Radiological and Histological Correlation of Cysts of The Jaws Part - I
Radiological and Histological Correlation of Cysts of The Jaws Part - I
Radiological and Histological Correlation of Cysts of The Jaws Part - I
DR AARYA H NAIR
SIGNATURE OF FACULTY
CONTENTS
INTRODUCTION
ODONTOGENESIS
DEFINITION
TYPES OF CYSTS
PARTS OF A CYST
CLASSIFICATION OF CYSTS
TREATMENT
INTRODUCTION
The cysts of maxilla, mandible & perioral tissue comprise several entities and these entities
vary markedly in histogenesis, frequency, behaviour & treatment. The majority occur within
This is an area where radiology plays an important role in assisting with the diagnosis,
determining the size of the lesion and the relationship to adjacent structure.
Cysts occur more commonly in the jaws than in any other bone. Why cysts more commonly
ODONTOGENESIS
Odontogenesis is a highly co-ordinated and complex process which relies upon cell to cell
interaction that results in the initiation and generation of the tooth. The gross histological
processes are well documented, the mechanisms that are involved at a molecular level are
only now beginning to be elucidated due to the revolution in molecular biological techniques
During their early development, tooth germs exhibit many morphological and molecular
similarities with other developing epithelial appendages, such as hair follicles, mammary and
salivary glands, lungs, kidneys, etc. The developing tooth germ, which is an experimentally
accessible model for organogenesis, provides a powerful tool for elucidating the molecular
Initiation of tooth development occurs when the crown-rump length of the embryo is between
13 and 14mm or about 6.5 weeks of gestation. The primary epithelial band forms a
continuous horseshoe shaped sheet of epithelium around the lateral margins of the developing
oral cavity and correspond in position to future dental arches. The formation of these
thickened epithelial bands are a result of not so much of increased proliferative activity
within the epithelium as of change in the orientation of the mitotic spindle and the cleavage
The free margin of this band gives rise to two processes, the vestibular lamina and the dental
lamina, which invaginate into the underlying mesenchyme. The outer process, the vestibular
lamina, will form the vestibule that demarcates the cheeks and lips from the tooth bearing
regions. The inner process is the dental lamina and it is from this ental lamina the tooth buds
form. The vestibule forms as a result of the proliferation of the vestibular lamina into the
ectomesenchyme. Its cells rapidly enlarge and degenerate to form a cleft that becomes the
positions of the future deciduous teeth. At this time the mitotic index, the labeling index and
the growth of the epithelium are significantly lower than corresponding indexes in the
From this point, tooth development proceeds in three stages: the bud, cap and bell.
important function in developing teeth, as well as in all other organs forming as ectodermal
appendages.
At certain points along the dental lamina, each representing the location of one of the 10
mandibular and 10 maxillary deciduous teeth, the ectodermal cells multiply still more rapidly
and form little knobs that grow into the underlying mesenchyme. Each of these down growth
from the dental lamina represents the beginning of the enamel organ of the tooth bud of a
deciduous tooth. Not all of these enamel organs start to develop at the same time, and the first
ectomesenchyme (dental papilla) and due to differential growth changes its shape. As it
develops it takes on the shape that resembles a cap, with the outer convex surface facing the
The shape of the enamel organ continues to change. The depression occupied by the dental
papilla deepens until the enamel organ assumes a shape resembling a bell. As the
development takes place the dental lamina, which had thus far connected the enamel organ to
the oral epithelium, becomes longer and thinner and finally breaks up and the tooth bud loses
Parent dental laminae: In the seventh week of development, tooth anlagen for 20 primary
teeth are formed by the dental lamina. This lamina also provides tooth germs for the
permanent teeth which have no primary predecessors. Because of this, the dental laminae
providing for the formation of the first, second, and third permanent molars may be referred
to as the parent dental laminae or the laminae for permanent molars. The mechanism
involved is simply one of continued distal growth. That is, the distal ends of the dental
laminae for each arch, after having established the tooth germs for the primary molars,
continues to grow posteriorly. These segments of the dental laminae elongate progressively,
The second stage of odontogenesis is called the bud stage and occurs at the beginning of the
eighth week of prenatal development for primary dentition. This stage is named for an
extensive proliferation, or growth, of dental lamina into buds or oval masses penetrating onto
the ectomesenchyme. At the ends of the proliferation process involving the primary
dentition’s dental lamina, both the future maxillary arch and the future mandibular arch will
the core, the cell components are morphologically and cytologically similar. Cell surfacing
the bud and hence the mesenchyme are low columnar or cuboidal in shape. While the basal
lamina over most of the bud conforms faithfully to the contour of the cell bases, such is not
the case for the cells on the superior surface. The core cells range in shape from round to
The third stage of odontogenesis is called the cap stage and occurs for the primary dentition
between the ninth and tenth week of prenatal development. The physiologic process of
proliferation continues during this stage, but the tooth bud of the dental lamina does not grow
different parts of the tooth bud, leading to the formation of a cap shape attached to the dental
lamina.
The fourth stage of odontogenesis is the bell stage. which occurs for the primary dentition
However, differentiation on all levels occurs to its furthest extent, and as a result, four
different types of cells are now found within the enamel organ. These cell types form layers
and include the inner enamel epithelium, the outer enamel epithelium, the stellate reticulum,
and stratum intermedium. Thus the cap shape of enamel organ evident in the last stage
cells that will be making the hard tissues of the crown (ameloblast and odontoblasts) acquire
their distinctive phenotype (histodifferentiation). Cysts will develop in these and prevent
eruption of teeth.
Root development is initiated through the contributions of the cells originating from the
enamel organ, dental papilla and dental follicle. The cells of the outer enamel epithelium and
inner enamel epithelium contact at the base of the enamel organ, the cervical loop. Later as
the crown is completed the cells of the cervical loop continue to grow away from the crown
and become the root sheath cells. The inner root sheath cells cause root formation by
inducing the cells of the dental papilla to form odontoblasts, which in turn will form root
dentin. The root sheath will dictate whether the root will be single or multiple. The remainder
of the cells of the dental papilla will form the pulp. The cells of the dental follicle form the
supporting structures of the teeth, the cementum and the periodontal ligament.
A. Bud Stage B. Cap Stage C. Bell Stage D and E. Dentinogenesis and amelogenesis
“A pathological cavity having fluid, semifluid or gaseous contents and which is not created
by the accumulation of pus. Most cysts, but not all, are lined by the epithelium.” ---------------
-----[KRAMER,1974]
The British Standards Institution' defines a cyst as 'an abnormal cavity within a tissue, the
contents of which may be fluid or semi-fluid, but not pus, at least at the onset', and
conventionally the benign cystic lesions occurring in the jaws are subdivided into
“A cavity occurring in either hard or soft tissue with a liquid, semiliquid or air content. It is
surrounded by a definite connective tissue wall or capsule and usually has an epithelial
“An abnormal cavity in hard or soft tissues which contains fluid, semi - fluid or gas and is
Odontogenic cysts are defined as “those cysts that arise from odontogenic epithelium and
occur in the tooth-bearing regions of the jaws. It is usually considered that proliferation
and/or degeneration of this epithelium leads to odontogenic cyst development. Cystic jaw
TRUE CYSTS: Those cysts that are lined by the epithelium. Eg: Dentigerous cysts,
Radicular cysts,etc
PSEUDO CYSTS: Those cysts that are not lined by an epithelium. Eg: Solitary bone cyst,
PARTS OF A CYST
PATHOGENESIS
(1)CYST INITIATION
CYST INITIATION : proliferation of the epithelial cells and the formation of a small
cavity
Origin of odontogenic cysts: can occur from either of these cells namely;
Mural growth:
Hydrostatic enlargement:
Secretion
MURAL GROWTH
an irritant stimulus. Cyst regression occurs following the removal of such stimulus
cause cyst to enlarge. For eg: Keratocyst enlarges by the mural squames, which are produced
HYDROSTATIC ENLARGEMENT
SECRETIONS
Mucus secreting cyst are formed by the lining (goblet cells) which secrete mucus. The
within the cystic lumen, there is increased osmolarity and raised internal hydrostatic pressure.
It attracts fluid into the cavity and helps in the retention of fluid within the cavity.
Toller et al. had suggested that the increase in the osmotic pressure is related to proteins
present in the cyst fluid such as large molecules of albumin, globulin, fibrinogen. The
desquamated epithelial cells of cyst lining undergo autolysis and produce a larger number of
The lining acts as a semipermeable membrane and the attracted fluid are unable to diffuse out
of the cavity. The products of epithelial autolysis could affect both osmotic attraction and
BONE RESORPTION
Increased internal pressure is transmitted to the adjacent bone and the bone undergoes
resorption thereby causing the bone cavity to be enlarged. The surface area of cyst lining is
increased by cell multiplication. The epithelial cells divide – cyst enlarges within bony cavity
by the release of bone resorbing factors from the capsule. They also stimulate osteoclast
ODONTOGENIC
3.DENTIGEROUS CYST
4.ERUPTION CYST
NON-ODONTOGENIC
3.NASOLABIAL CYST
INFLAMMATORY
RADICULAR CYST
RESIDUAL CYST
PARADENTAL CYST
PERIODONTAL CYST
RADICULAR TYPE
LATERAL TYPE
RESIDUAL TYPE
DENTIGEROUS CYST
PRIMORDIAL CYST
MEDIAN CYST
GLOBULOMAXILLARY CYST
SEWARDI CLASSIFICATION
NON-ODONTOGENIC EPITHELIUM
MAXILLARY
NASOPALATINE
MEDIAN PALATINE
NASOLABIAL
MANDIBULAR
ODONTOGENIC EPITHELIUM
CYSTIC NEOPLASM
BONE CYST
DENTIGEROUS CYST
“FOLLICULAR / PERICORONAL”
It is the second most common type of odontogenic cyst. Dentigerous cyst were first described
in France in 1778 but was not delineated until 1842 when Harris C.A published a case report
either between the reduced enamel epithelium and the enamel, or within the enamel organ
itself or dental lamina. i.e. Degeneration of stellate reticulum at an early stage of development
– associated usually with enamel hypoplasia. Or it may develop after completion of the
crown by accumulation of fluid between the layers of the reduced enamel epithelium. Or
epithelium to crown. Provides starting point for the development of the cyst. Crown of
permanent tooth may erupt into a radicular cyst of it’s deciduous predecessor – exceptionally
rare – tooth may indent rather than penetrate the wall. Inflammation at the apex of the
deciduous tooth can lead to the development of an inflammatory follicular cyst – Benn (1991)
PATHOGENESIS
Inflammatory:
permanent tooth due to periapical inflammation from an overlying primary tooth. Eg:
Partially erupted mandibular third molar is usually associated with inflamed cyst like lesion
Intrafollicular-
It is formed by the fluid accumulation between the reduced enamel epithelium and the
enamel, or within the enamel organ itself or dental lamina. Later, it is characterized by the
Extrafollicular:
enamel epithelium to crown and provides starting point for the development of the cyst.
Crown of permanent tooth may erupt into a radicular cyst of it’s deciduous predecessor and
in exceptionally rare cases, the tooth may indent rather than penetrate the wall. Inflammation
at the apex of the deciduous tooth can lead to the development of an inflammatory
dentigerous cyst.
The pathogenic mechanism is as follows:
Potentially – erupting tooth exerts pressure over impacted follicle → obstructs Venous out
flow → Breakdown of proliferating cells of follicle → Rapid transduction of serum across the
from the crown with or without reduced enamel epithelium – with time →Altered capillary
Dentigerous cyst
Bilateral dentigerous cysts are associated with BASAL CELL NEVUS SYNDROME
RADIOLOGICAL FEATURES
o Attached to CEJ
o Well-defined
INTERNAL STRUCTURE:
o Apical/ramus
o Expansion of cortex
a)Central
b)Lateral
c)Circumferential
According to Mourshed:
Class I: associated with completely unerupted teeth which fail to erupt due to lack of space in
CT and CBCT – help in determinining the relationship of the unerupted tooth with the cyst to
the mandibular canal and maxillary sinus prior to surgery, to assess cyst contents and also the
MRI EVALUATION
Classically T1 hypointense and T2 hyperintense with an enhancing rim can be seen. Presence
BONE SCAN
Bone scan may show a central photon defect with surrounding peripheral rim uptake of
mandibular cyst.
HISTOPATHOLOGICAL FEATURES
Non-inflamed : Will show a loosely arranged fibrous connective tissue wall. The epithelial
lining-two to four layers of Stratified squamous epithelium. The epithelium and CT interface
is flat. Small islands or cords of inactive – appearing scattered odotnogenic epithelial rests –
Inflamed : Epithelial lining wlli be thicker with rete pegs. The connective tissue wall will be
more densely collagenized. Focal mucin producing cells (Mucous cells) may be seen. It may
show evidence of ciliated epithelial cells, sebaceous cells,etc. Mucous, Ciliated and
Sebaceous contents are responsible for the multipotentiality of the odontogenic epithelial
lining.
CORRELATION
RADIOLOGICALLY HISTOLOGICALLY
of impacted tooth
INFLAMMATORY:
DIFFERENTIAL DIAGNOSIS :
• HYPERPLASTIC FOLLICLE
• AOT
• ODONTOGENIC KERATOCYST
• AMELOBLASTIC FIBROMA
• UNICYSTIC AMELOBLASTOMA
TREATMENT
Larger lesions: Marsupialization with decompression by placing a small acrylic button in the
COMPLICATIONS
Mucoepidermoid carcinoma
ERUPTION CYST(ERUPTION HEMATOMA)
Eruption cyst is characterized by the presence of a bluish dome-shaped swelling over the
unerupted tooth. The associated tooth is impeded within the soft tissues overlying the bone.
The etiology is not clear. Aguilo et al., has suggested the possible factors to be:
o Early caries
o Trauma
o Infection
Sometimes associated with expansion of normal follicular space of the erupting tooth crown.
It may appear as saucer-shaped excavation of bone projecting very slightly into the cavity
Differential diagnosis
o Granuloma
o Amalgam tattoo
o Bohns nodule
HISTOPATHOLOGY
It is characterized by the presence of surface oral epithelium on the superior aspect. The
underlying lamina propria consists of variable inflammatory cell infiltrate and the deep
portion which forms the roof of the cyst shows thin layer of non- keratinizing squamous
epithelium.
CORRELATION
Advanced modalities are usually not indicated since the lesion is self-limiting.
MANAGEMENT
Mostly do not require treatment. Surgical intervention - when they hurt, bleed, are infected,
or esthetic problems arise. Simple excision of the roof of the cyst generally permits speedy
eruption of the tooth. Er, Cr-YSGG laser for treatment of eruption cysts : doesnot require
anesthesia, no excessive operative bleeding, does not produce heat or friction, comfortable,
bactericidal and has coagulative effects, and the tissue healing is better and faster, and not
ODONTOGENIC KERATOCYST
DEFINITION:
A cyst derived from the remnants of the dental lamina, with a biologic behavior similar to a
benign neoplasm ,with a distinctive lining of six to ten cells in thickness, and that exhibits a
The terminology Odontogenic Keratocyst was first suggested by PHILIPSEN(1956) and the
This cysts arises from the dental lamina. Unlike other cysts which are thought to grow solely
from osmotic pressure, the epithelium in OKC appears to have an innate growth potential
similar to a benign tumor. This difference in growth mechanism gives OKC a different
radiographic appearance.
WHO 2005 classification. Again the terminology has been reverted to Odontogenic
The epithelial lining is distinctive because it is keratinized and thin. In some cases , bud like
proliferation from the basal cell layerinto adjacent connective tissue wall or proliferation of
islands of odontogenic epithelium that may be present in the wall giving rise to satellite
microcysts which support the fact that OKCs have a high recurrence rate.
CLINICAL FEATURES:
Gorlin-Goltz syndrome
Marfan syndrome
Noonan’s syndrome
RADIOGRAPHIC FEATURES
LOCATION: Posterior body mandible & ramus. The epicentre is usually superior to
PERIPHERY & SHAPE: Usually it has a cortical border. If infected, the cortical
border may be absent. It usually has a smooth round or oval shape and a scalloped
outline.
presence of the internal keratin usually doesnot increase radiopacity. It usually has a
internal aspect and causes minimal expansion. Sometimes may cause expansion of the
ramus & coronoid process. It may displace & resorb teeth but to a lesser extent than
dentigerous cyst. It may displace Inferior alveolar canal. When associated with
RADIOLOGICAL TYPES:
Characteristic of OKCs:
2) Expansion, especially toward the lingual (medial) side, and growth along the length of
syndrome
CT EVALUATION
CT provides additional information about the contents of the lesion. Presence of a high
attenuation may suggest high protein concentration in the dense keratin filling the lumen.
Other possibilities could include hemorrhage or Calcification. With a vascular lesion, a
nonenhanced CT scan. High attenuation within an expansile benign lesion of the mandible on
nonenhanced CT scans, with no enhancement after contrast material injection, can indicate an
OKC. High attenuation suggests the presence of a dense proteinacious material such as
keratin.
MRI EVALUATION
OKC typically has low to intermediate signal intensity on T1-weighted images. High signal
intensity on T2-weighted images. Weak enhancement of rim can be seen, caused by fluid
T1-weighted images while homogenous signal intensity in other odontogenic cysts can be
seen.
DIFFERENTIAL DIAGNOSIS:
Dentigerous cyst: in OKC, the cyst is connected to the tooth at a point apical to the
CEJ.
Ameloblastoma: usually seen in the older age group, usually multilocular, causes
Traumatic cyst: unilocular with scalloped margins, rarely shows cortical expansion, if
it does occur, then buccal only, positive history of trauma. Needle aspiration is usually
serosanguinous fluid.
Giant cell granuloma: usually found in the anterior region of the jaw.
Odontogenic myxoma: usually rare, may be considered if the tooth has failed to
OKC has a thin friable wall with cystic lumen containing clear liquid similar to transudate of
serm or cheesy material with keratinaceous debris. The thin fibrous wall is devoid of
thickness. The epithelium – connective tissue interface is usually flat and rete ridge formation
is inconspicuous, so detachment can be seen commonly. The basal cell layer has cuboidal /
columnar cells with reversly polarized nuclei giving a picket fence /tombstone appearance.
be seen in the connective tissue. The basal epithelial layer will be palisaded cuboidal /
columnar epithelium with a hyperchromatic nuclei. Rarely, cartilage can be seen within the
lesion. The presence of inflammation may alter the typical features such that the
parakeratinized luminal surface may disappear and the epithelium proliferate to form rete
RADIOLOGICAL HISTOLOGICAL
of odontogenic cysts
TREATMENT:
Some practitioners leave this bone in place, whereas others remove it with a drill to get down
solution is neurotoxic and chemically fixes the inferior alveolar or lingual nerves if it comes
in contact with them for up to 2 minutes. The nerve should therefore be protected; bone wax
can be used for protection of the inferior alveolar nerve. The other issue with Carnoy
COMPLICATIONS IN OKC
Recurrence(With simple enucleation, it seems that the recurrence rate may be from 25% to
60%)
New cysts may develop from basal cells of overlying epithelium, especially in ramus-
This entity was first reported by Wright in 1981. Thin layer of luminal orthokeratin ( without
RADIOLOGY
o Expansion – 5% cases
The cyst lining consists of stratified squamous epithelium with orthokeratotic surface of
varying thickness. Keratohyaline granules may be present in the superficial epithelial layer.
The epithelial lining is relatively thin and the prominent palisaded basal layer will be absent.
Definition:
It is an uncommon cyst occurring either on a free or attached gingival margin, from the
degenerative changes in the epithelium or from the remnants of dental lamina, enamel organ
Origin:
RADIOGRAPHIC FINDINGS:
No radiological changes
Sometimes a faint round shadow which is indicative of superficial bone erosion with
HISTOPATHOLOGY
The histopathological appearance is similar to lateral periodontal cyst. The epithelium will be
The gingival cyst is removed by local surgical excision and in the majority of cases there is
no tendency for recurrence. However, caution must be observed if the pathologist reports a
multicystic or botryoid variety of cyst. This may signal that one is dealing with a lateral
The designation ‘lateral periodontal cyst’ is confined to those cysts that occur in the lateral
OKC have been excluded on clinical and histological grounds (Shear and Pindborg, 1975).
The first five well-documented cases were reported by Standish and Shafer (1958).
CLINICAL FEATURES:
It is asymptomatic and less than 1cm in diameter occurs chiefly in adults between the age of
22 to 85 years. It shows a male predilection. The Site commonly involved is the lateral PDL
SIGNS & SYMPTOMS: Usually asymptomatic as it occurs on the lateral aspect of the root
of the tooth. When observed on the labial surface it appears as a slight onvious mass. It
appears as a dome-shaped fluctuant swelling of the interdental papilla. If the cyst becomes
infected, it resembles a periodontal abscess. The associated teeth are vital. Cysts are usually
less than 1cm in size,except for BOTYROID variety which is larger and also a multilocular
type.
RADIOLOGICAL APPEARANCE OF LATERAL PERIODONTAL CYST
RADIOGRAPHIC FEATURES OF BOTYROID CYST
One of the locules occupies the same location as the LPC. With respect to the teeth present,
the lesion cause resorption of the lamina dura in areas where it extends to the roots of
adjacent teeth. It usually appears high on the alveolar crest. When the lesion extends beyond
apical region, this extension appears to be limited to approx. 1cm. The periphery of locules
shows continuous cortication with well-defined, intact borders and the internal loculations are
mostly absent, with scalloped outline. When present, loculations are circular & well –
HISTOLOGICAL FEATURES
The epithelium is lined by a thin,non inflamed, fibrous wall with layer of stratified squamous
or cuboidal epithelium-1-5 layers wide. The cells consist of flattened squamous cells,
sometimes cuboidal. Foci of glycogen-rich clear cells among epithelial lining are present.
Also presence of localized plaque /thickenings of the epithelial lining are characteristic.
CORRELATION
RADIOGRAPHICALLY HISTOLOGICALLY
DIFFERENTIAL DIAGNOSIS
Lateral radicular cyst – associated with a non-vital tooth, pulpal infection and a discontinuous
lamina dura.
Primordial cyst – more common in the younger age. If the primordial cyst arising from a
supernumerary tooth is superimposed on the adjacent tooth surface, then it may be considered
in differential diagnosis.
MANAGEMENT:
Provided that the lesion is unilocular on radiological examination, the lateral periodontal cyst
associated tooth, but this may not always be possible.It is not yet clear from the literature
whether the encapsulated multicystic lateral periodontal cyst has the same tendency to recur
following simple enucleation. Eight of 10 recurrent cases reported by Greer and Johnson
This is an unusual lesion with features suggestive of a cyst and characteristics of a solid
It has many features of odontogenic tumor, hence placed in the category of benign tumors
the WHO 2005 classification. It usually arises centrally within the bone, but it may occur
‘A cystic lesion in which the epithelial lining shows a well-defined basal layer of columnar
cells, an overlying layer that is often many cells thick and that may resemble stellate
reticulum, and masses of “ghost” epithelial cell that may be in in the epithelial lining or in the
fibrous capsule. The “ghost” epithelial cells may become calcified. Dysplastic dentine may be
laid down adjacent to the basal layer of the epithelium, and in some instances the cyst is
associated with an area of more extensive dental hard tissue formation resembling that of a
BY REICHART
2) Neoplastic variant
1) Benign type
1) Cystic subtype
2) Solid subtype
2) Malignant type
1) Cystic
2) Solid
CLINICAL FEATURES
Age: affects a wide age range that peaks at 10-19 years, with mean age of 36 years and the
Site: 3/4th lesion occurs centrally, 75% occurring anterior to the first molar. It is equally
It is a slow growing, painless, non-tender swelling, which may cause expansion and/or
destruction of the cortical plates. The cystic mass may become palpable and discharging.
It may be associated with an odontoma, and may have calcified material identified as
The pathogenesis of calcifying odontogenic cyst is a unicystic process and develops from the
REE or remnants of dental lamina. The cyst lining has the potential to induce the formation
is considerably complicated by the fact that the epithelial lining of a calcifying odontogenic
cyst appears to have the ability to induce the formation of dental tissues in the adjacent
connective tissue wall; and that other odontogenic tumours such as the ameloblastoma, the
sometimes be associated with it. Prætorius believes that the dentinogenic ghost cell tumour is
a neoplasm de novo, but the COC plus benign neoplasm or hamartoma is a cyst from the
beginning.
RADIOGRAPHIC FEATURES
The central lesion may appear as a cyst like radiolucency with variable margins which may
be smooth well defined or irregular in shape with poorly defined borders. It may be
unilocular or multilocular. The expanded bone appears perforated. Inspite of these features,
tooth
Additional imaging:
The desquamated keratin creates an increased attenuation area in a cyst. By varying the
window setting, both keratin and calcifications can be identified on the CT. By widening the
window settings, desquamated keratin with a CT value of 100-200 HU becomes less distinct
due to less of soft tissue details, whereas calcifications with HU value of 800-1600 HU
The epithelial lining thin usually about 6-8 cell thick; and may be thickened in other areas. It
may show characteristic odontogenic features with reversely polarized basal layer. Typically
GHOST CELLS may be seen in thicker areas of lining. The ghost cells are enlarged,
ballooned, ovoid or elongated elliptoid epithelial cells. They are eosinophilic and although
the cell outlines are usually well-defined, they may sometimes be blurred so that groups of
them appear fused. A few ghost cells may contain nuclear remnants but these are in various
stages of degeneration and in the majority all traces of chromatin have disappeared leaving
only a faint outline of the original nucleus. The ghost cells represent an abnormal type of
keratinisation and have an affinity for calcification. They have the same histological reactions
An atubular dentinoid is often found in the wall close to the epithelial lining and often in
relation to the epithelial proliferations. Sometimes many cells may fuse which represent
MANAGEMENT:
The COC is treated by surgical enucleation unless it is associated with another odontogenic
tumour, in which case wider excision may be required. In the presence of a complex
variants with foci of ghost cells must be treated as would be an ameloblastoma without ghost
cells. Although classic uncomplicated cases of COCs may grow to a large size, reported
CORRELATIVE FINDINGS
RADIOLOGY PATHOLOGY
Small foci of calcified material - white flecks Tubular dentine / odontome - connective
Thus the knowledge of odontogenic cysts are required for accurate diagnosis and
management. Also the correlation between the radiological and histopathological entities will
help in diagnosing these lesions more effectively in the clinics. Also, the classification of
odontogenic cysts has been widely debated and there has been much debate and controversy
about the true nature of some of the lesions. Although cysts are common in the jaws, most are
radicular cysts of inflammatory origin or simple dentigerous cysts. Others are less frequently
encountered and may present diagnostic difficulties because of their varied features. The
neoplasms, but this was controversial and was not based on sound evidence. For the latest
WHO classification (2017), an international consensus group reappraised these lesions and
:2013
premolars as a result of Dentigerous cyst: A case report. J Indian Soc Pedod Prev
report
odontogenic cysts. British Journal of Oral and Maxillofacial Surgery 53 (2015) 217–
222
• Tanushri et al. All About Dentigerous Cyst- A Review Article. International Journal