Jaw Cysts Research Articles

A Study on Sequale of Development and Clinical Features of Radicular Cyst

Radicular cysts are the most common cystic lesions affecting the jaws. They are most commonly found at the apices of the involved teeth, however they may also be found on the lateral aspects of the roots in relation to lateral accessory root canals. Quite often a radicular cyst remains behind in the jaws after removal of the offending tooth and this is referred to as a residual cyst. Radicular cysts are the most common of all jaw cysts and comprise about 52% to 68% of all the cysts affecting the human jaws.

Сучасні хірургічні методи лікування одонтогенних кіст щелеп (огляд літератури та власні дані)

The purpose of the study was to analyze the data of modern domestic and foreign professional literature, which are devoted to new surgical methods of treatment of odontogenic cysts, to highlight the results of own clinical studies on the effectiveness of developed methods of cystectomy in jaw bones and their anesthesia. Materials and methods. Analytical and bibliosemantic methods were used in the research. The search for scientific information on medical topics for the period from 2010 to 2021 was carried out in the databases of electronic searching systems. Results and discussion. The use of standard techniques of conduction anesthesia of the trigeminal nerve is not always effective during cystectomy in the lateral parts of the mandible, due to the variability of branching of the trigeminal nerve, the possibility of additional innervation of the jaw branch from the superficial cervical plexus. Taking into account these anatomical factors, it is painless to perform a cystectomy of odontogenic cysts on the mandible. During oronasal cystectomy of odontogenic cysts that have grown into the nasal cavity it is advisable to block the nasopalatine nerve in the middle nasal passage. Modified methods of marsupialization can be used as an independent method of treatment of odontogenic cysts of large size, or be combined with radical removal of the cyst membrane. The use of ultrasound medical techniques reduces the risk of damage to adjacent soft tissues during enucleation of bone membranes in complex topographic and anatomical areas. The use of modern laser technologies and medical radiophysical equipment can increase the effectiveness of surgical treatment of odontogenic jaw cysts. The use of endovideosurgery techniques reduces the percentage of intraoperative complications. The introduction of computer spatial imaging of anatomical objects in dental practice has made it possible to develop new surgical technologies for precision-guided osteotomy and resection of the tips of the roots of masticatory teeth adjacent to the shells of radicular jaw cysts. Conclusion. In modern clinical practice, technical developments are used, which are based on the latest advances in laser optics, radio physics, bioacoustics, computer technology, which minimizes injuries during cystectomy operations, reduces the frequency of intraoperative complications. Individual-anatomical features of innervation of the maxillofacial area should be taken into account during local anesthesia, cystectomy and cystotomy operations in the jaw bones

SURGICAL MANAGEMENT OF AMELOBLASTOMA OF ANTERIOR MANDIBLE- A CASE REPORT

Ameloblastoma is a benign, locally aggressive neoplasm arising from ameloblasts that typically occurs at the mandibular angle and is frequently associated with an un-erupted tooth. Ameloblastoma is estimated to account for 1-3 percent of all jaw tumours and cysts. The tumour is far more common in the mandible than in the maxilla, and it preferentially affects different parts of the mandible in different racial groups. The relative frequency of the mandible to the maxilla has been reported to range from 80-20% to 99-15%. We are presenting a case of ameloblastoma of the anterior mandible, which was thought to be a rare site of occurrence which was surgically treated successfully.

OPTIMIZATION OF SURGICAL INTERVENTION METHODS IN THE TREATMENT OF ODONTOGENIC CYSTS OF THE UPPER JAW

Abstract: The therapy of odontogenic cysts of the upper and lower jaws, both conservative and operative, is of a complex nature – the frequency of this disease, according to the data, does not decrease. A number of researchers believe that the risk of inflammatory complications in odontogenic cysts is very high. The result of the injection of an odontogenic cyst of the upper jaw can be the occurrence of acute osteomyelitis with the development of a fistula and the outflow of purulent discharge into the maxillary sinus, which can later lead to the development of chronic odontogenic sinusitis. Studies of pus and granulations and analysis of the results obtained in most cases indicate a mixed microflora (staphylococcus, streptococcus, proteus, etc.). Also, when analyzing the literature, it was noted that the surgical treatment of odontogenic cysts localized on the upper jaw, as well as the use of osteoplastic materials for filling bone defects is very ambiguous and contradictory. The authors justify this fact by the fact that there is a high risk of relapses, in particular, after cystectomy, the probability of relapse is at least 17.8%. The usual scenario for conducting such nosologies is radical excision of odontogenic cysts of the jaws, after which a long time is needed to restore the bone defect, as well as adequate subsequent prosthetics. Based on these data, modern authors develop low-traumatic, sparing methods of surgical treatment of odontogenic cysts, especially of the upper jaw, including using endoscopic techniques. Based on the above, an urgent task for dental surgeons is to optimize the methods of surgical treatment of odontogenic cysts of the upper jaw, in particular with a decrease in the volume of the operating field.

The Radicular Cyst in a Child: Case Report

The most commonly occurring odontogenic cysts of the jaws are radicular cysts.
 Causes of jaw cysts are different, numerous and depend on the type of cyst. The basic precondition for the occurrence of a cystic lesion is the previous presence of epithelial tissue at the site of future development of the cystic formation.
 Radicular cysts are one of the most common odontogenic cysts and arise from epithelial so-called Malassez - these residues in the periodontal tissue, as a consequence of inflammation of the pulp. They can occur at any age, and are equally prevalent in both sexes. The aim of this paper is to present the clinical symptoms and treatment of a radicular cyst in a 12-year-old child.
 The treatment of radicular cysts in most cases is surgical. The possibilities for such treatment and the choice of surgical method depend on the size of the cyst, its location, and the pathological formation.
 
 The present article reported a case of a 12-year-old male with the chief complaint of pain on the right lower back tooth region. The radiographic examination revealed the presence of a well-defined radiolucency surrounded by a corticated border between mandibular central incisive. The case was managed by complete enucleation under local anesthesia without extraction of any teeth.
 We chose enucleation (cystectomy) as a surgical procedure as the method of choice, because postoperative complications are the rarest, and the best healing is also provided. Аfter one month of surgery treatment, complete wound healing was recorded at the clinical control at the Department for oral surgery.

Deep Learning-Based Microscopic Diagnosis of Odontogenic Keratocysts and Non-Keratocysts in Haematoxylin and Eosin-Stained Incisional Biopsies.

Background: The goal of the study was to create a histopathology image classification automation system that could identify odontogenic keratocysts in hematoxylin and eosin-stained jaw cyst sections. Methods: From 54 odontogenic keratocysts, 23 dentigerous cysts, and 20 radicular cysts, about 2657 microscopic pictures with 400× magnification were obtained. The images were annotated by a pathologist and categorized into epithelium, cystic lumen, and stroma of keratocysts and non-keratocysts. Preprocessing was performed in two steps; the first is data augmentation, as the Deep Learning techniques (DLT) improve their performance with increased data size. Secondly, the epithelial region was selected as the region of interest. Results: Four experiments were conducted using the DLT. In the first, a pre-trained VGG16 was employed to classify after-image augmentation. In the second, DenseNet-169 was implemented for image classification on the augmented images. In the third, DenseNet-169 was trained on the two-step preprocessed images. In the last experiment, two and three results were averaged to obtain an accuracy of 93% on OKC and non-OKC images. Conclusions: The proposed algorithm may fit into the automation system of OKC and non-OKC diagnosis. Utmost care was taken in the manual process of image acquisition (minimum 28–30 images/slide at 40× magnification covering the entire stretch of epithelium and stromal component). Further, there is scope to improve the accuracy rate and make it human bias free by using a whole slide imaging scanner for image acquisition from slides.

Multiple Lesions With Recurrent Bleeding.

A 63-year-old man with frontal bossing and a history of jaw cysts presented with numerous lesions on the scalp, trunk, and legs with recurrent bleeding. Both of his siblings had similar findings. Many lesions had been present for at least 40 years.

CBCT report of three intresting cases of cysts and its radiographic presentations

Accurate diagnosis with imaging and treatment planning are key in the execution of any surgical procedure.Panoramic radiography has been routinely used in dentistry to assist in clinical diagnosis, treatment procedure but it has limitations such as overlapping of anatomical areas which are of interest in the diagnosis. The invention of computed tomography (CT) had revolutionized the digital imaging though their limitations like 2-dimensional imaging features such as distortion, magnification, and superimposition were present. Cone beam computed tomography (CBCT) is rapidly gaining Interest in the medical fraternity. it was designed with the aim to offset some of the limitations of panoramic and CT imaging .CBCT ever since its inception, it had been routinely used in dentistry for its numerous advantages such as 3-dimensional and multi-planar views. Linear, Curved and angular measurements could be performed along with area and volume calculation and density. All with less radiation exposure compared to conventional computed tomography (CT) scans. In this case series three cases of jaw cysts have been presented with varied radiographic features and the role of CBCT in these cases flooding us with enormous radiographic informations which paved the way for precise surgical management.

1537 Squamous Cell Carcinoma Arising in A Maxillary Odontogenic Keratocyst in Gorlin Goltz Syndrome - A Rare Case Report

Abstract Introduction Gorlin Goltz syndrome (GGS) is a rare, hereditary, AD condition with multiple BCCs, odontogenic keratocysts (Jaw cysts), calcification of falx cerebri, skeletal anomalies & a predisposition to neoplasms like medulloblastomas, fibromas and rhabdomyosarcomas. Aim We present a rare case of a Squamous cell carcinoma (SCC) developing in a Maxillary odontogenic keratocyst in a 32-year male with GGS. Discussion This patient was referred to the OMFS unit with a non-healing UL3 extraction socket and exophytic growth. Initial biopsies suggested an atypical squamo-proliferative lesion, however a repeat biopsy demonstrated an invasive SCC arising from a background odontogenic keratocyst of the maxilla. He was initially reluctant to undergo a staging CT scan to avoid risks of developing further BCCs due to IR exposure. This was eventually performed as per H&N MDT recommendation & showed a T4aN0M0 SCC of the left maxilla and bilateral multiple mandibular odontogenic keratocysts. He underwent a left maxillectomy, left neck dissection & reconstruction with a DCIA free flap, but did not want his mandibular keratocysts treated at the same time. Complete tumour clearance was achieved with no involved neck nodes & he remains disease-free at 4 months postoperatively. Although for a T4 tumour he would have needed postoperative radiotherapy, in view of the GGS, no adjuvant treatment was indicated. Conclusions SCC developing in a maxillary OKC is exceedingly rare with only two previous cases reported in GG syndrome. This is the first reported case of a GGS patient with oral SCC undergoing a complex free flap reconstruction.

Unicystic Ameloblastoma of Mandible: A Case Report

Amelo blastoma is a neoplasm that originates from odontogenic epithelium. It is the second most common neoplasm of the oral cavity. Uni cystic ameloblastomas refer to those cystic lesions that show clinical, radio graphic, or gross features of a jaw cyst, but on histologic examination show a typical ameloblastomatous epithelium lining part of the cyst cavity, with or without luminal and/ or mural growth. Even though the lesion is not that aggressive as the solid ameloblastoma, an accurate diagnosis should be made. This lesion needs to be treated more aggressively than any other periapical lesions. This study shows that the term 'uni cystic ameloblastoma' is derived from the macro and microscopic appearance, the lesion being a well defined, often large monocystic cavity with a lining, focally but rarely entirely composed of odontogenic(ameloblastomatous epithettlium).Clinically, ameloblastoma appears as an aggressive tumor of the odontogenic tumor, more often asymptomatic, slow growing with no evidence of swelling.

Multidisciplinary Approach to Management of a Large Cyst in the Mandible - A Case Report

Most jaw cysts originate from odontogenic epithelium and they may be associated with vital or non-vital tooth. Cysts are classified into developmental, neoplastic and inflammatory. There is overall predominance in males, and the mandible is three times affected more than the maxilla. The aim of this case report is to describe a multidisciplinary conservative approach to manage mandibular cystic lesion confined lingually to the anterior region.

Vegan jaw cyst

Hyaline ring granuloma is a rare oral lesion with an unclear and controversial etiology, characterized by the presence of rings of palely eosinophilic structure less material (the so-called hyaline rings) with multinucleated giant cells around and within the very same rings. Various theories have been proposed about the pathogenesis of hyaline ring granulomas. Many authors consider a vegetable origin, suggesting that it may represent a reaction to foreign material such as food (and in particular pulses). Instead, other authors deny this possibility, proposing that the hyaline rings might represent degenerated blood vessels, degenerated collagen, or fibrosed extravasated serum proteins. The aim of this article is to present a case of hyaline ring granuloma and to briefly review the literature.

Massive Dentigerous Cyst within the Anterior Part of The Mandible: A Case Report

Dentigerous cysts are the most common developmental odontogenic jaw cysts, associated with crowns of an Unerupted tooth. Usually, they occur in the second and third decade of life with a male predilection. They are frequently asymptomatic and mostly discovered incidentally on routine dental radiographic examination. Its growth is slow, and can reach a considerable size causing bone expansion and displacement of teeth. Mandibular lower third molars are the most frequently effected teeth; dentigerous cysts involving impacted mandibular canines are rarely reported. Surgical enucleation with extraction of the associated tooth is the standard treatment for dentigerous cyst, marsupialization is recommended for large lesions. We report a rare case of a large dentigerous cyst in a 62-year-old male patient, associated with impacted left mandibular canine, extending from the retro-molar area of left side crossing the midline to the 2nd premolar in the other side, that was successfully treated by marsupialization followed by enucleation and removal of the impacted tooth.

Nasopalatine duct cyst with sebaceous differentiation: a rare case report with literature review

BackgroundThe aim of this study was to report a rare case of nasopalatine duct cyst with sebaceous differentiation. Further, a systematic search of the literature was performed to identify studies reporting patients with intraosseous jaw cysts with sebaceous differentiation.Case presentationA 55-year-old Korean man was referred to our hospital because of a cystic lesion of the anterior maxilla. Radiologic examination revealed a well-circumscribed radiolucent lesion in the anterior maxilla. Histology showed a respiratory columnar and cuboidal epithelium-lined cyst. Transition from the ciliated columnar epithelium to stratified squamous epithelium with sebaceous differentiation was observed. Based on these findings, the final diagnosis was nasopalatine duct cyst with sebaceous differentiation. A systematic search of the literature was performed to identify studies reporting patients with intraosseous jaw cysts with sebaceous differentiation. There were 24 cases of sebaceous differentiation in the epithelium of the cysts including 2 odontogenic keratocysts, 8 orthokeratinized odontogenic cysts, 8 dentigerous cysts, 1 radicular cyst, and 2 glandular odontogenic cysts. However, no case reports describing the occurrence of nasopalatine duct cysts with sebaceous differentiation have been reported.ConclusionThis first case report of nasopalatine duct cysts with sebaceous differentiation could provide insight into the diagnostic process of cystic lesions with sebaceous differentiation.

PARAKERATINIZED ODONTOGENIC KERATOCYST: A CASE REPORT WITH 8 YEARS FOLLOW-UP

OKC (odontogenic keratocyst) of parakeratinized variant is a benign developmental cyst in jaw, aggressive in nature, and is considered a mystery for surgeons in terms of its management. Though they are benign in nature they have a unique tendency to recur after conservative treatment. Therefore most appropriate management still remains controversial. Treatment modalities advocated ranges from conservative approach of enucleation to most radical form of resection. Here is a case of Parakeratinized odontogenic keratocyst in which treatment was done by enucleation with peripheral ostectomy along with chemical cauterization through CarnoyÂ’s solution. The patient was kept under follow up without any signs of recurrence for past 8 years.

Glandular Odontogenic Cyst

Glandular odontogenic cyst (GOC) is a rare cyst occurring in the jaw bone having an uncertain and aggressive behavior with high recurrence rate. The diagnosis of this lesion is trying as it can be confused with other jaw cysts and malignant lesions. Treatment methods vary from conservative surgical treatment to jaw resection. This article presents a case of GOC mimicking radiographically as a lateral periodontal cyst.

Minimally Invasive Technique for Removal of a Mandibular Radicular Cyst : A Case Report

The removal of an odontogenic jaw cyst usually requires at least elevation of the mucoperiosteal flap for adequate access to the cystic lesion and its complete enucleation. In this report, we present a simple intra-socket flapless cystic removal technique for a radicular cystic lesion related to the mandibular first molar. This technique produces an optimal outcome and gives the patient the most comfortable surgical experience.

Multiple Odontogenic Keratocysts in a Non-syndromic Young Patient: An Unusual Case Report

Odontogenic keratocyst (OKC) is a benign intraosseous lesion with invasive and aggressive behavior. It comprises approximately 2-21.8% of all jaw cysts. Odontogenic keratocysts (OKCs) are believed to arise from remnants of the dental lamina most common site in the molar ramus area. OKCs have a specific histopathologic appearance and are found to be locally aggressive and have a high recurrence rate, thus requires close long-term follow-up. OKCs are one component of the Gorlin-Goltz syndrome and all patients with multiple OKCs should be evaluated for this syndrome. In this paper, we present a case of a 13-year old non-syndromic female patient with multiple OKCs located at symphysis and bilateral mandibular angle region who was treated surgically with no obvious post-operative complications during follow-up period.

Dental pathologies in tumor patients with bone metastases or multiple myeloma scheduled for antiresorptive therapy.

Background: Medication-related osteonecrosis of the jaw (MRONJ) is a potentially severe complication of mainly antiresorptive drugs. We evaluated the frequency of dentoalveolar pathologies in patients scheduled for antiresorptive therapy in a 'real-world'setting, also including patients with poor oral health potentially requiring tooth extractions and/or other dentoalveolar surgery. This approach is in contrast to the setting of recent randomized trials with restrictive exclusion criteria. Patients & methods: We prospectively included patients suffering from solid tumors with osseous metastases or multiple myeloma. Screening for dentoalveolar pathologies was done prior to initiation of antiresorptive therapy at the specialized MRONJ clinic of the University Hospital for Cranio-Maxillofacial and Oral Surgery, Innsbruck, Austria. Results: 119 subjects could be included. In 76 patients (63.9%), a dental focus was revealed including deep caries (24.4% of patients), chronic apical periodontitis (26.9%), periodontal disease (45.8%), root remnants (16%), jaw cysts (2.5%), partially impacted teeth (5.0%)and peri-implantitis (5.0%). Conclusion: Considering the high number of dentoalveolar pathologies (63.9%), systematic dental focus screening prior to initiation of antiresorptive therapy is of utmost importance to lower the risk for MRONJ.

A volumetric prediction model for postoperative cyst shrinkage

ObjectivesWith only limited information available on dimensional changes after jaw cyst surgery, postoperative cyst shrinkage remains largely unpredictable. We aimed to propose a model for volumetric shrinkage based on time elapsed since cyst surgery.Material and methodsWe used data from patients that underwent cyst enucleation or decompression between 2007 and 2017 and had at least three computed tomography (CT) scans per patient. We fitted one simple exponential decay model [V(t) = V0 · e−ɑt] and one model with a patient-specific decay rate [Vk(t) = V0 · e−βt + γkt].ResultsBased on 108 CT scans from 36 patients (median age at surgery: 45.5 years, IQR: 32.3–55.3, 44% female), our simple exponential decay model is V(t) = V0· e−0.0035t where V(t) is the residual cyst volume after time t elapsed since surgery, V0 is the initial cyst volume, and e is the base of the natural logarithm. Considering a patient-specific decay rate, the model is Vk(t) = V0· e−0.0049t + γkt where γk is normally distributed, with expectation 0 and standard deviation 0.0041.ConclusionsUsing an exponential regression model, we were able to reliably estimate volumetric shrinkage after jaw cyst surgery. The patient-specific decay rate substantially improved the fit of the model, whereas adding specific covariates as interaction effects to model the decay rate did not provide any significant improvement.Clinical relevanceEstimating postoperative cyst shrinkage is relevant for both treatment planning of jaw cyst surgery as well as evaluating the clinical success of the surgical approach.