1. 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

3. 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.

4. 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

5. 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

6. 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

7. Cyst Radiographic Features: Effects on Surrounding Structures
Cyst grow slowly
Sometimes displacement and resorption of the teeth
Cyst can expand the mandible

8. 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

9. 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

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Odontogenic Cysts
Nonodontogenic Cysts

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Radicular Cyst
Dental Cyst

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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

13. 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

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Radicular Cyst
Periapical cyst, Dental cyst
Differential Diagnosis
RO : Granuloma – Cyst – Abscess
Odontogenic Keratocyst
Lateral periodontal Cyst

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Dentigerous Cyst
Follicular Cyst

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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

35. 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

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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

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Keratocyst
Odontogenic Keratocyst
OKC

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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”

58. 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

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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

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Nevoid Basal Cell
Carcinoma
Syndrome
Gorlin-Goltz Syndrome

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76. Basal cell nevus syndrome
Gorlin-Goltz Syndrome
Multiple basal cell carcinomas of the skin
Skeletal abnormalities
Eye abnormalities
Multiple OKC

77. 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

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Residual Cyst
Radicular Cyst
Dentigerous Cyst

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Paradental Cyst
Infected Buccal Cyst

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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:

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Lateral Periodontal
Cyst

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Nonodontogenic Cysts

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Incisive Canal
Cyst
Nasopalatine Canal Cyst

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Nasopalatine Duct Cyst
Remnants of the nasopalatine duct
10% of jaw cyst
Most cases between years old
Asymptomatic or mild symptoms

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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

104. 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.

105. 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!!!

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107. 58 y.o. male, continuous neuropathic pain upper maxilla

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115. Periapical Radiolucencies

116. Periapical Radiolucencies
> 10 mm

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Median
Mandibular
Cyst

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Pseudocysts
and Non-Cysts

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Mucous Retention
Pseudocyst

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Serous Retention Pseudocyst
Mucous RetentionCyst
Serous Retention Cyst
Mucosal Cyst

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Simple Bone
Cyst

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Traumatic Bone Cyst
Hemorrhagic Bone Cyst
Solitary Bone Cyst

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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

139. 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

140. 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

141. 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….)

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Salivary Gland
Inclusion Defect
Stafne Defect

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Submandibular Salivary Gland
Inclusion Defect
Sublingual Salivary Gland

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Submandibular Stafne Defect
Sublingual Stafne Defect

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