Cysts of the jaws: A multicentre study

OBJECTIVES

To determine the relative frequency, demographic and pathologic profiles of patients diagnosed with cysts of the jaws.

MATERIALS AND METHODS

Biopsy records of the participating institutions from 2000 to 2020 were reviewed for lesions diagnosed in the cyst category. Demographic data, the location of the cysts and pathologic diagnoses were collected. Data were analyzed by appropriate statistics using IBM SPSS software version 28.0.

RESULTS

From 148,353 accessioned cases, 25,628 cases (17.28%) were diagnosed in the cyst category. Mean age of the patients ± SD = 42.62 ± 19.36 years. Paediatric patients (aged ≤ 16 years) accounted for 9.63%, while geriatric patients (aged ≥ 65) comprised 14.22% of all the patients. The male-to-female ratio was 1.27:1. The majority of the lesions were encountered in the mandible. The most prevalent cyst was radicular cyst followed by dentigerous cyst and odontogenic keratocyst. In the paediatric group, dentigerous cyst was the most prevalent, whereas in the geriatric group, radicular cyst was the most common.

CONCLUSIONS

In general, the results of this study are in accordance with previous studies. This study provides an invaluable database for clinicians when formulating clinical differential diagnoses as well as for pathologists in rendering the final diagnosis.

How reliable are follow-up studies on odontogenic keratocysts?

Follow-up studies on odontogenic keratocysts have reported widely varying recurrence rates. This raises the question of how reliable these studies are and how the results should be interpreted. The aim of this study was to critically assess the information from all follow-up studies published since 2004 against a set of criteria to determine how thorough the study was. These criteria include the exclusion of the orthokeratinized variant, exclusion of cysts associated with nevoid basal cell carcinoma syndrome, and appropriate reporting of dropouts. A search of four electronic databases covering the years 2004-2022 was performed. Only studies with a sufficient follow-up period (covering a range of 1-8 years) were included. Studies with fewer than 40 cases were excluded. Fourteen relevant studies were identified in the literature search. The vast majority of these studies had considerable shortcomings, giving rise to serious doubts about the validity of their recurrence rate results. Of note, these studies have often been included in meta-analyses that report on the best treatment options to reduce the tendency of recurrences. The results of this review strongly suggest that multicentre studies with strict protocols should be performed to advance knowledge of the presentation of recurrences, both the timing and frequency.

A Rare Odontogenic Cyst: Gingival Cyst of the Adult. A Case Report and Review of the Literature in Elderly Patients

Gingival cysts of adults (GCAs) are a relatively rare type of odontogenic cysts developing from the remnants of the dental lamina. Although GCAs generally affect individuals below the age of 65, their findings in older patients may exceptionally occur. Usually asymptomatic, they present as small, generally solitary nodules, located on the attached gingiva, primarily in the mandibular canine and premolar regions. This report highlights a rare case of a solitary GCA in an 82-year-old patient, who presented with a discrete nodule located between the right mandibular canine and first premolar. An excisional biopsy was performed, and the diagnosis of GCA was confirmed by the histological examination. No recurrence was observed during the 18-month follow-up period. Additionally, a literature review was conducted to analyse the clinical and pathological characteristics of GCAs in patients aged 65 and older. By providing details of this rare entity, our case study highlights the importance of considering GCAs when diagnosing gingival lesions in geriatric patients. By increasing our understanding of GCAs in the elderly population, our findings can help improve diagnosis as well as management strategies for these lesions.

Frequency and Demographic Profile of Odontogenic Cysts in Riyadh, Saudi Arabia: Retrospective Multicenter Study

Odontogenic cysts (OCs) are etiologically diverse conditions with a shared origin in the jaws. Unfortunately, there is a scarcity of published data regarding OC frequency, treatment, and follow-up information in Saudi Arabia, especially from tertiary centers.

OBJECTIVES

The study aims to assess the relative frequency, clinicopathological features, treatment, and follow-up of OCs in three tertiary medical centers.

METHODS AND MATERIAL

OCs were identified from King Abdulaziz Medical City, King Fahad Medical City, and Prince Sultan Military Medical City from January 2010 to December 2021.

RESULTS

Three hundred and seventy-two cases of OCs were identified from the archive of three medical centers in Riyadh; one hundred and forty-nine (40%) cases were retrieved from Prince Sultan Military Medical City. The mean age of all OCs was 32 years (range 2-90), with 225 (60.4%) cases occurring in males. There was an almost equal distribution of OCs between the maxilla (47.0%) and the mandible (53.0%). The apical radicular cyst (ARC) accounted for half of the cases, followed by dentigerous cyst (DC) (29.3%) and odontogenic keratocyst (OKC) (14.2%). Enucleation was the most common treatment modality (52.8%), followed by excision (35.0%). Thirteen cases showed recurrence: one ARC, four DCs, and eight OKCs.

CONCLUSION

This is the first large multicenter study of OCs in Riyadh, Saudi Arabia. All three centers showed that ARC was the most common, followed by DC and OKC.

Retrospective Analysis of Oral and Maxillofacial Pathologies

Objectives: The aim of this study is to analyze the biopsy results of oral and maxillofacial lesions and to discuss them in the accompanied by the literature. Material and Method: In the study, biopsy results of 644 patients who were admitted to Zonguldak Bülent Ecevit University Faculty of Dentistry, Department of Oral and Maxillofacial Radiology between 2016-2021 for various reasons and subsequently diagnosed with oral and maxillofacial pathology were retrospectively analyzed using digital archives. Age, gender, location of the lesions and pathological diagnoses of the patients were recorded. Results: In the study, 344 (53,41%) of the patients whose biopsy reports were examined were male and 300 (46,59%) were female, and the male: female (M: F) ratio was determined to be 1,15:1. The age range varied between 7 and 88 years and the mean age was 37,85±17,35 years. Out of a total of 644 lesions, 436 (67,8%) were cysts, 148 (23,1%) were inflammatory/reactive lesions, 57 (9,3%) were benign tumors and tumor-like lesions, and 3 (0,5%) were included in the malignant tumor and tumor-like lesion group. Conclusions: The analysis of data on oral and maxillofacial lesions is of great importance for the planning of preventive and therapeutic services. Amaç: Bu çalışmanın amacı, oral ve maksillofasiyal lezyonların biyopsi sonuçlarını analiz etmek ve literatür eşliğinde tartışmaktır. Gereç ve Yöntem: Çalışmada, 2016-2021 yılları arasında Zonguldak Bülent Ecevit Üniversitesi Diş Hekimliği Fakültesi Ağız, Diş ve Çene Radyolojisi Anabilim Dalı'na çeşitli nedenlerle başvuran ve sonrasında oral ve maksillofasiyal patoloji tanısı alan 644 hastanın biyopsi sonuçları dijital arşiv kullanılarak retrospektif olarak incelenmiştir. Hastaların yaşları, cinsiyetleri, lezyonların lokalizsyonları ve patolojik tanıları kaydedildi. Bulgular: Çalışmada, biyopsi raporu incelenen hastaların 344'ü (%53,41) erkek, 300'ü (%46,59) kadın olup, erkek:kadın (E:K) oranı 1,15 :bir olarak belirlendi. Yaş aralığı 7 ile 88 arasında değişmekte olup, yaş ortalaması 37,85±17,35 yıl idi. Toplam 644 lezyonun 436'sı (%67,8) kist, 148'i (%23,1) inflamatuar/reaktif lezyonlar, 57'si (%9,3) iyi huylu tümörler ve tümör benzeri lezyonlardı ve geriye kalan 3 (% 0,5) patoloji malign tümör ve tümör benzeri lezyon grubundaydı. Sonuç: Oral ve maksillofasiyal lezyonlara ilişkin verilerin analizi, koruyucu ve tedavi edici hizmetlerin planlanması için büyük önem taşımaktadır.

The prevalence, distribution, and radiological evaluation of dentigerous cysts in a Lebanese sample

Purpose

This study was performed to evaluate the prevalence, distribution, and radiological features (as per the Shear classification) of dentigerous cysts in a Lebanese sample.

Materials and Methods

It was an epidemiological, cross-sectional, 5-year retrospective study of 137 dentigerous cysts treated at Lebanese Army Dental Departments. The collected data comprised demographic and radiological information corresponding to patients from July 2015 to July 2020. Syndromic cases were excluded. Demographic data and the radiological features of cases were studied and analyzed.

Results

Dentigerous cysts were treated in 109 patients (58.7% males and 41.3% females; mean age: 28.3±16.3 years) out of 6,013 patients (52% males and 48% females), with a prevalence of 1.8%. Dentigerous cysts were more commonly found in patients in their second and third decades of life than in older age groups. Of the 109 patients, 22.9% had multiple dentigerous cysts. Of the 137 cysts, 71.5% were mandibular. The most prevalent anatomical location was the posterior mandible, followed by the posterior maxilla. The most commonly involved tooth was the mandibular third molar. Regarding radiological types, the central type was the most common (60.6%), followed by the lateral type (29.2%), and the circumferential type (10.2%).

Conclusion

The results of this study were similar to studies of other populations in terms of distribution and features. Multiple non-syndromic dentigerous cysts were more common than reported in other studies, which warrants further clinical studies to reveal previously undetected factors.

Prevalence of odontogenic cysts and its associated factors in South Indian population

Background:

Odontogenic cysts (OCs) constitute a major part of oral pathological lesions, but little is known about their distribution patterns in various populations.

Aims:

The aim was to determine the prevalence and factors associated with the cases of histopathologically diagnosed OCs that report to our institution and to analyze the factors associated with the presence of OCs and to study the biologic behavior of different types of cysts.

Materials and Methods:

A cross-sectional study was performed on 596 oral and maxillofacial specimens during 2013–2017. Out of these, the cases which were histopathologically proven as OCs were separated and data were collected and analyzed regarding the age, gender, primary symptom, site, radiographic feature, histopathologic diagnosis, treatment given, recurrences and associated conditions if any.

Results:

Of the 596 cases included in the study, 67 (11.2%) had a histopathological diagnosis of OCs. 41 cases were inflammatory cysts and 26 developmental cysts. 28 cases (41.8%) were reported as periapical cysts, 10 cases (14.9%) were odontogenic keratocysts (OKCs), 9 cases (13.4%) were dentigerous cysts, 8 cases (11.9%) were inflamed cyst wall, 5 cases (7.5%) each of residual cyst and developmental OCs and one case (1.5%) each of orthokeratinized OC and calcifying OC.

Conclusion:

This study showed that the prevalence of OCs was similar to other reported studies. Periapical cysts were the most common cysts reported, followed by OKCs showing that the latter were more frequent than dentigerous cysts.

Positional Changes of Mandibular Canal Before and After Decompression of Cystic Lesions in the Mandible

PURPOSE

Significant displacement of the mandibular canal (MC), which occurs frequently in extensive mandibular cystic lesion cases, may raise the risk of inferior alveolar neurovascular bundle injury in surgery. The aim of the present study was to measure the association between positional changes of the MC and the direction (in the coronal plane) of bone expansion of cystic lesions in the mandible.

PATIENTS AND METHODS

We performed a retrospective study of patients who had undergone decompression and enucleation surgery from January 2014 to December 2018. Based on coronal planes of cone-beam computerized tomography, the centroids of the expanded mandibles were calculated and considered markers for evaluation of the directions of bone expansion. In addition, the changes in the position of the MC before decompression and enucleation were measured and compared. A Cartesian coordinate system was introduced in this study to illustrate the relationship of positional changes between the displacement of the MC and expansion of the mandible in a straightforward manner. Statistical analysis was performed using the paired t test, unpaired t test, one-way analysis of variance or linear regression as appropriate.

RESULTS

Thirty-six patients with an average age of 29.8 years (14 men, 22 women) who received treatment of decompression and enucleation for mandibular cystic lesions were included in this study. The MCs were displaced in the direction toward the lower edge of the mandible and opposite to the direction of mandibular expansion. In addition, the MCs were relocated close to their original location by 1.67 ± 1.45 mm (mean ± standard deviation) approximately 1 year after decompression, accounting for 22.66% of the total displacement.

CONCLUSIONS

In mandibular cystic lesion cases, the MCs tend to displace opposite to the direction of mandibular expansion and relocate less after decompression.

A comparative study of osteopontin expression, Ki67 index and prognosis in squamous cell carcinoma and cysts of the oral cavity

Background

Recent studies have shown a strong relationship between the expression of osteopontin and oral carcinogenesis. Osteopontin (OPN) has been shown to play a major role in regulating the aggressiveness of cancer cells and promote tumor growth. Odontogenic cysts are an essential aspect of oral and maxillofacial pathology. They are relatively frequent lesions with different clinical behavior. Some of them may have a proliferative pattern of growth and neoplastic nature. Evaluation of osteopontin expression with Ki-67 index may help examine clinical behavior and recurrence of oral squamous cell cancer and radicular cyst patients.

Methods

A total of 44 oral cavity cancer cases and 21 cysts samples were analyzed by immunohistochemical staining. Data used for analysis were derived from medical records. The following information was obtained from all patients’ medical records: survival, age, sex, lymph node status, tumor size, and location, as well as grade and histologic type of tumor. Expression status of OPN and Ki-67 was statistically assessed.

Results

Our data demonstrated that for summary immunoreactive scores of OPN and Ki-67 expressions in OSCC vs. RC patients statistical significance was found for both markers’ between OSCC and RC groups. Moreover, osteopontin is significantly higher expressed in larger OSCC tumors.

Conclusions

In conclusion, the role of OPN expression both in oral squamous cancer cells and radicular cyst and possible correlation with demographic and clinicopathological features remain undetermined in some aspects, further high-powered studies to develop a more standardized assessment of Ki-67 and osteopontin expression in OSCC and are needed.

Relative frequency of dentigerous cyst in Iranian population: A 20-year retrospective study

Purpose

Dentigerous cyst (DC) is the most common type of developmental odontogenic cysts which apparently develops via accumulation of fluid between the reduced enamel epithelium and crown of the tooth. The aim of this study is to analyze the frequency of DC in Iranian population.

Materials and Methods

The files of oral pathology, Shahid Beheshti University of Medical Sciences, served as the source of the materials from 1992 to 2012 for this study. All lesions diagnosed as DCs were subjected to microscopic reevaluation. Patient's age, sex, location, and microscopic characteristics were recorded. Based on these data, a descriptive statistical analysis was performed using SPSS 19 software (IBM SPSS Statistics 19, New York, United States) and the results with P < 0.05 were considered as significant.

Results

DC accounted for 34.37% of all odontogenic cysts of the jaws during the 20-year period. The mean age of patients was 24.72 years and most cases are diagnosed in the second and third decades of life. The male-to-female ratio was 1.52. About 73.89% of all lesions had occurred in the mandible and 26.11% in maxilla. DCs showed Vickers and Gorlin (ameloblastomatous) changes in 2.36% of cases. The mean age was significantly lower in the premolar area (P = 0.00).

Conclusion

Age, sex, and location of DCs in Iranian population are similar to previous studies. In addition, the age of occurrence for this lesion in the premolar region was relatively lower than at other sites. Although the risk of ameloblastic change is low, it should be considered as an important issue.

Comparative analysis between developmental and inflammatory odontogenic cysts: retrospective study and literature review

PURPOSE

To assess epidemiological, clinical, and radiographic characteristics of odontogenic cysts (OCs) in a South Brazilian sample and to compare the results with international literature.

METHODS

For the main study purposes, biopsy and histopathological records were retrospectively analyzed from December 2006 to December 2018, OC cases were selected, and data about clinical characteristics were evaluated. Further, a literature review was performed for similar studies.

RESULTS

In the main study, the prevalence of OCs was 11.26% (n = 406), the majority of patients was male (56.73%), and the mean age was 39 ± 17.33 years. Radicular cyst was the most common OC (46.06%), followed by the odontogenic keratocyst (15.02%), dentigerous cyst (14.04%), and paradental cyst (13.55%). Inflammatory OCs were more prevalent in the maxilla (54.84%) and developmental cysts in the mandible (69.92%) (p < 0.05). Individuals with inflammatory OCs were usually older (41.0 ± 15.34 years) than the ones with developmental OC (28.0 ± 19.68 years) (p < 0.05). Regarding the literature review, 22 articles were included. Analysis of pooled data showed that global prevalence of OCs was 11.62% (95%CI = 9.97-13.37), from which radicular cyst was the most common (54.26%; 95%CI = 49.30-59.18), followed by dentigerous cyst (22.94%; 95%CI = 19.22-26.89) and odontogenic keratocyst (11.99%; 95%CI = 8.88-15.49). Furthermore, studies from Asia (72.40%; 95%CI = 70.30-74.40) and South America (68.48%; 95%CI = 64.07-72.72) presented the highest frequencies of inflammatory OCs.

CONCLUSION

The main study showed that the prevalence of OCs was 11.26%, which corroborates with international literature. Considering geographic variability of OC distribution, public health authorities and researchers could use these data for the development of focused prevention interventions, especially with regard to inflammatory OCs.

Spontaneous Eruption of a Deeply Impacted Premolar After Conservative Treatment of an Associated Dentigerous Cyst: A Case Report

Dentigerous cysts are benign odontogenic cysts that develop around the crowns of permanent teeth and are considered rare in children. This article reports a case of a 10-year-old girl with an inflammatory dentigerous cyst associated with the right mandibular premolar and deeply displacing it to the lower border of the mandible. To preserve the developing mandibular premolar and the mental nerve, marsupialization of the lesion under local anesthesia was performed. During the first month postoperatively, the impacted premolar naturally started to correct its position towards the normal path of eruption. After 13 months of follow-up, full spontaneous eruption of the impacted premolar with complete resolution of the cystic lesion, new bone formation, and closure of the root apex were observed. The use of marsupialization as a first-line approach is encouraged to treat dentigerous cysts in children, as it has been reported effective in terms of conservative management.

The presentation of odontogenic keratocysts in the jaws with an emphasis on the tooth-bearing area: a systematic review and meta-analysis

PURPOSE

This study was conducted in order to gain insight in the actual ratio of odontogenic keratocysts occurring in the tooth-bearing area as compared to the posterior region of the jaws in order to come up with reliable data to base upon a rational treatment policy.

METHODS

We searched MEDLINE, Web of Science, Scopus, and Cochrane databases for studies reporting on the location of mandibular and maxillary odontogenic keratocysts. All records were independently assessed and a meta-analysis was performed. Risk difference with a confidence interval of 95% of having the lesion in the posterior region versus the tooth-bearing area was the effect measure. P value for the summary effect of < 0.05 was considered statistically significant.

RESULTS

The 2615 records retrieved were reduced to 34 studies to be qualitatively/quantitatively assessed. The pooled values showed that the difference in the clinical risk of having keratocysts in the posterior region of the mandible and in the tooth-bearing area of the maxilla is 21 and 43%, respectively (P < 0.02 and P < 0.00001).

CONCLUSIONS

A substantial amount of keratocysts occur in the tooth-bearing area of the jaws, requiring attention.

Demographic and Clinical Characteristics of 5294 Jaw Cysts: A Retrospective Study of 38 Years

The aim of the present study is to report the demographic and clinical characteristics of all jaw cysts diagnosed in a single Oral Pathology Department. 5294 cases of jaw cysts diagnosed during a 38-year period were retrospectively collected and classified according to the latest classification of Head and Neck Tumors of the World Health Organization. The patients' gender and age, as well as the main clinical features of the cysts were retrieved from biopsy report forms. Jaw cysts were more common in male patients, with a male to female ratio of 1.6:1. Most patients were in the 4th-6th decade of life, with a mean age of 42.3 ± 16.1 years. There was no jaw predilection and the majority of lesions were more commonly encountered in the anterior region of the maxilla, followed by the molar region of the mandible. The most common jaw cyst was radicular cyst followed by dentigerous cyst, residual cyst and odontogenic keratocyst. The majority of jaw cysts are of inflammatory origin and represent a sequale of pulp necrosis. However, other type of jaw cysts may also be found.

Tratamento cirúrgico e conservador de cisto periapical de grande proporção: relato de caso

O objetivo deste estudo foi descrever uma técnica de tratamento conservadora, cuja conduta preconizada foi a realização da descompressão seguida pela enucleação cística através do relato de um caso de cisto periapical de grande extensão. Paciente de 50 anos de idade, melanoderma, apresentando cisto periapical com aproximadamente 4,5 cm em seu maior diâmetro associado ao incisivo central inferior esquerdo. Na primeira etapa do tratamento foi realizada descompressão cística e biopsia incisional, cujo exame histopatológico confirmou o diagnóstico clínico. Após 25 semanas de acompanhamento, houve uma considerável regressão do tamanho da lesão e a mesma foi enucleada sem comprometimento dos elementos dentários envolvidos e dos tecidos adjacentes. O relato de caso evidenciou que o tratamento cirúrgico e conservador pode ser um recurso em cistos periapicais de maior dimensão, sendo importante a cooperação do paciente no acompanhamento pós-operatório.

Comparison of the osteogenic differentiation of orofacial bone marrow stromal cells prior to and following marsupialization in patients with odontogenic cyst

Decompression has been considered a valuable tool for odontogenic cystic lesions to minimize cyst size with low morbidity and recurrence. However, whether decompression has a role in regulating stem cell properties of orofacial bone marrow stromal cells (BMSCs) around the cysts has not been fully investigated. The present study compared the stem cell marker profile and osteogenic differentiation potential of orofacial BMSCs prior to and following marsupialization (pre-BMSCs vs. post-BMSCs) in the same individuals. The results demonstrated that post-BMSCs proliferated significantly faster, displayed higher colony-forming unit-fibroblast capacity and demonstrated higher expression of octamer binding protein 4, Nanog and SRY-related HMG box 2 when compared with the pre-BMSCs. Notably, the osteogenic potential was greater in the post-BMSCs compared with in pre-BMSCs, by demonstrating that the protein and mRNA expression levels of osteopontin, runt-related transcription factor 2, osteocalcin, alkaline phosphatase and osterix were upregulated in pre-BMSCs. Furthermore, the phosphorylated levels of extracellular signal-regulated kinase and c-Jun N-terminal kinase were enhanced in post-BMSCs. In conclusion, the study indicated that decompression influences the stem cell properties of orofacial BMSCs, and further studies are needed to verify the findings.

Use of refrigerant spray of a propane/butane/isobutane gas mixture in the management of keratocystic odontogenic tumors: a preliminary study

PURPOSE

Keratocystic odontogenic tumor (KCOT) is an aggressive benign tumor and the management by complete enucleation followed by cryotherapy maintains the inorganic bone matrix, resulting in better repair and reduces the rates of recurrence. A refrigerant spray with a propane/butane/isobutane gas mixture has been pointed to as an alternative to liquid nitrogen, because the device is easy to handle and contain within the cavity, providing better control and lower risk of injury to the adjacent soft tissue. Thus, the aim of this study was to evaluate the outcome of enucleation followed by cryosurgery using a refrigerant spray of this gas mixture in ten patients diagnosed with KCOT.

METHOD

The biggest lesions received a prior treatment consisting of marsupialization to decrease the tumor size. During the surgeries, the lesions were removed by enucleation and the surgical site was sprayed with the gas mixture.

RESULTS

Wound dehiscence was observed in all cases, which healed by the second intention. The mean follow-up period was 64.3 months (range 24-120 months). Eight of the ten patients showed no evidence of clinical or radiographic recurrence. Pathologic fractures and infections were not observed.

CONCLUSIONS

The results obtained suggest that enucleation followed by cryosurgery is an effective therapy for managing KCOT.

Clinical and radiological analysis of a series of periapical cysts and periapical granulomas diagnosed in a Brazilian population

BACKGROUND

Periapical cysts (PC) and periapical granulomas (PG) are the two most common chronic inflammatory periapical diseases, but their clinicoradiological characteristics can vary depending on the methods employed in each study. The aim of the present work was to analyze the clinical and radiological profile of a series of PC and PG diagnosed in a Brazilian population.

MATERIAL AND METHODS

The files of two Oral Pathology laboratories were reviewed and all cases diagnosed as PG and PC were selected for the study. Clinical and radiological information were retrieved and data were tabulated and descriptively and comparatively analyzed.

RESULTS

Final sample was composed by 647 inflammatory periapical lesions, including 244 PG (38%) and 403 PC (62%). The number of women affected by PG was significantly higher than the number of women affected by PC (p=0.037). Anterior region of the maxilla was the most common affected area for both entities (39% of the cases), but the most common anatomical location of PG (anterior maxilla and posterior maxilla) was different from PC (anterior maxilla and posterior mandible) (p<0.0001). Upper lateral incisor was the most affected tooth. The mean radiological size of the PC was larger than the mean radiological size of the PG (p<0.0001) and PC showed well-defined radiological images more frequently than PG (p<0.0001).

CONCLUSIONS

PC were more common than PG, both showed predilection for adult females, most lesions affected predominantly the anterior maxilla and PC presented larger mean radiological diameter and well-defined images when compared with PG. Key words:Periapical granuloma, periapical cyst, radicular cyst, diagnosis, Oral Pathology.

Malignant changes developing from odontogenic cysts: A systematic review

The aim of this study was to systematically review scientific literature in orderto describe the characteristics and prognosis of malignant entities developing from odontogenic cysts. A search in Pubmed (MEDLINE) and Cochrane databases was conducted. The inclusion criteria were articles published in English related to the malignisation of odontogenic cysts in humans. The exclusion criteria were articles that do not specify the type of odontogenic cyst, malignisation of parakeratinised keratocysts, the presence of an ameloblastic carcinoma and metastasis from distant primary tumours. The selected articles were classified according to Strength of Recommendation Taxonomy criteria. Statistical analysis of the data was carried out using statistical package software SPSS version 22.0. From the 1,237 articles initially obtained, the authors included 3 case series and 45 case reports in the end. Descriptive analysis showed that men have a disposition for malignisation from odontogenic cysts and they frequently appear at the posterior mandible, with pain and swelling being the most frequent signs and symptoms. Follicular cysts were the entities that underwent the most malignant changes with well differentiated squamous cell carcinomas being the most prevalent type of malignancy. The real prognosis of this malignancy is not known because of the heterogeneity of available studies.

Key words:Odontogenic cysts, squamous cell carcinoma, neoplastic cell transformation, oral cancer.

Lingual Gingival Cyst of the Adult

INTRODUCTION

Gingival cysts of the adult (GCAs) are rare developmental soft tissue cysts usually found on the facial attached gingiva. Documented cases on the lingual aspect are extremely uncommon. This report details a lingual GCA along with distinguishing characteristics of this lesion.

CASE PRESENTATION

The patient, a 37-year-old female, presented with a firm, round-shaped, bluish swelling on the lingual gingiva in the interproximal area between teeth #21 and #22. Radiographs revealed a circular radiolucency at the osseous crest. Surgical exploration showed cystic-appearing tissue with accompanying bone resorption. Histologic examination, along with clinical presentation, confirmed a diagnosis of gingival cyst. Healing was uneventful with no evidence of recurrence at a 5-month recall.

CONCLUSIONS

A GCA is usually of odontogenic origin and occurs typically in the attached gingiva of the mandibular premolar region. Occasionally, it demonstrates radiographic evidence of bone loss from pressure resorption. Its more frequent intraosseous counterpart, the lateral periodontal cyst, shares histopathologic characteristics with the GCA. These findings underscore the importance in establishing a definitive diagnosis.

Immunohistochemical Assessment of HER3 Expression in Odontogenic Cysts

Background:

It has been demonstrated that HER3 plays an important role in some human cancers and the HER3 expression is associated with worse survival in solid tumors.

Objectives:

This study was conducted to compare HER3 expression in epithelial lining of radicular cysts (RCs), dentigerous cysts (DCs) and odontogenic keratocysts (OKCs).

Materials and Methods:

This was a descriptive-analytical study, which assessed all 57 paraffin blocks of RCs, DCs and OKCs (21 RCs, 16 DCs, 20 OKC) from pathological archive of Dentistry College of Zahedan, Iran. The HER3 expression in cytoplasm and membrane was examined by immunohistochemical method. The data collected was analyzed using SPSS16 by ANOVA and Chi-square. P < 0.05 was considered as statistically significant.

Results:

The HER3 expression had positive results in 52.4% of OKC, 50% of DC and only 20% of RC samples. There was a significant difference between HER3 expression in OKCs and RCs.

Conclusions:

The HER3 expression in developmental odontogenic cysts was higher than that in inflammatory odontogenic cysts. The higher rate of HER3 expression in OKC may justify inherent growth potential, stimulation-independent proliferation capability, invasive growth and high recurrence rate of the cyst accepted today as a tumor.

A 5 year retrospective study of biopsied jaw lesions with the assessment of concordance between clinical and histopathological diagnoses

INTRODUCTION

The jaw can be affected by several lesions that manifest in the oral cavity, but little is known about their distribution patterns in various populations.

AIMS AND OBJECTIVES

This study presents the frequency and distribution of biopsied jaw lesions recorded in Faculty of Dentistry and gathers the information including provisional and final diagnosis of the lesions.

MATERIAL AND METHODS

Biopsy of 1938 lesions (2008-2013) was reviewed and 1473 lesions were included in this study. The provisional diagnosis and histopathological validations of lesions were compared. Data on the location of the lesion, as well as patient demographics, were also evaluated. The lesions were divided into three major groups as 1 - developmental/reactive and inflammatory lesions of the jaw, 2 - cystic lesion and 3 - tumor and tumor-like lesions.

STATISTICAL ANALYSIS

The variables were recorded and analysed using descriptive statistics.

RESULTS AND OBSERVATIONS

Three hundred and ninety-six lesions were in Group 1 and periapical granuloma was the most frequent diagnosis. Seven hundred and eighty-nine lesions were in Group 2 and the radicular cyst was the most frequent diagnosis. Two hundred and eighty-eight lesions were in Group 3 and the keratocystic odontogenic tumor was the most frequent. Two hundred and ninety-one biopsied lesions were in disagreement with respect to the diagnoses on clinical and histopathological examination.

CONCLUSION

Consequently, a provisional diagnosis of some of the malignant lesions was reactive, inflammatory, cystic or benign lesions, therefore the importance of evaluation of the specimen is emphasized.

Diagnostic Factors of Odontogenic Cysts in Iranian Population: A Retrospective Study Over the Past Two Decades

BACKGROUND

Early diagnosis of odontogenic cysts due to their silent progression is always a challenging problem for clinicians.

OBJECTIVES

The current study aimed to evaluate the frequency of odontogenic cysts and related factors in a selected Iranian population.

PATIENTS AND METHODS

The current cross-sectional study was conducted on 312 patients' recorded data in Taleghani Hospital, Tehran, Iran, from April 1993 to December 2013. All related data were extracted from the records and categorized in tables. The correlation between the variables was analyzed by either chi-square or multinominal logistic regression tests. The P values < 0.05 were considered significant.

RESULTS

Evaluation of 312 patients' records (185 males and 127 females) with the mean age of 27.6 showed that Odontogenic Keratocyst (OKC) was the most common odontogenic cyst of all followed by the dentigerous cyst as the second most common lesion. Most of the patients were in the second or third decades of their lives, although there was no statistically significant age distribution. The finding of the current study showed that calcifying odontogenic cyst (COC) occurrence was significantly related to the history of trauma. Enucleation and curettage of the odontogenic cysts were the most common treatment plans of all.

CONCLUSIONS

The current study showed that clinicians should consider the many factors associated with the occurrence of odontogenic cysts.

Prevalence of developmental odontogenic cysts in children and adolescents with emphasis on dentigerous cyst and odontogenic keratocyst (keratocystic odontogenic tumor)

OBJECTIVE

To investigate the incidence and prevalence of developmental odontogenic cysts in children and adolescents and compare the features of the two most common types, dentigerous cyst and keratocystic odontogenic tumor (KCOT).

STUDY DESIGN

A retrospective review in a series of 369 patients with all histological diagnoses of developmental odontogenic cysts in children (≤12 years) and adolescents (13-18 years) was conducted.

RESULTS

Among these, 361 (97.8%) patients were diagnosed as dentigerous cyst (n = 281) and KCOT (n = 80), with the male-to-female ratios of dentigerous cyst and KCOT both being 2:1. The average age of the patients with KCOT was older than that of those with dentigerous cyst (14.7 years vs 11.8 years, p < 0.001). Dentigerous cyst (59.1%) was more common in children, but KCOT (78.8%) was more common in adolescents (p < 0.001). Dentigerous cyst (57.6%) predominantly located on the maxilla, but KCOT (60.3%) predominantly located on the mandible (p = 0.010).

CONCLUSIONS

Adolescent patients with lesions located on the mandible would favor KCOT over dentigerous cyst. This study aids in better knowledge of the prevalence of developmental odontogenic cysts in a large pediatric population, and shows that a well-supported early diagnosis is indispensable for a more adequate treatment.

Retrospective study of biopsied head and neck lesions in a cohort of referral Taiwanese patients

Introduction

A study of the whole spectrum of biopsied head and neck (HN) diseases in Taiwan has not yet been performed. Therefore, the current study aimed to provide updated information about HN lesions in a cohort of referral Taiwanese patients for histopathological examination.

Methods

HN lesions (2000–2011) in patients with records of age, sex, and histological diagnoses were retrieved from the Oral Pathology Department of the institution. These lesions were classified into four main categories: tumor/tumor-like reactive lesions, cystic/pseudocystic lesions, inflammatory/infective lesions, and others/miscellaneous lesions.

Results

A total of 37,210 HN lesions were included in the current study. Most of these lesions were distributed in the group of tumor/tumor-like reactive lesions, followed by the groups of inflammatory/infective lesions, cystic/pseudocystic lesions, and others/miscellaneous lesions. Squamous cell carcinoma was the most common HN lesion, and was also the most frequent malignant lesion among the referral patients.

Conclusion

It was worthy of note that squamous cell carcinoma and oral potentially malignant disorders comprised high percentages of all HN lesions for the present cohort of referral patients.

Jaw cysts diagnosed in an Italian population over a 20-year period

BACKGROUND

Cysts of the jaws (JCs) are an important topic of oral pathology, but few epidemiological data are present in the literature, in particular about the potential of recurrence. The aim of this study was to describe a case series of JCs from a single institution, evaluating the frequency, the site, the age distribution, and the percentage of recurrence of all types of JCs.

METHODS

All JCs present in the histological records of the Section of Anatomic Pathology of the University of Bologna at Bellaria Hospital from 1992 to 2012 were retrieved.

RESULTS

A total of 1136 jaws cysts were obtained, of which 1117 (98.3%) were odontogenic and 19 (1.7%) were nonodontogenic. About odontogenic cysts (OCs), the most frequent was the radicular cyst (538 cases), followed by parakeratinized keratocystic odontogenic tumor (pKOT, 193 cases) and dentigerous cyst (120 cases). Among pKOT, 21 out of 193 cases (10.89%) showed a recurrence after a mean time of 4.5 years (range, 1-12 years). During follow-up (mean 11 years, range 1-19 years), all 3 cases of botrioid cysts, 12 out of 46 cases of unicystic ameloblastoma (26.09%), 2 out of 20 cases of calcifying OCs (10%) and 2 out of 538 cases of radicular cyst (0.37%) showed a recurrence.

CONCLUSION

Our study confirms that the distribution pattern of JCs in Italy is relatively similar to other studies worldwide and emphasizes the importance of recognizing the different histological types of JCs for their potential local aggressive behavior.

Clinicopathological study of jaw cysts in southeast region of Turkey

Objective:

The purpose of this retrospective study was to analyze clinic and radiologic features and the prevalence of jaw cysts in southeast region of Turkey.

Materials and Methods:

This study was carried out in 149 cysts of the jaw diagnosed among 407 individuals who were taken biopsy in our department from October 2008 to December 2012. All cysts were treated by enucleation, marsupialization, or combination, and all cases were histologically examined.

Results:

One-hundred-and-forty-eight cases were classified odontogenic, one was non-odontogenic. There were 89 cysts (59.7%) in men, 60 (40.3%) in women. The mean age was 32.72 years. We found 80 cysts (35 F, 45 M) in the maxillary and 69 (28 F, 41 M) in mandible. It is observed that 94 were radicular cysts (63%), 40 were dentigerous cysts (26.9%), 9 were odontogenic keratocysts (OKC) (6.1%), 5 were residual radicular cysts (3.4%), and 1 was nasopalatine cyst (0.6%). In radicular cysts, 56 of them (59.5%) were located in the anterior region of the jaws; 18 dentigerous cysts and 2 OKCs were found in the posterior region of mandible. Clinically, the chief complaint of patients was expansion and pain. Radiographically, scalloping of the lesion between the teeth was found in 1 case, root resorption was seen in 3 cases, and displacement of the teeth and follicles was observed in 16 cases.

Conclusions:

We found similar prevalence of jaw cysts that reported in the literature, in which most odontogenic cysts (OCs) were inflammatory origin.

Conservative surgical-orthodontic treatment of a young patient with a dentigerous cyst

INTRODUCTION: The dentigerous cyst is a developmental odontogenic cyst, whose therapeutic approach depends on the size of the lesion. This paper describes the treatment performed on a 14-year-old male patient who presented with a large dentigerous cyst on the permanent mandibular left second molar. CASE REPORT: The permanent mandibular left first molar was extracted, and the lesion was decompressed and marsupialized by excision of the overlying mucosa, opening a window into the cystic cavity and suturing an acrylic resin drain to the oral mucosa. The specimen removed during surgery confirmed the diagnosis of a dentigerous cyst. Within ninety days of surgery, there was a significant reduction in lesion size. Orthodontic treatment was then started, and included traction of the impacted tooth and opening of adequate space with a fixed appliance, providing favorable tooth alignment and leveling. CONCLUSION: Marsupialization and orthodontic traction should be considered when planning the treatment of a dentigerous cyst, mainly in young patients with large lesions, to avoid damage to the surrounding structures.

The predominant bacteria isolated from radicular cysts

Purpose

To detect predominant bacteria associated with radicular cysts and discuss in light of the literature.

Material and methods

Clinical materials were obtained from 35 radicular cysts by aspiration. Cultures were made from clinical materials by modern laboratory techniques, they underwent microbiologic analysis.

Results

The following are microorganisms isolated from cultures: Streptococcus milleri Group (SMG) (23.8%) [Streptococcus constellatus (19.1%) and Streptococcus anginosus (4.7%)], Streptococcus sanguis (14.3%), Streptococcus mitis (4.7%), Streptococcus cremoris (4.7%), Peptostreptococcus pevotii (4.7%), Prevotella buccae (4.7%), Prevotella intermedia (4.7%), Actinomyces meyeri (4.7%), Actinomyces viscosus (4.7%), Propionibacterium propionicum (4.7%), Bacteroides capillosus (4.7%), Staphylococcus hominis (4.7%), Rothia denticariosa (4.7%), Gemella haemolysans (4.7%), and Fusobacterium nucleatum (4.7%).

Conclusions

Results of this study demonstrated that radicular cysts show a great variety of anaerobic and facultative anaerobic bacterial flora. It was observed that all isolated microorganisms were the types commonly found in oral flora. Although no specific microorganism was found, Streptococcus spp. bacteria (47.5%) – especially SMG (23.8%) – were predominantly found in the microorganisms isolated. Furthermore, radicular cysts might be polymicrobial originated. Although radicular cyst is an inflammatory cyst, some radicular cyst fluids might be sterile.

Prevalence and distribution of odontogenic cyst in Indian population: a 10 year retrospective study

The purpose of this study is to determine the prevalence of odontogenic cyst in an Indian population and compare it with various reports from the other geographic areas of the world. The files on odontogenic jaw cysts treated between 2001 and 2011 at the oral and maxillofacial surgery unit were retrieved retrospectively. Patient's demographic information mainly age, sex and location of the lesion was recorded and analyzed using descriptive statistics. The diagnosis of odontogenic cyst accounted in 150 cases and accounted for 15.31 % of all lesions biopsied throughout the period. Mean age of the patient was 32.2 years, and 58 % were males. The overall male to female ratio was 1.38:1. Radicular cyst was most prevalent histological type (48.67 %) followed by dentigerous cyst, odontogenic keratocyst, lateral periodontal cyst, paradental cyst, residual cyst, adult gingival cyst, glandular odontogenic cyst, calcifying odontogenic cyst. The most common locations of the odontogenic cysts were the mandibular (49.33 %) and posterior region (33.33 %). The distribution pattern of odontogenic cyst in this study is relatively similar to that in other parts of the world but there are some geographic differences with regard to the relative frequency, sex, and anatomic distribution of the odontogenic cyst.

Histopathological study of radicular cysts diagnosed in a Brazilian population

The aim of this study was to investigate the histopathological features of radicular cysts (RCs) diagnosed in a Brazilian population. Seventy-three cases of RCs, from a total of 1480 biopsies diagnosed between 2001 and 2008 at the Laboratory of Oral Surgical Pathology of the Dental School of the Federal University of Bahia were investigated regarding their histopathological features. Morphological results showed that exocytosis (n=50), spongiosis (n=40), acanthosis (n=28), atrophic epithelium (n=27) and apoptotic bodies (n=21) were the most common findings. Other morphological findings included: foamy macrophages (n=10), Russell’s bodies (n=7), cholesterol crystals (n=7) and glandular-like odontogenic epithelial rests (n=1). Evidence of exogenous material was seen in 16 samples. It was concluded that the clinical and histopathological findings observed in Brazilian patients were comparable with those described for other populations.