Dentigerous Cyst: Difference between revisions
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* Other [[Overview: Cysts of the Jaws|cysts of the jaws]] | * Other [[Overview: Cysts of the Jaws|cysts of the jaws]] | ||
* Specifically keratocysts and ameloblastomas may occasionally envelope the crown of the tooth and ∴ mimic dentigerous cyst | * Specifically odontogenic keratocysts and ameloblastomas may occasionally envelope the crown of the tooth and ∴ mimic dentigerous cyst | ||
==Aetiology and Pathogenesis== | ==Aetiology and Pathogenesis== |
Latest revision as of 12:26, 1 December 2021
- A developmental odontogenic cyst that surrounds the crown of an unerupted tooth
- The cyst is attached to the neck of the tooth (CEJ), prevents its eruption and may displace it for considerable distance
- Considered a dilatation of the follicle hence also known as a follicular cyst
Epidemiology[edit | edit source]
- Second most common cyst of the jaw (most common of developmental aetiology) - 10-15% of all jaw cysts
- ♂ > ♀ (1.5:1)[1]
- 80% occur in the mandible[1]
- Affect permanent teeth
- Mandibular 3rd molar (77%) > maxillary 3rd molar (11%) > maxillary canine (5%)[1]
- Most common in age 20-50yrs
Clinical Features[edit | edit source]
- Cyst usually affects single tooth (rarely affects multiple teeth)
- Associated with unerupted teeth - but as lower third molar is most commonly affected, patients are commonly unaware
- Usually asymptomatic until the swelling becomes noticeable
- When large an intra-oral swelling may become noticeable (usually painless)
- Very large or infected cysts may cause extra-oral swelling
- Usually an incidental finding on routine radiography or when looking for a missing tooth
- Infected cysts also associated with rapid growth and pain
- May displace the tooth with which they are associated and tilt adjacent teeth
- In the maxilla, teeth may be displaced into the sinus therefore can present with classic symptoms of sinus disease
- Rarely cause resorption of adjacent tooth roots/tooth enclosed within cyst
Differential Diagnosis[edit | edit source]
- Other cysts of the jaws
- Specifically odontogenic keratocysts and ameloblastomas may occasionally envelope the crown of the tooth and ∴ mimic dentigerous cyst
Aetiology and Pathogenesis[edit | edit source]
Aetiology[edit | edit source]
- Dentigerous are developmental anomalies (but some cysts may be induced by inflammation)
- No genetic defect has been identified
- Can be associated with various syndromes (consider when multiple lesions are present):
- Cleidocranial dysplasia
- Maroteaux-Lamy syndrome
- Gardener's syndrome
Pathogenesis[edit | edit source]
- Formed by accumulation of fluid between the reduced enamel epithelium and crown of an unerupted tooth
- Occurs after enamel formation is complete
- Strong association between failure of eruption of teeth and formation of dentigerous cyst
- ∴ commonly affects lower third molars and upper canines (teeth that commonly impact)
- Alteration in the reduced enamel epithelium → encloses the crown of an unerupted tooth at the cemento-enamel junction
- Intrafollicular fluid accumulates between reduced enamel epithelium and enamel
- Pressure of tooth on impacted follicle →
- Obstructs venous outflow
- Serum transudation
- Exudation
Investigations[edit | edit source]
Imaging[edit | edit source]
Plain film[edit | edit source]
- Commonly an incidental finding on routine intra-oral or panoramic radiographs
- Common radiographic features:
- Round radiolucent area (uniformly radiolucent)
- Unilocular
- Sharply defined with corticated margins (∵ slow growth)
- Associated with crown of unerupted permanent teeth
Computed Tomography[edit | edit source]
- Can facilitate diagnosis, and 3D characterisation for surgical planning
Histopathology[edit | edit source]
- Common histopathological findings:
- Clear yellow fluid (cholesterol)
- Purulent if infected
- Lined by flattened, non-keratinized stratified squamous epithelium
- Continuous with reduced enamel epithelium
- Mucus and ciliated columnar metaplasia
- These cells can sometimes be found in the lining of the epithelium
- Fibrous wall and variable inflammation
Management[edit | edit source]
- Enucleation + extraction of tooth
- Marsupialization - if tooth is in a favourable position and space is available this may allow tooth to erupt. Also helpful if cyst is large and risks fracture of mandible
Prognosis and Complications[edit | edit source]
- Recurrence is rare
- Although rare, the lining of a dentigerous cyst can undergo transformation and develop into:
Follow-up[edit | edit source]
- Routine follow-up not needed
- Suitable for results to be given to patient via remote consultation/mail
- Be aware that malignancy in the cyst wall is usually unexpected at the time of presentation and the diagnosis is usually made following enucleation - these cases obviously need follow-up
References[edit | edit source]
- ↑ 1.0 1.1 1.2 Zhang LL, Yang R, Zhang L, Li W, MacDonald-Jankowski D, Poh CF. Dentigerous cyst: a retrospective clinicopathological analysis of 2082 dentigerous cysts in British Columbia, Canada. International journal of oral and maxillofacial surgery. 2010 Sep 1;39(9):878-82.
- ↑ Bhushan NS, Rao NM, Navatha M, Kumar BK. Ameloblastoma arising from a dentigerous cyst-a case report. Journal of clinical and diagnostic research: JCDR. 2014 May;8(5):ZD23.
- ↑ Pearcey RG. Squamous-cell carcinoma arising in dental cysts. Clinical radiology. 1985 Jan 1;36(4):387-8.
- ↑ Abdeldayem MA. A case report of maxillary dentigerous cyst transforms into mucoepidermoid carcinoma and systematic review of literature. Advances in Oral and Maxillofacial Surgery. 2021 Apr 2:100072.