Dentigerous Cyst

A dentigerous cyst surrounds the crown of an unerupted tooth, mostly the maxillary canine or the mandibular third molar tooth (Fig. 4.3). They are quite common.

The cyst wall has a thin epithelial lining that may be only two to three cells thick. In case of inflammation, the epithelium becomes thicker and will show features similar to the lining of a radicular cyst. Also, mucous-producing cells as well as ciliated cells may be observed (Fig. 4.6). The connective tissue component of the cyst wall may be fibrous or fibromyxoma-tous. The cyst wall may also contain varying amounts of epithelial nests representing remnants of the dental lamina.

Radiologically, a lot of jaw diseases associated with unerupted teeth may have an appearance similar to that of a dentigerous cyst. Histologic examination, however, will be decisive in ruling out these possibilities among which keratocyst and unicystic ameloblastoma (see Sects. 4.3.2.4 and 4.4.1.1) are the most prevalent. Moreover, the radiologic picture of the dentigerous cyst may be mimicked by hyperplasia of the dental follicle, the connective tissue capsule that surrounds the unerupt-ed tooth [33].

Fibromyxomatous areas in the connective tissue wall of the dentigerous cyst may resemble the odontogenic myxoma (see Sect. 4.4.2.1). The presence of odontogen-ic epithelial rests may lead to the erroneous diagnosis of one or another type of epithelial odontogenic tumour [71]. However, identification of the epithelial cyst lining will rule out these alternatives.

In most instances, dentigerous cysts are a fortuitous finding on oral radiographs. Only when excessively large may they cause swelling of the involved part of the jaw. If there is inflammation, they will cause pain and swelling. Removal of the cyst wall and the tooth involved will yield a permanent cure.

The eruption cyst is a specific type of dentigerous cyst located in the gingival soft tissues overlying the crown of an erupting tooth. Mostly, these cysts are short-lived, rupturing with the progressive eruption of the associated tooth. They are lined by squamous epithelium that is thickened due to inflammatory changes in the underlying connective tissue and thus similar to the lining of a radicular cyst.

Lateral periodontal cysts are rare lesions, derived from odontogenic epithelial remnants, and occurring on the lateral aspect or between the roots of vital teeth (Fig. 4.3) [166]. They are lined by a thin, non-keratinising squamous or cuboidal epithelium with focal, plaque-like thickenings consisting of clear cells that may contain glycogen (Fig. 4.7) [150].

Lateral periodontal cysts do not cause any symptoms. They are fortuitous findings on radiographs where they present as a well-demarcated radiolucency on the lateral surface of a tooth root. Simple enucleation is adequate treatment.

The botryoid odontogenic cyst represents a multiloc-ular form of the lateral periodontal cyst [54]. Treatment by curettage is the most appropriate treatment, but recurrences may occur [52].

The glandular odontogenic cyst, also called sialo-odon-togenic cyst is a rare cystic lesion characterised by an epithelial lining with cuboidal or columnar cells both at the surface and lining crypts or cyst-like spaces within the thickness of the epithelium [34, 73].

The lining epithelium is partly non-keratinising, squamous and with focal thickenings similar to the plaques in the lateral periodontal cyst and the botryoid odontogenic cyst. There may be a surface layer of eosinophilic cuboidal or columnar cells that can have cilia and may form papillary projections. Some superficial cells assume an apocrine appearance. Also, mucus-producing cells may be present. Focally, the epithelium shows areas of increased thickness in which glandular spaces are formed. Moreover, the epithelial cells may lie in spherical structures with a whorled appearance (Fig. 4.8).

Mucous cells and cuboidal cells with cilia may also occur in other jaw cysts, but the latter lack the other epithelial features described above. Mucous cells and non-keratinising squamous epithelium also occur in mu-coepidermoid carcinoma [91, 177]. However, epithelial plaques consisting of clear cells are not a feature of this latter lesion.

The glandular odontogenic cyst most commonly affects the body of the mandible and the most prominent

Fig. 4.7. Lateral periodontal cyst. The epithelial lining forms plaques consisting of clear cells
Fig. 4.8. Epithelial lining of glandular odontogenic cyst showing intraepithelial duct formation and apocrine differentiation at the surface

symptom is painless swelling [126]. Treatment may be conservative, but recurrence may occur [48].

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