1. Pseudotumors and cysts Jan Laco, M.D., Ph.D.

2. Causes of swellings of jaws Cysts –odontogenic x non-odontogenic Odontogenic tumors Giant cell lesions Fibro-osseous lesions Non-odontogenic tumors of bone Metastatic tumors Chronic osteomyelitis

3. Cysts of jaws = pathological cavity lined by epithelium RTG: sharply-defined lucencies ? fluid slowly growth  teeth displacement asymptomatic x infection  painfull rarely: pathological fracture

4. Cysts of jaws Odontogenic –developmental dentigerous eruption gingival lateral periodontal odontogenic keratocyst calcifying odontogenic cyst –inflammatory radicular paradental

5. Cysts of jaws Non-odontogenic –nasopalatine duct –nasolabial Pseudocysts –solitary bone cyst –aneurysmal bone cyst

6. Cysts of jaws – frequency (%) 1. radicular 65-70 2. dentigerous 15-50 3. keratocyst 3-5 4. nasopalatine 5-10

7. Odontogenic cysts – radicular cyst  common swelling of jaws and cyst  males (M : F … 3 : 2) 20 - 60 years maxilla : mandible … 3 : 1 painless sweeling enucleation

8. Odontogenic cysts – radicular cyst relationship to root of dead tooth pulpitis  periapical granuloma  proliferation of Malassez rests Mi: hyperplastic squamous epithelium (net-like) + hyaline (Rushton) bodies wall: granulation tissue + fibrous tissue mixed inflammation hemosiderin, cholesterol clefts

9. Odontogenic cysts – residual cyst = radicular cyst persisting after extraction - spontaneous regress lateral radicular cyst –at side of nonvital tooth –lateral branch of root canal –enucleation

10. Odontogenic cysts – paradental cyst inflammation around partially erupted tooth lower 3. M  males, 20 - 25 years vital tooth with pericoronitis Mi: ~ radicular cyst enucleation

11. Odontogenic cysts – dentigerous cyst cystic change of enamel organ after complete enamel formation surrounds crown + attached to tooth neck at amelo-cemental junction  crown inside (RTG) M : F … 2 : 1 20 - 50 years 3. M, C  prevents eruption Mi: thin squamous epithelium fibrous wall with scanty inflammation

12. Odontogenic cysts – eruption cyst in soft tissue over tooth about to erupt from enamel organ (superficial dent. cyst) children teeth with no predecessors soft bluish swelling in gingiva spontaneously disappear

13. Odontogenic cysts – gingival cysts newborn (Bohn´s nodules) > 80% gingiva - proliferation of Serres nests midline of palate (Epstein pearls) spontaneously resolve adults - rare

14. Odontogenic cysts – lateral periodontal cyst uncommon cyst beside vital tooth botryoid odontogenic cyst –lower P and C –> 50 years –Mi: multilocular cyst with fibrous septa squamous epithelium + clear cells (glycogen) –recurrency glandular odontogenic cyst –Mi: mucous cells –recurrency

15. Odontogenic cysts odontogenic keratocyst  keratocystic odontogenic tumor calcifying odontogenic cyst  calcifying cystic odontogenic tumor

16. Odontogenic cysts – odontogenic keratocyst uncommon from enamel organ before tooth formation (20 – 30) + (50 – 70) years mandible angle  extending in finger-like fashion in bone marrow spaces asymptomatic RTG: multilocular

17. Odontogenic cysts – odontogenic keratocyst Mi: squamous epithelium - basal layer (mitoses) - thin wavy para- keratotic layer - folded cyst lining wall - scanty inflammation complete enucleation - difficult 60% recurrency in first 5 years !!!

18. Odontogenic cysts – odontogenic keratocyst Gorlin-Goltz syndrome = multiple keratocysts + multiple naevoid basal cell carcinomas of skin

19. Odontogenic cysts – calcifying odontogenic cyst Gorlin´s anterior parts of jaws RTG: cystic cavity + calcifications Mi: ameloblastoma-like epithelium ghost cells – large, pale, outlines of nucleus  calcification + odontomas (10% cases) enucleation recurrency

20. Odontogenic cysts wall thickening –cholesterol clefts –carcinoma –ameloblastoma

21. Odontogenic cysts biopsy practice nonspecific findings – inflammation X odontogenic keratocyst X calcifying odontogenic cyst X unicystic ameloblastoma

22. Non-odontogenic cysts – nasopalatine duct cyst uncommon from nasopalatine duct epithelium midline of palate position variants (to incisive canal) –nasopalatine –palatine papilla –median alveolar Mi: squamous + respiratory epithelium wall: mucous glands + neurovascular bundle enucleation

23. Non-odontogenic cysts – nasolabial cyst = Klestadt´s, nasoalveolar very uncommon from remnants of nasolacrimal duct in soft tissue deep in nasolabial fold excision

24. Cysts of soft tissues thyroglossal duct cyst lymphoepithelial cyst lingual dermoid mucocele

25. Cysts of soft tissues - thyroglossal duct cyst uncommom from remnants of any part of thyroglossal duct early age swelling in midline of mouth or neck Mi: squamous + respiratory epithelium wall: thyroid tissue, chronic inflammation removal + part of hyoid bone

26. Cysts of soft tissues - lymphoepithelial cyst branchiogenic cyst ??? cystic change of epithelium entrapped in LN early age lateral part of neck + mandible angle + parotid soft swelling fistula to skin / oral cavity / pharynx Mi: squamous + respiratory epithelium wall: dense lymphoid tissue + germ centres enucleation

27. Cysts of soft tissues - sublingual dermoid developmental anomaly of branchial arches or pharyngeal pouches between hyoid and jaws or beneath tongue no symptoms Mi: epidermoid cyst dermoid cyst – dermal appendages dissection

28. Cysts of soft tissues - mucoceles  minor salivary glands  lower lip superficial, 1 cm swellings extravasation type – damage of duct –saliva leak  inflammation + mucophages –NO epithelium  mucofagic granuloma retention type – obstruction of duct –epithelium of dilated duct

29. Cysts of soft tissues - mucoceles ranula = mucocele of submandibular or sublingual gland unilateral painless swelling, 2-3 cm floor of mouth