CYST
 -c)if expands anteriorly between central incisors,destroying or expanding
labial plate of bone and causing teeth to diverge MEDIAN ANTERIOR
MAXILLARY CYST

53.  2) Periphery and shape:
 -well-defined and corticated circular or oval in shape
 -HEART SHAPE is due to shadow of nasal spine superimposed on the cyst

54.  Internal structure:
 -radiolucent
 Effects on Surrounding structures:
 -roots of central incisors diverge
 -root resorption
 -expansion of labial cortex and palatal cortex
 -floor of nasal fossa may be displaced in superior direction

55.  Differential Diagnosis:
 1) large incisive foramen
 -cyst is presumed when the width of foramen exceeds 1cm and cause tooth
displacement.
 2) a radicular cyst or granuloma
 -absence of lamina dura and enlargement of periodontal ligament space
around apex of central incisors indicate an inflammatory lesion.
 -vitality test
 -a second periapical view taken at different horizontal angulation should
show altered position of a nasopalatine duct cyst, whereas radicular cyst
should remain centered about the apex of central incisors.
 Management:
 -enucleation
 -marsupialize indicated for large cyst

56. NASOLABIAL CYST
 Synonyms:Nasoalveolar cyst
 Definition
 -exact origin is unknown, may be fissural cyst arising from epithelial rests in
fusion lines of globular,lateral nasal and maxillary process.

57.  Clinical Features:
 Age:12-75 years
 Sex:female predilection
 Usually UNILATERAL
 a)small lesion
 -very subtle,unilateral swelling of
 nasolabial fold associated with
 pain or discomfort.
 b) large lesion
 -it may bulge into floor of nasal
 cavity causing obstruction,flaring
 of alae,distortion of nostrils
 and fullness of upper lip.

58.  Radiographic Features:
 1) location:
 -located adjacent to alveolar process above apices of incisors
 -because this is soft tissue lession, investigation should be done using CT or
MRI(magnetic resonance imaging.
 2)Periphery and shape:
 -CT images shows circular or oval lesion with slight tissue enhancement on
periphery
 3)Internal structure:
 -CT images shows homogenous & relatively radiolucent compared with
surrounding structure.

59.  4)Effects on surrounding structures:
 -erosion on underlying bone
 -usual outline of inferior border of nasal fossa become distorted resulting
posterior bowing of this margin.
 Management:
 -excision through an intraoral approach.