CYSTS OF ORAL AND MAXILLOFACIAL REGION Oluwatosin Ajibade DEN/2014/010 OUTLINE • • • • • • DEFINITION CLASSIFICATION AETIOPATHOGENESIS CLINICAL FEATURES INVESTIGATIONS TREATMENTS DEFINITION • A cyst is a pathological cavity having fluid semi-fluid or gaseous contents and which is not created by the accumulation of pus. • It is usually, but not always, lined by epithelium. (Kramer 1974). • May be lined by fibrous tissue or occasionally by neoplastic tissue (neoplastic transformation). • They are important in the differential diagnosis of radiolucent lesions of the jaws • Orofacial cysts are amongst the commonest pathological lesions ecountered in dentistry. . CLASSIFICATION Several Classifications have been proposed; • Killey and Kay (1966) • Lucas (1976) • Shear (1985) • WHO (1992) • Shear’s modification of WHO classification However, they are broadly divided into; Odontogenic, Non-odontogenic, Pseudocyst and Soft Tissue CYSTS. CLASSIFICATION I. CYSTS OF THE JAWS A}. EPITHELIAL 1.Developmental a.Odontogenic ; Dentigerous cyst (Follicular) Eruption cyst Odontogenic keratocyst (neoplastic lesion) Gingival cysts of Adults Lateral Periodontal cysts Botryoid odontogenic cyst Glandular odontogenic cyst(sialo-odontogenic cyst) Gingival cysts of infants Orthokeratinized Odontogenic cyst • CLASSIFICATION b. Non-odontogenic; Nasopalatine duct (incisive canal cyst) Globulomaxillary cyst. Nasolabial (naso-alveolar) cyst Median mandibular cysts Median alveolar cyst 2.Inflammatory Radicular cyst(Apical Dental cyst) Residual cyst, Paradental cyst Inflammatory collateral cyst B. NON-EPITHELIAL (PSEUDOCYSTS) • Simple bone cyst • Aneurysmal bone cyst • Stafne’s bone cyst. CLASSIFICATION • • II. CYSTS ASSOCIATED WITH THE MAXILLARY ANTRUM Benign mucosal cyst of maxillary antrum Surgical ciliated cyst of maxilla III. CYSTS OF SOFT TISSUES OF THE NECK, MOUTH AND FACE. • • • • • • • • Dermoid or Epidermoid cyst Branchial cleft (lympho-epithelial) cyst Thyroglossal duct cyst Cystic hygroma Anterior median lingual Cyst. Oral cyst, with gastric or intestinal epithelium Cysts of salivary glands. Parasitic cysts e.g hydatid cyst:: (Cysticercus cellulosae) Histogenetic classification of odontogenic cysts. • CYSTS DERIVED FROM RESTS OF MALASSEZ Periapical cyst Residual cyst • CYST DERIVED FROM REDUCED ENAMEL EPITHELIUM Dentigerous cyst Eruption cyst Paradental cyst • CYSTS DERIVED FROM DENTAL LAMINA(RESTS OF SERRES) Odontogenic Keratocyst Lateral Periodontal cyst Polycystic(Botryoid ) Gingival cyst of the adult Dental Lamina cyst of the Newborn Glandular Odontogenic cyst • • • • • HISTOGENETIC CLASSIFICATION OF DEVELOPMENTAL CYSTS CYSTS OF VESTIGEAL DUCTS Nasopalatine Duct Cyst(derived from islands of remnant epithelium after closure of embryonic nasopalatine duct). Nasolabial cyst(derived from remnants of inferior portion of the nasolacrimal duct). LYMPHOEPITHELIAL CYSTS Oral lymphoepithelial cyst Cervical lymphoepithelial cyst(derived from epithelium trapped in lymphoid tissues of the neck during embryonic development of the cervical sinuses, or 2nd branchial clefts or pouches/salivary duct epithelium entrapment in cervical lymph nodes during embryogenesis) CYST OF VESTIGEAL TRACT Thyroglossal Tract Cyst(derived from remnants of embryonic thyroglossal tract) CYST OF EMBRYONIC SKIN Dermoid Cyst(derived from remnants of embryonic skin) Epidermoid Cyst CYST OF THE MUCOSAL EPITHELIUM Surgical Ciliated Cyst of the Maxilla(derived from implantation of normal mucus secreting sinus epithelium during previous surgery Heterotropic Oral Gastrointestinal Cyst.(derived from entrapment of undifferentiated endodermal cells during 4th to 5th week of embryonic development , followed by gastro intestinal differentiation). AETIOPATHOGENESIS Odontogenic cysts are derived from tissues of developing teeth. – Dental Lamina – Projection of dental lamina into underlying ectomesenchyme(tooth buds) – Layered cap consisting of inner and outer enamel epithelium between which are stratum intermedium & stellate reticulum layers (cap stage bell stage) Mechanism of Cyst formation The relative frequency of cysts in the orofacial region especially in the jaw bone, is related to the presence and wide distribution of epithelial rests and residues/remnants in this region such as: (i.) Vestigial structures like embryonic ectodermal inclusions. (ii) The dental lamina and its residue – glands of serres (iii)Reduced enamel epithelium (iv)Rest cells of malassez Mechanism of Cyst formation Two phases of cystic pathogenesis have been identified ; 1. Initiation/formation 2.Subsequent growth and enlargement While initiation appears to be different for each group of cyst, enlargement and growth process seems to be similar in most types of cyst. Initiation: a .Starts with profuse epithelial cell formation through mitosis (– cell proliferation) b . Followed by cleft formation within the epithelial cell mass. c .Degeneration of the cells at the centre of the epithelial cell mass. d .Finally, encirclement of the spaces thus left at the centre by epithelium. Mechanism of Cyst formation Growth/Enlargement; Cyst growth and enlargement is through • Continuous proliferation of lining epithelium • Increase in size of cyst content through accumulation of fluid • Resorption of bone around the cyst. Mechanism of Cyst formation • Accumulation of fluid: • Main (1970) Harris and Toller (1975) both suggested an osmotic pressure effect. • They believe the cystic wall acts as semi-permeable membrane. . high osmotic pressure builds up in the cyst due to the components of cell degeneration. • Absorption of fluid (water) from the surrounding tissues into the cystic cavity. • Other suggested mechanisms of cystic accumulation of fluid are through –Secretion of fluid into the cystic cavity by mucous secreting cells – (II) Transudation/exudation of fluid through mural vessels (e.g. in periodontal cyst) through hydrostatic pressure. Mechanism of Cyst formation Resorption of bone (for intraosseus cysts) • Accumulation of fluid enlargement and pressure build up against the bony wall. There is release of bone resorbing factors from the capsule stimulation of osteoclastic activity . • Factors released include; – Prostaglandins from fibroblasts PGE2 and PGE3, PGI2 . These prostaglandins cause the release of OAFs resorption of bone – Lymphokines from B – lymphocytes – Co-factors released from inflammatory cells – Interleukin from monocytes ( stimulates fibroblast to release prostaglandin). CLINICAL FEATURES -Long standing jaw swelling -Usually painless (unless infected) -Bony hard –> depressible (ping-pong) –> egg-shell cracking –fluctuant sometimes (soft tissue cyst or late stage bone perforation - Related teeth – displaced -- Non-vital -- Missing -- Loose (late stage of cyst) -location ; 3 / 3 (dentigerous) 8/8 8764 / 4678 ( Keratocyst horizontal ramus = body of mandible) -Age – 1st & 2nd decades(DEPENDING ON THE CYST) -Content – aspiration yields fluid – golden yellow or straw color – dentigerous or periodontal cyst - dirty white or grayish. - keratocysts INVESTIGATIONS 1. Plain Radiographs: Dental radiographs Orthopantomographs 2. CT Scan : : Larger cysts or aggressive lesions 3. MRI Common radiographic appearance. - Well circumscribed unilocular radioluscency with sclerosed border (except if infected) INVESTIGATIONS 2. Aspiration technique: To r/o vascular lesions or inflammatory lesions ; -Physical Examination -Biochemical analysis -Microbiological Examination - Microscopic view 3. Ultrasonography: Can to some extent differentiate cysts from solid tumors -useful only in soft tissue cysts and cysts with thin cortex or perforated cortex. 4. FNA: To R/O Vascular lesions INVESTIGATIONS 5. BIOPSIES: • INCISIONAL(diagnostic) Cystic lesion is in the angle or ramus of the mandible (where Keratocysts & ameloblastoma are common) and cannot be differentiated from these lesions clinically - when malignancy or an aggressive benign lesion is suspected. • EXCISIONAL (diagnostic and therapeutic):- Indicated for small , unilocular cystic lesions, cystic tumours TREATMENT METHODS OF TREATMENT 1. Enucleation: 2. Marsupialisation (“Deroofing”)-decompression/Partsch operation 3. Enucleation and treatment of adjacent bone(enucl + curettage) 4. En-block resection 5. Partial resection 6. Excision Treatment of tooth involved in a cyst. 1. Where a tooth is vital rightly oriented and there is space – Marsupialisation followed by orthodontic mvt of teeth into position. 2. Extract with cyst if not useful 3. RCT + apicectomy RCT apicectomy marsupialisation Dental Cyst: (Radicular/Residual) From chronic infection of tooth • Most common cyst (52.3% of OCs) Jones et al. (2006), Sheffield. • Any age • Commonest – in anterior region • Mx > Md • Develops from rest cells of malassez in p.d.l. • Usually forms at apex of a root (non vital tooth) • Sometimes related to accessory canal – simulates lateral developmental periodontal cyst. • may regress following R.C.T. • Extraction of tooth without cyst removal –>Residual cyst. • Radiology: usually unilocular radioluscency at the apex of a root. HISTOPATHOLOGY • Xterised by ; -non-keratinized stratified squamous epithelium -may present in an arcades pattern -varying epithelium thickness with mixed inflammatory infiltrates -presence of rushston and russels bodies -cholesterol clefts and multinucleated giant cells Odontogenic Keratocyst • About 11% of odontogenic cysts • A developmental cyst. • Derived from epithelium associated with the development of the tooth – enamel organ/dental lamina • Associated with missing tooth in the series. • Peak incidence 2nd – 3rd decade • Occur more frequently in the mandible 2:1 – usually posterior to the premolars • M>F • Usually painless slowly growing expansile swelling • Potential for aggressive clinical behaviour NOW RECLASSIFIED AS A NEOPLASM • Unilocular/multilocular • Tendency to recur after excision(20-60%) Keratocyst Microscopy: 6-10 layers of convoluted epithelium with characteristic superficial corrugated parakeratinized layer. • pallisading of basal layer consisting of tall columnar cells with hyperchromatic and polarised nuclei. • Rete-ridges are notably absent. • Budding of the basal layer with “daughter cysts”. • Capsule thin & free of inflammatory cells. • Orthokeratinized variant with a granular layer and poorly organized basal layer(less aggressive in behaviour). Keratocyst – Clinical types – – – – Solitary Multiple jaw cysts Syndromic Syndromic(Naevoid basal carcinoma / Gorlin-Goltz synd) in about 5% of all Keratocyst : multiple jaw cysts • • • • • • Multiple basal cell carcinoma Skeletal anomalies – bifid rib Cranial calcification – calcified falx Associated with mutation in the PATCHED tumour suppressor gene Autosomal dominant trait. Treatment: Enucleation and treatment of adjacent bone(enucl + curettage) Marsupialisation En-block resection(marginal resection)or Segmental resection . Tendency for recurrence is HIGH LATERAL PERIODONTAL CYST • intraosseus cysts on the root surface of a vital teeth. Usually unilocular; but may be multilocular (BORTRYOID ODONTOGENIC CYSTS). • - Often seen in adults • - Asymptomatic, more frequently in the premolars segment of the mandible. • - In the maxilla, the lateral incisor area is a common site. HISTOPATHOLOGY Thin lining of non-keratinized epithelium of about 1-3 cells thickness Lining often exhibits focal epithelial thickening(plaque) Variable numbers of glycogen-rich clear cells • Radiology radiolucent area in contact with the lateral surface of root. Small, rare with 1cm, well circumscribed sclerotic border. Developmental Origin remnants of dental lamina Treatment Surgical enucleation preserving the tooth. GLANDULAR ODONTOGENIC CYST (Sialoodontogenic cyst) • • • • • rare cyst a recently described developmental cyst occurs in adults with peak in fifth and sixth decades Has propensity for the mandible, anterior to the molars. Microscopically : Lined by non-keratinized epithelium with focal thickening composed of mucous cells in a pseudoglandular pattern. • (May mimic a central muco-epidermoid carcinoma) • Occasionally, local aggressive behaviors Erosion of cortical plate • Maybe unilocular but usually multilocular DENTIGEROUS CYST • common developmental odontogenic cyst • associated with the crown of an unerupted ( clinically missing) tooth or impacted tooth. • • • • • • Often painless expansile growth Occurs mainly between the age of 0 – 50 years(peak=10-30) Associated with impacted teeth More common in males Commonly related to 3/3, ___ 8/8 5/5 • Radiology; • Unilocular pericoronal radioluscency about the crown of an unerupted tooth in THREE VARIANTS • Smooth sclerotic margin • Margins when poorly defined, is due to inflammation. HISTOPATHOLOGY The cystic cavity is lined by a relatively uniform number of epithelial cells of about 3-10 cells thickness. Non-keratinized stratified squamous epithelium, often with no rete pegs Mucous metaplasia of the epith may be present Cholesterol clefts, lipid-ladden macrophages, rushston bodies could also be seen DENTIGEROUS CYST Treatment Enucleation Marsupialisation Differential DiagnosisAOT,OKC,UNILOCULAR. AMELOBLASTOMA ERUPTION CYST • • • • A dentigerous cyst occurring on the alveolar tissue which overlies an erupting tooth Common in children May be associated with deciduous or permanent tooth especially permanent molars Bluish and fluctuant; painless Treatment: Superficial marsupialisation CYSTIC NEPLASMS • Cystic ameloblastoma • Keratocystic odontogenic tumour • Calcifying odontogenic tumour • NOTE ALSO THAT: Tumours have been reported to develop from cystic linings of long - standing dentigerous, primordial/keratocyst, and residual cysts — - Ameloblastoma - Squamous cell carcinoma - Mucoepidermoid carcinoma Nasopalatine Duct cyst • Aetiology • Uncommon The nasopalatine duct connects the organ of Jacobson in the nasal septum to the palate in many animals. Jacobson's organ is an organ of smell. Nasopalatine canal cysts, also known as incisive canal cysts, are located within the nasopalatine canal or within the palatal soft tissues at the point of the opening of joined centrally to an accessory olfactory bulb. Cats, for instance, may sometimes be noticed to sense an interesting odour by inhaling through the mouth, and in most species Jacobson's organ is used to assess the state of sexual readiness of potential mates. Disappointingly therefore, Jacobson's organ has disappeared in man, and only a few epithelial cells lying along the line of the nasopalatine duct, persist. These cells can give rise to nasopalatine duct cysts. Nasopalatine cysts, which form in the midline of the anterior maxilla, are uncommon. Other acronyms The nasopalatine, incisive canal, median palatine, palatine papilla and median alveolar cysts are variants of the same lesion, varying slightly in position in relation to the postulated line of the incisive canal. Nasopalatine Duct Cyst • Incisive Canal Cyst –Most common non-odontogenic cyst in oral cavity • Any age, most common in 4th-6thdecades • Slight male predilection • B/4 Cystic degeneration of epithelial remnants of the nasopalatine duct (Fissural) • Many are asymptomatic, symptoms often indicate infection • “heart shaped”radiolucencybetween roots of central incisors • Clinical threshold is > 6 mm • Cyst of incisive papilla if no bone involvement Nasopalatine duct cyst: key features • Often asymptomatic, chance radiographic findings • Immediate dental implant failure associated with nasopalatine duct cyst. • Form in the incisive canal region • Arise from vestiges of the nasopalatine duct and may be lined by columnar respiratory epithelium • The long spheno-palatine nerve and vessels may be present in the wall • Can usually be recognised radiographically (CT, MRI) • Histological examination necessary to exclude other cyst types arising at this site • Do not recur after enucleation Nasopalatine Duct Cyst Histopathology –Variable epithelial lining, often more than one type • Stratified squamous 75% • Pseudostratified columnar 33% –Moderate sized nerves, arteries, veins in the wall of the cyst • Islands of hyaline cartilage on occasion –Treatment –surgical enucleation–palatal flap • • • • • • NASOLABIAL CYST This very uncommon cyst forms outside the bone in the soft tissues, deep to the nasolabial fold. Arises from remnants of the nasolabial duct and is occasionally bilateral SEX F:M=4:1 The lining is pseudo-stratified columnar epithelium with or without some stratified columnar epithelium. If allowed to grow sufficiently large, the cyst produces a swelling of the upper lip and distorts the nostril. Treatment is by simple excision usually but occasionally may be complicated if the cyst has perforated the nasal mucosa and discharged into the nose. GLOBULOMAXILLARY CYSTS • • • • • • • • These exceedingly rare cysts have been traditionally ascribed to proliferation of sequestered epithelium along the line of fusion of embryonic processes. It is now accepted that this view of embryological development is incorrect and there is no evidence that epithelium becomes buried in this fashion. Most so-called globulomaxillary cysts are usually found to be odontogenic cysts of various types. Probably periodontal cysts. Thus today the term globulomaxillary can be justified only in an anatomic sense. definitive diagnosis of lesions located in this area made by combined clinical and microscopic examination. Radio logically, a globulomaxillary lesion appears as a well-defined radiolucency, often producing divergence of adjacent 2 and 3 • Radiolucencies in this location, when reviewed microscopically,have been shown to represent radicular cysts, periapical granulomas, lateral periodontal cysts, OKCs, central giant cell granulomas, calcifying odontogenic cysts, and odontogenic myxomas. Pseudocysts of the jaws Aneurysmal bone cysts • A benign lesion of bone. • Arise in the mandible, maxilla, or other bones. • Within the craniofacial complex, approximately 40% of these lesions arc located in the mandible and 25% are located in the maxilla. Aneurysmal Bone Cyst • • • • Etiology and Pathogenesis. Pathogenesis is obscure, Generally regarded as reactive. An unrelated antecedent primary lesion of bone, such as fibrous dysplasia, central giant cell granuloma, nonossifying fibroma, chondroblastoma, and other primary bone lesions, is believed to initiate a vascular malformation,resulting in a secondary lesion or aneurysmal bone cyst. Aneurysmal Bone Cysts Clinical Features. • Typically occur in persons younger than 30 years of age. • The peak incidence occurs within the second decade of life. • Slight female predilection. • When the mandible and maxilla are involved, the more posterior regions are affected, chiefly the molar areas. • Pain is described in approximately half the cases. • common clinical sign is firm, non-pulsatile swelling. • On auscultation, a bruit is not heard, indicating that the blood is not located within an arterial space, and • On firm palpation, crepitus may be noted. Aneurysmal Bone Cysts • Radiographic features include the presence of a destructive or osteolytic process with slightly irregular margins. • A multilocular pattern is noted in some instances. • When the alveolar segment of the mandible and maxilla is involved, teeth may be displaced with or without concomitant external root resorption. Aneurysmal Bone Cysts • Histopathology - A fibrous connective tissue stroma contains variable numbers of multinucleated giant cells - Sinusoidal blood spaces are lined by fibroblasts and macrophage With the exception of the sinusoids, the aneurysmal bone cyst is similar to central giant cell granuloma. -Reactive new bone formation is also commonly noted. • Differential Diagnosis. Odontogenic keratocyst, central giant cell granuloma, and ameloblastic fibroma should be included in a differential diagnosis. Ameloblastoma and odontogenic myxoma could be included, althoughthese lesions more typically appear in older patients. • Treatment and Prognosis. A relatively high recurrence rate has been associated with simple curettage. Excision or curettage with supplemental cryotherapy is the treatment of choice. Traumatic bone cyst • Is an empty intrabony cavity that • lacks an epithelial lining. • The designation of pseudocyst relates to the cystic radiographic appearance and gross surgical presentation of this lesion. • It is seen mostly in the mandible. • Pathogenesis. The pathogenesis is not known, although some cases seem to be associated with antecedent trauma. Assuming this to be the case, it has been hypothesized that a traumatically induced hematoma forms within the intramedullary portion of bone. Rather than organizing, the clot breaks down, leaving an empty bony cavity. • Alternative developmental pathways include cystic degeneration of primary tumors of bone, such as central giant cell granuloma, disorders of calcium metabolism, and ischemic necrosis of bone marrow. Traumatic bone cyst • Clinical Features. • Teenagers are most commonly affected, although traumatic bone cysts have been reported overa wide age range. • An equal gender distribution has been noted. • By far, the most common site of occurrence is the mandible. • The lesion may be seen in either anterior or posterior regions. • Rare bilateral cases have been described. • Swelling is occasionally seen, and • pain is infrequently noted. • Radiographically, a well-delineated area of radiolucency with an irregular but defined edge is noted. • Interradicular scalloping of varying degrees is characteristic, • and occasionally slight root resorption may be noted. • Traumatic bone cysts have often been seen in association with florid osseous dysplasia. The relationship between these two entities is not understood. Traumatic bone cyst • Histopathology. • Grossly, only minimal amounts of fibrous tissue from the bony wall are seen. • The lesion may occasionally contain blood or serosanguineous fluid. • Microscopically, delicate, well-vascularized, fibrous connective tissue without evidence of an epithelial component is identified. • Treatment and Prognosis. • Once entry into the cavity is accomplished, the clinician need merely establish Stafne Bone Cyst • A.K.A. – Stafne Defect – Lingual Submandibular Salivary Gland Depression – Latent Bone Cyst – Static Bone Cyst – Lingual Cortical Mandibular Defect Stafne Bone Cyst • Asymptomatic radiolucency –Well circumscribed –Sclerotic border –May interrupt the continuity of the inferior border • Posterior mandible • Below the inferior alveolar canal • Males 4:1 CYSTS OF THE SOFT TISSUES • Some cysts described earlier form in or extend into the soft tissues overlying the jaws. • However, most soft tissue cysts are nonodontogenic. • The most common soft tissue cysts are mucoceles (extravasation or retention cysts) which originate in minor salivary glands and the ranula(MAJOR SALIVARY GLAND). Dermoid (sublingual/submental) is a developmental anomaly. DERMOID. • Clinical features: • Dermoid cysts develop between the hyoid and jaw or may form immediately beneath the tongue • Intra/Extra-Oral Mid-line swelling of the anteriro region of the neck • They are sometimes filled with desquamated keratin SUBLINGUAL DERMOID CYST • Unusually large specimen • Even larger because the patient is raising and protruding her tongue. • This cyst, unlike a ranula, can be seen to have a thick wall because it has arisen in the deeper tissues of the floor of the mouth. • Solid, putty-like consistency. • A sublingual dermoid is more deeply placed than a ranula; the latter is obviously superficial, having a thin wall and a bluish appearance. • No symptoms until large enough to interfere with speech or • eating. • Can be accommodated in the floor of the mouth without disability and can be completely concealed by the tongue in its normal resting position. DERMOID CYST • Pathology • The lining of epidermoid cysts is keratinising stratified squamous epithelium alone. • Have dermal appendages in the wall and are then referred to as dermoid cysts. • These cysts should be dissected out. Ranula • • • • Ranula is a clinical term that also includes mucus extravasation phenomenon and mucus retention cyst, floor of the mouth. Ranula is associated with the sublingual or submandibular glands • fluctuant, unilateral, soft tissue mass. • bluish color • frog's belly; hence the term ranula. • When it is significantly large, it can produce medial and superior deviation of the tongue. • It may also cross the midline if the retained mucin dissects • through the submucos • plunging ranula develops if mucus herniates through the mylohyoid muscle and along the fascial planes of the Neck or mediastinum Mucus retention cysts • result from obstruction of salivary flow because of a sialolith, periductal scar, or impinging tumor. • The retained mucin is surrounded by ductal epithelium, giving the lesion a cyst like appearance microscopically. • Mucus extravasation phenomenon is as a result traumatic severance of a salivary gland excretory duct, resulting in mucus escape, or extravasation, into the surrounding connective tissue Thyroglossal Duct Cysts • – Developing fetuses have a channel called the thyroglossal duct, which is a temporary channel between the developing thyroid gland and the tongue. Once the thyroid gland descends from the base of the tongue, this duct normally closes and disappears (usually by the time of birth). Sometimes a piece of the duct remains, however, and will develop into a cyst, usually during childhood or adolescence. In such cases, the remaining portion of the thyroglossal duct and cyst (and its underlying attachment to the hyoid bone, at the base of the tongue) must be removed completely. If they are not removed completely, there is a high recurrence rate of such cysts. In adulthood, these cysts can develop into cancer. Diagnostic tests such as ultrasound of the neck can determine if the thyroid gland is in a normal position. Branchial Cleft Cysts • Branchial Cleft Cysts –Also called cervical lymphoepithelial cysts. • Branchial cleft cysts or sinuses are congenital lesions that arise from remnants of a slight cleft or defect during gestation. They are usually found on the side of the necks of children aged 2 – 10. They may change in size and shape, and are often noticed after an upper respiratory tract infection. Branchial cleft cysts or sinuses may have external openings or pores from which a mucus-like material drains out. • They should be removed for several reasons, including 1) ascertaining a correct diagnosis, 2) improving appearance, and 3) preventing infection. Sebaceous Cysts • Sebaceous Cysts – lumps in or just under the skin. A sebaceous cyst is a catch-all term for a benign, harmless growth that occurs under the skin and tends to be smooth to the touch. Ranging in size, sebaceous cysts are usually found on the scalp, face, ears, and genitals. They are formed when the Sebaceous release of sebum, a mediumthick fluid produced by sebaceous glands in the skin, is blocked. Unless they become infected and painful or large, sebaceous cysts do not require medical attention or treatment, and they usually go away on their own. If they become infected, the physician may drain the fluid and cells that make up the cyst wall. Or, if the cyst causes irritation or cosmetic problems, it may be removed through a simple excision procedure. Diagnosis and Management • Hx • Examination –palpation, auscultation, aspiration • Investigation-radiograph , ultra sound, CT, MRI • Treatment-Enucleation, marsupialisation, currettage References • Killey, Seward & Kay An Outline of Oral Surgery. Bristol John Wright & Sons • R.A Cawson Essentials of Dental Surgery & Pathology . Edinburgh: Churchill Livingstone • IRH Kramer,JJ Pindborg & M Shear : Histological Typing of odontogenic Tumours. Berlin: SpringerVerlag. • Malik NE Cyst of the jaws and orofacial soft tissue In: Textbook of Oral & Maxillofacial Surgery; New Delhi;Jaypee Brothers Medical publishers.
