Cysts in the jaw


Cysts in the jaw. This course about cyst the jaw is part of an online course in all pathology for dental students allclinical pictures and radiographs are taken by doctor by optical who is in awhich and specialist in all surgery and all medicine the pictures are a chiralmaterial from his practice and since they represent only a very limited areaof the body they cannot be identified to any person the histological cases areall from the Department of Pathology hoechlin University Hospital BergenNorway now clinical pictures are radiographs may be copied from thiscourse the histological pictures may be copied for other educational purposesthis course is based on the classification of cysts published inwhu-oh classification of had a neck tumors from 2017 as you may see thisclassification includes much more than cysts in the jaws the list includes alsoodontogenic tumors and bone tumors which I will present in another course here I have highlighted what this coursewill include odontogenic cysts of inflammatory origin that is ridiculouscyst and inflammatory collateral cysts and odontogenic and non odontogenicdevelopmental cysts which includes dented racist odontogenic alert assistlateral periodontal cysts and betrayed odontogenic cysts general cyst glandularodontogenic cyst calcifying odontogenic cyst also keratinizedodontogenic cyst and Nassau peloton duct cyst I will go through these cysts oneby one what are the characteristics of the cysts clinically on radiographs andhistologically this will be exemplified by clinical pictures radiographs andbiopsy cases from our archival material at hoechlin University Hospitalso what is assists assist is an epithelial lined pathologic cavity mostoften filled with liquid the cavity should not be preformed that means thatthe maxillary sinus is not assist since it is preformed and not pathologic inthe jewels there are remnants of epithelium from the tooth developmentthe T’s are formed by Ingres of epithelium which is thereafter resorthowever some remnants will persist and these may be triggered by a stimulus andstart to grow which may be the start of cyst formation such odontogenic rests ofepithelium maybe for instance rests of molasses reduced anomalous epitheliumrests of dental lamina or non odontogenic rests for instanceremnants of nasopalatine duct I will mention some general points aboutcysts in the jaw most cysts are interests only thegingival cysts and the NASA label cysts are in the soft tissue the lesser labialcyst is not on the WHI list but will be mentioned by the end of the cyst courseonly the inflammatory cysts may be related to infectionthe others are developmental cysts disease may be discovered the next wayaccidentally that means that the patients have no pain or other symptomsand that there may be no clinical findings like for instance swelling inother cases the cysts may give clinical symptoms the teeth are vital except forridiculous cysts this fact states the importance of taking maternity testsbefore making a clinical diagnosis some have high recurrence rates and may beaggressive this is especially relevant for Don – DNA cannot assist since thiscyst is a rather common cyst about 10 to 20 percent of all cysts in the jaw thelist of odontogenic cysts in the jaw includes ridiculous cysts aninflammatory collateral cysts ridiculous is there by far the most common and isrelated to the apex of a necrotic tooth the inflammatory collateral cyst isrelated to partially or recently erupted teeth and there are two types the paradental cyst and a mandibular buccal beef occasion cysts the last type of anantigenic inflammatory cysts is the residual cyst this is a cyst which isoften discovered on routine examination sometime after tooth extractionobviously not all epithelium has been eliminated after tooth extraction andassist has developed in this slide I will go through thepathogenesis of the ridiculous cyst which is an adult a gene exists ofinflammatory origin associated with a non vital necrotic tooth the picture onthe left is the development of a periodical granuloma why the one on theright is the further development of a ridiculous cyst on the right column theprocess is described somatically the start is a necrotic pulp most often dueto caries or trauma the necrotic debris will find a way through the apex of thetooth to the periodontal membrane and induce an inflammatory reaction in theperiodontal membrane in the apical region since the necrotic material willkeep on inducing inflammation this will lead to a chronic inflammation and boneresorption and after a time a lesion that will be visible on a radiograph wehave a periodical granuloma epithelial rests on malossi that are present in thepre African Brennan oma may be stimulated to grow by growth factorsfrom the inflammatory cells and that is the start of a cyst formation after sometime the epithelium has formed a cyst cavity and a ridiculous cyst has beendeveloped this is another somatic way of describing the clinical consequences ofpolyp necrosis if a tooth is infected heavily by bacteria a periapical abscessmay develop this is illustrated to the left and a figure in this case there isacute inflammation with a classical clinical science leading to increasedpressure in the bone cavity and accordingly pay in addition there willbe excitation and pause for mation and the pus may be drained through afistula which may end up either on the vestibular Phonics in the old cavity oron the skin dependent on which tooth that is affected alternatively if thereis some drainage the acute situation may decline and the lesion may develop intoa more chronic situation as a periapical granuloma Illustrated to the right onthe figure and possibly further development into a radicular cyst radiologically a ridiculous cyst willalways be seen as a radial lucency since there is loss of bone the size may varyfrom a few millimeters to several centimeters the shape is round or ofweight and it is Yuna local ER quite often there is a narrow part margin ofthe radial lucency the lesion may have resolved the toothapex and even neighboring teeth and this may be reflected on the radiograph andlastly there is no absolute criteria to differentiate between periodicgranulomas and ridiculous cysts when a lesion is big for instance more than onecentimeter it is more likely assist however this may not be thecase and even small lesions of only five millimeters may contain assists lumenthis lights shows examples of radiographs of ridiculous cysts fromdifferent patients some tees have been and authentically treated but this hasnot been sufficient for complete healing while other tees with prereq killedready loosen C’s have only irregular filling of the tooth in some cases thereis root resorption especially in the picture in the upper row to the left inthe picture in the lower road to the left there are two radiolucency x’ onthe roots of the tooth for six in this case the cysts one is also especiallywell demarcated while parry apical radiolucency x’ on other pictures have amore diffuse borderline this slide shows an expected premolar with a deep cariouslesion and some soft tissue attached to the root apex we can fix the expectedtooth in formalin split it and decalcify the hard tissue after that sections fromthe specimen must be stained with him a tox Elena Nilsen and so they are readyto be studied in a microscope we can see the decalcified tooth when bent in andcementum and this salvaged soft tissue which is attached to the apex of thetooth this is a close-up of the periodical area where you can see theirregular border of the apex confirming tooth resorption and also the cell whichconnected tissue follow inflammatory cells the diagnosis is very apicalgranuloma related to expected tooth an even closer up showing the chronicinflammatory cells in this case it is predominated by plasma cellswe proceed to another biopsy also taken from the periodical region in this casealso the truth is expected due to pain this is also a solid tissue gnosis lumencan be seen and there is a central zone which is more Salvage compared with theperiphery we focus on the central area which is full of inflammatory cells anddilated blood vessels tightly packed with the little sites and there is alsoa central area with exudate seen as a pinkish liquid in the picture this maybe the initial phase of abscess formation closer up you may see theexudate and the neutrophil granulocytes in addition to scattered electro sitesthis is a typical picture of an active information increased pressure due toactive inflammation may explain why this lesion has caused pain and the diagnosisis periodical granuloma with active inflammation the next biopsy is alsofrom a curious tooth and also in this case there is soft tissue attached tothe apex the biopsy has been decalcified before sectioning and staining in thiscase there is a central lumen in the soft tissue indicating cyst formationthis is confirmed on this slide where you can see the cyst wall withepithelium towards the cyst lemon and the outer fibrous capsule the borderlineof the toothed apex is irregular which indicates that the apex has beenresolved in the system and there are cholesterol clefts and remnants of cellsand blood clinically this will be seen as a highly viscous grainy yellowishliquid this is a close-up of the biopsy confirming that epithelium is anon-keratinized squamous epithelium which is typical for a ridiculous cystthe capsule consists of fibrous connective tissue with only some fewscattered inflammatory cells another biopsy from a periodical cystic lesionthe biopsy has been cut into two parts you can see a cystic lesion with acentral lumen lined by epithelium the cyst wall varies in thickness some partsare really thin when there are other areas which have a thickerfibrous cyst wall inflammation is especially localized in the sublimitylleol area while the outer zone has much less inflammation this indicates thatthe stimulus for inflammation lies in the cyst lumen this is a close-up of anarea with a hypoplastic non-keratinized squamous epithelium with branching rateof edges making a network between the retro riches there is connected tissuewith inflammation also there are inflammatory cells in theepithelium growth factors from the inflammatory cells may explain theproliferation of the epithelium and the diagnosis is ridiculous cysts this is anew biopsy from a periapical lesion the tooth has been endodontic early treatedsome years back but when the illusion see persisted Appy colectomy wastherefore performed and soft tissue was sent as biopsy the biopsy showsirregular pieces of homogeneous farmers tissue no epithelium can be seen on aclosed Rock we can confirm that the biopsy contains densely packed fibroustissue with only few fibroblasts and hardly any inflammatory cells inconclusion there has been a healing process but bone formation has ought notoccurred instead healing speed fibrosis this may however not be possible toconfirm before a biopsy has been taken and the diagnosis is Peri apicalfibrosis compatible with scar formation this is a biopsy from a periapicallesion the truth had been endodontic early treated some years back but wherethe illusion see persisted OB collector me was therefore performed and softtissue was sent as biopsy the biopsy consists of an irregular piece of softtissue there’s no epithelium mainly there is fibrous tissue but what isstriking is the hard tissue formation some of the hot issue is lost duringsectioning since the tissue has not been decalcified also there is some greyishsubstance in quite large areas and also some yellowish material these areforeign bodies in close rot we can see that the greatest granules have beenphagocytized by macrophages and are localized intracellularly the otherarrow points to the heart tissue where we can see remnants of the same granulesthese foreign bodies are calcium hydroxide the calcium hydroxide is verybasic and will induce hard tissue formation however in this case the truthhas been overfilled and the calcium hydroxide has been pressed into theperiodontal membrane and the diagnosis is periodical granuloma with foreignbodies originated from endodontic treatment this is another biopsy from aperiapical lesion the tools had been endodontic li treated some years backbut radiolucency persisted Oppie colectomy was therefore performedand soft tissue was sent as biopsy this is a cystic lesion and also in this casethe wall has a varying thickness it is a cyst since it is lined with anepithelium and there is a dense inflammatory cell infiltrate in the cystwall as we have seen in a case before the lumen is filled with remnants ofcells blood and cholesterol clefts what is striking is the foreign bodies in thesystemin seen as some dark material attached to the cyst wall these are alsoforeign bodies originating from endodontic treatment in closer up we cansee that the foreign bodies are crystals and granules underneath there’s a layerof a little sites indicating some bleeding and thereafter thenon-keratinized sister brazilian and inflamed connective tissue and thediagnosis is ridiculous cysts with foreign bodies originated fromendodontic treatment we will now look into the inflammatory collateral cyststhat arise on the buccal aspect of the roots of partially or recently eruptedteeth as a result of inflammation in the peri coronal tissues this is a list ofcharacteristics of the two types of inflammatory color to insists they arecurrently related to mandibular molars the para dental cyst is related to thethird molar with most often longstanding hairy coral itis and symptoms of painswelling and Christmas it is related to a vital tools and on radiograph it’swell demarcated it is superimposed over the buccal aspects of the roots of theteeth and it is distinct from the follicular space surrounding a partiallyerupted tooth on the head other hand the mandibular buck will be vacations cystarises on a lower first and second molar it is most often a pain and swelling butinfection with pain and separation may occur the truth is tilted buckle e wendyperiodontal pockets and on a radiograph there is a welder marketed buccalradiolucency whichmay extend to the lower border of the mandible in a biopsy the picture will belike a ridiculous cyst with a cystic lesion lined with non-keratinizedepithelium and with more or less inflammation in the cyst world the lasttype of odontogenic cysts of inflammatory origin is the residual cyst these cysts may be without symptoms anddiscovered on routine examination or as illustrated on this slide be discoveredbecause there is a swelling on the alveolar Ridge where a tooth is missingx-ray of this case shows a welder located radiolucency another radiographfrom another case also shows a radial lucency in an indenture –less area bothcases were confirmed by biopsy to be residual cysts this is a biopsy of aradial lucency discovered some years after extraction of tooth to 6 this is acystic lesion and as seen in other cases the cyst wall has varying thickness andthe cyst wall is lined by epithelium towards the lumen there is inflammationin the cyst wall and lumen is filled with remnants of cells blood andcholesterols Clift’s as seen in other cases a closer opt shows that theepithelium is a non-keratinized squamous epithelium there are some scatteredepithelial cells with Celia this may be explained by the fact that the extractedtooth was a mogila from the upper jaw with roots very close to the maxillarysinus in the connected tissue there are cholesterol clefts and scattered chronicinflammatory cells and the diagnosis is odontogenic cystline with squamous epithelium compatible with residual cyst you

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