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1. Cysts of the jaws
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2. Cysts of the jaws
Significance for a general practitioner
Often encountered in practice
Though benign increase in size
Likely to get infected, lead to fracture of the mandible
Surgical treatment is simple
Recurrences
are
rare
except
keratocysts
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odontogenic

3. Cysts of the jaws
Definition: Conventional
“ It is an epithelial-lined sac filled with fluid
of semi fluid material”
Appropriate
“It is an abnormal cavity in hard or soft
tissues which contains fluid, semi fluid or
gas and is often encapsulated and lined by
epithelium”
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4. Cysts of the jaws
Classification
Robinson’s classification (1945)
A From odontogenic tissues
1. Periodontal cyst
2. Dentigerous cyst
3. Primordial cyst
B From Non dental tissues
1. Median cyst
2. Incisive canal cyst
3. Globulo-maxillary cyst
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5. Cysts of the jaws
Lucas classification (1964)
Odontogenic
Periodontal
Dentigerous
Primordial
Fissural
Nasopalatine
Globulo maxillary
Naso labial
Median cysts
Bone cysts
Solitary bone cyst
Aneurysmal bone cyst
Stafne’s bone cavity
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6. Cysts of the jaws
Odontogenic cysts
Cyst
Epithelial source
Periodontal cell rests of malassez
Dentigerous reduced enamel epithelium
Keratocysts cell rests of serre
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7. Cysts of the jaws
Clinical features
Radiological examination
Aspiration biopsy
Histopathology
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Diagnosis

8. Cysts of the jaws
Diagnosis
Symptoms
If small asymptomatic
Pain & swelling if infected
Missing tooth
Non-vital tooth
Displacement & irregularity of the teeth
Displacement of the denture
Pathological fracture
Salty taste
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9. Cysts of the jaws
Diagnosis
Signs
•If small no physical signs
•Hard, smooth painless bulging of outer
cortical plate
•Thinning of outer cortical plate
•Fragmentation of the outer cortical plate
•Resorbtion of the fragments
•Fluctuation
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10. Cysts of the jaws
Significance of location or site
Fissural cysts have definite location
Dentigerous cyst more common in mandibular
third molar and maxillary canine areas
Periodontal more in maxillary anterior region
Odontogenic keratocyst more in mandible
Solitary bone cyst & aneursymal bone cyst occur
only in mandible
Stafne’s only in mandible
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11. Cysts of the jaws
Relationship with teeth
Non vital teeth Periodontal cyst
Impacted teeth Dentigerous cyst
Missing teeth
Occassionally odontogenic
keratocyst if developed from
enamel organ
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12. Cysts of the jaws
Diagnosis
Radiographic examination
Radiographs required
Intra oral peri apical
Occlusal films
Orthopantomogram
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13. Cysts of the jaws
Diagnosis
Radiographic examination
Round or oval area of radiolucency
Surrounded by a sharp radio opaque
margin
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14. Cysts of the jaws
Diagnosis
Use of radio opaque medium
Useful to demonstrate the relationship
of naso labial cyst to the surface of
the maxilla and to the nasal cavity
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15. Cysts of the jaws
Diagnosis
Aspiration Biopsy
Light straw coloured fluid rich in cholesterol
indicates periodontal, dentigerous, fissural cysts
Light yellow cheese like
odontogenic keratocyst
material
indicates
Presence of blood under pressure indicates
aneurysmal bone cyst
Minute amount of serous fluid indicates solitary
bone cyst
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16. Cysts of the jaws
Diagnosis
Aspiration Biopsy
Odontogenic Keratocyst
Electrophoresis :The protein content of the
cystic fluid is less than 4 grams per 100 ml.
Identification of Keratin under microscope
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17. Cysts of the jaws
Management
Reasons for treatment
1. Progressive increase in size
2. Likely to get infected
3. Constitute an area of weakness
4. May result in pathological fracture
5. To confirm the benign nature
6. Encroachment on neighbouring structures
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18. Cysts of the jaws
Treatment
Operative procedures
a. Enucleation Removal of the entire
cystic lining with primary closure or
cavity packed open
b. Marsupialisation  Decompression
of the cystic cavity by making a
small opening and evacuating the
cystic contents
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19. Cysts of the jaws
Enucleation
Treatment
contra indications
Large cyst where surgical access would
further weaken the jaw
Involving apices of one or more teeth
where stripping of lining may make them
non vital
A dentigerous cyst in a young person
where the tooth is likely to erupt.
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20. Cysts of the jaws
Treatment
Marsupialisation operative procedure
A window is created surgically to
relieve intra cystic tension
The aperture should be large
An acrylic bung is constructed
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21. Cysts of the jaws
Enucleation
Treatment
surgical procedure
Anaesthesia
Incision & reflection of mucoperiosteal flap
Making bony window to gain access to the cyst
Removal of cystic lining
Preparation of the wound for closure
Haemostasis
Closure of the wound
Post operative www.indiandentalacademy.com
care

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Leader in continuing dental education
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