What Is A CYST?

Best Cysts and Tumor Removal In India

What Is A CYST?
A cyst is an abnormal cavity in hard or soft tissue that contains fluid, semifluid, or gas and is often encapsulated and lined by epithelium. At Richardson’s Face Hospitals, we specialize in the Best Cysts and tumor removal in India, offering expert care for diagnosis and treatment.

Dentigerous CYST

Histogenesis

Dentigerous cysts arise from the dental follicle. Two prominent theories explain their formation, making it essential for the Best Cysts and Tumor Removal in India.

Fluid Accumulation Theory:
- Fluid accumulates between the Reduced Enamel Epithelium (REE) and the crown of the tooth.
- This causes pressure, leading to the proliferation of the REE into a cyst.
Breakdown of Stellate Reticulum:
- Fluid forms between the Inner Enamel Epithelium (IEE) and Outer Enamel Epithelium (OEE).
- This incites the proliferation of the outer enamel epithelium, resulting in cyst formation.

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Clinical Features

Associated with the 3rd molar in the mandible.
2nd most frequent location: maxillary canine region, followed by the posterior maxilla.
Peak incidence in teens (20s).
Male: female = 1.6:1.
Can attain 10-15 cm.
Not painful unless secondarily infected or the size creates a pathologic fracture.
Bony expansion and facial fullness.

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Radiological Features

Three Variants:
a) Central
b) Lateral
c) Circumferential

Smooth, unilocular lesion, but multilocular may occur.
Radiolucent area surrounded by a thin sclerotic line representing bony reaction.

Histological Features

Uninflamed cyst:

Lining resembles REE.
Constitutes 2-3 rows of cuboidal or flattened epithelium.
Mucous cells present.
Wall is composed of mucopolysaccharides.
Dystrophic calcifications present.

Inflamed cyst:

Rete ridges.
Rushton bodies.
Cholesterol clefts.

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Treatment

Enucleation – Preferred treatment and widely performed at Richardson’s Face Hospitals, known for the Best Cysts and tumor removal in India.
Marsupialisation – Less ideal, as it runs the risk of allowing an ameloblastoma in situ or a microinvasive ameloblastoma or other neoplastic transformations of the cyst lining to develop into a more invasive disease.
Caldwell-Luc – Used for large dentigerous cysts in the maxilla.

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Odontogenic Keratocyst (OKC)

Histogenesis:

Primordial Origin: Arises from dental lamina rests.
Dentigerous Origin: Arises from the reduced enamel epithelium of the dental follicle.

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Clinical Features:

Peak Incidence: 2nd and 3rd decades.
Male Predilection.
Common Sites:
- Mandible: Majority occur in the ramus-third molar area, followed by 1st & 2nd molars, then anterior mandible.
- Maxilla: 3rd molar > cuspid region.
Bony Expansion: Causes antero-posterior bony expansion.
Some may rupture and leak keratin, causing pain and swelling due to an inflammatory reaction.
Displaces the inferior alveolar nerve bundle to the inferior border but does not affect nerve sensation.

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Radiological Features:

Unilocular Radiolucency: Most commonly seen.
Multilocular Radiolucency: Represents a central cavity containing satellite cysts. Multilocularity is associated with larger lesions.

Variants:

Replacement
Envelopment
Extraneous
Collateral

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Histological Features:

Lined by stratified squamous epithelium with a flat epithelium-connective tissue junction (no rete ridges).

Parakeratinised Type:

Corrugated surface.
Basal cell layer: Hyperchromatic, cuboidal/columnar shape.
Palisaded nuclei.
Fibrous wall contains epithelial islands → central keratinisation → Daughter/Satellite cysts.
Cystic lumen contains keratin.

Orthokeratinised Type:

Thin lining with a flat orthokeratinised surface.
Basal cells: Not hyperchromatic and not palisaded.
Satellite cysts are absent, hence referred to as keratinizing odontogenic cysts.
No recurrence.

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Treatment

At Richardsons Face Hospitals, known for the Best Cysts and tumor removal in India, we offer specialized treatment approaches:

Marsupialisation is followed by enucleation.
Enucleation, followed by cryosurgery.
Enucleation with adjunctive chemical cauterization using Carnoy’s solution alongside excision of the overlying attached mucosa.
Radical excision: Reserved for multiple recurrent lesions.

Radicular Cyst

Histological Features:

Cystic Contents: Soft brown material with glistening, oily yellow flecks.
Epithelium: Stratified squamous non-keratinised epithelium.
Wall: Dense, mixed inflammatory infiltrate rich in plasma cells, lymphocytes, and neutrophils.
Russell Bodies: Found within or outside the plasma membrane.
Cholesterol Deposits: Seen as foamy histiocytes in sheets or clefts.
Hemorrhage and Hemosiderin Deposits.
Rushton Bodies.

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Treatment and Prognosis:

Endodontic restoration of the tooth.
For non-restorable teeth:
- Removal of the tooth and curettage of the apical area.
Prognosis: Excellent.
- If the tooth is removed but the cyst remains → it may involute.
- If left untreated → it may persist as a residual cyst.

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