Developmental Abnormalities of Soft Tissue and Developmental Cysts

Developmental Soft Tissue Abnormalities

• Ankyloglossia (Tongue-tie)

  • Extensive adhesion of the tongue to the floor of the mouth.

  • Can lead to gingival recession and bone loss if the frenum is attached high on the lingual alveolar ridge.

  • Cause: Unclear, but genetics may play a role.

  • Treatment: Surgical removal of the lingual frenum (frenectomy) if it causes complications such as recession, bone loss, or speech issues.

• Commissural Lip Pit

  • Located at the corners (commissures) of the mouth.

  • May be shallow or several millimeters deep.

  • Cause: Unclear; possibly incomplete fusion of the maxillary and mandibular processes.

  • Treatment: Usually, no treatment necessary.

• Congenital Lip Pit

  • Occurs near the midline of the lip's vermilion border, can be unilateral or bilateral.

  • Treatment: No treatment indicated.

• Double Lip (Ascher's syndrome)

  • Rare condition resulting in a double upper lip.

  • Associated with thyroid enlargement in 10-50% of patients.

  • Treatment: Surgical correction through a transverse elliptical incision if psychological distress due to appearance occurs.

• Lingual Thyroid Nodule

  • Ectopic mass of thyroid tissue located on the tongue, caused by failure of thyroid tissue to migrate properly.

  • Clinically observed as a midline mass on the dorsal surface of the tongue.

  • Treatment: Removal necessary if it obstructs swallowing or is the only functioning thyroid tissue, after evaluating for other thyroid tissue presence.

Developmental Cysts

• General Information

  • Definition: An abnormal, pathologic sac or cavity lined by epithelium, enclosed in connective tissue.

  • Types include odontogenic (related to tooth development) and non-odontogenic cysts (not related to tooth development).

• Periapical Cyst

  • Most common cyst in the oral cavity, caused by pulpal inflammation.

  • Develops from a pre-existing periapical granuloma found at the apex of a non-vital tooth.

• Residual Cyst

  • Remains post tooth extraction.

• Dentigerous Cyst

  • Also known as a follicular cyst, forms around the crown of an unerupted or developing tooth.

  • Most commonly associated with the mandibular third molars.

  • Treatment: Surgical removal of the cyst and usually the involved tooth is necessary.

• Eruption Cyst

  • Similar to dentigerous cyst, found in soft tissue around the crown of an erupting tooth.

  • Treatment: Often no intervention needed as the tooth typically erupts through the cyst; removal may be necessary if complications arise.

• Primordial Cyst

  • Develops in place of a tooth, often found in the area of a third molar.

  • Diagnosed via biopsy and histologic examination.

  • Treatment: Surgical removal of the cyst, with recurrence depending on histological diagnosis.

• Odontogenic Keratocyst (OKC)

  • Characterized by recurrence and unique histological appearances (8-10 cell layers thick and parakeratinized).

  • Most often seen in the mandibular third molar region.

  • Treatment: Surgical excision and careful follow-up are essential due to recurrence potential.

• Calcifying Odontogenic Cyst

  • Developmental cyst lined by odontogenic epithelium, featuring "ghost cells."

  • Treatment: Conservative surgical removal; does not recur.

• Lateral Periodontal Cyst

  • Found in the mandibular cuspid and premolar area; usually asymptomatic.

  • Gingival Cyst: Similar epithelium lining but located in soft tissue.

  • Treatment: Both treated by surgical excision.

• Nasopalatine Canal Cyst

  • Located within the nasopalatine canal, common in adults over 40, with a male predilection.

  • Treatment: Surgical enucleation, with rare recurrence.

• Median Palatine Cyst

  • Located in the midline of the hard palate, similar to nasopalatine canal cyst.

  • Treatment: Surgical enucleation with good prognosis.

• Globulomaxillary Cyst

  • Seen between the maxillary lateral incisor and cuspid roots; thought to be of odontogenic origin.

  • Treatment: Surgical enucleation based on microscopic diagnosis.

• Median Mandibular Cyst

  • Rare, located midline in the mandible; unclear origin.

  • Treatment: Surgical removal with good prognosis.

• Nasolabial Cyst

  • Soft tissue cyst with no bone involvement; arises from nasolacrimal duct.

  • Treatment: Surgical excision with good prognosis and rare recurrence.

• Brachial Clef Cyst

  • Located on the lateral neck, can appear intraorally on the floor of the mouth.

  • Treatment: Surgical excision with good prognosis.

Pseudocysts

• Static Bone Cyst (Stafne Bone Defect)

  • Not a true cyst, lacks epithelial lining; may cause depression in the mandible.

  • Treatment: No treatment if asymptomatic.

• Simple Bone Cyst (Traumatic Bone Cyst)

  • Unlined pathologic cavity in bone, often discovered during x-rays.

  • Treatment: Surgical intervention and curettage, with excellent prognosis.

• Aneurysmal Bone Cyst

  • Composed of blood-filled spaces, often with a multilocular appearance on x-ray.

  • Treatment: Surgical excision and possible cryotherapy, with variable prognosis based on individual cases.