Pseudotumors and cysts

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