Classification of Cysts
- Odontogenic cysts:
- Radicular cyst: most common type, caused by dental pulp necrosis
- Dentigerous cyst: associated with non-erupted tooth crown
- Odontogenic keratocyst: may be linked to Nevoid basal cell carcinoma syndrome
- Buccal bifurcation cyst: appears in the buccal bifurcation region of mandibular molars
- Eruption cyst: small cyst in the gingiva during tooth eruption
- Developmental/Non-odontogenic cysts:
- Nasopalatine duct cyst: most common jaw cyst, found in mid-line of maxilla
- Developmental cysts of the soft tissues around the jaws:
- Palatal cysts of the newborn (Epstein's pearls)
- Nasolabial cyst (nasoalveolar cyst)
- Epidermoid cyst of the skin
- Dermoid cyst
- Thyroglossal duct cyst
- Branchial cleft cyst (cervical lymphoepithelial cyst)
- Oral lymphoepithelial cyst
- Developmental cysts of questionable cause:
- Globulomaxillary cyst
- Median palatal cyst
- Median mandibular cyst
Signs and Symptoms
- Cysts are usually asymptomatic unless:
- Secondarily infected
- Expanded beyond normal anatomical boundaries of the bone
- Palpable lump is felt (hard if bone covers cyst, fluctuant if eroded)
- Acute infection causes discharge into oral cavity and loosening of adjacent teeth
- Rarely, roots of teeth are resorbed
Diagnosis
- Cysts are often discovered through routine dental radiography
- They are usually asymptomatic unless there is significant enlargement or secondary infection
- On x-rays, cysts appear as radiolucent areas with radiopaque borders
- Cysts in maxillary sinus may appear radiopaque due to surrounding air
- Aspiration may aid in diagnosis by analyzing fluid characteristics
- Histopathologic examination of cyst lining confirms the exact diagnosis
Treatment
- Common treatment options for jaw cysts:
- Surgical removal of cyst and histopathologic examination of cyst lining
- Minor surgery to partially or completely remove the cyst
- One or two-stage procedure depending on the case
- Some cysts may not require treatment
- Definitive treatment is determined based on the type of cyst and patient's condition
Cysts Treatment Techniques
- Surgical removal is the primary treatment for the majority of cysts.
- Enucleation involves removing the entire cyst and closing the defect with sutures.
- Marsupialization creates a window in the cyst wall to drain the contents and allow the cyst to shrink.
- Enucleation following marsupialization is performed for large cysts to avoid significant surgical defects.
- Enucleation with curettage removes the cyst and surrounding bone, especially if the cyst is infected.
Note: The content has been organized into 5 comprehensive groups, combining identical concepts while keeping the facts, statistics, and detailed points intact.
A cyst is a pathological epithelial lined cavity that fills with fluid or soft material and usually grows from internal pressure generated by fluid being drawn into the cavity from osmosis (hydrostatic pressure). The bones of the jaws, the mandible and maxilla, are the bones with the highest prevalence of cysts in the human body. This is due to the abundant amount of epithelial remnants that can be left in the bones of the jaws. The enamel of teeth is formed from ectoderm (the precursor germ layer to skin and mucosa), and so remnants of epithelium can be left in the bone during odontogenesis (tooth development). The bones of the jaws develop from embryologic processes which fuse, and ectodermal tissue may be trapped along the lines of this fusion. This "resting" epithelium (also termed cell rests) is usually dormant or undergoes atrophy, but, when stimulated, may form a cyst. The reasons why resting epithelium may proliferate and undergo cystic transformation are generally unknown, but inflammation is thought to be a major factor. The high prevalence of tooth impactions and dental infections that occur in the bones of the jaws is also significant to explain why cysts are more common at these sites.
| Jaw cysts | |
|---|---|
| Specialty | Oral and Maxillofacial Surgery, Dentistry |
Cysts that arise from tissue(s) that would normally develop into teeth are referred to as odontogenic cysts. Other cysts of the jaws are termed non-odontogenic cysts. Non-odontogenic cysts form from tissues other than those involved in tooth development, and consequently may contain structures such as epithelium from the nose. As the cyst grows from hydraulic pressure it causes the bone around it to resorb, and may cause movement of teeth or other vital structures such as nerves and blood vessels, or resorb the roots of teeth. Most cysts do not cause any symptoms, and are discovered on routine dental radiographs. Some cysts may not require any treatment, but if treatment is required, it usually involves some minor surgery to partially or completely remove the cyst in a one or two-stage procedure.
