Cystic Conditions of the jawbones: A Review of Early Classification Systems.

Cystic conditions of the jawbones were recognized long before the establishment of the American Academy of Oral Pathology (AAOP) in 1948, but it was around this time when they were studied, characterized, and classified. The history of the classification systems implemented by oral pathologists to study the cystic conditions of the maxillary bones is intimately related with the birth of oral and maxillofacial pathology as a specialty of dentistry. The purpose of this paper is to review the early classification systems proposed for the cystic conditions of the jawbones.

The unusual cyst: solitary bone cyst of the jaws.

UNLABELLED: Solitary bone cyst of the jaws is an uncommon lesion detected usually as an incidental finding on dental radiographic examination. Historically, this cyst has been known by several different names within the literature. It is usually asymptomatic but can present with buccal swelling, pain, paraesthesia and be associated with non-vital teeth. Radiographically, it has characteristic features that distinguish it from other lesions. The following is an overview of the literature, the experience of two centres over an eight-year period, and a discussion of the dental implications. Clinicians should be aware of this lesion and that unexplained radiolucent lesions of the jaws require referral. CLINICAL RELEVANCE: Clinicians should be aware of both the clinical and radiographic characteristics of solitary bone cyst of the jaws.

[Odontogenic cysts]. / Odontogene Kieferzysten.

Odontogenic cysts form a group of diseases whose origin is linked to the persistence of epithelium resulting from the complex embryonic development of the teeth and jaws within the connective tissue. Inflammatory reactions of the surrounding area of the persisting odontogenic epithelium accompany epithelium proliferation, which leads to the development of a gradually expanding cavity that supersedes the surrounding structure. The correlation between activity of the inflammatory reaction and the development of the epithelial proliferation results in a relatively broad variation of histological features of the cyst wall. Since classification of cyst forms depends on their topographical features, clinical information on the classification of variations is urgently needed. For the classification of their clinical course of development and, in particular, in order to differentiate them from cystic odontogenic tumors of the jaw region, a histological examination of cyst wall tissue is necessary, all the more so since the development of a carcinoma deriving from the odontogenic epithelium has only been described in very few cases.

Quiste bucal mandibular infectado bilateral: reporte de caso estudiado con CBCT / Bilateral mandibular infected buccal cyst: report of a case studied by CBCT

El quiste bucal mandibular infectado (QBMI), también conocido como quiste de bifurcación, es un quiste odontogénico inflamatorio poco frecuente y descripto por primera vez por Stoneman y Worth. Ha sido incluido en la clasificación de la OMS de quistes y tumores odontogénicos en 1992. Este quiste suele darse, específicamente, en pacientes entre 6 y 13 años, y su localización más frecuente son el primer y segundo molar permanente y, eventualmente, segundo premolar. Su fisiopatología sigue sin estar clara y se han propuesto múltiples teorías. Este quiste se observa como una inflamación en el vestíbulo del molar afectado. Los síntomas frecuentes son dolor en el área afectada y supuración, pero también muchos casos permanecen asintomáticos. Radiográficamente se describe como un área radiolúcida circunferencial. El quiste está revestido con un epitelio escamoso no queratinizado con infiltrado inflamatorio de células en el tejido conectivo. La mayoría de las características clínicas e histológicas son similares a las reportadas para los quistes paradentales, de ahí la importancia de un buen diagnóstico radiográfico complementario en base a tomografía computada de haz cónico. Los enfoques conservadores suelen ser el tratamiento de elección, con la enucleación del quiste y el seguimiento del diente afectado (AU)

Mandibular infected buccal cyst (MIBC), also known as bifurcation cyst; it is a rare inflammatory odontogenic cyst first described by Stoneman and Worth. It was included in the WHO classification of cysts and odontogenic tumours in 1992. It usually occurs, specifically, in patients between 6 and 10 years of age and its most frequent location is the first and second permanent molars, and eventually the second premolar. Its pathophysiology remains unclear and multiple theories have been proposed. This cyst is seen as an inflammation in the vestibule of the affected molar. Frequent symptoms are pain in the affected area and suppuration, but many cases remain asymptomatic. Radiographically it is described as a circumferential radiolucent area. The cyst is lined with a nonkeratinized squamous epithelium with an inflammatory cell infiltrate in the connective tissue. Most of clinical and histological characteristics are like those reported for paradental cysts, hence the importance of a good complementary radiographic diagnosis based on cone beam computed tomography. Conservative approaches are usually the treatment of choice, with enucleation of the cyst and monitoring of the affected tooth (AU)

The pathology of head and neck tumors: cysts of the jaws, part 12.

The jaws are unique bones of the skeleton because of their intimate involvement with tooth and facial development. Abnormal sequelae of these developmental processes may give rise to cystic lesions later in life. This paper reviews the pathogenesis, clinical features, and behavior of these odontogenic and nonodontogenic cysts. Justification is found for the exclusion of the globulomaxillary, midmandibular, and midpalatine cysts from a current classification. Emphasis is placed on the importance and controversy surrounding the odontogenic keratocyst.

Histopathologic and radiographic findings of the simple bone cyst.

OBJECTIVE: The purpose of this study is to examine the correlation between histopathologic and radiographic findings and to discuss the cause of the simple bone cyst. STUDY DESIGN: Histopathologically, we classified 53 simple bone cysts into two types. Type A has a connective tissue membrane and type B has a partially thickened wall with dysplastic bone formation. Radiographically, we evaluated the following: margin, radiolucency, or radiopacity, relationship with tooth apices, bucco-lingual bone expansion, and displacement of the mandibular canal. RESULTS: Bone expansion and radiopacity were closely related to histopathologic findings although there was no correlation between the histopathologic findings and radiographic margin, relationship with tooth apices, and displacement of mandibular canal. Local recurrence was more likely to be observed in patients diagnosed as having type B than type A lesions. CONCLUSIONS: Type A and type B bone cysts may have different causes. Cysts determined radiographically to be radiopaque, those diagnosed as type B histopathologically, and cysts that have been treated surgically should all be followed by radiographic examinations.

Review of the idiopathic bone cavity of the jaws.

The IBC is a lesion that favors the anterior portions of the jaws and occurs principally in young patients. The lesion radiographically tends to scallop up between the roots of the affected teeth and result in cortical expansion. The cause of the IBC has not been determined, but trauma seems least likely as the cause. The IBC is best treated by curettage, and follow-up is mandated. A biopsy is required to establish a definitive diagnosis and to rule out aggressive lesions that can appear radiographically similar to the IBC, such as the ameloblastoma and the parakeratinizing odontogenic keratocyst.

Idiopathic bone cavity: a clinical, radiographic, and histological study.

The aim of the present study was to evaluate the clinical, radiographic and histological characteristics of idiopathic bone cavities from the Oral Pathology archives at Universidade Federal de Minas Gerais. Forty-three cases were retrieved. Age, sex, some radiographic variables and morphological variables measured of the connective tissue, were studied. The results showed the men who developed cavities tended to be younger than women (median 16 years (range 11-48) compared with 18 (12-64)). Radiographically rounded lesions that were single, unilocular, and small were more common in younger patients. While rounded cavities occurred mainly in the anterior region, cavities with interdental scalloping occurred in the posterior area. The median age of the patients with thin connective tissue on the wall of the bony cavity was lower than that of those with a thicker lining. In conclusion, the present study shows that there is a significant relation between age and sex, radiographic and histological variables. These findings may contribute to the diagnosis of idiopathic bone cavities.

[Upper maxillary cysts: embryogenic and surgical considerations in our cases]. / Cisti del mascellare superiore: considerazioni embriogenetiche e chirurgiche su una nostra casistica.

Upper maxillary cysts are a chapter in otorhinolaryngological pathology which have been relatively neglected by the Literature. The reason for this most likely lies in the difficulty in producing a nosographic picture of these pathologies which border on other surgical fields (dentistry, maxillofacial surgery), and because they show significant clinical and etiopathogenic polymorphism. The elements that characterize upper maxillary cysts as a separate clinical entity are basically their cystic nature and origin within the upper maxillary bone, although they can expand widely within the medio-facial region (nasal vestibule, oral vestibule, nasolabial region, palate, maxillary sinus). After having reviewed the various classification schemes proposed over the years, and briefly examining the main clinical and etiopathogenic characteristics and principles for surgical treatment, the present work offers a surgical case study, together with the related iconography. Moreover this work does not neglect embryogenic considerations which are indispensable for the study of some of these pathologies. In this manner the results for 35 surgical procedures on upper maxillary cysts performed from 1989 to 1996 are presented and classified following the Cudennec classification module (1991). This study shows the variety of possible clinical manifestations for these pathologies. Such a variety makes correct diagnosis imperative--today facilitated by modern imaging techniques--and requires diversifying the surgical approach, conditioned not only by the site, extension and nature of the specific lesion, but also by the related symptoms. The significant progress in surgical techniques has made increasingly functional surgery possible and led to the abandonment of such conventional radical techniques as the Caldwell-Luc procedure. Moreover, CT and NMR have provided good image definition, specifying precisely the limits and extensions and, in most cases, facilitating diagnosis of the nature of the disorder with direct and indirect signs of the cystic nature of the lesions whenever the clinical data proves inadequate.

[Aneurysmal cysts of the jaws. The nosological picture and a clinical case report]. / La cisti aneurismatica dei mascellari. Inquadramento nosologico e presentazione di un caso clinico.

After discussing the classification of aneurysmatic cyst with particular reference to its characteristics for differential diagnosis with other pathologies of various origin, a personal case is reported. The diagnosis and treatment protocol of the clinical case in question is presented together with clinico-therapeutic problems and the results obtained with the diagnostic and therapeutic aids used.

Statistical observations on jaw cysts in Enugu, Nigeria, 1987-1996.

Cases of jaw cysts treated at the Department of Oral and Maxillofacial Surgery in the University of Nigeria Teaching Hospital, Enugu during the 10 year period between 1987 and 1996 were studied clinically. A diagnosis of jaw cyst was established in 20 patients during the above period. According to pathological classification by the WHO method, these patients included 10 (50%) with dentigerous cyst, 3 (15%) with radicular cyst, 3 (15%) with odontogenic keratocyst, 3 (15%) with fissural cyst (nasopalatine duct cyst, nasoalveolar cyst, globulomaxillary cyst), 1 (5%) with dermoid cyst. Patients with dentigerous cyst, which was found at relatively high frequency, were further analyzed with regard to age, sex, and anatomical distribution. Among patients with dentigerous cyst, those aged between 21 and 40 years accounted for 60%. Males outnumbered females in a ratio of 1.5:1. Dentigerous cyst occurred most frequently in the region of the mandibular wisdom teeth. The relatively very small number of cases, the need for more research on the subject and the need to educate the general public on oral hygiene are highlighted.

[Temporomandibular joint primitive tumors and pseudo tumors]. / Pseudotumeurs et tumeurs primitives de l'articulation temporomandibulaire.

The temporomandibular joint (TMJ) can be the site of bone, cartilaginous, or synovial tumors. There is no well-defined histological classification. We listed all benign tumors, malignant primitive tumors, and rare pseudo tumors of the TMJ. We provide a list to help for the diagnosis and the differential diagnosis of non-tumoral lesions by far the most frequent.

Fibro-osseous disease: harmonizing terminology with biology.

Classification systems and associated terminology are inherently slow in reflecting rapidly unfolding scientific discoveries in the mechanism and presentation of diseases. Misleading concepts, which often have historical value only, may become entrenched in the literature, leading to confusion and inaccurate communication. The purpose of this communication is to stimulate discussion and debate on inappropriate terminology associated with fibro-osseous disease that continues to be perpetuated in the literature. Use of the terms "cementum," "aggressive," "active," "gigantiform," and "maturation" are questioned, and the criteria applied to the interpretation of secondary changes in fibro-osseous lesions critically are evaluated.

CT analysis of the Stafne's bone defects of the mandible.

OBJECTIVE: To investigate the aetiology of Stafne's bone defects by analysing the CT findings of two types of defects, which appeared differently on panoramic radiographs. METHODS: 32 lesions with suspicion of the Stafne's bone defect on a panoramic radiograph were categorised into two groups: typical "Stafne type", which showed the connection to the base of the mandible, and non-typical "Cyst type", which showed no connection. Age, sex, the existence of hypertension and the following CT findings: location, size and inner content of the defect, existence of expansion of the buccal cortical bone, and location of submandibular glands, were analysed. RESULTS: There were 14 "Stafne type" and 17 "Cyst type" on the panoramic radiographs. One lesion in the "Cyst type" was a true cystic lesion and was excluded from further review. The "Stafne type" was seen primarily in the posterior and inferior locations, while the "Cyst type" was seen in the anterior and superior locations on the CT. The size of the defect was significantly larger in the "Stafne type". Buccal cortical expansion was observed only in three lesions in the "Stafne type". While the "Cyst type" contained mainly fatty tissue, the "Stafne type" contained other soft tissues. Though the submandibular glands on the defect side were located anteriorly in both types compared with those on the contralateral side and on the control patients, they spread mainly outwards in the "Stafne type". CONCLUSION: The Stafne's bone defects are thought to be caused by the dislocated submandibular gland. The differences between the two types might occur as a result of a different location of the submandibular gland.

Quistes inflamatorios. Abordaje preventivo con técnica descompresiva: presentación de situación clínica / Inflammatory cysts. A preventive approach with decompression technique: report of a clinical case

Se realiza una revisión bibliográfica sobre quistes inflamatorios de los maxilares y se presenta una situación clínica de udna paciente niña de 9 años de edad que concurre a la guardia del Hospital de Odontología Infantil Don Benito Quinquela Martín, con quistes inflamatorios bilaterales (cuyas biopsias confirmaron el diagnóstico inicial) y desplazamiento de los gérmenes de segundos premolares inferiores derecho e izquierdo (3.5 y 4.5) hacia la basal. Considerando la edad de la paciente y el pronóstico favorable de las piezas dentarias en desarrollo, se decidió utilizar como tratamiento la técnica de Waldron-Axhausen o técnica descompresiva. La evolución de la paciente fue favorable, ya que se logró la remisión del proceso patológico y la normal erupción de dichas piezas dentarias...

The mandibular infected buccal cyst--a reappraisal.

The mandibular infected buccal cyst was first described over ten years ago as a discrete pathological entity found only in children. The features of this lesion have been consistently described as a buccal location adjacent to erupting first molar teeth, a thick, hyperplastic non-keratinized epithelial lining, expansion of buccal cortex and associated infection. The paradental cyst had been described some years previously. This lesion was noted to have a similar non-specific hyperplastic non-keratinized epithelial lining but was described as being associated predominantly with third molar teeth in young adults. Recently investigators have called for the mandibular infected buccal cyst to be reclassified as a variant of the paradental cyst. In this paper, ten previously unreported cases of mandibular infected buccal cysts are presented and the evidence for their reclassification as paradental cysts is advanced.

Cystic lesions of the mandible and maxilla--radiological evaluation and differentiation.

Cystic lesions of the mandible and maxilla are easily recognizable with various imaging modalities: different conventional X-ray films, computed tomography and magnetic resonance imaging. In this article, the author defines and classifies the most-encountered kinds of odontogenic and nonodontogenic cysts and presents in each case the various parameters that should be analyzed in order to reach a radiological diagnosis: location of the lesion within the mandible, its relationship to adjacent structures, its shape, etc. Nevertheless, there remain cystic lesions that cannot be differentiated from benign and, occasionally, malignant lesions. In some of these cases, final diagnosis will be reached only after surgical intervention and histopathological examination.

Jaw cysts with orthokeratinization: analysis of 12 cases.

The clinico-pathologic, immunohistochemical and radiological features of 12 jaw cysts with a prominent orthokeratinized epithelial lining were studied and compared with those of typical odontogenic keratocysts and dentigerous cysts. They differed significantly from odontogenic keratocysts in terms of biologic behavior and histopathologic findings. Although immunohistochemical staining of the epithelial linings for cytokeratins, EMA, CEA and involucrin has not shed any light on the histogenesis of these lesions, staining patterns for these markers were significantly different from those of odontogenic keratocysts and non-keratinized dentigerous cysts. Radiologically, nine cases appeared as dentigerous cysts; two cases, one with sebaceous differentiation, as non-dentigerous unilocular cysts, and the remaining one was exceptional as it showed multiple epidermal cysts with prominent dermal appendages histologically. It is suggested that most of the orthokeratinized jaw cysts may belong to clinico-pathological entities different from odontogenic keratocysts with the majority representing dentigerous cysts with orthokeratinization. The possibility of the existence of rare central dermoid or epidermoid cysts is also to be considered.

Determinants of MR relaxation rates in jaw cysts: implications for diagnostic values of the relaxation times.

OBJECTIVES: The MRI signal intensities and the relaxation times (T1 and T2) have already been used for comparisons among various types of cysts. The signal intensities (or T1 and T2) were suggested to be related to cyst content. However, such a relationship between the relaxation rates (1/T1 and 1/T2) and the aspirated content of jaw cysts was not given. Therefore, an investigation on the determinants of the relaxation rates in the jaw cysts may be helpful in elucidating the biological basis for the differences in relaxation rates among the categories of jaw cysts. METHODS: The aspirated contents of 23 cysts (16 radicular and 7 haemorrhagic) were scanned using an MR imager operating at 1 T magnetic field strength. The viscosities and the dry-weight-to-water-weight ratios (Ms/Mw) were determined. Also, the mean values of cyst categories were compared using statistical analysis. RESULTS: The 1/T1 had a moderate correlation with viscosity (0.66) and Ms/Mw (0.56), while the 1/T2 had a good correlation with viscosity (0.87) and Ms/Mw (0.82). The mean values of viscosity, Ms/Mw and relaxation rates in radicular cysts were significantly lower (P < 0.05) than those of haemorrhagic cysts. CONCLUSIONS: The present data suggest that similarities and differences between relaxation rates of radicular and haemorrhagic cysts can be explained by the solid content and viscosity of cysts.