PRESENTED BY:

FASAHAT AHMED BUTT

CYST

OBJECTIVES

What is cyst?Types of cystsa. Clinical featuresb. Radiographic

findingsc. Histology Diagnosis Treatment

A cyst is a pathological fluid filled cavity lined by

epithelium.

CYST

TYPES OF CYSTS

Gingival cyst Periodontal cyst

GINGIVAL CYST LOCATION: Lingual surface of mandibular canine and premolars. COLOR: Bluish gray. APPEARANCE: Nodular and resembles mucocele CONTOURLocalized enlargement. PAINLESS ATTACHED or MARGINAL GINGIVA

ORIGINDevelop from odontogenic epithelium or from surface or sulcular epithelium

RADIOGRAPHIC FINDINGS

No radiographic findings because the usually involve the soft tissues

HISTOLOGY

Gingival cyst cavity is lined by a thin , flattened

epithelium with or without localized areas of thickening.

Types of epithelium Non keratinized stratified squamous epithelium Keratinized stratified squamous epithelium Parakeratinized epithelium with palisading basal cells

PERIODONTAL CYST(Lateral Periodontal Cyst)

Uncommon lesion.Localized destruction of periodontal tissues.Lateral root surface. LOCATION Mandibular canine-premolar area.ORIGINDerived from rests of Malassez.CONTOURLocalized enlargementASYMPTOMATICPAINFUL

RADIOGRAPHIC FINDINGS

Interproximal periodontal cyst appears on the side of the root as a radiolucent area bordered by a radiopaque line.

Periodontal abscess is difficult to differentiate from periodontal cyst, radiographically

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Cyst Abscess

Filled with fluid<1.5cmGingiva appears

bluish gray

Filled with puss 2-10cmGingiva appears

red

HISTOLOGY

Cystic lining may be a loosely arranged , thin, nonkeratinized epithelium, sometimes with thicker proliferating areas.

DIAGNOSIS

CLINICAL FINDINGSRADIOGRAPHBIOPSY

TREATMENT

Treatment is surgical excision and histopathologic examination for a conclusive diagnosis.

ENUCLEATIONMARSUPIALIZATIONCOMBINATION ENUCLEATION WITH CURETTAGE

ENUCLEATION

Enucleation means shelling out the entire cystic lesion without rupture.

INDICATION:Small cyst, which can be done when the vital

structures are not involved.

Local Anesthesia

Flap design is made

Incision made according to the

designTooth

extraction

Bur and forcep

Intraosseous window

Irrigation to clean the

cavity

Closure by suture (6-12

months)

MARSUPIALIZATIONMarsupialization refers to creating a surgical

window in the wall of the cyst, excavating the contents of the cyst and maintaining continuity between the cyst wall and the oral cavity.

This process decreases the pressure inside the cyst,

and promotes shrinkage of the cyst as well as bone fill.

INDICATIONS:If surgical access is difficultUnerupted tooth involved Small cyst

Prophylactic antibiotic

Anesthesia

Marsupialization

Others

Aspiration

Thin bone

Cavity

IncisionCircular or Eleptical

Large window

Thick bone Bur

SuturedPt instructed for cleansing

of cavity

Contents are evacuated

Irrigation via normal saline

COMBINATIONCombined approach morbidity and

complete healing of the defect. In this technique marsupialization is done

first and the enucleation is done at a later date.

The advantage is that as marsupialization is done first, it spares the vital structures. The size of the cystic cavity also becomes small and after healing the cystic lining becomes thick, making enucleation easier at this stage.

ENUCLEATION WITH CURETTAGE

After enucleation is done, a curette or bur is used to remove 1 to 2 millimeter of bone around the entire periphery of cystic cavity.

INDICATIONSFor cysts reported to have high recurrence rate, for

example odontogenic keratocyst

AdvantagesIf enucleation leaves any remnants, curettage may remove

them thereby decreasing the likelihood of recurrence.DisadvantageCurettage is more destructive to adjacent bone, blood

vessels and nerves therefore extreme care has to be taken to prevent this.

REFERRENCES

CARRANZAEOPGOOGLE