cyst of oral and maxillofacial region

1. CYSTS OF ORAL &
MAXILLOFACIAL REGION
Dr. Savita Sahu.
2nd yr. Post graduate

2. CONTENT
• INTRODUCTION & CLASSIFACTION
• DEVELOPMENTAL ODONTOGENIC CYST
• INFLAMATORY ODONTOGENIC CYST
• NON- ODONTOGENIC CYST
• TREATMENT MODALITIES

3. DEFINATION
• Kramer (1974) ‘a pathological cavity having fluid, semifluid or
gaseous contents and which is not created by the accumulation of
pus’
• Killey and Key 1966 — this entity constituted an epithelium-lined
sac filled with fluid or semifluid material.
Outer wall - Connective tissue
 Inner wall – Epithelium
 Cystic content - Watery, Colloidal
or Semisolid

4. Classification by Robinson(1945)
A. From odontogenic tissues
• Periodontal cyst
– Radicular or dental root apex type
– Lateral type
– Residual type
• Dentigerous cyst
• Primordial cyst
B. From non-dental tissues
• Median cyst
• Incisive canal cyst
• Globulomaxillary cyst

5. • Classification by WHO (1992)
• A. Developmental B. Inflammatory
• • Odontogenic cysts - Radicular
• – Primordial - apical and lateral
• – Gingival cyst of infants - residual
• – Eruption cyst - paradental
• – Dentigerous cyst (follicular)
• – Gingival cyst of adults
• – Lateral periodontal cyst
• – Glandular odontogenic cyst, sialo-odontogenic cyst
• • Non-odontogenic
• – Nasopalatine duct (incisive canal) cyst
• – Globulomaxillary cyst
• – Nasolabial cyst

6. • WHO CLASSIFICATION PUBLISHED IN ‘HISTOLOGIC TYPING
OF ODONTOGENIC TUMOURS’ (KRAMER, PINDBORG,
SHEAR – 1992)- most accepted

7. I) CYSTS OF THE JAWS
(A) EPITHELIAL
(A) DEVELOPMENTAL
(A) ODONTOGENIC cyst
1. Gingival Cysts Of Infants
2. Odontogenic Keratocyst (Primordial Cyst)
3. Dentigerous (Follicular) Cyst
4. Eruption Cyst
5. Lateral Periodontal Cyst
6. Gingival Cyst Of The Adults
7. Botryoid Odontogenic Cysts
8. Glandular Odontogenic (Sialo-odontogenic /
Mucoepidermoid-odontogenic) Cyst
9. Calcifying Odontogenic Cyst

8. (B) NON-ODONTOGENIC
1. Naso-palatine Duct (Incisive Canal) Cyst
2. Naso-labial (Naso-alveolar) Cyst
3. Midpalatine Raphae Cyst Of Infants
4. Median Palatine, Median Alveolar And Median Mandibular
Cysts
5. Globulomaxillary Cyst
(C) INFLAMMATORY
1. Radicular Cyst (Apical / Lateral)
2. Residual Cyst
3. Paradental (Mandibular Infected Buccal) Cyst
4. Inflammatory Collateral Cyst

9. • B) NON-EPITHELIAL
• 1. Solitary (Traumatic/Simple/Haemorrhagic) Bone Cyst
• 2. Aneurysmal Bone Cyst
• II ) CYSTS ASSOCIATED WITH THE MAXILLARY
ANTRUM
• 1. Benign Mucosal Cyst Of The Maxillary Antrum
• 2. Post-operative Maxillary Cyst (Surgical Ciliated Cyst Of
The Maxilla)

10. III) CYSTS OF THE SOFT TISSUES OF THE MOUTH, FACE AND
NECK
1.Dermoid And Epidermoid Cyst
2. Lymphoepithelial (Branchial Cleft) Cyst
3. Thyroglossal Duct Cyst
4. Anterior Median Lingual Cyst (Intralingual Cyst Of Fore-gut Origin)
5. Oral Cyst With Gastric / Intestinal Epithelium (Oral Alimentary Tract
Cyst)
6. Cystic Hygroma
7. Naso-pharyngeal Cysts
8. Thymic Cysts
9. Cysts Of The Salivary Glands
10. Mucous Extravasation Cyst
11. Mucous Retention Cyst
12. Ranula
13. Polycystic (Degenerative) Disease Of Parotid.
14. Hydatid Cyst
15. Cysticerus Cellulosae
16. Trichinosis

11. • WHO 2017 classification

15. PATHOGENESIS OF CYST
CYST
Cyst
initiation
Cyst
formation
Cyst
enlargement

16. • A] CYST INITIATION – is from odontogenic epithelium.
• Stimulus of cyst is not known.
• Epithelium of cyst can be derived from any one of the below-
• 1) a tooth germ
• 2) reduced enamel epithelium
• 3) epithelial rests of malassez, remants of HERS
• 4) remants of dental lamina
• 5) basal layer of epithelium.

17. • B] CYST FORMATION-
• Cystic cavity is lined by stratified squamous epithelium
• Blood supply is rich at periphery and lack of nutrition in centre.
• These cell tend to desquamate and under go necrosis.
• Produces a fluid with increased osmolarity in centre surrounded by
epithelial lining.
• As the central cells get away from periphery usually 0.18 to 0.2 mm,
they degenerate creating a lumen

18. • C] CYST ENLARGEMENT-
• The attraction of fluid into the cystic cavity.
• The retention of fluid into the cavity.
• The production of raised internal hydrostatic pressure.
• The resorption of surrounding bone with an increase in the size of
bone cavity
•

19. Harries classified the theories of cyst enlargement
in the following manner
• Mural growth
– Peripheral cell division
– Accumulation of cellular content
• Hydrostatic enlargement
– Secretion
– Transudation and exudation
– Dialysis
• Bone resorbing factor

20. • Mural growth
– Peripheral cell division
– Accumulation of cellular content
Cyst enlargement by cell proliferation

21. • Hydrostatic enlargement
– Secretion: goblet cells in follicular cyst. There little evidence
of intracystic secretions
– Transudation and exudation: proposed mainly for the
enlargement of the follicular and periodontal cyst respectively.
The presence of fibrin and cholesterol in periodontal and
follicular cysts suggests that hemorrhage also contributed to
the cystic fluid.

22. • -dialysis: mean osmolality of the cystic fluid is 10 miliosmoles
higher than that of serum. This gradient is attributed to the
accumulation of the low molecular weight cells shed from the
lining epithelium and maintained by inadequate lymphatic access
to the cyst lumen, the consequence is net entry of fluid from the
capsule capillaries into the cystic lumen.

23. • Bone Resorbing Factor
• Vital cyst tissue in culture has been shown to release a potent
bone resorbing factor, which is predominately a mixture of
prostaglandin E2 (PGE2) and prostaglandin E3 (PGE3).
• The source of this resorbing factor appears to be the capsule
and leukocyte content.

25. • Cyst regression
• Any process that leads to the involution of cyst epithelium, e.g.
extraction of tooth or reduction of intracystic pressure as with
marsupialisation, may cause connective tissue capsule to regress
and the cavity to be filled by bone or scar tissue

26. •ODONTOGENIC
CYST

27. 1.DENTIGEROUS CYSTS
• Definition: A cyst that forms around the
crown of Unerupted tooth.
• It begins when fluid accumulates in the layers
of REDUCED ENAMEL EPITHELIUM or
between the epithelium and the crown of
unerupted tooth.
• Dentigerous cyst is the developmental
odontogenic cyst of epithelial origin.
• It is also called as 'follicular cyst' or
'pericoronal cyst'.

28. • Epidemiology
• Second most common odontogenic cyst
• Usually seen in teenagers / young adults,
• Sites
• Association with an unerupted tooth - permanent mandibular third
molars
• Rarely involves supernumerary teeth and odontomas
• Distinctly rare to occur around unerupted primary teeth
• Pathophysiology
• Develops from accumulation of fluid (including glycosaminoglycans)
between reduced enamel epithelium of dental follicle and crown of
unerupted tooth
• Some may have inflammatory pathogenesis

29. • Clinical features
• May be small / asymptomatic, identified on routine radiographs
taken for unrelated reasons or for imaging to investigate delayed
tooth eruption
• Can grow large enough to produce a painless bony expansion,
can displace the involved tooth, cause resorption of adjacent teeth
• If secondarily infected, may be associated with pain

30. • Radiology description
• Most commonly a well defined, unilocular radiolucency on X-ray
• Often has sclerotic rim
• Can cause resorption of adjacent teeth

31. • Three different radiographic relationships between involved tooth
and cyst described: according to thoma
• Central variety:
• Lateral variety:
• Circumferential:

32. • According to Mourshed
• Class I — dentigerous cyst associated with completely
unerupted teeth.
• Dentigerous cyst associated with unerupted teeth, who failure to
erupt is due to lack of space in the dental arch.
• Dentigerous cyst associated with unerupted teeth, who failure to
erupt is due to malpositioning of the tooth germ.
• Dentigerous cyst associated with unerupted supernumerary
teeth.
• Class II — dentigerous cyst associated with partially erupted
teeth

33. • Histopathological Features
• thin layer of non-keratinized stratified squamous epithelium.
• 2-4 cell layer thick primitive type of epithelium.
• Retepegs formation is absent except in cases that are
secondarily infected
• On aspiration-
Clear , pale , straw coloured fluid with cholesterol crystals

34. • COMPLICATION
• 1) recurrence
• 2) ameloblastoma (mural type)
• 3) Mucoepidermoid carcinoma
• Treatment- 1) surgical removal
• 2) decompression of cyst.
• Recurrance is rare until the fragments of cyst has been left.

35. ODONTOGENIC KERATOCYST
• The term ‘odontogenic keratocyst’ was introduced by Philipsen
(1956).
• First described by Mikulicz, 1876 as a “Dermoid cyst”
• In Hauer, 1926 “Cholesteatoma”.
• It is more common in male then female and most in black then
white . It is least in white female.
• Ratio = male : female = 1.7 : 1

36. • Epidemiology
• 4 - 12% of all odontogenic cysts
• Multiple tumors seen in Nevoid Basal Cell Carcinoma Syndrome /
Gorlin Syndrome
• Sites
• Mandible most commonly involved, angle of mandibular region,
posterior mandible
• Woolgar et al. (1987c) have shown that OKCs occur with much
greater frequency in the maxilla after the age of 50 years.

37. • It was benign tumour because-
• 1.asymptomatic till it reaches a large size
• 2. tends to extend through the medullary cavities rapidly
• 3. proliferative index OKC (mean = 8), nonodontogenic cyst
(mean = 2.3) and radicular cyst (mean = 4.5).
• Origin of Cyst
• The OKC is originating from the the odontogenic
• epithelium; Dental lamina or it's remnants. Which possesses
marked growth potential or
• Alternatively from proliferation of basal cells as 'basal cell
hamartias' which are offshoots of the basal cells.

38. • Symptoms-Asymptomatic
• The maxillary sinus gets infected in the initial phase of cyst
enlargement.
• paraesthesia is experienced of the lower lip or teeth with
mandibular cases , if there is a pathological fracture
• Teeth — teeth may be displaced, if it expands through cancellous
bone and the body of the mandible.
• Sign-
• The lesion can lead to pathologic fracture. Those that occur in the
maxilla causes buccal expansion.
• On aspiration there is odourless creamy white or caseous
content, thick aspirate.

39. • Reasons Recurrence
1) satellite cyst, which is a budlike projection of basal cell layer into
the connective tissue, i.e. retained during the enucleation procedure.
2) Some instances of recurrence are likely because of new cyst
formation rather than true recurrence.
3) Lining Is thin, difficult to enucleate chances of leaving fragments
out is high.
4) Toller suggested that there may be an intrinsic growth potential in
the epithelial lining which may be responsible for a higher
recurrence rate.

40. • Radiographic Features
• Site — more than 90% are seen posterior to the canines in the
mandible and more than 50% at the angle of the mandible.
• Internal structure — undulating borders cloudy interior
appearances suggestive of multilocularity.
• Size — size varies and may be 5 cm or more in diameter. Maxillary
lesions are smaller and rounder than those in the mandible.
• Shape — shape of cyst is usually oval extending along the body of
the mandible with little mediolateral expansion.
• Margins — margins are hyperostotic and tooth displacement is
seen.
• Radiolucency is usually hazy due to keratin filled cavity and it is
surrounded by thin sclerotic rim due to reactive osteocytes

41. • Effect on bone— expand and perforate the buccal and lingual
cortical plates of bone and involve the adjacent soft tissue.
• Downward displacement of the inferior alveolar canal and
resorption of the lower cortical plate of the mandible may be seen
as well as perforation of bone and a pathologic fracture may
occasionally occurs.
• There may be extensive involvement of the body and ascending
ramus of the mandible with little or no bony expansion.
• Teeth — Produce deflection of unerupted teeth resorption is also
seen

42. • Radiological Types of Keratocyst (Fig. 16.20)
• Envelopment type — it is referred to a variety of keratocyst which
embraces an adjacent unerupted tooth.
• Replacement — those which forms in the place of normal teeth.
• Extraneous — those in the ascending ramus away from the teeth.
• Collateral — those adjacent to the root of teeth which are
indistinguishable radiologically from the lateral periodontal cyst.

43. • Management
• Enucleation of entire cyst with vigorous curettage of the
cystic wall.
• Periodic post treatment examination.

44. • Multiple odontogenic keratocyst
• • Gorlin-Goltz syndrome.
• • Marfan syndrome.
• • Ehler's Danlos syndrome.
• • Noonan's syndrome.

45. GORLINGOLTZ SYNDROME
• Gorlin-Goltz syndrome is an uncommon autosomal dominant
inherited disorder, which is characterized by multiple odontogenic
Keratocysts and basal cell carcinomas, skeletal, dental,
ophthalmic, and neurological abnormalities, intracranial ectopic
calcifications of the falx cerebri, and facial dysmorphism.

46. • Kimonis in 2004. The presence of two major and one minor or one
major and three minor criteria are necessary to establish diagnosis.
• Major criteria
• Multiple basal cell carcinomas or one occurring under the age of 20
years.
• Histologically proven OKCs of the jaws.
• Palmar or plantar pits (three or more).
• Bilamellar calcifications of the falx cerebri.
• Bifid, fused, or markedly splayed ribs.
• First degree relative with nevoid basal cell carcinoma syndrome.
Evans DG, Ladusans EJ, Rimmer S, Burnell LD, Thakker N, Farndon PA. Complications of the
naevoid basal cell carcinoma syndrome: Results of a population based study. J Med
Genet. 1993;30:460–4.

47. • Minor criteria
• Macrocephaly.
• Congenital malformation: Cleft lip or cleft palate, frontal bossing,
coarse face moderate or severe hypertelorism.
• Other skeletal abnormalities: Sprengel deformity, marked pectus
deformity, marked syndactyly of the digits.
• Radiological abnormalities: Bulging of sella turcica, vertebral
anomalies such as hemi vertebrae, fusion or elongation of
vertebral bodies, modeling defects of the hands and feet, or
flame-shaped hands or feet.
• Ovarian fibroma.
• Medulloblastoma.

48. OTHER ODONTOGENIC CYSTS ARE
• 1)GINGIVAL CYST OF INFANTS-
• Occurs within few hours to month.
• CLINICAL APPERANCE- mutiple,white,firm, gingival nodules on
the edentulous maxillary and mandibular ridge

49. • 2.GINGIVAL CYST OF AND ADULTS
• Gingival cysts of adults occur along gingiva of older adults, It is
uncommon and is considered to be soft tissue counter part of
lateral periodontal cyst..
• DERIVED from dental lamina..

50. • Rare, approximately 0.5% of all odontogenic cysts
• Arise in middle aged or peak incidence in fifth to sixth decade of life
• More common in females
• Sites
• Facial gingiva of mandibular canines and premolars
• Pathophysiology
• Arise from epithelial rests of dental lamina epithelium within soft
tissue
• Clinical features
• Solitary, well circumscribed, usually less than 0.5 cm
• Rarely bilateral
• Bluish, smooth surfaced, dome shaped swelling on attached gingiva
or unattached alveolar mucosa

51. 2. LATERAL PERIODONTAL CYST
• The designation ‘lateral periodontal cyst’ is confined to
those cysts that occur in the lateral periodontal position and
in which an inflammatory aetiology and a diagnosis of
collateral OKC have been excluded on clinical and
histological grounds(Shear and Pindborg, 1975).
• Clinical features
• Age : 20 – 60 years, peak in 6th decade.
• Sex : Male predilection.
• Site : Lateral PDL regions of mandibular premolars,
followed by anterior maxilla

52. • Signs & symptoms
• Usually asymptomatic as it occurs on the lateral aspect of
root of tooth.
• Occasionally pain and swelling may occur.
• Associated teeth are vital, unless otherwise affected
• Radiological features
• Round to ovoid ‘lucency with sclerotic margins.
• Cyst can be present anywhere between cervical margin to
root apex.
• Radiographically, it can be confused with collateral OKC

53. 3.GLANDULAR ODONTOGENIC CYST
• The cyst resembles both Botryoid
Odontogenic Cyst and Mucoepidermoid
Carcinoma.
• Epidemiology
• Rare lesion, 0.2% of all odontogenic cysts
• Average age at diagnosis is 51 years
• Sites
• Mandible is most common location, 80% & 55% occur in anterior
mandible
• Maxilla affected in 20% cases in this 88% in anterior maxilla,
usually canine area

54. • Etiology
• Probable origin is rests of
dental lamina
• Clinical features
• Can present with painful swelling
(most common symptom is swelling) or paresthesia
• Radiology description
• Variable: unilocular or multilocular radiolucent lesions with well
defined borders on plain radiography
• Scalloped borders
• Tooth displacement 50%, tooth root resorption 30%, association
with unerupted tooth or teeth 11%
• Can mimic other 'classic' developmental jaw cysts

55. 4.CALCIFYING EPITHELIUM ODONTOGENIC
CYST
• Also called Gorlin cyst, calcifying odontogenic cyst
(COC) , keratinizing and calcifying odontogenic
cyst
• Epidemiology
• 6% of central odontogenic tumours
• Mean age 31 years, range 5 - 92 years
• Sites
• Usually anterior regions of jaws, incisor cuspid
region
• Size- 2 to 4 cm in diameter

56. • Radiological features
• Either none (incidental
radiographic finding of
painless bony expansile
remodeling) or pain
• May be associated with
other odontogenic pathology
,most commonly odontoma
• Usually unicystic, well defined radiolucency with focal opacification
but 10 - 25% are multilocular
• Scattered radiopacities in 1/3 to 1/2
• 1/3 associated with impacted tooth

57. INFLAMATORY
CYST

58. 1. RADICULAR CYST
Epidemiology
•Most common odontogenic cyst (52% of jaw cystic lesions)
•Most common in 4th & 5th decades, but occurs over wide age
range
Sites
•60% in maxilla (vs. mandible)
•Most commonly in apex of lateral incisors,
but also along lateral accessory root canals

59. • PATHOPHYSIOLOGY
• Dental caries or trauma cause chronic inflammation which
eventually forms a periapical inflammation; continued
inflammation stimulates cells of the rests of Malassez, the
epithelial cells undergo necrosis to form the cyst which may be
sterile or become secondarily infected
• May be oral epithelium from a fistula or oral epithelium
proliferating down a periodontal pocket

60. Clinical features
•May be asymptomatic and incidentally found with radiographs
•Possible swelling (occurs slowly)
•May be painful if infected
• Radiology description
• Round to oval radiolucency, often with well defined cortical border
(this border can be lost when infected)
• Can displace or reabsorb roots of adjacent teeth if large

61. • Gross description
• Usually attached to tooth root, may be firm or have deflated
capsule, lumen can contain thin straw coloured fluid, opaque
yellow-white debris, muddy brown fluid from old haemorrhage or
frank purulent debris
• Microscopic (histologic) description
• Lined by stratified squamous epithelium of variable thickness,
often with scattered ciliated cells
• Exception is when epithelium is derived from maxillary sinus and
thus lined with respiratory epithelium (pseudostratified ciliated
columnar epithelium), may have acute inflammatory cell infiltrate

62. • Rushton hyaline bodies: amorphic, eosinophilic, linear to
crescent shaped bodies, found in epithelium of 10% of periapical
cysts
• Fibrous capsule: varying thickness with chronic inflammatory
cells, plasma cells may be particularly prominent
• Cholesterol clefts are common within cyst lining
• Recurrence- at 28+_23week. Endo t/t was done.
• Success rate of resurgical
Intervention at 12 month
is 30% .

63. • 2. RESIDUAL CYST- It is a radicular
lateral periodontal, dentigerous or any other
Cyst that has persisted after
it's associated tooth has been lost.
• Epidemiology
• •Most common odontogenic cyst (52% of jaw cystic lesions)
• •Most common in 4th & 5th decades, but occurs over wide
age range
• Sites
• •60% in maxilla (vs. mandible)
• •Most commonly in apex of lateral incisors, but also along
lateral accessory root canals

64. Clinical features
• May be asymptomatic and incidentally found with radiographs
• Possible swelling (occurs slowly)
• May be painful if infected
• Radiology
• Round to oval radiolucency, often with well defined cortical
border (this border can be lost when infected)
• Can displace or reabsorb roots of adjacent teeth if large

65. • 3.PARADENTAL CYST
• After excluding cysts occurring along the lateral / buccal surface
of a partially impacted mandibular molar of a young individual,
the term paradental cyst also refers to a variant of the
dentigerous cyst with an inflammatory, rather than
developmental pathogenesis
• Epidemiology
• •1 - 5% of odontogenic cysts

66. • Clinical features
• Recurring periodontal inflammatory process (pericoronitis)
• Symptoms: discomfort, swelling, tenderness, pain
• Often Asymptomatic
• Radiology description
• Periosteal reaction common
• Onion skin deposition of bone appears as parallel opaque layers

67. •NON-
ODONTOGENIC
CYST

68. •1.NASOPALATINE CYST-
• Epithelial lined cyst of non odontogenic
origin though to be derived from
1) originates from spontaneous proliferation of remnants of
nasopalatine duct within incisive canal.
Later on it was thought to
2) originates from trapping of epithelial remnants during embryologic
fusion between nasal cavity and anterior maxilla
• Sites
• Exclusively in maxilla, located in anterior midline of hard palate

69. • It is a common non odontogenic cyst. Occuring
commonly in male .
Age predilection- 3rd to 6th decade
• Symptoms —
• There is a small well defined swelling just posterior to the palatine
papilla.
• Sometime it may become infected, producing pain
• Burning sensation and numbness may be experience due to pressure
on the nasopalatine nerve.
• • Sometimes cystic fluid may drain and patient reports a salty taste.
• Foul taste in case of infectiion
• Prognostic factors
• •Although extremely rare, malignant transformation
• •Relapse rate varies but usually from 0 - 11%

70. Signs —
• Swelling is fluctuant and bluish if it is near the surface.
• It opens by a tiny fistula on or near the palatine papilla. In such
cases a tiny drop of watery fluid or pus may be elicited by
pressure in this area.
• Deeper cysts are covered by normal mucosa, unless it is
ulcerated.
• If cyst expands, it may penetrate the labial plate and produce a
swelling below the maxillary labial frenum
• Teeth — roots of central incisors diverge. It may bulge into the
nasal cavity and distort nasal septum.
• It may occur in nasoplataine canal or in soft tissue of palate.

71. 2. MEDIAN PALATINE CYST-
• Clinical Features
• Site — it is very rare and develops in midline of the hard palate
posterior to pre-maxilla.
• Symptoms — if it becomes larger, then it bulges into the oral
cavity and produces a swelling in the roof of mouth.
• Signs — it is fluctuant and non-tender. Overlying mucosa is
normal. Corticated plate is rapidly perforated as the cyst grows.
• If floor of nasal fossa is eroded, cyst may be superiorly displaced.
• Teeth — maxillary teeth are vital and aspiration produces amber
colored fluid.

72. • Radiographic Features
radiolucent lesion is behind the incisive canal in premolar- molar
area.
.

73. 3.MEDIAN MANDIBULAR CYST-
Extremely rare lesion occurring in midline of mandible.
• Site — it has got predilection for the inferior part of the mandible, so
that it does not come in close relationship with the roots of lower
incisors.
• Symptoms — most are clinically asymptomatic and are discovered
only during routine radiographic examination.
• Signs — they seldom produce obvious expansion of the cortical
plate of bone.
• Teeth — associated teeth react normally to pulp vitality test.

74. • Radiographic Features
• Appearance — it is unilocular, well circumscribed radiolucency,
although it appears multilocular.
• Shape — the image is well defined, round or ovoid radiolucency
that may be regular or irregular in shape.
• Lamina dura — the lamina dura around the lower incisor teeth is
intact.
• Teeth — as it expands, it diverges the roots of the mandibular
incisors

75. • 4. GLOBULOMAXILLARY CYST-
• It’s a fisural cyst within bone found
• between maxillary lateral incisor and canine
Symptoms-
asymptomatic ,. Pain- in case of infection.
Teeth- It diverges the roots of two
teeth and their crown may rotate
causing the contact point to move incisal.
• Adjacent teeth are usually vital.
Signs-.If it becomes secondarily infected,
the expansion will mimic lateral periodontal abscess.
• Aspiration of the swelling is productive of typical amber coloured
cystic fluid.

76. • Radiographic Features
• Shape — it appears as pear-shaped or tear-shaped radiolucency
between roots of maxillary lateral incisors and canines. Small end
of the pear is directed toward the crest of alveolar ridge.
• The upper border may invaginate the floor of the nasal fossa or the
antrum.
• Size — the size is variable and may reach the maximum level of
diameter of 3-4 cm.

77. •NONEPITHELIAL
CYST

78. 1. ANEURYSMAL BONE CYST
Age- more than 90% of lesions occurring in individuals younger
than the age of 30 years.
• Sex — common in females than in males.
• Site — mandibular molar region as compared to anterior region.
• History — history of traumatic injury and of recent displacement
of teeth which remain vital.
• Symptoms-firm ,swelling which may be painful and tender.
• Difficulty in opening the mouth i.e. if there is impingement of the
lesion on the capsule of TMJ.

79. • Radiographic image- soap bubble appearance.
• Margins are distinct than other odontogenic cyst.
• the cyst enlarges to more than a few centimetres in anterior-
posterior dimension,
• produces expansion of the buccal and lingual cortical plates

80. 2. SOLITARY BONE CYST
• It is a solid fluid filled or empty intraosseous lesion found most
commonly in proximal metaphyseal region of long bone in children
and adolescents.
• Age and sex — the traumatic bone cyst occurs in young persons
at an age of 6 to 20 years with a male : female- 3:2.
• Site — it is usually found in mandible anywhere from the
symphysis to the ramus, but about one third are found in the
maxilla, usually in the anterior region.
• Symptoms — it is asymptomatic, may have pain.
• Signs — cortical swelling or slight tooth movement are not the
usual finding and the teeth are vital.

81. 555
• Radiographic Features
• Appearance — it appears as a radiolucent lesion with a spectrum
of well defined to moderately defined borders.
• Margins — Most cases are unilocular with a fairly regular border.
• There is evidence of hyperostotic borders around the entire lesion
but occasionally such border is lacking.
• Most characteristic radiographic feature of this cyst is scalloped
superior or occlusal margins where it extends between the roots of
the teeth.

82. • Size — some cyst may be only a centimetre in diameter while
others may be so large that they involve most of the molar area of
the body of the mandible as well as part of the ramus.
• Treatment
• Thorough curettage
• Rarely recurs

83. •CYST OF
MAXILLARY
ANTRUM

84. 1. SURGICAL CILIATED CYTS OF MAXILLA
• The surgical ciliated cyst of the maxilla is a rare lesion and
appears as a delayed complication after surgery in
the maxillary sinus, midface osteotomies, traumatic tooth
extraction and maxillary fractures
• SITE- close proximity to sinus
• C/F- localised pain which is otherwise
not associated with any tooth.
R/F –well defined radiolucen texpansion of
Maxilla with radoiopaque margins and close
proximity to sinus
T/T- surgical enucleation

85. 2.BENIGN MUCOSAL CYST
• Also called as mucocele or retention cyst of maxillary antrum
• Etiology- infection and inflammation of mucus gland.
• Incidence- 3rd decade. No gender predilection found
• C/F-dull pain
• -numbness in maxilla
• -nassal obstructionor yellowish discharge
• R/F- spherical , ovoid radiopacities wit maxillary antrum with
smooth uniform outline.
• T/T-remove cyst via caildwell-luec operation, enhance drainage
via intranasal antrosomy.
• Followed by antibiotic, decngestants and antral lavage.

86. •SALIVARY
GLAND CYST

87. 1.MUCOCELE
• TYPES-
• 1) true retention cyst, lined by epithelium
• 2) extravasation cyst not lined by epithelium ,composed of
connective tissue or granulation tissue
• Etilogy
• 1) trauma
• 2) obstruction to salivary gland.
• Incidences- common in minor salivary gland.
• No age or sex prediliction
• Site- lowerlip.

88. • C/F- well circumscribed, painless small swelling in the mucosa.
• Size 1-2 cm.
• fluctuation positive
• TREATMENT-surgical excision with associated minor salivary
gland.

89. 2 RANULA
• The ranula is a form of mucocele which specifically occurs in the
floor of the mouth
• TYPES
• 1) plunging ranula- overlying mucosa appears normal.
• 2)superficial ranula- overlying mucosa is blue in colour.
• Incidences- common in female
• Age- 2nd decade.
• C/F- a dome shaped bluish swelling of a
Superficial ranula located beneath tongue
On the floor of mouth

90. • Etiology
• 1) extravasated mucus gets collected due to trauma to extremity
duct of sublingual salivary gland.
• 2)plunging type the extravasated mucus passes through the
mylohyoid muscle and collects in the submandibular region.
• T/T-marsupalizaton results in recurrence.
• Removal of ranula along with the involved sublingual gland for
both superficial and plunging type.

91. DIAGNOSIS OF CYST
• 1] CLINICAL FINDINGS
• A) vitality of tooth- nonvital-radicular cyst
• vital in case of LPC
• B)expansion of jaw- cyst expands in direction of less cancellous
bone and later produces fragile outer shell of bone which cracks
later producing an egg shell cracking on palpation.
• C)Percussion of the teeth-overlying the solitary bone cyst
produces a dull or hollow sound in contrast with the high-pitched
note produced by percussing normal teeth.
• D) Neurapraxia- caused by pressure from cyst .

92. • E) SINUS TRACT- when the cyst has drained intra or extra orally
• F) SINUSITIS- when cyst in maxillary antrum gets infected.
• G) LOCATION-

93. • G) LOCATION
• -1. Nasolabial cyst
• 2. Nasoalveolar cyst
• 3. Globulomaxillary cyst
• 4. Nasopalatinecyst
• 5. Cyst of palatine papilla
• 6. Median palatal cyst

94. • H)-Expansion of the cyst causes loosening of the teeth.
• •I)-Missing teeth in the dental arch may be due to the presence of
odontogenic keratocyst.
• J) In edentulous patients, a change in the fitting of denture may
occur due to the presence of swelling
• K) Radiographs-
• Periapical and occlusal views
• Occlusal radiographs
• Lateral oblique view
• Waters’view.
• Orthopantomograms

95. • L) Contrast studies
• M) Aspiration
• N) Biopsy- Biopsy is the gold standard for determining the type of
cysts and to differentiate them from neoplasms

96. cyst Aspiration Other findings
Dentigerous
cyst
Clear, straw coloured fluid
Cholesterol crystals
proteins in excess of 4gm/100ml
Odontogenic
cyst
Dirty, creamy white, viscoid
suspension Para-keratinized
squames
protein less than 5gm/100ml and most
of which is albumin
Periodontal
cyst
Clear, pale, yellow straw
coloured fluid Cholesterol
Crystals
Protein contents between 5-
11gm/100ml
PMN’s leukocytes foam cells
Cholesterol clefts
Infected cyst Pus or brownish fluid,
seropurulent or sanguinopurulent
fluid, at time paste like or
caseous consistency
PMNs leukocytes
Foam cells
Cholesterol clefts
Solitary bone
cyst
Serous or sanguineous fluid,
blood or empty cavity
Necrotic blood clot
Stafne’s bone
cyst
air

97. Prakash R, Shyamala K, Girish HC, Murgod S, Singh S, Rani PSV. Comparison of
components of odontogenic cyst fluids: A review. J Med Radiol Pathol Surg
2016;2:15-17.

98. Principles of treatment selection
• 1. The lining should be removed or rearranged in order to
eliminate it from the jaw
• 2. The tooth germ, the unerupted or partially erupted teeth should
be conserved as far as possible and should be allowed to erupt.
• 3. Preservation of the adjacent vital structures like neurovascular
bundle, nasal or antral lining mucosa, etc.

100. INDICATIONS
• young children- preserves the tooth germ associated with the cyst.
• Adolescents it helps in the eruption of the unerupted tooth
associated with the cyst.
• Cases with risk of pathologic fracture.
• Cases where cyst is in close proximity to vital structure

101. PROCEDURE
• Can be performed under GA or LA
1) Elevation of flap
• Usually an H-shaped incision
Alternatively, a circular, elliptical or
oval incision. is made on the cyst,
the lining turned outwards and
sutured to the mucosa.
• Small area of lining epithelium may
be dissected and sent for biopsy at
this stage.
• .

102. • 2) hydrostatic dissection-A cartridge syringe with a fine
needle is inserted through the mucoperiosteum and bone is
contacted from the lesion and injection at this point begins to
raise the mucoperiosteum from the underlying bone and cyst
wall.

103. • 3) REMOVAL OF BONE
• rounger
• bur depending upon the thickness.
• Bone removal up to maximum diameter.
cyst lining is exposed to the mouth with raw
edges at its circumference and sutured to
mucoperiosteum to the periphery.

104. • 4) PACKING OF THE CAVITY- medicated ribbon gauze (e.g.
Whitehead’s varnish) and sutured.
• COMPOSITION:
• BENZOIN-10mg
• IODFORM-10 mg
• STORAX-7.5g
• BALSAM OF TOLU- 5g
• SOLVENT ETHER -100ml
• Approximately 7-10 days after operation, the pack is removed.
• an acrylic plug.
INDICATIONS OF USING PLUG-
1)When the bony opening is small as compared size of cyst.
2)When the circumferential area is close to sulcus mucosa
supported by connective tissue only.

105. Decompression
• involves any technique that relieves the pressure
within the cyst that causes it to grow.
• Decompression may be performed by making a
small opening in the cyst and keeping it open with
a drain.
• Not a definitive treatment, but allows a second
stage of enucleation to be undertaken on a much
smaller lesion which otherwise would not have
been impossible.

107. • Dredging Method”- A Conservative Surgical Approach for the Treatment of
Ameloblastoma of Jaw SADAT S, M AHMED. J Bangladesh Coll Phys Surg 2011; 29:
72-77

108. • Marsupialisation by opening into the maxillary sinus or nose
1.incision: curvilinear incision along the involved teeth and then
releasing incision
2. offending tooth: it is either endodontically treated or extracted
3. mucoperiosteal flap: raised with howarth’s periosteal elevator.
4. removal of bone
5. removal of cystic lining
6. removing the antral lining b/w two cavities
7. additionally, intranasal antrostomy
8. packing
9. replace the flap

110. • (A–C) Cyst in the maxillary region involving the
• sinus. Note the artery forceps introduced through inferior meatus
• evident in maxillary sinus (nasal antrostomy)

111. Enucleation (cystectomy)
• Enucleation involves complete removal of the cyst lining and its
contents.
• To gain maximum advantage of the method, it is usually
completed by primary closure, although on occasion it can be
combined with open packing.
• Indication of enucleation-
• 1) small cyst
• 2) large cyst not close to vital structure.
• 3) recurrent cysts like OKC.

112. Advantages of enucleation
• Entire cystic lining is removed making the entire pathologic tissue
available for microscopic study.
• Rapid healing occurs as the wound is closed primarily.
Disadvantages of enucleation
• Tooth germ or unerupted teeth involved with the cyst are
extracted or removed with the lining of the cyst.
• Pathological jaw fractures.
• endangers the adjacent vital structures.
• Direct observation of healing site is not possible.

113. Procedure
• Partsch II—Enucleation with primary closure-
• I. Incision
• When the teeth are involved, the incision should be placed around
the teeth regardless of whether they should be retained or
extracted.
• This incision would provide complete access and help in easy
repair.
• Secondly, it permits satisfactory closure of the defect if unexpected
extraction of a tooth or teeth becomes necessary during the
operation

114. • 2. Bone removal- The thin overlying bone should be preserved.
• In case where this bone cannot be saved, overlying bone is
removed with an acrylic bur, gouges or rongeurs, sufficient to
create good access for the enucleation of the sac.
• 3. enucleation- cyst should be enucleated in toto. In case where
this is not possible a gauze is rolled over an artery and blunt
dissection is performed.
Or
• cyst can be aspirated and then removed. After thorough irrigation,
inspection of the cavity and its margins are done, followed by
closure with sutures)

115. • 2.1 Enucleation with open packing – in case of infected cyst the
flap is turned into the bone cavity. It is fixed with a half-inch
medicated gauze pack for 10 days.
• In case of huge defect bone grafts can be used to fill the defects.
• 2.2 Enucleation and curettage-It denotes scrapping of the cyst
cavity with in exact thickness of surrounding bone by hand
instruments.
• Recurrence rate is highest with this method (9%– 62%). Adjuncts
such as Carnoy’s solution or cryotherapy may be used along with
it.

116. • 2.3) Enucleation and peripheral ostectomy
• It involves enucleation of the cyst along with an inexact thickness
of surrounding bone by powered rotary instruments.
• Curette or bur is used to remove 1 to 2 mm of bone around the
entire periphery of cystic cavity
• Methylene blue dye can be used to mark the bone.
• 2.4) Enucleation and chemical cauterisation- Carnoy’s solution
powerful fixative, haemostatic and a cauterising agent which
penetrates cancellous spaces in the bone and devitalises and fixes
the left out epithelial remnant cells.

117. • Its average depth after 5 min of application.
• bone penetration of this solution is to a depth of 1.54 mm,
• nerve penetration to 0.15 mm,
• mucosa to a depth of 0.51 mm.
• COMPOSITION-
• 6 mL of absolute alcohol
• 1 mL of glacial acetic acid
• 1 gm of ferric chloride
• 3 mL chloroform

118. • Side effect-
• Neurotoxic—Nerve should be protected using bone wax
• Necrosis of maxillary sinus
• Better to use fresh solution

119. • 2.5) Enucleation and cryotherapy
• Liquid nitrogen has the ability to devitalise bone in situ and leave
osseous inorganic framework untouched.
• It acts by direct damage from intracellular and extracellular ice
crystal formation leading to cell death.
• Also it creates osmotic and electrolytes disturbance in cell.
• After enucleation, cystic cavity is sprayed with liquid nitrogen twice
for 1 min, with 5 min thaw between freezes.

120. • Enucleation with adjunctive therapy
• Cysts associated with crowns/unerupted tooth/teeth in the
ascending ramus and in the tuberosity areas of the maxilla should
be enucleated with the attached overlying mucosa.
• Eliminate newly developing cysts from epithelial islands or
microcysts, which are found in approximately 50% of the cases.
• Use of electrocauterization in the areas where the cyst had
contact with soft tissues

121. 3.) Resection
• marginal resection or a
• segmental resection in the mandible.
• In maxilla the resections are classified as
• partial maxillectomy (alveolectomy) or
• subtotal
• total maxillectomies.
• lowest recurrence rate (0%) but, the highest morbidity rate
because reconstructive measures are necessary to restore jaw
function and aesthetics.

122. • Indications
• Infiltrative lesions that have tendency to recur.
• Lesions close to lower/ posterior border of mandible.
• Lesions extending to maxillary sinus/ nasal cavity.
• OKC which has higher recurrence rate.

123. To extract or preserve the teeth involved in the cyst ?
• Varinauskas et al. argued that relapse was associated with the
presence of the residual cystic wall or multicystic settings rather
than the maintenance of the involved teeth
• Varinauskas V, Gervickas A, Kavoliūniene O Analysis of odontogenic cysts of the jaws.
Medicina (Kaunas) 2006;42:201-7.
• Zhao et al. found 3 recurrences in a review of 19 recurrent OKCs.
may be due to incomplete removal of the epithelium around the
tooth roots, which extended into the cyst cavity.
• recommended removal of the involved teeth or treatment by
apicoectomy if the roots extended into the cyst lumen or interfered
with the complete removal of the cyst wall
• Zhao Y, Liu B, Cheng G, Wang SP, Wang YN Recurrent keratocystic odontogenic tumours:
Report of 19 cases.Dentomaxillofac Radiol 2012;41:96-102.

124. • In case of dentigerous cyst- many literature is found of DC
occurring in young adults. The emphasis is on conservative
surgical treatment, with orthodontic , in order to retain the teeth.
• Hyomoto etal in 2003 did retrospective study in eruption of teeth
associated with DC involving 47 mandibular premolar & 11
maxillary canine .
• GROUP1 – 81% of mandibular premolar and 36% of maxillary
canine erupted successfully about 100 days after marsupialization
without traction .
• 100 days critical for eruption of teeth.
• Incomplete root formation- good potential to erupt
• Complete root formation- couldn’t erupt.

125. Complications of untreated cysts
• 1. secondary infection leading to cellulitis or osteomyelitis.
• 2. pressure effects’ on nerves and vessels that may cause
symptoms of paraesthesia, neuropraxia or decreased blood flow.
• 3. precursors to odontogenic tumours or primary intraosseous
carcinoma
• 4. pathological fracture, OAC formation.
• 5. Loss of vitality of teeth.
• 6. Gross facial deformation

126. • ENUCLEATION WITH ADJUNCTIVE THERAPY
• Cysts associated with crowns/unerupted tooth/teeth in the
ascending ramus and in the tuberosity areas of the maxilla should
be enucleated with the attached overlying mucosa.
• Cyst in lower third molar ascending ramus area should be treated
aggressively
• However, even after using Carnoy’s solution, microcysts and
epithelial islands were always seen in the overlying attached
mucosa of OKC and so recurrence took place. The authors
described the use of electrocauterization in the areas where the
cyst had contact with soft tissues

127. • USE OF EVOCYST- ]
• The system provides a negative pressure
of approximately 45 mm Hg.
• Irrigation with normal saline solution is
done through the intraoral unit’s needle
port.
• Castro J, Rey D, Amaya L. An Innovative Intracystic
Negative Pressure System to Treat Odontogenic Cysts
The Journal of Craniofacial Surgery 2017;00:1-2.

130. Castro J, Rey D, Amaya L. An Innovative Intracystic Negative Pressure System to
Treat Odontogenic Cysts The Journal of Craniofacial Surgery 2017;00:1-2.

131. Treatment modalities for OKC
• OKC had a significantly higher recurrence rate in patients in the
fifth decade of life than in patients in the other age groups (P =
.005).
• Recurrence rates were significantly dependent on the sites of
involvement, and OKCs in the mandibular molar region had
significantly higher recurrence rates than those in other sites (P =
.001).
• The histopathologic presence of one or more daughter cysts was
significantly related to recurrence (P = .03)
• Myoung H etal. Odontogenic keratocyst: Review of 256 cases for recurrence and
clinicopathologic parameters. J of Oral Surg Oral Med Oral Pathol Oral Radiol Endod
2001;91:328-33.

132. • ‘‘Conservative methods’’ of treatment, such as enucleation and
marsupialization, consistently have produced less-than-optimal results.
• CONVENTIONAL SURGICAL MANAGEMENT INCLUDE-
• 1) ENUCLEATION and CURETTAGE-
• 2) ENUCLEATION AND PERIPHERAL OSTECTOMY- rotary
instruments enables the surgeon to remove as much bone as necessary
to ensure that all residual lining is gone. Methylene blue marker-
• 3) OSSEOUS RESSECTION- marginal resection preserves the
continuity and
• Segmental resection violates the continuity. APT in case of recurrent
lesion.
• Ghali G, Scott M. surgical management of the odontigenic keratocys.oral
maxillofacial surg clin N Am 15 (2003) 383-392

133. • Anecdotal reports have suggested that a minimum 5-mm bony
margin is adequate to ensure satellite cyst removal.
• Scharfetter K, Balz-Herrmann C, Lagrange W, Koberg W, Mittermayer C. Proliferation
kinetics: study of the growth of keratocysts. J Craniomaxillofac Surg 1989;17:226– 33
• Bataineh and Al Qudah reported their series of 31 consecutive
OKCs treated by marginal resection and followed from 2 to 8
years with 0% recurrence .
• Indication
• recurrent/extensive lesions,
• involvement of the condyle,
• a pathologic fracture caused by an untreated cyst, or
• ameloblastomatous or carcinomatous degeneration within an
OKC
• Bataineh AB, Al Qudah MA. Treatment of mandibular odontogenic keratocysts. Oral
Surg Oral Med Oral Pathol Oral Radiol Endod 1998;86:42– 7.

134. • Use of 5 Flurouracil.
• After enucleation and peripheral ostectomy of the KOT lesion,
sterile ¼-inch ribbon gauze was coated with 5% 5-FU
• RESULT-Thirty-two patients with 32 KOTs
• no KOTrecurrences in the 5-FU group
• 4 recurrences in the MC group
• There was a significantly lower incidence of inferior alveolar nerve
paresthesia with 5-FU treatment.
• J Nicholas etal.Topical 5-Fluorouracil is a Novel Targeted Therapy for the
Keratocystic Odontogenic Tumor. J Oral Maxillofac Surg 75:514-524, 2017.

135. Liquid nitrogen for OKC
• Mechanism- formation of intra & extracellular ice crystals, osmotic
and electrolyte disturbances, denaturation of proteins complex
and vascular statist.
• -2.2 degree causes freezing.
• -20 degree causes cell death.
• Response of liquid nitrogen on various tissue –
• 1) ORAL MUCOSA-
• Within hour- hyperaemic.
• 24 hrs- discoloration of mucosa .
• 72- necrosis and ulceration.
• 16th day- reepithelization completed.
• Complication – wound dehiscence, T/T –saline rinses

136. • 2) BONE- frozen bone loses its vitality but, maintains the skeletal
structure.
• 48-72 hrs- cellular element necrosis.
• 2-3 weeks cellular element repopulate.
• COMPLICATION- sequestrate formation in case of wound
dehiscence and bone exposure to oral cavity.
• Weaken bone resulting in pathological fracture.
• T/T- bone graft after cryotherapy

137. • 3) TEETH- teeth in contact with liquid nitrogen remains
asymptomatic.
• Direct effects are still not known
• 4) INFERIOR ALVEOLAR NERVE- doesn't cause any permanent
damage.
• Average time for return or improvement in sensation was 91days.

138. Rate of recurrence of OKC according to various
treatment
1 1pindborg (1963). E/ M 62.5%
2 BROWNE( 1970) M /E With primary
closure or pack open.
24.7%
3 BRANNON (1976) E 12%
4 VEDTOFTE 1976 E/ M 51%
5 VOORSMIT (1981) E, Excission of
overlying mucosa,
carnoys solution
2.5%
6 Brondum(1991) D+ ctstectomy 0%
7 Marker (1996) d+ Cystectomy 8.7%
8 SCHMIDT E+ cryotherapy 11.5%

139. • INDICATION FOR CRYOTHERAPY-
• 1) recurrent OKC
• 2) large complex mandibular lesion
• 3) non compliant patient.
• Schmidt B. the use of liquid nitrogen cryotherapy in the management of odontogenic
keratocyst. Oral maxillofacial Surg N Am 15(2003) 393-405.

140. TREATMENT OF MINOR SALIVARY GLAND
CYST
• Mucocele- Enucleation
• Ranula – complete excision of the minor salivary gland.
• 1) Micro-Marsupialization -draining the accumulated saliva and
creating a new epithelialized tracts along the path of the sutures.
• more successful if treated within 90 days..
• passing thick silk thread through it largest diameter and then
making a surgical knot.
• The suture is removed after 7-10 days, enough time for the
mucocele to disappear.
• Advantage- simple, relatively painless.

141. • 2) modified micro-marsupialization technique that involves giving
the maximum possible number of sutures maintaining a short
distance between entry and exit.
• Chalathadka M, Ranganathan A, Rachana PB, Kunnilathu A, Gera M, Unakalkar S.
Management of Mucocele: A Review. J Res Adv Dent 2018;8:2:227-234

142. 3)cryosurgery in treating mucoceles with encouraging results
4) Some authors have also suggested using intralesional steroid
injection,
5)CO2 laser
6) Injection of Sclerosing Agent In Management of Mucocele
Administration of intralesional sclerosing agents like absolute
ethanol at varying doses of 0.1ml to 0.5ml according to the size of
the mucocele of glands of Blandin and Nuhn
• Ata-Ali J, Carrillo C , Bonet C , Balaguer J, Peñarrocha M , Peñarrocha M. Oral
mucocele: review of the literature. J Clin Exp Dent. 2010;2(1):e18-21

143. REFERRANCE
1. Cyst of theoral and maxillofacial regions by mervin shear and paul M speight.
4th edition.
2. Textbook of oral and maxillofacial surgegy S M Balaji.
3. Killey and kays outline of oral surgery part one.
4. Daniel M Laskin oral and maxillofacial surgery.
5. Borle Textbook of oal and maxillofacial surgery
6. Castro J, Rey D, Amaya L. An Innovative Intracystic Negative Pressure
System to Treat Odontogenic Cysts The Journal of Craniofacial Surgery
2017;00:1-2.
7. Dredging Method”- A Conservative Surgical Approach for the Treatment of
Ameloblastoma of Jaw SADAT S, M AHMED. J Bangladesh Coll Phys Surg
2011; 29: 72-77
8. Prakash R, Shyamala K, Girish HC, Murgod S, Singh S, Rani PSV.
Comparison of components of odontogenic cyst fluids: A review. J Med
Radiol Pathol Surg 2016;2:15-17.
9. Ata-Ali J, Carrillo C , Bonet C , Balaguer J, Peñarrocha M , Peñarrocha M.
Oral mucocele: review of the literature. J Clin Exp Dent. 2010;2(1):e18-21

144. 1. Chalathadka M, Ranganathan A, Rachana PB, Kunnilathu A, Gera M,
Unakalkar S. Management of Mucocele: A Review. J Res Adv Dent
2018;8:2:227-234
2. Myoung H etal. Odontogenic keratocyst: Review of 256 cases for
recurrence and clinicopathologic parameters. J of Oral Surg Oral Med
Oral Pathol Oral Radiol Endod 2001;91:328-33.
3. Ghali G, Scott M. surgical management of the odontigenic
keratocys.oral maxillofacial surg clin N Am 15 (2003) 383-392.
4. Scharfetter K, Balz-Herrmann C, Lagrange W, Koberg W, Mittermayer
C. Proliferation kinetics: study of the growth of keratocysts. J
Craniomaxillofac Surg 1989;17:226– 33
5. Bataineh AB, Al Qudah MA. Treatment of mandibular odontogenic
keratocysts. Oral Surg Oral Med Oral Pathol Oral Radiol Endod
1998;86:42– 7.
6. Varinauskas V, Gervickas A, Kavoliūniene O Analysis of odontogenic
cysts of the jaws. Medicina (Kaunas) 2006;42:201-7.
7. Zhao Y, Liu B, Cheng G, Wang SP, Wang YN Recurrent keratocystic
odontogenic tumours: Report of 19 cases.Dentomaxillofac Radiol
2012;41:96-102.

145. •THANK YOU

146. • Decompression of the lesion- recurrence rate of 25%
Brondum and Jensen (1991)
• Other studies have shown that marsupialization of KCOT can be
followed by total resolution of the lesion without any further surgery
(Eyre and Zakrzewska, 1985; Pogrel and Jordan, 2004; Hopper,
1982).
• Voorsmit et al. (1981) -with enucleation and Carnoy’s solution
(2.5%), compared with enucleation alone (13.5%).
• The recurrence rate following enucleation and liquid nitrogen
cryotherapy has been reported at 3–9% (Pogrel, 2005; Schmidt,
1999).
• Extensive resection of the mandible with its attendant morbidity may
be too radical for large KCOT and even an overtreatment (Giuliani et
al., 2006; Marker et al., 1996; Nakamura et al., 2002