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Background

Odontogenic cysts are common cysts occurring in the oral cavity. There are two broad categories. In general, periapical cysts located at the tooth root tip and are associated with a nonvital tooth. Dentigerous cysts surround the crown of an impacted tooth and are associated with a vital tooth.

Inflammatory Cysts Periapical cysts
Paradental cysts
Developmental Cysts Dentigerous cysts
Odontogenic keratocyst
Calcifying odontogenic cyst
Lateral Periodontal cyst
Glandular odontogenic cyst

 

GROSS APPEARANCE/
CLINICAL VARIANTS
CHARACTERIZATION
INFLAMMATORY  
PERIAPICAL CYST

Also known as radicular cyst, apical periodontal cyst, or lateral radicular cyst
Trauma or dental caries causes necrosis of the dental pulp allowing inflammatory mediators to exit through the apical foramen leading to granulation tissue in the apical periodontal connective tissue

Causes proliferation of epithelial rests of Malassez and cyst formation

PARADENTAL CYST

Also known as inflammatory paradental cysts, mandibular infected buccal cyst, or buccal bifurcation cyst

Occurs buccal and distal to a mandibular molar within 2 years after eruption of the tooth
Inflammation induces odontogenic epithelium

DEVELOPMENTAL  
DENTIGEROUS
AKA follicular cyst
Should never diagnose unless there is an associated impacted tooth
ODONTOGENIC KERATOCYST
AKA primordial cysts, parakeratinized odontogenic cyst, or OKC
May be associated with basal cell nevoid syndrome
Unilocular cyst occurring between or apical to teeth
Multilocular cyst frequently in posterior mandible
Little jaw expansion
Radiographs reveal edge effect with scalloped periphery with incomplete septation
CALCIFYING ODONTOGENIC CYST
AKA Gorlin cyst, COC

Most are intraosseous but occasional extraosseous (peripheral or gingival) lesions occur
LATERAL PERIODONTAL CYST

AKA LPC

0.5-1 cm unilocular cyst between tooth roots in the premolar/canine region of the mandible
Associated teeth are vital

Extraosseous analogue is gingival cyst of the adult occurring in the buccal gingiva of the premolar area of the mandible

Multicystic intraosseous LPCs are botryoid odontogenic cysts and may recur following currettage

GLANDULAR ODONTOGENIC CYST

AKA sialo-odontogenic syst, GOC

Large multilocular cyst in anterior mandible

 

HISTOLOGICAL TYPES CHARACTERIZATION
INFLAMMATORY  
PERIAPICAL CYST
Thin nonkeratinized stratified squamous epithelium with slender interconnecting rete processes, exocytosis of neutrophils, and granulation tissue

Lining may have mucous cells and Rushton bodies (intraepithelial curvilinear eosinophilic hyaline bodies) and occasional keratinization
PARADENTAL CYST
Histologically identical to periapical cyst
DEVELOPMENTAL  
DENTIGEROUS
 
ODONTOGENIC KERATOCYST
Resembles steatocystoma simplex with corrugated surface
Basal layer with palisaded columnar cells with hyperchromatic nuclei
Parakeratotic cells present on luminal surface
Orthokeratinized odontogenic cyst
Identical to epidermal inclusion cyst with orthokeratin and a granular layer
CALCIFYING ODONTOGENIC CYST
Ghost cell keratinization in lining epithelium and may be found in connective tissue wall with foreign body giant cell reaction
LATERAL PERIODONTAL CYST
Thin nonkeratinized epithelium with polygonal to flattened squamous cells
May have intraepithelial nodular aggregations of polygonal cells with clear cytoplasm
Connective tissue may have islands of clear cells or nests of squamous odontogenic epithelium (dental lamina or rests of Serres)
GLANDULAR ODONTOGENIC CYST
Surface columnar to cuboidal cells with eosinophilic cytoplasm with rounded apices and intraepithelial lumina
Mucous cells and ciliated cells
Intraepithelial spherules of concentrically whorled keratinocytes

 

DIFFERENTIAL DIAGNOSIS KEY DIFFERENTIATING FEATURES
Hyperplastic dental follicle Thickness of the membranous connective tissue wall is >3mm
Thickened normal dental follicular tisssue
Dental papilla 0.7 cm translucent white button-like nodule of myxoid tissue associated with an incompletely developed third molar with little or no evidence of root formation
Pericoronitis Inflammation in soft tissue around the crown of an impacted or erupting mandibular third molar

 

PROGNOSIS AND TREATMENT CHARACTERIZATION
PROGNOSTIC FACTORS  
RECURRENCE

If a cyst recurs, it is one of these three cysts
It is always advisable to review the histology of the original cyst

For these three entities, curettage is inadequate

Odontogenic keratocyst
43% recurrence following currettage
Unicystic ameloblastoma
Look for palisaded columnar cells in the basal layer with hyperchromatic nuclei polarized from the basement membrane
Glandular odontogenic cyst
 

Rosai J. Ackerman's Surgical Pathology. Eight Edition. Mosby 1996.
Sternberg S. Diagnostic Surgical Pathology. Third Edition. Lipincott Williams and Wilkins 1999.


Commonly Used Terms

Mouth and Oral Cavity


Last Updated 11/29/2001

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