Demographic profile of odontogenic and selected nonodontogenic cysts in a Brazilian population

Epidemiological Features of 4777 Cysts and Odontogenic Tumors Based on the 2022 WHO Classification

OBJECTIVE

The epidemiology of cysts and odontogenic tumors is important for differential diagnosis and treatment strategies. We aimed to describe the epidemiological features of cysts and odontogenic tumors in the Chilean population using the current WHO classification.

MATERIALS AND METHODS

We reviewed 22,914 biopsy requests received between January 1984 and September 2023 at the oral pathology department, School of Dentistry, Universidad Mayor, Santiago, Chile. Patients diagnosed with cysts of the jaws and odontogenic tumors were selected and information regarding age, sex, and location was recorded.

RESULTS

4226 (18.4%) were cysts, and 551 (2.4%) were odontogenic tumors, ranging from 2 to 97 years old. Males represented 54.4% and females 45.7% of the total sample. The most prevalent cysts were radicular cysts (58.6%), dentigerous cysts (17.9%), and odontogenic keratocysts (13.3%). The most prevalent odontogenic tumors were odontomas (40.1%) and conventional ameloblastoma (17.6%).

CONCLUSIONS

Our study was the first retrospective analysis to determine the epidemiological features of both cysts and odontogenic tumors together, based on the 2022 WHO classification. This is relevant as it offers a potential basis for comprehensive comparisons of the epidemiological features of these entities, which could contribute to an accurate differential diagnosis, therefore, leading to more effective therapeutic interventions.

Prevalence, Characteristics and Distribution of Odontogenic Cysts amongst the Indian Subpopulation of Southern Rajasthan: A 5-year Retrospective Study of 218 Cysts

BACKGROUND

Odontogenic cysts (OCs) arise from the odontogenic epithelium and occur in the tooth-bearing regions of the jaws. Proliferation and/or degeneration of this epithelium lead to OC development.

AIM AND OBJECTIVES

The purpose of this study was to determine the prevalence, characteristics, distribution and clinicopathological features of OCs and compare with other studies.

MATERIALS AND METHODS

Records of OCs were retrieved, and patient's data, aetiology, clinical features, histopathological distribution, treatment, complications and recurrence were studied.

RESULTS

A total of 218 OCs were studied in 200 patients. The mean age of patients was 35.74 years. The overall sex ratio (male: female) was 1.22:1. Second, third and fourth decades of life were commonly affected. The majority of the patients (85%) reported with a complaint of pain (with or without swelling). Radicular cyst was the most prevalent type (49.55%). The most common site involved was the anterior maxilla (41.75%). Dental complications such as displacement, mobility, discoloration and root resorption were diagnosed in 91 cysts (41.75%). Bony complications such as expansion and perforation were present in 136 cysts (62.38%). Dentition was non-vital in 61.46% of cysts. The most common treatment method performed was combination surgery (enucleation with or without endodontic treatment/extraction and apicoectomy). Recurrence rate was 3.20%.

CONCLUSION

The prevalence, characteristics and distribution features of OCs in India are similar to those of studies conducted in other parts of the world. There is a broad spectrum of OCs, with some cysts having a propensity for certain age, gender and site, whereas a few cysts have distinct properties to recur and have aggressive and invasive behaviour.

Cysts of the jaws: A multicentre study

OBJECTIVES

To determine the relative frequency, demographic and pathologic profiles of patients diagnosed with cysts of the jaws.

MATERIALS AND METHODS

Biopsy records of the participating institutions from 2000 to 2020 were reviewed for lesions diagnosed in the cyst category. Demographic data, the location of the cysts and pathologic diagnoses were collected. Data were analyzed by appropriate statistics using IBM SPSS software version 28.0.

RESULTS

From 148,353 accessioned cases, 25,628 cases (17.28%) were diagnosed in the cyst category. Mean age of the patients ± SD = 42.62 ± 19.36 years. Paediatric patients (aged ≤ 16 years) accounted for 9.63%, while geriatric patients (aged ≥ 65) comprised 14.22% of all the patients. The male-to-female ratio was 1.27:1. The majority of the lesions were encountered in the mandible. The most prevalent cyst was radicular cyst followed by dentigerous cyst and odontogenic keratocyst. In the paediatric group, dentigerous cyst was the most prevalent, whereas in the geriatric group, radicular cyst was the most common.

CONCLUSIONS

In general, the results of this study are in accordance with previous studies. This study provides an invaluable database for clinicians when formulating clinical differential diagnoses as well as for pathologists in rendering the final diagnosis.

Can CAPRIN-1 Be Responsible for the Recurrence Potential of Odontogenic Keratocysts?

Objectives

The purpose of this retrospective study is to compare dentigerous cysts and odontogenic keratocysts for cytoplasmic activation/proliferation - associated protein-1 antibodies via immunohistochemical staining to obtain a new perspective about the specific behavioural characteristics of odontogenic keratocysts at the molecular level.

Material and Methods

Forty dentigerous cysts (DC) and forty odontogenic keratocysts (OKC) tissue samples were examined using immunohistochemical staining to detect cytoplasmic activation/proliferation - associated protein-1 (CAPRIN-1) antibodies. Nuclear and/or cytoplasmic staining was evaluated as "positive". Cell staining rate (%) and cell staining intensity were determined, and a staining intensity distribution (SID) score was calculated for each sample. Cases were considered "negative" if they showed no staining for CAPRIN-1 antibodies, thus were given a SID score of zero. According to the SID scores, the expression levels were rated as negative, mild, moderate, or high.

Results

Of 80 samples, 16 that could adversely affect immunohistochemical evaluation were excluded. Ten negative, 21 positive and three negative, 30 positive CAPRIN-1 expressions were observed in DC and OKC groups, respectively. The difference between the negative and positive cases within groups was significant only in the OKC group (P = 0.000). The SID score range and mean were 0 to 160 and 31.1 (SD 35.7) for DC and 0 to 160 and 57.3 (SD 42.3) for OKC groups. CAPRIN-1 expression was significantly higher in the OKC group (P = 0.043).

Conclusions

The molecular basis for increased mitotic activity, high recurrence rates or presence of satellite cysts in odontogenic keratocysts may be attributed to the expression of cytoplasmic activation/proliferation - associated protein-1.

Peripheral calcifying odontogenic cyst: a case report and comprehensive review of 60 years of literature

Peripheral Calcifying Odontogenic Cyst (PCOC) is the extraosseous form of calcifying odontogenic cyst that is limited to peripheral soft tissue without bony involvement. This case report presents a case of PCOC manifested as a progressive growth of gingival mass in a young male treated with excisional biopsy. Histological examination confirmed diagnosis of PCOC with presence of characteristic ghost cells and sporadic calcifications. No recurrence of the lesion and no complication were noted at three-year follow-up. Review of available literature on PCOC noted a predilection of occurrence in the mandible (61%) and in the anterior area of the jaws (58%). Mean age of patients was 41.7 ± SD25.43 (7-83) and 95% CI [33.6, 49.8] yrs. Mean size of the lesions was 1.38 ± SD1.1 (0.5-4.3) and 95% CI [0.93, 1.83] cm. Gender distribution was noted to be 51.3% male and 48.7% female.

Prevalence of odontogenic cysts in a group of Libyan population: A retrospective study

Background

Odontogenic cysts (OCs) are commonly encountered lesions affecting the human jaws having special clinical and radiographic features depending on cyst type. The aim of this study was to determine the prevalence of odontogenic jaw cysts in a Libyan population in Benghazi and to compare these data with previously published reports from Libyan and other geographic areas.

Materials and Methods

This is a descriptive study where screening of 2189 biopsies (retrieved from the archives of The Department of Oral Pathology/University of Benghazi, Libya) was performed for the sake of recognizing the three cysts chosen for the purpose of this study.

Results

: Out of the screened lesions, 276 cases (12.6%) were diagnosed as odontogenic cysts in the period from 2006 to 2019. Of those, 67.39% were inflammatory and 32.61% were developmental in nature. Radicular cysts (60.5%) were the most frequent cysts followed by dentigerous cysts (14.8%) and keratocysts (14.5%). The mean ages of the patients were 32.3, 29.7, and 33.2 years, respectively. Occurrence of the cysts was noticed more in the maxilla than in the mandible (1.3:1). The overall male-to-female ratio was 1.1:1.

Conclusions

The prevalence of odontogenic cysts was similar to that reported in a previous study in Libya and other countries irrespective to WHO (2017) classification of odontogenic cysts.

Jaw Cysts: A Retrospective Study in a Turkish Subpopulation

Objectives: Cysts seen in the jaws may be odontogenic or non-odontogenic, depending on the tissue of origin. Although there are different methods to diagnose these lesions, histopathological examination of tissue biopsy of the lesion is accepted as the 'gold standard' in cases where the diagnosis is insufficient. Although there are different methods to diagnose these lesions, histopathological examination of tissue biopsy of the lesion is accepted as the 'gold standard' in cases where the diagnosis is insufficient. Materials and Methods: Pathology results of 436 patients who applied to Zonguldak Bülent Ecevit University Faculty of Dentistry, Oral and Maxillofacial Radiology Clinic between 2016-2021 for any reason and underwent biopsy were retrospectively scanned using digital archives. While classifying the cyst, the criteria published by the World Health Organization (WHO) in 2017 were taken into account. Obtained results were recorded for statistical analysis. SPSS 22.0 Software Package Program (SPSS 22.0 Software Package Program, Inc. Chicago, IL, USA) was used as statistical software in the study. Results: Of the 436 patients included in the study, 250 (57.3%) were male and 186 (42.7%) were female. The ages of the patients ranged between 7 and 82 years, and the mean age of the patients was 35.5±15.8. As a result of the findings, it was determined that the most common cysts were radicular cysts (53.7%). Radicular cysts were most commonly located in the posterior mandible and anterior maxilla anatomically. Conclusions: In addition to clinical and radiological examination, histopathological examination of biopsy samples taken from tissues is of great importance in the correct diagnosis and treatment planning of jaw cysts.

Epidemiological evaluation of jaw cysts according to the new WHO classification: a 30-year retrospective analysis

The aim of the present study was to analyze the epidemiology of maxillofacial odontogenic and non-odontogenic cysts diagnosed for 30 years in a Brazilian population. A retrospective descriptive cross-sectional study was performed. Biopsy records were obtained from the archives of a Brazilian referral center between 1989 and 2019. Data regarding age, gender, anatomical location, and histopathological diagnosis were collected and categorized. Further, a literature search for similar studies was performed. A total of 6.994 biopsy records were evaluated, but only 367 (5.24%) cases were classified as odontogenic cysts (OC) or non-odontogenic cysts (NOC). Among all cystic lesions, 341 cases (92.9%) were OC and 26 cases (7.1%) were NOC. These lesions were more common in females (n = 208 / 56.67%) and located mostly in the mandible (n = 195 / 53.1%). In patients with OC, the radicular cyst was the most frequent (n = 134 / 36.5%), followed by the dentigerous cyst (n = 101 / 27.5%) and the odontogenic keratocyst (n = 52 / 14.2%). Patients with NOC had a higher frequency of epidermoid cyst (n = 12 / 3.3%), oral lymphoepithelial cyst (n = 7 / 1.9%), and nasopalatine duct cyst (n = 4 / 1.1%). The OCs were more prevalent than NOCs, and inflammatory cysts were the most common among all the OCs.

The Development of Large Radicular Cysts in Endodontically Versus Non-Endodontically Treated Maxillary Teeth

Background and Objectives: Large radicular cysts of the maxilla present a clinical challenge, as they may cause recurrent infection, severe alveolar bone loss and disruption of the nasal and maxillary sinus floors. The aim of this study was to evaluate the effect of previous root canal treatment on the clinical presentation of large maxillary radicular cysts. Materials and Methods: All cases of radicular cysts treated at the Oral and Maxillofacial Surgery Department of a tertiary public hospital over a period of six years (2012–2018) were evaluated. Histologically confirmed radicular cysts of the maxilla with a maximal dimension of over 15 mm were included. Demographic data of the patients, clinical presentation and radiographic features of the lesions were analyzed. Results: A total of 211 inflammatory cysts were treated in the study period, of these 54 histologically diagnosed radicular cysts in the maxilla were found to have a maximal dimension of over 15 mm. The mean age of patients with large maxillary radicular cysts was 43.3 years, 57.6% of which were male and 42.4% female. The lateral incisor was the most common tooth affected (46.3%). The mean size of the large radicular cysts was 25 mm. Then, 83.8% of the cysts were observed in teeth with previous endodontic treatment. Teeth without endodontic treatment presented clinically with significantly fewer acute symptoms in comparison to teeth with previous endodontic treatment. Conclusions: the vast majority (83.8%) of large maxillary radicular cysts were associated with endodontically treated teeth. Previous endodontic treatment was correlated to increased frequency of clinical symptoms.

An Unusual Case of a Large Periapical Cyst Mimicking a Nasopalatine Duct Cyst

This article reports on the management of a large median symmetrical lesion of the anterior palate, which was clinically and radiographically diagnosed as an infected nasopalatine duct cyst. However, histopathology demonstrated it to be a radicular cyst of endodontic origin.

Five Years Follow-up of a Spontaneous Eruption of an Impacted Mandibular Premolar Associated with a Dentigerous Cyst Treated by Marsupialization

Dentigerous cysts (DC) are developmental odontogenic cysts associated with impacted or partially erupted teeth; they can occur at any location of the jaw. Being generally asymptomatic, they are fortuitously discovered when radiographs are taken to investigate a tooth eruption failure. In this report, we present a case of a 10-year-old girl presented with the absence of the right second mandibular premolar and retention of the right second primary molar. After clinical and radiological examinations a preliminary diagnosis of the DC was made and confirmed later histopathologically. The lesion was treated by marsupialization to allow eruption of the affected tooth and followed up for five years with no evidence of recurrence.

Nasopalatine canal and periapical radiolucency fusion following dentoalveolar trauma: A CBCT-based case-control study

BACKGROUND/AIM

There is a lack of evidence regarding the radiological characteristics of a periapical radiolucency (PRL) fusion with the nasopalatine canal (NPC) following dentoalveolar trauma. The aim of this study was to assess the NPC enlargement resulting from fusion with a PRL and its relationship with the surrounding anatomical structures.

MATERIAL AND METHODS

A total of 100 patients was retrospectively recruited and divided into two groups: case group and control group. The case group consisted of 50 cone-beam computed tomography scans of the maxilla of patients (32 males, 18 females; age range: 11-83 years) with a known history of dentoalveolar trauma in the maxillary anterior region and the presence of an undiagnosed and/or asymptomatic NPC and PRL fusion. An age- and gender-matched control group of 50 patients (32 males, 18 females; age range: 11-82 years) without trauma history to the upper anterior teeth, demonstrating normal maxillary scans, was recruited. A subjective scoring criterion was established for assessing the characteristics of the fused lesion and its relationship with the buccal/palatal alveolar cortex, nasal cavity cortex, NPC cortical border, and maxillary sinus floor.

RESULTS

The fused NPC and PRL was mainly lobular in appearance (88%) with non-corticated well-defined margins (80%). Male patients showed larger (68%) dimensions compared with female patients (32%). The NPC cortical bone was the most commonly perforated structure in relation to fusion (72%), whereas maxillary sinus cortical bone was the least effected (2%). A statistically significant difference was observed between the NPC dimensions in the control and test groups, with fused lesions having larger mesiolateral, craniocaudal, and buccopalatal dimensions (P < .001).

CONCLUSIONS

Periapical radiolucencies should be treated as soon as possible before they fuse with NPC. In case of fusion, surgical enucleation should be considered as the treatment of choice.

Relative frequency of dentigerous cyst in Iranian population: A 20-year retrospective study

Purpose

Dentigerous cyst (DC) is the most common type of developmental odontogenic cysts which apparently develops via accumulation of fluid between the reduced enamel epithelium and crown of the tooth. The aim of this study is to analyze the frequency of DC in Iranian population.

Materials and Methods

The files of oral pathology, Shahid Beheshti University of Medical Sciences, served as the source of the materials from 1992 to 2012 for this study. All lesions diagnosed as DCs were subjected to microscopic reevaluation. Patient's age, sex, location, and microscopic characteristics were recorded. Based on these data, a descriptive statistical analysis was performed using SPSS 19 software (IBM SPSS Statistics 19, New York, United States) and the results with P < 0.05 were considered as significant.

Results

DC accounted for 34.37% of all odontogenic cysts of the jaws during the 20-year period. The mean age of patients was 24.72 years and most cases are diagnosed in the second and third decades of life. The male-to-female ratio was 1.52. About 73.89% of all lesions had occurred in the mandible and 26.11% in maxilla. DCs showed Vickers and Gorlin (ameloblastomatous) changes in 2.36% of cases. The mean age was significantly lower in the premolar area (P = 0.00).

Conclusion

Age, sex, and location of DCs in Iranian population are similar to previous studies. In addition, the age of occurrence for this lesion in the premolar region was relatively lower than at other sites. Although the risk of ameloblastic change is low, it should be considered as an important issue.

Odontogenic cysts and odontogenic tumors in a large rural area from India. A 10-year reflection

Objectives

To determine the prevalence of odontogenic cysts and tumors along with age range, sex distribution, site of presentation and also to identify the most common type of odontogenic cyst and tumor among the population of coastal Karnataka over a 10-year period.

Methods

Data was collected from patient records and histologically diagnosed cases of odontogenic cysts and tumors. The age, gender of patients, as well as the site of lesion was recorded.

Results

A total of 167 cases were retrieved. Among them, 125 cases were diagnosed as odontogenic cysts and 42 cases were odontogenic tumors. Radicular cyst was the most frequently diagnosed cyst and unicystic ameloblastoma was the most frequently diagnosed tumor. A strong predilection for males was observed for both the odontogenic cysts and odontogenic tumors. Odontogenic cysts were more commonly seen in individuals in the age range 21–41 years, while odontogenic tumors were frequently seen in individuals in the age range 1–20 years.

Conclusion

This study provides an epidemiological profile of odontogenic cysts and odontogenic tumors among a rural population of coastal Karnataka. There is a notable variation in demographic profile of odontogenic cysts and odontogenic tumors in this population when compared with other populations.

The presentation of odontogenic keratocysts in the jaws with an emphasis on the tooth-bearing area: a systematic review and meta-analysis

PURPOSE

This study was conducted in order to gain insight in the actual ratio of odontogenic keratocysts occurring in the tooth-bearing area as compared to the posterior region of the jaws in order to come up with reliable data to base upon a rational treatment policy.

METHODS

We searched MEDLINE, Web of Science, Scopus, and Cochrane databases for studies reporting on the location of mandibular and maxillary odontogenic keratocysts. All records were independently assessed and a meta-analysis was performed. Risk difference with a confidence interval of 95% of having the lesion in the posterior region versus the tooth-bearing area was the effect measure. P value for the summary effect of < 0.05 was considered statistically significant.

RESULTS

The 2615 records retrieved were reduced to 34 studies to be qualitatively/quantitatively assessed. The pooled values showed that the difference in the clinical risk of having keratocysts in the posterior region of the mandible and in the tooth-bearing area of the maxilla is 21 and 43%, respectively (P < 0.02 and P < 0.00001).

CONCLUSIONS

A substantial amount of keratocysts occur in the tooth-bearing area of the jaws, requiring attention.

Demographic and Clinical Characteristics of 5294 Jaw Cysts: A Retrospective Study of 38 Years

The aim of the present study is to report the demographic and clinical characteristics of all jaw cysts diagnosed in a single Oral Pathology Department. 5294 cases of jaw cysts diagnosed during a 38-year period were retrospectively collected and classified according to the latest classification of Head and Neck Tumors of the World Health Organization. The patients' gender and age, as well as the main clinical features of the cysts were retrieved from biopsy report forms. Jaw cysts were more common in male patients, with a male to female ratio of 1.6:1. Most patients were in the 4th-6th decade of life, with a mean age of 42.3 ± 16.1 years. There was no jaw predilection and the majority of lesions were more commonly encountered in the anterior region of the maxilla, followed by the molar region of the mandible. The most common jaw cyst was radicular cyst followed by dentigerous cyst, residual cyst and odontogenic keratocyst. The majority of jaw cysts are of inflammatory origin and represent a sequale of pulp necrosis. However, other type of jaw cysts may also be found.

A Comparison of Ki67, Syndecan-1 (CD138), and Molecular RANK, RANKL, and OPG Triad Expression in Odontogenic Keratocyts, Unicystic Ameloblastoma, and Dentigerous Cysts

BACKGROUND AND OBJECTIVE

Reduced expression of syndecan-1 (CD138), increased proliferation index, and modifications in the expression of the molecular RANK/RANKL/OPG triad are related to an intensified potential of aggressiveness and invasion of diverse tumors and cysts. The aim was to compare the expression of Ki-67, CD138, and the molecular triad RANK, RANKL, and OPG in odontogenic keratocysts (OKC), unicystic ameloblastomas (UA), and dentigerous cysts (DC).

METHODS

Immunohistochemistry for Ki-67, CD138, RANK, RANKL, and OPG was performed in 58 odontogenic cystic lesions (22 OKC, 17 DC, and 19 UA).

RESULTS

A higher expression of Ki-67 was identified in OKC as compared to UA (p < 0.0001). UA exhibited a greater loss of CD138 expression versus OKCs (p > 0.0034). RANKL was expressed higher in the epithelium (p = 0.0002) and in the stroma (p = 0.0004) of UA. DC had a lower expression of these markers.

CONCLUSION

Higher RANKL expression together with the reduction on CD138 expression in UA could be linked to a greater invasive and destructive potential, while the increased proliferation rate observed in OKC could be related to its continuous intrabony growth. The expansion of DC does not seem to be related to such factors, justifying the different therapeutic approaches proposed for each of these entities.

Epidemiologic study of odontogenic and non-odontogenic cysts in children and adolescents of a Brazilian population

BACKGROUND

the objective of this study was to describe the frequency of cystic lesions in a Brazilian population of patients histopathologically diagnosed in the first and second decade of life.

MATERIAL AND METHODS

Retrospective descriptive cross-sectional study was performed. Biopsy records were obtained from the archives of a Brazilian referral center between 1980 and 2016.

RESULTS

A total of 2.114 biopsy records of pediatric patients were analyzed with oral and maxillofacial lesions. Data such as gender, age, anatomical location, and histopathological diagnosis were collected and categorized. Among all oral and maxillofacial lesions (n=2.114), were diagnosed 294 cases of odontogenic cysts (13.9%) and 16 cases of non-odontogenic cysts (0.8%). The most frequent lesions in each group were, respectively: radicular cyst (n=145) and epidermoid cyst (n=4). These lesions were most common in female (n=158), with a mean age of 14 years. For intraosseous lesions, the mandible (n=148) was the most affected anatomic site; moreover, the floor of the mouth (n=6) was most affected by cysts in soft tissues.

CONCLUSIONS

Odontogenic cysts were relatively common in population studied, but non-odontogenic cysts were rare in these patients.

Clinical and histopathological features of nasopalatine duct cyst: A 47-year retrospective study and review of current concepts

PURPOSE

To evaluate the clinical and histopathological features of nasopalatine duct cysts (NDCs) stored in the archives of a referred Oral Pathology Service over a 47-year-period, and to review current concepts about these cysts.

MATERIAL AND METHODS

All NDCs were reviewed, and clinical data were obtained from the patient records. Thirty cases were re-evaluated microscopically by 2 oral pathologists.

RESULTS

Among 14,564 cases, 30 (0.20%) were NDCs. Fifteen (50.0%) of the patients were female, and the mean age was 42.7 years. The lesions measured on average 2.37 ± 1.69 cm. Histologically, stratified squamous epithelium, alone or in combination with other epithelia, was present in 13 (46.6%) cases. Goblet cells and subepithelial hyalinization were common. Fourteen (46.6%) cases exhibited a slight degree of inflammation. Nerves were observed in 15 (50%) cases and mucous glands in 7 (23.3%). Hyaline ring granulomas (which is described here for the first time in NDC) and cholesterol crystals were not common.

CONCLUSION

Knowledge of clinical-histopathological aspects of NDCs provides more accurate data about their nature and behavior. Our results suggest that the predominant epithelial lining of these cystic lesions is exclusively stratified squamous epithelium or combined with another type. Vessels, nerves, mucous glands and inflammatory infiltrate are frequently observed.

Use of refrigerant spray of a propane/butane/isobutane gas mixture in the management of keratocystic odontogenic tumors: a preliminary study

PURPOSE

Keratocystic odontogenic tumor (KCOT) is an aggressive benign tumor and the management by complete enucleation followed by cryotherapy maintains the inorganic bone matrix, resulting in better repair and reduces the rates of recurrence. A refrigerant spray with a propane/butane/isobutane gas mixture has been pointed to as an alternative to liquid nitrogen, because the device is easy to handle and contain within the cavity, providing better control and lower risk of injury to the adjacent soft tissue. Thus, the aim of this study was to evaluate the outcome of enucleation followed by cryosurgery using a refrigerant spray of this gas mixture in ten patients diagnosed with KCOT.

METHOD

The biggest lesions received a prior treatment consisting of marsupialization to decrease the tumor size. During the surgeries, the lesions were removed by enucleation and the surgical site was sprayed with the gas mixture.

RESULTS

Wound dehiscence was observed in all cases, which healed by the second intention. The mean follow-up period was 64.3 months (range 24-120 months). Eight of the ten patients showed no evidence of clinical or radiographic recurrence. Pathologic fractures and infections were not observed.

CONCLUSIONS

The results obtained suggest that enucleation followed by cryosurgery is an effective therapy for managing KCOT.

Clinical and radiological analysis of a series of periapical cysts and periapical granulomas diagnosed in a Brazilian population

BACKGROUND

Periapical cysts (PC) and periapical granulomas (PG) are the two most common chronic inflammatory periapical diseases, but their clinicoradiological characteristics can vary depending on the methods employed in each study. The aim of the present work was to analyze the clinical and radiological profile of a series of PC and PG diagnosed in a Brazilian population.

MATERIAL AND METHODS

The files of two Oral Pathology laboratories were reviewed and all cases diagnosed as PG and PC were selected for the study. Clinical and radiological information were retrieved and data were tabulated and descriptively and comparatively analyzed.

RESULTS

Final sample was composed by 647 inflammatory periapical lesions, including 244 PG (38%) and 403 PC (62%). The number of women affected by PG was significantly higher than the number of women affected by PC (p=0.037). Anterior region of the maxilla was the most common affected area for both entities (39% of the cases), but the most common anatomical location of PG (anterior maxilla and posterior maxilla) was different from PC (anterior maxilla and posterior mandible) (p<0.0001). Upper lateral incisor was the most affected tooth. The mean radiological size of the PC was larger than the mean radiological size of the PG (p<0.0001) and PC showed well-defined radiological images more frequently than PG (p<0.0001).

CONCLUSIONS

PC were more common than PG, both showed predilection for adult females, most lesions affected predominantly the anterior maxilla and PC presented larger mean radiological diameter and well-defined images when compared with PG. Key words:Periapical granuloma, periapical cyst, radicular cyst, diagnosis, Oral Pathology.

Metaplastic changes in the epithelium of radicular cysts: A series of 711 cases

Background

This study was aimed to evaluate the prevalence of metaplastic changes in the epithelium of radicular cysts and to investigate how they relate to the clinical and radiographic characteristics of the cysts, based on a large series of radicular cysts.

Material and Methods

Biopsies of cysts of endodontic origin that were examined at the Department of Oral Pathology between 2004 and 2011 have been re-evaluated for this study. Only cases that were re-confirmed with clinical and histological diagnoses of a radicular or residual radicular cyst were included. The included cases were evaluated for the prevalence of metaplastic changes in the form of mucous secreting cells (MSC) or ciliated cells (CC). The relations between the metaplastic changes and the cyst type (radicular or residual radicular), as well as demographic, clinical and radiographic parameters, were statistically evaluated using Fischer and chi-square tests. Significance was set at p<0.05.

Results

A total of 711 cysts were included: 677 were radicular cysts (95%) and 34 (5%) were residual radicular cysts. 23 cases had histopathological diagnoses other than radicular or residual radicular cysts and were excluded from the study. MSC were present in 47 (6.6%) cysts. MSC were significantly more common in residual radicular cysts than in radicular cysts [8 (23.5%) and 39 (5.8%), respectively; p<0.001]. MSC-containing cysts were commonly found in asymptomatic patients (10.5%, p<0.001), and usually presented with well-defined radiographic borders (7.2%, p<0.05). CC were present in 34 (4.8%) cysts, with a markedly high prevalence in the maxillary molar sextant (15%, p<0.001).

Conclusions

In the epithelium of radicular and residual radicular cysts the presence of specific metaplastic changes may be related to cyst type, symptomatology, radiographic findings and tooth location.

Key words:Radicular cyst, metaplasia, mucous secreting cells, ciliated cells.

Spontaneous Eruption of Premolar Associated with a Dentigerous Cyst

Dentigerous cyst (DC) is the second most common odontogenic cyst with greater incidence in young patients. It presents as a unilocular, asymptomatic radiolucency involving the crown of an impacted tooth, commonly noticed in X-rays to investigate absence, wrong tooth position, or delay in the chronology of eruption. Decompression/marsupialization (D/M) is the most implemented treatment, especially when preserving the tooth involved is advised. The aim of this study is to discuss the DC characteristics that contribute to spontaneous eruption of premolars, by reporting the case of a conservative treatment of DC. This eruption depends on factors such as age, angulation of inclusion, rate of root formation, depth of inclusion, and eruption space. This paper reports the case of a 10-year-old patient with a radiolucent lesion diagnosed as DC involving element 35, which erupted as a result of treatment. The patient was observed during 1 year and 6 months.

A 5 year retrospective study of biopsied jaw lesions with the assessment of concordance between clinical and histopathological diagnoses

INTRODUCTION

The jaw can be affected by several lesions that manifest in the oral cavity, but little is known about their distribution patterns in various populations.

AIMS AND OBJECTIVES

This study presents the frequency and distribution of biopsied jaw lesions recorded in Faculty of Dentistry and gathers the information including provisional and final diagnosis of the lesions.

MATERIAL AND METHODS

Biopsy of 1938 lesions (2008-2013) was reviewed and 1473 lesions were included in this study. The provisional diagnosis and histopathological validations of lesions were compared. Data on the location of the lesion, as well as patient demographics, were also evaluated. The lesions were divided into three major groups as 1 - developmental/reactive and inflammatory lesions of the jaw, 2 - cystic lesion and 3 - tumor and tumor-like lesions.

STATISTICAL ANALYSIS

The variables were recorded and analysed using descriptive statistics.

RESULTS AND OBSERVATIONS

Three hundred and ninety-six lesions were in Group 1 and periapical granuloma was the most frequent diagnosis. Seven hundred and eighty-nine lesions were in Group 2 and the radicular cyst was the most frequent diagnosis. Two hundred and eighty-eight lesions were in Group 3 and the keratocystic odontogenic tumor was the most frequent. Two hundred and ninety-one biopsied lesions were in disagreement with respect to the diagnoses on clinical and histopathological examination.

CONCLUSION

Consequently, a provisional diagnosis of some of the malignant lesions was reactive, inflammatory, cystic or benign lesions, therefore the importance of evaluation of the specimen is emphasized.

Diagnostic Factors of Odontogenic Cysts in Iranian Population: A Retrospective Study Over the Past Two Decades

BACKGROUND

Early diagnosis of odontogenic cysts due to their silent progression is always a challenging problem for clinicians.

OBJECTIVES

The current study aimed to evaluate the frequency of odontogenic cysts and related factors in a selected Iranian population.

PATIENTS AND METHODS

The current cross-sectional study was conducted on 312 patients' recorded data in Taleghani Hospital, Tehran, Iran, from April 1993 to December 2013. All related data were extracted from the records and categorized in tables. The correlation between the variables was analyzed by either chi-square or multinominal logistic regression tests. The P values < 0.05 were considered significant.

RESULTS

Evaluation of 312 patients' records (185 males and 127 females) with the mean age of 27.6 showed that Odontogenic Keratocyst (OKC) was the most common odontogenic cyst of all followed by the dentigerous cyst as the second most common lesion. Most of the patients were in the second or third decades of their lives, although there was no statistically significant age distribution. The finding of the current study showed that calcifying odontogenic cyst (COC) occurrence was significantly related to the history of trauma. Enucleation and curettage of the odontogenic cysts were the most common treatment plans of all.

CONCLUSIONS

The current study showed that clinicians should consider the many factors associated with the occurrence of odontogenic cysts.

Prevalence of developmental odontogenic cysts in children and adolescents with emphasis on dentigerous cyst and odontogenic keratocyst (keratocystic odontogenic tumor)

OBJECTIVE

To investigate the incidence and prevalence of developmental odontogenic cysts in children and adolescents and compare the features of the two most common types, dentigerous cyst and keratocystic odontogenic tumor (KCOT).

STUDY DESIGN

A retrospective review in a series of 369 patients with all histological diagnoses of developmental odontogenic cysts in children (≤12 years) and adolescents (13-18 years) was conducted.

RESULTS

Among these, 361 (97.8%) patients were diagnosed as dentigerous cyst (n = 281) and KCOT (n = 80), with the male-to-female ratios of dentigerous cyst and KCOT both being 2:1. The average age of the patients with KCOT was older than that of those with dentigerous cyst (14.7 years vs 11.8 years, p < 0.001). Dentigerous cyst (59.1%) was more common in children, but KCOT (78.8%) was more common in adolescents (p < 0.001). Dentigerous cyst (57.6%) predominantly located on the maxilla, but KCOT (60.3%) predominantly located on the mandible (p = 0.010).

CONCLUSIONS

Adolescent patients with lesions located on the mandible would favor KCOT over dentigerous cyst. This study aids in better knowledge of the prevalence of developmental odontogenic cysts in a large pediatric population, and shows that a well-supported early diagnosis is indispensable for a more adequate treatment.

Demographic profile of oral nonodontogenic cysts in a Brazilian population

Objectives: The purpose of this study was to determine the clinical and demographic characteristics of oral non-odontogenic cysts (ONOC) in a Brazilian population over a 53-year period and to compare this data with the literature. Study Design: A total of 20.391 biopsies records were evaluated, from April/1959 to August/2012. Cases of oral developmental cysts were selected. Data regarding age, gender, time of evolution, and anatomic site of all cases were collected. The data were analyzed by descriptive statistics. Results: Among 20.391 oral biopsies, 71 (0.35%) met the criteria of ONOC. Females accounted for 50.70% of all cases. The mean age observed was 38.14 years (range: 5-88 years). Nasopalatine duct cysts, oral lymphoepithelial cysts and epidermoid cysts were the most common ONOC, accounting for 63 cases (88.73%). Nasopalatine duct cysts occurred in 31 cases (43.66%), followed by 22 patients with oral lymphoepithelial cysts (30.99%) and 10 cases of epidermoid cysts (14.08%). Nasopalatine duct cysts revealed predominance among males (58.06). Oral lymphoepithelial cysts were more commonly observed in tongue (50%). Epidermoid cysts were most frequently found in the buccal mucosa (40.00%). Conclusions: The differential diagnosis of ONOC is based on the clinical, radiological, and histological findings. It is difficult to establish an epidemiological profile of ONOCs, considering the low frequency of these lesions and the divergences in the demographic and clinical presentation data among different populations.

Key words:Diagnosis, epidemiology, jaw cysts, mouth.

Clinicopathological study of jaw cysts in southeast region of Turkey

Objective:

The purpose of this retrospective study was to analyze clinic and radiologic features and the prevalence of jaw cysts in southeast region of Turkey.

Materials and Methods:

This study was carried out in 149 cysts of the jaw diagnosed among 407 individuals who were taken biopsy in our department from October 2008 to December 2012. All cysts were treated by enucleation, marsupialization, or combination, and all cases were histologically examined.

Results:

One-hundred-and-forty-eight cases were classified odontogenic, one was non-odontogenic. There were 89 cysts (59.7%) in men, 60 (40.3%) in women. The mean age was 32.72 years. We found 80 cysts (35 F, 45 M) in the maxillary and 69 (28 F, 41 M) in mandible. It is observed that 94 were radicular cysts (63%), 40 were dentigerous cysts (26.9%), 9 were odontogenic keratocysts (OKC) (6.1%), 5 were residual radicular cysts (3.4%), and 1 was nasopalatine cyst (0.6%). In radicular cysts, 56 of them (59.5%) were located in the anterior region of the jaws; 18 dentigerous cysts and 2 OKCs were found in the posterior region of mandible. Clinically, the chief complaint of patients was expansion and pain. Radiographically, scalloping of the lesion between the teeth was found in 1 case, root resorption was seen in 3 cases, and displacement of the teeth and follicles was observed in 16 cases.

Conclusions:

We found similar prevalence of jaw cysts that reported in the literature, in which most odontogenic cysts (OCs) were inflammatory origin.

A prospective epidemiological study for odontogenic and non-odontogenic lesions of the maxilla and mandible in Queensland

OBJECTIVES

Investigate the epidemiological profile for odontogenic and non-odontogenic intra-osseous lesions in the Queensland population (4.56 million) over 12 months.

STUDY DESIGN

The following data were prospectively collected from all Queensland histopathology laboratories in 2011: gender, age at diagnosis, location of lesion, histopathological diagnosis of the lesion and the patient's postcode.

RESULTS

Six-hundred and thirty-three lesions were collected, comprising 540 odontogenic cysts and 93 odontogenic tumors. Radicular cyst was the most frequently diagnosed lesion (247/540, 45.7%). The overall incidence of odontogenic tumors was 20.4/million. Keratocystic odontogenic tumor was the highest (15.1/million), followed by ameloblastoma (2.41/million) with odontoma and calcifying cystic odontogenic tumor having the same incidence (1.1/million). The 39 non-odontogenic intra-osseous lesions had an overall incidence of 8.55/million. Nasopalatine cysts had an incidence of 2.19/million, followed by fibrous dysplasia and central giant cell granuloma (1.97/million).

CONCLUSIONS

Odontogenic tumors are 5 times less common than cysts. Non-odontogenic lesions are rare, with benign lesions 6.8 times more common than malignant lesions.

Demographic distribution of odontogenic cysts in Isfahan (Iran) over a 23-year period (1988-2010)

Background:

Odontogenic cysts are relatively common lesions which can cause different complications. As demographic information is lacking in Iran and specially in Isfahan, the aim of this study was to determine the prevalence of odontogenic cysts according to age, gender and affected area among patients referring to the Oral Pathology Department of the Dental School of Isfahan University of Medical Sciences (Iran) over a 23-year period.

Materials and Methods:

A total of 7412 diagnosed lesions recorded in the Oral Pathology Department archives of Isfahan Dental School between 1988 and 2010 were reevaluated, then odontogenic cysts were separated through reviewing microscopic slides according to the 2005 World Health Organization classification and variables such as age, gender, the infected jaw, and its specific region were obtained by SPSS Version 16.0 from the recorded database.

Results:

21.62% of the lesions were odontogenic cysts, of which 48.72% were inflammatory and 51.28% were developmental cysts. These cysts were more common in the mandible. The mean age of patients was 29.53 ± 16.1. Male to female ratio was 1.31:1. The four most frequent odontogenic cysts were radicular cysts (35.12%), dentigerous cysts (25.77%), odontogenic keratocysts (22.58%) and residual cysts (12.98%).

Conclusion:

Odontogenic cysts are fairly frequent jaw lesions (21.62%), of which radicular cyst was the most common cyst. The four most common lesions constituted a sum of 96.45% of the total. In general, the prevalence rates in our study are similar to the studies from other geographic parts of the world but with a lower incidence of inflammatory cysts, higher prevalence of dentigerous cysts and residual cysts and also mandibular predominance for residual cysts.

Keratocystic odontogenic tumor: systematic review with analysis of 72 additional cases from Mumbai, India

OBJECTIVE

The aim of this systematic review was to assess the clinical and imaging findings of keratocystic odontogenic tumor (KOT). This article also attempts to determine the prevalence of KOTs and orthokeratinized odontogenic cyst (OOC) in the western Indian population and to compare demographic and radiographic findings of KOT of our cohort with that of the rest of the world.

STUDY DESIGN

Relevant publications on KOT were reviewed from the published literature from 1976 to March 2012. Data regarding the 72 additional cases from Mumbai also were analyzed.

RESULTS

Sixty-five reports were identified for this systematic review. The findings were divided into 4 global groups for analysis. The prevalence of KOT was 0.0173% and that of OOC 0.0012%. Male sex, mandible, and the unilocular variation were predominant for the additional cases.

CONCLUSIONS

The characterization of the KOT lesions was accomplished, taking into consideration the variations to the western Indian population.

Analysis of 153 cases of odontogenic cysts in a South Indian sample population: a retrospective study over a decade

The purpose of this study was to determine the prevalence of odontogenic cysts and to identify their clinico-pathological features among patients by studying biopsy specimens obtained from the archives of the Department of Oral and Maxillofacial Pathology, College of Dental Sciences, Davangere, Karnataka, India, during the past 10 years. Data for the study were retrieved from the case records of patients fitting the histological classification of the World Health Organization (1992). Analyzed clinical variables included age, gender, anatomical location, and histological diagnosis. Of the 2275 biopsy reports analyzed, 194 cases (8.5%) were jaw cysts, including odontogenic (6.7%) and nonodontogenic cysts (0.25%). Odontogenic cysts included 69.3% radicular, 20.3% dentigerous, 5.2% keratinizing odontogenic, 3.3% residual, and 1.9% other cysts, such as lateral periodontal, botryoid odontogenic, and gingival cysts. The most frequent clinical manifestation was swelling, followed by a combination of pain and swelling. Age, gender, and location were related to the etiopathologic characteristics of the cyst type. A definitive diagnosis can be made on the basis of clinical, radiological, and histological findings, which makes a good interdepartmental relationship between the clinicians and pathologists essential. Knowledge of the biological and histological behavior of the odontogenic cysts is required for their early detection and treatment.

Prevalence and distribution of odontogenic and nonodontogenic cysts in a Turkish population

OBJECTIVE

To determine the relative frequency and distribution of odontogenic and nonodontogenic cysts in a large Turkish population.

STUDY DESIGN

A retrospective survey of jaw cysts was undertaken at the Oral Diagnosis and Radiology and Oral and Maxillofacial Surgery Department, Ondokuz Mayis University Dental School, Samsun, Turkey. Data were retrieved from clinical files, imaging, and histopathology reports from 2000 to 2008; a total of 12,350 patients were included. In each case, we analyzed age, gender, type and number of cysts, and cyst location. Imaging patterns and pathologies associated with cystic lesions were also determined.

RESULTS

The prevalence of odontogenic and nonodontogenic cysts was 3.51%; males were affected more frequently than females. There were 452 odontogenic cysts (98.5%) and seven nonodontogenic cysts (1.5%). The most frequent odontogenic cyst was radicular (54.7%), followed by dentigerous (26.6%), residual (13.7%), odontogenic keratocyst (3.3%), and lateral periodontal cyst (0.2%). Nasopalatine duct cyst (1.5%) was the only nonodontogenic cyst. By age, cysts peaked in the third decade (24.2%). Concerning location, no statistically significant difference was found between the maxilla and mandible (p>0.05). The most frequent radiological feature of these lesions was unilocular cyst (93.7%). Pathologies associated with cystic lesions occurred in 14.7%.

CONCLUSION

The prevalence of both odontogenic and nonodontogenic cysts were lower than that reported in many other studies. In our study population, cysts were mainly inflammatory in origin.

Histopathological Features of Keratocystic Odontogenic Tumor

The aim of this study was to describe the clinicopathologic features of 177 keratocystic odontogenic tumors (KCOTs) diagnosed in a Brazilian population. A total of 177 KCOTs were reviewed and affected 158 patients with ages ranging from 5 to 79 years (mean age = 32 years) with a slight female predominance. Mandible was the most common affected site (69.3%), and a unilocular radiolucency was the most common radiographic image. Microscopically, all cases showed at least focal areas of classic KCOT, but several histological aspects were also observed, including diffuse and focal epithelial lining hyperplasia (48.6%), epithelial budding (12.4%), reactive cytological alterations (11.3%), dystrophic calcification (7.9%), daughter cysts (7.8%), odontogenic epithelial remnants (4.5%), focal areas of orthokeratinization (2.8%), and ameloblastomatous epithelium (1.7%). These variations may make KCOT diagnosis challenging in some cases, so careful full-sample analysis and knowledge of these uncommon histological features associated with KCOT are essential for correct diagnosis.

Expansive nasopalatine duct cysts with nasal involvement mimicking apical lesions of endodontic origin: a report of two cases

INTRODUCTION

The nasopalatine duct cyst (NPDC) is the most frequent nonodontogenic cyst of the jaws and can be misinterpreted as an apical lesion of endodontic origin.

METHODS

In the first case, a 17-year-old male patient was referred because of a pressure sensation in the anterior maxilla. The teeth #7, #8, #10, and #11 responded to cold sensitivity testing, and on tooth #9 an endodontic treatment had been performed 3 years ago. Only periapical radiographs had been taken, and a radicular cyst was suspected. In the second case, a 42-year-old man reported inconvenience wearing his upper removable partial denture. Suspecting a jaw cyst in the anterior maxilla, the general dental practitioner referred the patient.

RESULTS

Limited cone-beam computed tomography scans visualized the expansion of the cysts and the involvement of the neighboring structures in both cases. In both patients, the NPDCs were treated first by marsupialization in local anesthesia and second with cystectomy in general anesthesia with reconstruction of the defect areas with bone gained from the iliac crest. The final diagnosis was achieved by histopathological examination.

CONCLUSIONS

If not diagnosed early, the NPDC can expand through the palatal and/or buccal cortical wall and also into the nasal cavity. The more expansive the NPDC is becoming, the more complex the final diagnosis is and the subsequent surgical therapy.

The nasopalatine duct cyst: an analysis of the relation between clinical symptoms, cyst dimensions, and involvement of neighboring anatomical structures using cone beam computed tomography

PURPOSE

This study evaluates the dimensions of nasopalatine duct cysts (NPDCs) and the involvement of neighboring anatomical structures using standardized limited cone beam computed tomography (CBCT) and a possible correlation to the patient's age, gender, preoperative symptoms, and postsurgical complications.

MATERIALS AND METHODS

The study included 25 patients with a confirmed histopathologic diagnosis of NPDC. Standardized measurements of NPDC dimensions were performed on sagittal, coronal, and axial CBCT sections. Maximas, minimas, mean, standard error of mean, and confidence intervals (95%) of all measurements were performed. The Kruskal-Wallis test was used to analyze group differences and to assess any association between measurements and preoperative symptoms or postoperative complications.

RESULTS

The patients' mean age was 49.5 years, and a male-to-female ratio of 2.1:1 was assessed. Mean cyst dimensions for men and for patients less than 50 years old tended to be higher, without statistical significance. The cyst dimensions had no statistically significant correlation to preoperative symptoms. Initial symptoms were present in all cases with a nasal defect, however. Most of the standardized cyst dimensions exhibited a statistically significant correlation to postoperative complications.

CONCLUSIONS

The presence or the absence of symptoms does not correlate with the dimensions of an NPDC. With progressive size of the cyst, the risk for minor postsurgical complications increases.

Keratocystic odontogenic tumour: systematic review

OBJECTIVES

The aim of this review is to evaluate the principal clinical and conventional radiographic features of non-syndromic keratocystic odontogenic tumour (KCOT) by systematic review (SR), and to compare the frequencies between four global groups.

METHODS

The databases searched were the PubMed interface of Medline and LILACS. Only those reports of KCOTs that occurred in a series of consecutive cases, in the reporting authors' caseload, were considered.

RESULTS

51 reports, of 49 series of cases, were included in the SR. 11 SR-included series were in languages other than English. KCOTs affected males more frequently and were three times more prevalent in the mandible. Although the mean age at first presentation was 37 years, the largest proportion of cases first presented in the third decade. The main symptom was swelling. Over a third were found incidentally. Nearly two-thirds displayed buccolingual expansion. Over a quarter of cases recurred. Only a quarter of all SR-included reported series of cases included details of at least one radiological feature. The East Asian global group presented significantly as well-defined, even corticated, multilocular radiolucencies with buccolingual expansion. The KCOTs affecting the Western global group significantly displayed an association with unerupted teeth.

CONCLUSIONS

Long-term follow-up of large series that would have revealed detailed radiographic description and long-term outcomes of non-syndromic KCOT was lacking.

Orthokeratinized odontogenic cyst: a systematic review

OBJECTIVES

The aims of the review were to evaluate the principal clinical and conventional radiographic features of orthokeratinized odontogenic cyst (OOC) by systematic review (SR), and to compare the frequency of OOC between four global groups.

METHODS

The databases searched were the PubMed interface of MEDLINE and LILACS. Only those reports of OOCs that occurred in a consecutive series of OOCs in the reporting authors' caseload were considered.

RESULTS

37 reports on 36 case series were included in the SR. OOC affected males twice as frequently and the mandible almost 2.5 times as frequently. Although the mean age at first presentation was 35 years, the largest proportion of cases first presented in the third decade for the Western, East Asian and Latin American global groups. Seven reports included details of at least one clinical finding. 11 reported case series included at least 1 radiological feature. All OOCs were radiolucent, 93% were unilocular and 68% were associated with unerupted teeth. 28% of the reported case series included follow up. 4% of OCC recurred and all of these were in the Western global group.

CONCLUSIONS

Although one feature of OOCs is that they are unlikely to recur, some do. Not only is there a lack of long-term follow up of large series with long-term outcomes of OOC, but there is a paucity of clinical and radiological details of OOC at initial presentation.