Cysts in the Oral and Maxillofacial Region
This fact sheet provides an overview of common jaw cysts, divided into odontogenic, non-odontogenic, and pseudocysts. A cyst is a pathological cavity surrounded by epithelium. Treatment options include enucleation, marsupialization, or resection depending on the type and extent.
Table of contents
This article is based on an original article in Swedish which can be found here
INTRODUCTION
This article regarding cysts is not a comprehensive overview of all cysts but rather an overview of some of the most common cysts in the oral and maxillofacial region, divided into odontogenic cysts and non-odontogenic cysts. At the end, a lesion that is not a true cyst will also be discussed under the heading pseudocyst.
Pathogenesis
A cyst is defined as a pathological cavity that is delineated by epithelium. It develops through the stimulation of epithelial remnants, which proliferate into a mass of epithelial cells. As the mass increases in diameter, the epithelial cells in the center of the mass become increasingly distant from the nearest blood vessels and eventually cannot survive through diffusion. This leads to the death of epithelial cells, resulting in the formation of a lumen. The intracellular products of the dead epithelial cells make the lumen hypertonic, leading to fluid being transported into the cyst lumen. This results in increased hydrostatic pressure, which causes bone resorption, expansion of the cyst, and sometimes paresthesia and pain. As the cyst grows in size, it compresses the surrounding connective tissue into a connective tissue capsule. The epithelium matures and forms a basement membrane.
TREATMENT PRINCIPLES
Large cysts should be investigated preoperatively with CBCT or CT.
To ensure the diagnosis before treating large cysts, aspiration may be considered. In the case of straw-colored aspirate, exploration is performed with the intention of enucleation of the cyst. If the aspiration yields no results, a solid lesion is suspected, and a biopsy is performed. If only blood is present in the aspirate, the lesion is further investigated with laser Doppler technology or angiography.
