Unusual jaw-bone cysts

Current Perspectives on Paradental Cyst: A Literature Review

Paradental cyst (PC) is an uncommon type of odontogenic cyst of inflammatory origin, which develops near the cervical margin of the outside of the root of a vital tooth. The category of paradental cyst includes the buccal bifurcation cyst, which is found in the buccal area adjacent to the mandibular first or second molars in children. A conclusive diagnosis of a PC needs to correlate the surgical, radiographic, and histologic findings. When strict diagnosis is neglected, they can be easily misdiagnosed and mistreated. PCs associated with mandibular first and second molars and those associated with the mandibular third molar may have slightly different clinical manifestations but have almost completely different treatment principles due to the distinction in location. For the third molars, removal of both the tooth and the cyst is preferred. However, when the first or second molars are affected, it may be advisable to perform enucleation of the lesion while preserving the associated tooth. There are also more conservative methods to retain vital permanent teeth within the mandibular arch. Additionally, the cyst wall primarily consisted of granulation tissue firmly attached to the periodontal ligament space. The exact origin of these cysts was a subject of ongoing debate, but they were believed to primarily arise from either the reduced enamel epithelium or the inflammatory proliferation of junctional/sulcular epithelium, which originate from the superficial mucosa during tooth eruption. The aim of the present review was to update information on clinical manifestations, diagnosis and treatment strategies of cysts and discuss their pathogenic mechanisms. Raising familiarity with the distinctive features is beneficial for accurately diagnosing these lesions and effectively caring for the patients.

Multifocal lateral periodontal cysts: a report of 4 cases and review of the literature

Lateral periodontal cyst (LPC) is a developmental jaw cyst of odontogenic origin. It has characteristic histopathologic features that are identical to those seen in the peripherally occurring gingival cyst of adults (GCA). The polycystic variant of LPC is termed the botryoid odontogenic cyst (BOC). The histogenetic origin of LPC is probably the rests of dental lamina in the alveolar bone. In the case of BOC, it might be that several adjacent epithelial rests simultaneously undergo cystic change and eventually form a polycystic lesion. Few previous examples of multifocal occurrence of LPC can be found in the literature. We report an additional 4 patients with this rare presentation of multiple, separate LPCs, and review the literature on this topic.

Paradental (mandibular inflammatory buccal) cyst

The paradental cyst is commonly misinterpreted when associated with atypical clinical and radiographic characteristics, in turn causing diagnostic problems. For this reason, the study of the differential diagnosis of this lesion has become extremely important. In addition, the correlation of clinical, histologic, and radiographic findings are also of great value in obtaining accurate diagnoses. The minor variations in the clinical appearance of paradental cysts make it feasible to consider the two main groups of cysts separately: those associated with 1st and 2nd permanent molars of the mandible and those associated with the 3rd mandibular molar. Moreover, this distinction in localization may well dictate the necessary treatment. Bearing in mind the minor clinical variations, the present article aims to discuss the differential diagnosis of this lesion and its different possible treatments by presenting a case report to illustrate the findings.

Review of floor of mouth dysontogenic cysts

OBJECTIVES

We report the common surgical approaches, incidence of sinus tracts, and recurrence rates of floor of mouth dysontogenic (epidermoid, dermoid, and teratoid) cysts in the pediatric population.

METHODS

Data were derived from PubMed, Medline, Embase, Google Scholar, and manual searches. Three cases from the senior author's (J.P.M.) practice were included. All English-language studies consisting of floor of mouth dysontogenic cysts were included. Case reports of tongue dysontogenic cysts, mandibular dysontogenic cysts, maxillary dysontogenic cysts, and dysontogenic cysts in the neck below the hyoid bone were excluded.

RESULTS

There are 198 case reports, including those presented here, of floor of mouth dysontogenic cysts. They are more common in male patients (55.1%), and the most common location is in the sublingual space (104 or 52.5%). Most floor of mouth dysontogenic cysts can be excised by an intraoral approach. There are 5 reported cases in the literature of recurrent dysontogenic cysts and 11 cases of multiple floor of mouth dysontogenic cysts.

CONCLUSIONS

Floor of mouth dysontogenic cysts most commonly present in the sublingual space, and most can be excised by an intraoral approach. Multiple dysontogenic cysts often require a combination of intraoral and extraoral approaches. Recurrence of a dysontogenic cyst may be secondary to a tract not identified at the time of surgery.

Glandular odontogenic cyst: a challenge in diagnosis and treatment

The present review analyzes the accumulated data from all cases of glandular odontogenic cyst (GOC) reported in the English language literature. In the 20 years since it was first described, 111 cases have been reported, an incidence of 0.2% of odontogenic cysts. The age range is 14-75, mean 45.7, with a M/F ratio of 1.3:1. GOC has a predilection for the mandible (70%), affecting both anterior and posterior areas. It is typically radiolucent, well defined, either unilocular (53.8%) or multilocular (46.2%). Frequent perforation (61%) and of thinning of cortical plates (24.4%) indicate aggressiveness. Sufficient follow-up indicates that 30% of cases can recur. Treatment by enucleation or curettage carries the highest risk for recurrence, especially in large and multilocular lesions. Peripheral osteoectomy or marginal resection can eliminate the risk. Defined criteria for microscopic diagnosis are described, which in addition to Ki67 and p53 can help in differentiating GOC from lesions with histological similarities (cysts with mucous metaplasia, botryoid and surgical ciliated cysts, low-grade mucoepidermoid carcinoma). Definite diagnosis may not be possible in small incisional biopsies due to the focal presentation of characteristic features required for diagnosis. There is now evidence to support an odontogenic rather than a sialogenic origin.

Use of guided tissue regeneration in the treatment of a lateral periodontal cyst with a 7-month reentry

BACKGROUND

The lateral periodontal cyst (LPC) is an unusual cyst of odontogenic origin, most frequently encountered in the mandible between the roots of canines and premolars. The most common treatment for LPC is surgical enucleation. This article reports a case of an LPC treated with guided tissue regeneration (GTR) and bone allograft.

METHODS

A 74-year-old woman presented for periodontal examination. Radiographs revealed a cystic lesion with LPC characteristics. After surgical incisions and flap reflection, the cyst was removed and sent for biopsy. Because of the anatomy of the resulting intrabony defect, GTR was considered the ideal treatment.

RESULTS

The biopsy revealed the histologic features of an LPC. Radiographs at 7 months post-treatment indicated bone fill of the initial defect. Although some attachment loss occurred, the reentry demonstrated a high percentage of bone fill of the defect after 7 months.

CONCLUSION

Depending on the anatomy of the defect left after the removal of an LPC, GTR, along with bone grafting, can be a very useful tool for its treatment by reducing the attachment loss observed after simple enucleation of the cyst.

Paradental cyst: report of two cases

BACKGROUND

The paradental cyst is an odontogenic lesion of inflammatory origin that has few clinical signs and symptoms apart from recurring acute episodes. A well-defined radiolucency associated with the roots or distal to the crown may be seen radiographically. The purpose of this article is to report on different aspects of two cases involving paradental cysts. In the first case, the patient complained about recurring pericoronitis. A semilunar-shaped radiolucency on the distal aspect of the mandibular third molar was noted on the periapical radiograph. In the second case, the patient's main complaint was chronic trauma of the overlying mucosa. Radiographs revealed an enlarged pericoronal space.

METHODS

In both cases, the mandibular third molar was extracted due to a lack of space. Lesional samples were sent for histopathologic analysis.

RESULTS

In the first case, the drainage of cystic fluid and a regular concavity were found during tooth removal. In the second case, a nodular lesion was found adhering to the disto-buccal surface of the tooth arising from the distal wall of a periodontal pocket. The histopathologic analysis revealed a hyperplastic stratified squamous epithelium with arcading lining a fibrous capsule with inflammatory infiltrate, resulting in a final diagnosis of a paradental cyst.

CONCLUSIONS

The presence of a paradental cyst should be considered when recurrent inflammatory periodontal processes are associated with partially erupted vital teeth, even when characteristic radiographic findings are absent. Definitive diagnosis requires a clinicopathologic correlation incorporating surgical, radiographic, and histologic findings.

Glandular odontogenic cyst in China: report of 12 cases and immunohistochemical study

OBJECTIVE

The purpose of this study was to present 12 additional cases of glandular odontogenic cyst (GOC) in the Department of Oral Pathology, School of Stomatology, Wuhan University, People's Republic of China, and to investigate their immunohistochemical cytokeratins (CKs) expression in the epithelial components.

METHODS

A total of 12 GOCs were reviewed clinically and radiographically, and immunohistologic CKs AE1, 7, 8/18, 10/13, 14, 16, 19 and 20 were performed by using a standard biotin-streptavidin immunoperoxidase technique on paraffin sections.

RESULTS

The present series showed that eight occurred in males and four in females. The mean age was 37.6 years with a peak incidence occurring in the third decades (six of 12). Mandibles were more affected than maxillas (7:5), especially anterior mandible (four of seven). Radiographically, ratio multilocular to unilocular radiolucencies was 5:7 usually with well-defined borders. Histologically, cystic spaces were lined by non-keratinized stratified epithelia containing focal plaque-like or whirlpool-like thickenings; surface epithelial layer-containing eosinophilic cuboidal cells; mucous cells; and mucin pools of microcystic areas in the epithelium. Immunohistochemistry showed that epithelium of GOCs stained for CKs AE1, 7, 8/18, 10/13, 14 and 19 with slight changes in their patterns, and no reaction to CKs 16 and 20.

CONCLUSIONS

Most clinical and histologic features in this study were analogous to those reported west population, although with slight difference between them. Histologically, the morphology of the epithelium strongly suggested an odontogenic origin, and CKs expression of GOC was similar to that of odontogenic epithelium, suggesting histochemically that GOC might be derived from odontogenic epithelium.

The use of molecular markers as an aid in the diagnosis of glandular odontogenic cyst

(1) To investigate the use of p53, Ki67, and PCNA as an aid in the diagnosis of glandular odontogenic cyst (GOC); (2) To compare the expression of these markers in GOC, low-grade mucoepidermoid carcinoma (MEPCa), and radicular cyst with mucous metaplasia (RCM) as an aid in the differential diagnosis; (3) To establish guidelines for the diagnosis of GOC.

STUDY GROUP

35 patients: 10 GOC, 15 RCM, 9 MEPCa. Immunostaining of archival specimens for p53, Ki67, PCNA. Twenty-nine articles (1987-2004) with detailed histopathological descriptions of GOC, analyzed for frequency of histopathological characteristics. Mean p53 labeling index (LI) was higher in GOC (3.0+/-4.3%) and MEPCa (4.9+/-7.4%) than in RCM (0.4+/-1.2%, p=0.048). Ki67 LI was higher in GOC (4.4+/-4.7%) and RCM (3.7+/-6.7%) than in MEPCa (0.7+/-1.6%, p=0.03). There were no significant differences in the expression of PCNA. In the literature, the most consistent histopathological characteristics of GOC included epithelial spherules/"knobs"/whorls (82.8%), cuboidal eosinophilic cells (65.5%), goblet cells (65.5%), intraepithelial glandular/microcystic ducts (58.6%), variations in lining width (55.2%), ciliated cells (51.7%) and mucous pools/mucous-lined crypts (41.4%). These histopathological features were divided into major and minor signs. The diagnosis of GOC should be based on at least the focal presence of the major signs. Measurement of p53 and Ki67 may aid in the differential diagnosis of GOC.

Glandular odontogenic cyst: Treatment and recurrence

PURPOSE

To investigate the correlation between clinical characteristics, radiologic features, treatment modalities, and treatment outcome of glandular odontogenic cyst, and to suggest a treatment protocol based on these results.

PATIENTS AND METHODS

The study included a total of 56 cases, 49 from the literature and 7 new cases. Demographic data, locularity and radiographic extension, cortical plate integrity, treatment modalities, follow-up, and recurrence were analyzed.

RESULTS

There were 34 male and 22 female patients aged 14 to 74 years (mean, 48 years). The mandible was involved in 41 cases (73.2%) and the maxilla in 15 (26.8%), predominantly in the anterior region; 53.6% of the lesions were unilocular and 46.4% multilocular. Large lesions were found in 78.5% of cases. Cortical integrity was compromised in 53.6% (cortical perforation in 39.3% and thinning or erosion of the cortical plate in 14.3%). Recurrence occurred at a rate of 29.2%, within 0.5 to 7 years (mean, 2.9 years). Mean follow-up was also 2.9 years. Two patients had 3 recurrences each. Recurrence was associated with minor surgery such as enucleation or curettage; none of the patients treated by peripheral ostectomy, marginal resection, or partial jaw resection had a recurrence. Compared with the patients without recurrence, the recurrence group had a higher frequency of multilocularity than the nonrecurrent group (64.3% vs 41.2%) and of compromised cortical integrity (71.4% vs 47.1%).

CONCLUSION

Glandular odontogenic cyst is an aggressive lesion. Treatment by enucleation or curettage alone is associated with a high recurrence rate. Small unilocular lesions can be treated by enucleation. In large uni- or multilocular lesions, an initial biopsy is recommended. Surgical treatment of large lesions should include enucleation with peripheral ostectomy for unilocular cases and marginal resection or partial jaw resection in multilocular cases. Marsupialization followed by second phase surgery is an option for lesions approaching vital structures. Follow-up should continue for at least 3 years (up to 7 years in cases with features associated with increased risk).

Mucous and ciliated cell metaplasia in epithelial linings of odontogenic inflammatory and developmental cysts

The incidence of mucous and ciliated cells in epithelial linings was examined among odontogenic inflammatory cysts (radicular cysts) and developmental cysts (dentigerous and primordial cysts). Mucous cells were found in 20.8% of all cysts examined, while ciliated cells were found in 11.4%; however, ciliated cells were always accompanied by mucous cells. The incidence of mucous cells in radicular cysts and dentigerous cysts and that of ciliated cells in radicular cysts was higher in the maxilla than in the mandible, while the incidence of mucous cells in primordial cysts and that of ciliated cells in dentigerous cysts and primordial cysts was higher in the mandible than in the maxilla. The present results regarding mucous cells and ciliated cells in the epithelial linings of intraosseous odontogenic cysts indicate a metaplasic origin, but the cause and biological significance of this phenomenon is not known. Mucous cells were present in the surface layer of epithelial linings, and intraepithelial gland-like structures lined with mucous cells were observed in the hyperplastic regions of epithelial linings of several radicular and dentigerous cysts. Such gland-like structures lined by mucous cells in the thickened epithelial lining, which have not been demonstrated previously, resembled the glandular structures of "glandular odontogenic cysts".

Radiological features of glandular odontogenic cyst

OBJECTIVES

To present five new cases of glandular odontogenic cyst (GOC) and to review the radiological features at presentation as reported in the English literature.

METHODS

From 1993 to 2002, five patients in our department were diagnosed with GOC based on histopathological findings and supported by radiography and CT. The radiographic features of the new GOC cases were analysed in addition to 51 literature cases.

RESULTS

There were 31 male and 25 female patients, aged 14-90 years (mean 50 years). The mandible was involved in 80% and the maxilla in 20%; most of the lesions were located in the anterior jaw. Radiographically, 52% of the lesions were unilocular and 48% were multilocular; 94.5% showed well defined borders, which were sclerotic in 7.7% and scalloped in 13%. Information on cortical plate integrity was available in only 24 cases: 50% showed perforation, 8.3% erosion of the cortical plates and 8.3% thinning of the cortical plates. Root resorption was reported in 22% of patients and tooth displacement in 24.4%.

CONCLUSIONS

Data collected indicate that GOC has potentially aggressive behaviour, with expansion and perforation in a significant number of cases. We recommend the use of multiple plane radiographs, with CT reserved for large lesions, especially those that are multilocular or involve extragnathic structures.

Heterotopic oral gastrointestinal cyst: report of 2 cases and review of the literature

Oral heterotopic gastrointestinal cyst is a rare entity occurring in infants and children and showing a predilection for males. The cyst usually appears as an asymptomatic swelling in the floor of the mouth. Difficulty in feeding, swallowing, respiration, and speech have been reported in approximately 30% of those affected. The tongue-in particular, its anterior aspectis involved in up to 60% of reported cases. The clinical, radiographic, and histopathologic features of cases of heterotopic gastrointestinal cyst involving the anterior tongue in a 2-year-old girl and the anterior floor of the mouth in a 2-month-old boy are presented, and theories of pathogenesis are discussed.

Glandular odontogenic cyst (sialo-odontogenic cyst): report of two cases and literature review of 45 previously reported cases

The clinical, radiological, histopathological and immunohistochemical (cytokeratin) features of two cases of glandular odontogenic cyst (GOC) are presented and discussed in a review of 45 cases of GOC hitherto reported. Of cases with available information, 34 occurred in the mandible and 6 in the maxilla; the male:female ratio was 19:28, and the mean age was 46.7 years in males and 50.0 years in females. Six cysts recurred once after 2-8 years (mean 2 years 8 months) and 2 (5.3%) recurred twice after 2 and 5 years and after 3 and 5 years, respectively, giving a rate of recurrence of 21%. The identification of osteodentin in one of the present cases and the co-expression of cytokeratins (CK) 13, 19 and 8 strongly support the concept of odontogenic differentiation in the GOC. Careful surgical removal of the lesion succeeded by a 5-year follow-up period is recommended.

Glandular odontogenic cyst: report of a case and review of the literature

The glandular odontogenic cyst is a rare jawbone cyst of odontogenic origin, first described in 1988 by Gardner et al. We describe a previously unreported case of a combined cyst composed of glandular odontogenic cyst and ghost cell keratinization that was present for 33 years. We also reviewed the published 38 cases of glandular odontogenic cyst found in the world literature and add this additional case.

Glandular odontogenic cyst. Report of seven cases

This study describes the clinical, radiographic and histopathological features of seven glandular odontogenic cysts. These cysts comprised 0.012% of 5800 jaw cysts diagnosed in a 19-year period. There was strong predilection for the mandible (five of the seven cases). Both clinical and radiographic features were nonspecific. The main histological findings were a nonkeratinized, stratified squamous epithelium lining to the cyst cavity which varied in thickness with superficial eosinophilic cuboidal cells and mucous pools within the spinous cell layer. Daughter cysts were found in the wall of 2 cysts. At surgery, most walls were found to be thin and lumen to contain a serous, low viscosity exudate. Because of the high rate of recurrence found in three cases out of the seven after conservative surgical treatment, careful clinical and radiographic follow-up is recommended.

Glandular odontogenic cyst with hyaline bodies: an unusual dentigerous presentation

We present an unusual case of glandular odontogenic cyst (GOC) enclosing the crown of an impacted canine that developed in the anterior mandible in a 54-year-old woman. Microscopically, it contained numerous glandular structures and hyaline bodies in the epithelial lining. The present rare case is sufficiently distinctive to be considered a dentigerous variant of GOC.

The polymorphous odontogenic cyst

Over the years there have been sporadic reports of unusual cystic lesions of the jaws, not readily classified under conventional headings but which have been variously diagnosed as median-mandibular, glandular, sialo-odontogenic or botryoid odontogenic cyst. We present five cases which do not fit into other categories of odontogenic cyst, two of which have recurred within a few years of conservative treatment. This paper aims to alert clinicians to the propensity for regrowth of these cysts, proposes the term polymorphous odontogenic cyst for these lesions, to encompass their varied histological appearances and discusses their distinction from other cyst types with mucous and papillary formations in epithelium.

Botryoid odontogenic cyst: analysis of 33 cases

The botryoid odontogenic cyst is considered to be a multiloculated variant of the lateral periodontal cyst. Fewer than 40 of these lesions have been described, many of which have recurred. This paper describes the demographic, clinical, microscopic, and radiographic features of 33 unreported cases from the files of the Oral Pathology Biopsy Service at the University of North Carolina School of Dentistry. Our findings are in agreement with previously published cases for an average age of 57 years and the most common site for occurrence in the lower premolar area. Follow-up information on 12 patients determined that 2 had recurrences.

Glandular odontogenic cysts. Diagnosis and treatment

Four cases of glandular odontogenic cyst are reported. Review of these and 13 previously reported cases indicates that they present as slowly growing, painless, radiolucent swellings with a predilection for the anterior part of the mandible. An incisional biopsy is essential to establish a definitive preoperative diagnosis. The unpredictable and potentially aggressive nature of these lesions is suggested by their extensive nature, penetration of cortical bone, locally invasive potential, and high incidence of recurrence after conservative treatment. In view of this behavior we suggest en bloc excision and primary reconstruction to ensure cure and reduce the operative morbidity.

Dermoid cyst in the floor of the mouth. Review of the literature and case reports

Dermoid cyst, frequently used to describe three closely related histologic cysts, the dermoid, epidermoid, and teratoma, is commonly considered a rare finding in the floor of the mouth. This review, which identifies 195 case reports of dermoid cysts in the floor of the mouth, has unveiled some findings that do not support conclusions expressed in previous articles. Examination of the literature includes muscle influence on clinical presentation and surgical approaches, locations, age distribution, histologic distribution, infection rate, incidence of multiple cysts, fibrous attachments, airway problems, anesthesia administration, surgical difficulties, and diagnostic aids. Brief suggestions in treatment are made in light of the clinical, radiographic, and historic findings. Three clinical cases are also included.

Glandular odontogenic cyst: analysis of cytokeratin expression and clinicopathological features

The glandular odontogenic cyst (GOC) is a rare odontogenic cyst which is still controversial in regard to classification, terminology, and origin. The first Japanese case of GOC is reported. Immunohistochemical examination for expression of cytokeratins and epithelial membrane antigen by monoclonal antibodies suggested that the lining epithelium was of odontogenic origin with metaplastic mucus-laden cells. We have reviewed the literature and compared the clinicopathological findings of the reported case of GOC with those of botryoid odontogenic cysts (BOC). The anatomical location, age range, and sex of GOC cases were very similar to those of BOC. GOC appears to be a multiocular and mucoepidermoid variant of non-keratinizing odontogenic cysts, which also includes BOC. GOC should be separated from the other types of odontogenic cyst and central mucoepidermoid tumours of salivary gland origin.

Developmental odontogenic cysts. An update

This review paper reports recent advances in the subject of developmental odontogenic cysts, essentially those of the past decade, starting with reference to the new WHO classification (1). On keratocysts, the latest reported recurrence rates are assessed as are their mode of growth, immunocytochemistry, immunology, genetic studies, and work on specific keratocyst antigens. There is a critical account of the group of lesions which includes the gingival cyst of adults, lateral periodontal cyst, botryoid odontogenic cyst and glandular odontogenic cyst, and their possible relationship to one another. On dentigerous cysts, reference is made to the relationship between them and deciduous teeth, as well as to their immunocytochemistry and immunology. Recent work on the unicystic ameloblastomas, their classification and prognosis, is assessed, as is the calcifying odontogenic cyst and its relationship with solid odontogenic tumours.