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Pathologic lesions of the jaws include a wide differential diagnosis. A thorough clinical history and physical examination aid in diagnosis, though in most situations, radiographs and histopathological analysis are necessary to determine proper treatment. Many are asymptomatic and found on routine dental radiograph screening. All jaw cysts, except periapical cysts, are generally associated with vital teeth, unless coincidental disease of adjacent teeth is present. Ice testing or electrical pulse testing can assess tooth vitality. Needle aspiration prior to open incisional biopsy of a radiolucent lesion is important to exclude diagnosis of arteriovenous malformation and although not always reliable, can give insight into cystic versus solid masses. Aspiration of a solid tumor would usually yield a dry tap. Radiographs play a critical role in management of such lesions of the jaws as they may appear radiolucent (“radiographically cystic”), radiopaque, or sometimes contain characteristics of both (see Figures 39-1 and 39-2). Computed tomography (CT) scans can be helpful when lesions are large, neurologic changes are present, or malignancy is suspected. Pertinent clinical, histopathological, and radiographical features, as well as treatment and prognosis will be reviewed for these lesions. The most current information based on the 2017 World Health Organization (WHO) classification is provided.

Figure 39-1

Clinical algorithm: Radiolucent lesions. (Conv—conventional; IO—intraosseous; NBCCS—nevoid basal cell carcinoma syndrome.)

Figure 39-2

Clinical algorithm: Radiopaque lesions.

Cysts of the Jaw

A true cyst contains an epithelial lining.



  1. Radicular cyst (periapical cyst)

    1. Clinical features:

      1. Overall most common odontogenic cyst of the jaws.

      2. Associated with nonvital tooth or trauma, not always symptomatic.

      3. Necrotic dental pulp creates inflammatory response at apex leading to granuloma formation or fistula to the gingiva or through cheek/jaw skin.

    2. Radiographical features: radiolucent, single lesion, well-demarcated, unilocular, surrounding apex of tooth

    3. Histopathological features: polymorphonuclear leukocytes (PMNs) intermixed with inflammatory exudate, cellular debris, necrotic material, bacterial colonies

    4. Treatment: removal of underlying inflammatory process through endodontic treatment (root canal) or tooth extraction with enucleation and curettage; antibiotics and drainage of any soft tissue abscess (if occurs)

    5. Prognosis: excellent

  2. Residual periapical cyst

    1. Clinical features:

      1. At the site of previous tooth extraction

      2. Remnant of process that led to tooth loss versus insufficient curettage during tooth extraction versus continuation of epithelial rest inflammatory response after tooth extraction

      3. Generally asymptomatic

    2. Radiographical features: radiolucent, single lesion, well-demarcated, unilocular

    3. Histopathological features: same as periapical cyst

    4. Treatment: enucleation and curettage

    5. Prognosis: excellent

  3. Collateral inflammatory cyst (paradental cysts/buccal bifurcation cysts)

    1. Clinical features:

      1. Typically in children from 5 to 13 years of age

      2. Found on the buccal surface of erupting mandibular first, second, and third molars

      3. Localized swelling and foul-tasting discharge location of the erupting tooth

    2. Radiographical features: radiolucent, single lesion, well-demarcated associated with the erupting mandibular ...

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