The Radiology of Oral and Perioral Cysts Juan F. Yepes, DDS, MD, MPH Assistant Professor Division of OD, OM, OMFR Department of Oral Health Practice UKCD ODM 820 Spring 2009
Cyst Pathologic cavity filled with fluid, lined by epithelium, and surrounded by a connective tissue wall. The cyst fluid either is secreted by the cells lining the cavity or derives from the surrounding tissue Fluid.
Cyst Cyst occur more often in the jaws because most cysts originate from the rest of odontogenic epithelium that remain after tooth formation. Cyst are radiolucent lesions Usually asymptomatic **** (infection) Related with missing teeth
Cyst Radiographic Features: Location Cyst may occur centrally in any location in the maxilla or mandible Cyst are rare in the condyle and the coronoid process A few cyst arise in the soft tissues of the orofacial region Periphery Radiolucent Well defined and corticated However a secondary infection can change this
Cyst Radiographic Features: Shape Cyst are usually round or oval, resembling a fluid filled ballon Some cyst may have a scalloped borders Internal Structure Cyst are often totally radiolucent Long standing cyst may have some calcifications inside Some cyst have septa
Cyst Radiographic Features: Effects on Surrounding Structures Cyst grow slowly Sometimes displacement and resorption of the teeth Cyst can expand the mandible
Cyst Radicular Cyst Odontogenic Cyst Residual Cyst Dentigerous Cyst Buccal bifurcation cyst Odontogenic Keratocyst Basal cell nevus syndrome Lateral Periodontal Cyst Calcifying odontogenic Cyst Odontogenic Cyst Non-Odontogenic Cyst
The Radiology of Oral and Perioral Cysts Embryonic epithelial precursor Adult epithelial derivative Surface epithelium Rests of Serres Gingival Cyst (Dentigerous Cyst if Crown involved) Reduced Enamel Epithelium Dentigerous Cyst Rest of Malassez Radicular cyst
The Radiology of Oral and Perioral Cysts Odontogenic Cysts Nonodontogenic Cysts
The Radiology of Oral and Perioral Cysts Radicular Cyst Dental Cyst
The Radiology of Oral and Perioral Cysts Radicular Cyst Periapical cyst, Dental cyst Radicular cyst is a cyst most likely originated when rest of epithelial cells (Malassez) in the periodontal ligament are stimulated to proliferate and undergo cyst degeneration by inflammatory products from a non-vital tooth. Most common cyst in the jaws They arise from non-vital teeth Asymptomatic, unless secondary infection occurs
The Radiology of Oral and Perioral Cysts Radicular Cyst Periapical cyst, Dental cyst In most cases the epicenter of the RC is located at the apex 60% are found in the maxilla, especially around incisors and canines Well defined cortical border, if secondary infected, the inflammatory reaction may result in loss of the cortical bone Internal structure Radiolucent
The Radiology of Oral and Perioral Cysts Radicular Cyst Periapical cyst, Dental cyst Differential Diagnosis RO : Granuloma – Cyst – Abscess Odontogenic Keratocyst Lateral periodontal Cyst
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts .
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts Dentigerous Cyst Follicular Cyst
The Radiology of Oral and Perioral Cysts Dentigerous Cyst A dentigerous cyst is a cyst that forms around the crown of an unerupted tooth. It begins from accumulation in the layers of reduced enamel epithelium or between the epithelium And the crown of the unerupted tooth. Second most common cyst in the jaws They develop around the crown of an unerupted or supernumerary tooth
The Radiology of Oral and Perioral Cysts Dentigerous Cyst Radiology Features The epicenter is just above the crown of the involved tooth The cyst is attaches at the CEJ Very often are quite big before diagnosis Well defined cortex Completely radiolucent
The Radiology of Oral and Perioral Cysts Dentigerous Cyst Radiology Features DG often displace and resorb adjacent teeth Displaces the associated tooth in a apical direction Differential Diagnosis - Hyperplastic follicle - OKC: Less likely resorb teeth Attach more apical - Cystic ameloblastoma
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts Keratocyst Odontogenic Keratocyst OKC
The Radiology of Oral and Perioral Cysts OKC Non-inflammatory odontogenic cyst that arises from the dental lamina. Unlike other cyst, the epithelium of the OKC appears to have innate growth potential The epithelium lining is keratinized and thin Inside the cyst viscous white material “cheese”
The Radiology of Oral and Perioral Cysts OKC OKCs account for above 1/10 of all cyst in the jaws Second and third decades with slightly male predilection No symptoms until mid size swelling High recurrence Aspiration Keratin
The Radiology of Oral and Perioral Cysts OKC Radiographic Features: 90% Posterior body of the mandible Epicenter superior to the inferior alveaolar canal Looks very similar to dentigerous cyst Well corticated and radiolucent MINIMAL EXPANSION Resorb teeth bust less than DC
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts Nevoid Basal Cell Carcinoma Syndrome Gorlin-Goltz Syndrome
The Radiology of Oral and Perioral Cysts
Basal cell nevus syndrome Gorlin-Goltz Syndrome Multiple basal cell carcinomas of the skin Skeletal abnormalities Eye abnormalities Multiple OKC
Basal cell nevus syndrome Usually after 5 years of age and before 30 Multiples OKC (mandible) High recurrence Bifid rib Polydactyly Temporoparietal bossing Calcification of the falx cerebri
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts Residual Cyst Radicular Cyst Dentigerous Cyst
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts Paradental Cyst Infected Buccal Cyst
The Radiology of Oral and Perioral Cysts Paradental Cyst ~0.5% of odontogenic cysts, histopathologically, but not radiographically. Daley, T.D., Wysocki, G.P., Pringle, G.A. Relative incidence Of odontogenic tumors and oral and jaw cysts in a Canadian population. Oral Surg oral med Oral Pathol 1994; 77:276-280.
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts Lateral Periodontal Cyst
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts Nonodontogenic Cysts
The Radiology of Oral and Perioral Cysts Incisive Canal Cyst Nasopalatine Canal Cyst
The Radiology of Oral and Perioral Cysts Nasopalatine Duct Cyst Remnants of the nasopalatine duct 10% of jaw cyst Most cases between 40-50 years old Asymptomatic or mild symptoms
The Radiology of Oral and Perioral Cysts Nasopalatine Duct Cyst + frequent complain: small, well defined swelling just posterior to the palatine papilla Sometimes (depending of the size) the cyst produces swelling below the maxillary labial frenum
The Radiology of Oral and Perioral Cysts Nasopalatine Duct Cyst RADIOGRAPHIC FEATURES: Well defined, corticated and is circular or oval in shape. The shadow of the ANS sometimes is superimposed heart shape Internal structure: complete radiolucent Most common this cyst causes the roots of the central incisors to diverge and occasionally root resorption occurs.
The Radiology of Oral and Perioral Cysts Nasopalatine Duct Cyst DIFFERENTIAL DIAGNOSIS -The most common differential diagnosis is a large incisive foramen Keep in main: Always compare with old images Radicular cyst VIATALITY!!!
The Radiology of Oral and Perioral Cysts
58 y.o. male, continuous neuropathic pain upper maxilla
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
Periapical Radiolucencies
Periapical Radiolucencies > 10 mm
Periapical Radiolucencies
Periapical Radiolucencies
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts Median Mandibular Cyst
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts Pseudocysts and Non-Cysts
The Radiology of Oral and Perioral Cysts Mucous Retention Pseudocyst
The Radiology of Oral and Perioral Cysts Serous Retention Pseudocyst Mucous RetentionCyst Serous Retention Cyst Mucosal Cyst
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts Simple Bone Cyst
The Radiology of Oral and Perioral Cysts Traumatic Bone Cyst Hemorrhagic Bone Cyst Solitary Bone Cyst
The Radiology of Oral and Perioral Cysts Simple Bone Cyst SBC is a cavity within the bone that is lined by connective tissue. It may be empty or it may contain some fluid. -SBC is not a true cyst Etiology: unknown, however probably is a abnormality in the bone metabolism
The Radiology of Oral and Perioral Cysts Simple Bone Cyst SBC’s are very common First or second decade of life Male predominance 2:1 Associated with cemento-osseous dysplasia Asymptomatic in most cases Expansion of the mandible or maxilla: unusual
The Radiology of Oral and Perioral Cysts Simple Bone Cyst RADIOGRAPHIC FEATURES Almost all SBC’s are found in the mandible More often in the posterior body or in the ramus Margin: varies, the lesion often scallops between the roots of the teeth The borders are better defined in the alveolar process Internal structure: Totally radiolucent No true septa
The Radiology of Oral and Perioral Cysts Simple Bone Cyst RADIOGRAPHIC FEATURES - In most cases these lesions have not effect on the surrounding teeth. Lamina dura usually is intact Tendency to grow along the long axis of the mandible DIFFERENTIAL DIAGNOSIS - OKC (however….)
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts Salivary Gland Inclusion Defect Stafne Defect
The Radiology of Oral and Perioral Cysts Submandibular Salivary Gland Inclusion Defect Sublingual Salivary Gland
The Radiology of Oral and Perioral Cysts Submandibular Stafne Defect Sublingual Stafne Defect
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts
The Radiology of Oral and Perioral Cysts