D2 Radiology Lecture 9: Cysts of the Jaws

Cyst

What is the term for a pathological cavity filled with fluid, lined by epithelium and surrounded by a definite connective tissue wall?

1. Radiolucent

2. Swelling without pain

3. Pain with secondary infection

What are the three clinical features of cysts?

1. Tooth bearing regions

2. Above mandibular canal

What are the two main locations for cysts?

Sinus

What can cysts expand into?

1. Well-defined

2. Corticated

What are the two main traits of peripheral cysts?

1. Loss of cortication

2. Sclerotic bone reaction

What are the two responses to secondarily infected cysts?

Scalloped

What type of border do cysts have?

1. Dystrophic calcifications

2. Septations

What are the two internal structures of cysts seen in radiographs?

1. Tooth displacement

2. Cortical expansion

3. Displace inferior alveolar nerve inferiorly

What are the three possible effects of cysts on surrounding structures?

Tumors

Do cysts or tumors tend to be more multilocular?

Cysts

Do cysts or tumors tend to be hydrostatic?

Tumors

Do cysts or tumors tend to be more likely to resorb roots?

1. Idiopathic bone cavity

2. Aneurysmal bone cyst

3. Stafne bone defect

4. Mucous retention phenomenon

What are the four cyst-like conditions?

Radicular cyst

What is the most common cyst in the jaws?

Rest of Malassez

Where does the epithelial lined cavity found with radicular cysts originate from?

Apex of nonvital tooth

Where are radicular cysts located?

1. Tooth displacement

2. Root resorption

What are the two possible effects of radicular cysts on surrounding structures?

Residual Cyst

What type of cyst is a radicular cyst that has been left behind after a tooth extraction?

Secondary infection

When can residual cysts cause pain?

Apical region of missing tooth

Where are residual cysts found?

Mandibular canal

What are residual cysts found above?

Displace mandibular canal or border of maxillary sinus

What is the unique effect of residual cysts on surrounding tissues?

Dentigerous cyst

What is the most common pathological pericoronal radiolucency of the jaws?

Dentigerous cyst

What is the second most common cyst found in the jaws?

Around CEJ of unerupted tooth

Where on the tooth are dentigerous cysts found?

Follicle

What could expand with accumulating fluid from dentigerous cysts?

1. 3rd molars

2. Canines

3. 2nd premolars

On which three teeth are dentigerous cysts found?

Buccal expansion

What is the unique effect on surrounding tissue found with dentigerous cysts?

Buccal Bifurcation Cyst

What is the inflammatory paradental cyst or the mandibular infected buccal cyst called?

Epithelial cell rests in buccal bifurcation

What is the most likely source of epithelium for buccal bifurcation cysts?

No

Are all buccal bifurcation cysts inflammed?

Delayed/missing eruption of mandibular first/second molar

What is the common sign of buccal bifurcation cysts?

First molars

Are buccal bifurcation cysts more common on first or second molars?

Yes

Can buccal bifurcation cysts be bilateral?

1. Tipping of tooth

2. Lingual cusp tip higher than buccal

3. Smooth expansion of buccal cortical plate

What are the three unique effects of buccal bifurcation cysts on surrounding tissue?

Lateral Periodontal Cyst

What is the cyst arising from the periodontium lateral to a tooth root?

< 1 cm

What is the size of lateral periodontal cysts?

Lateral periodontal abscess

What may lateral periodontal cysts mimic when secondarily infection?

Mandible

Where are 50 - 75% of lateral periodontal cysts located?

Lateral incisor to premolar

What is the most common area for lateral periodontal cysts on the mandible?

Lateral incisor to canine

What is the most common area for lateral periodontal cysts on the maxilla?

Prominent cortical boundary

What is the main physical trait of lateral periodontal cysts?

Thinning of lamina dura

What is the unique effect of lateral periodontal cysts on surrounding tissues?

Botryoid Odontogenic Cyst

What is the rare variation of lateral periodontal cysts that is grape-like?

Mandible

Where are Botryoid Odontogenic Cysts most common?

Canine to premolar (Interradicular)

What is the most common area that Botryoid Odontogenic Cysts are found?

Males

Is Odontogenic Keratocystic (OKC) more common in males or females?

Posterior mandible

Where is OKC the most common?

Keratin

What is the unique material found in OKC?

Ramus

What area could be filled by OKC?

Inferior alveolar nerve

What is the epicenter of OKC superior to?

Little to none

Does OKC cause expansion?

Pushing inferior alveolar nerve inferiorly

What is the unique effect of OKC on surrounding tissues?

Gorlin-Goltz Syndrome

What is the condition that causes multiple OKCs and basal cell carcinomas?

Slow

Are Calcifying Odontogenic Cysts (Gorlin cysts) fast or slow expanding?

Anterior to first molar

Where do most Calcifying Odontogenic Cysts occur?

30 - 50%

What percent of Calcifying Odontogenic Cysts have calcifications?

Nasopalatine Duct Cyst

What is the most common non-odontogenic cyst of the jaws?

Nasopalatine canal/foramen

Where are Nasopalatine Duct Cysts found?

Heart

What shape is made by Nasopalatine Duct Cysts?

Apices

What are Nasopalatine Duct Cysts superimposed on in radiographs?

Root divergence of central incisors

What is the unique effect of Nasopalatine Duct Cysts on surrounding tissues?

Women

Are nasolabial cysts more common in men or women?

Soft tissue next to alveolar process above lateral incisors

Where are nasolabial cysts located?

< 30 years

At what age are aneurysmal bone cysts found?

Women

Are aneurysmal bone cysts more common in men or women?

Well defined with hydraulic character

What is the radiographic appearance of aneurysmal bone cysts?

Can be either

Are aneurysmal bone cysts unilocular or multilocular?

Simple bone cavity

What is a cavity within bone lined by connective tissue called?

No

Do simple bone cavities have epithelial lining?

Men

Are simple bone cavities more common in men or women?

Ramus/Posterior mandible

What is the most common location for simple bone cavities?

Scallop between teeth

What is the unique effect of simple bone cavities on surrounding tissue?

Antral Pseudocyst

What is the cyst-like condition seen primarily in the maxillary sinuses?

Floor of maxillary sinus

Where are Antral Pseudocysts usually found?

1. Homogenous

2. Radiopaque

What two traits do Antral Pseudocysts have on radiographs?

CBCT

What should you use to differentiate between cysts and antral pseudocysts?

Between mandibular canal and inferior border

Where are Stafne bone defects found?

Radicular cyst

What cyst is this?

Radicular cyst

What cyst is this?

Residual cyst

What cyst is this?

Dentigerous cyst

What cyst is this?

Buccal Bifurcation Cysts

What cyst is this?

Lateral Periodontal Cyst

What cyst is this?

Botryoid Odontogenic Cyst

What cyst is this?

OKC

What cyst is this?

COC (Gorlin Cyst)

What cyst is this?

Nasopalatine Duct Cyst

What cyst is this?

Nasolabial cyst

What cyst is this?

Aneurysmal Bone Cyst

What cyst is this?

Simple bone cyst

What cyst is this?

Antral Pseudocyst

What is this?

Stafne bone defect

What is this?