Mandibular Cysts - Types, Symptoms, and Prognosis

Introduction:

A cyst is a pathologic cavity lined by an epithelium containing fluid or a semi-fluid substance that grows gradually due to the internal pressure caused by the fluid. Cysts commonly occur in the bones of the jaws, the maxillary, and the mandibular bones than in other parts of the body as they have abundant epithelial remnants.

What Are the Types of Jaw Cysts?

The World Health Organization has classified jaw cysts as odontogenic and non-odontogenic. Odontogenic cysts are further classified as developmental and inflammatory cysts.

• The inflammatory cysts of odontogenic origin are periapical cysts, residual cysts, and buccal bifurcation cysts.

• The developmental cysts of odontogenic origin are dentigerous, eruption cysts, odontogenic keratocysts, gingival cysts of newborns and adults, lateral periodontal cysts, calcifying odontogenic cysts, glandular odontogenic cysts.

• The non-odontogenic cysts include nasopalatine cysts, nasolabial cysts, median alveolar cysts, median palatal cysts, median mandibular cysts, and globulo-maxillary cysts.

What Are the Cystic Lesions Occurring in the Mandible?

• Periapical cyst or radicular cyst.

• Dentigerous or follicular cyst.

• Odontogenic keratocyst.

• Primordial cyst of the mandible.

• Stafne or static bone cyst.

• Traumatic or hemorrhagic or solitary bone cyst.

• Residual cyst of the mandible.

• Lateral periodontal cyst.

What Are the Causes of Mandibular Cysts?

• Odontogenic cysts develop from tissues involved in the normal development of teeth.

• Non-odontogenic cysts are lesions that develop from tissues other than teeth, such as soft tissues and bones.

• Cysts can arise from epithelial remnants left in the jaws. These remnants are left during the process of development of teeth.

• During the development of jaw bones, embryonic processes fuse with ectodermal tissue trapped in between, which undergoes atrophy and forms a cyst.

• Some of the cysts are associated with genetic conditions. For example,

What Are the Symptoms of Mandibular Cysts?

• Cysts cause symptoms only when they are secondarily infected. And the symptoms entirely depend on the site of the cyst.

• If a cyst undergoes slow expansion, it is not palpable clinically as the bone gets formed around the lesion and attempts to isolate it.

• If the cyst expands rapidly, it is still covered with a thin layer of bone which cracks on pressure application leading to an eggshell cracking sign.

• If the bone covers the cyst, it is hard, whereas if the lesion erodes the bone, the cyst fluctuates.

• If the cyst is infected, it may cause discharge into the oral cavity through the sinus.

• The cyst may affect the adjacent by causing its displacement and resorption of roots.

What Are the Complications of a Jaw Cyst?

• Bony destruction.

• Infection.

• Oral sinus.

• Facial sinus.

• Weakening of the jaw.

• Displacement of teeth.

• Resorption of roots of adjacent teeth.

• Encroachment of the floor of the maxillary sinus.

• Deflection of inferior alveolar canal.

How Are Mandibular Cysts Diagnosed?

• Cysts of the jaw can be diagnosed using imaging studies, such as X-rays, Ct(Computed Tomography), and MRI(Magnetic Resonance Imaging).

• A biopsy of the cystic lining will be performed for lab analysis.

What Are the Radiographic Features of Mandibular Cysts?

How Is a Mandibular Cyst Treated?

Many cysts have a similar clinical presentation, and the following procedures can be performed to treat them based on their severity. First, the cyst lining is removed and sent for histopathological examination. Then the majority of the cysts are surgically removed.

The two techniques to remove the cyst are

• Enucleation: It is the surgical removal of the entire cyst. A mucoperiosteal flap over the cyst is elevated, and the complete cyst is removed. Then sutures are placed to close the defect.

• Marsupialization: A mucoperiosteal flap is elevated, a window is created into the cyst's wall, and the lining is attached to the oral mucosa to allow drainage of the cyst. As the window is open, the pressure inside the cyst reduces, and the lesion shrinks. A plug is used to prevent the closure of the window. The window is left open and cleaned regularly until the contents are eliminated. Marsupialization can be performed in the case of a dentigerous cyst, and the tooth is allowed to erupt instead of extraction.

• Enucleation Following Marsupialization: When cysts are large, and their removal would lead to a fracture of the jaw bone, two steps are performed. Firstly, marsupialization is done to eliminate the contents and shrink the lesion. Secondly, enucleation is done to eliminate the cyst entirely.

• Enucleation With Curettage: In this method, the cyst removal by enucleation is followed by the removal of surrounding bone to eliminate any remnants of the cystic lining. This method is adopted if the cyst lining is thin or if the cyst is infected. Then the area is irrigated to flush out the debris.

Some options are acquired to reduce the recurrence rate of certain cysts, like odontogenic keratocyst. They include curettage post-enucleation, Carnoy's solution, and mandibular resection. In addition, supportive care is provided for maintaining the quality of life by assisting with nutrition, swallowing, speech, and replacing missing teeth.

Consult a Doctor:

If an individual experiences the symptoms of a jaw cyst, it is good to visit a dentist or a physician immediately. Most commonly, jaw cysts are not symptomatic and are accidentally found during routine radiographic examinations. And if the jaw cysts are diagnosed and are found to be aggressive, a team of specialists will formulate the treatment plan.

How Is the Prognosis of Mandibular Cysts?

The prognosis of a cyst depends on the type, size, and location of the cyst. Benign cysts do not require treatment, whereas locally aggressive cysts may lead to the destruction of the surrounding bone if left untreated. In such cases, the cyst and the healthy bone lining are removed to prevent residue build-up and recurrence. In some cases, a cyst can expand and lead to pathological fractures.

Conclusion:

Treatment options vary for each type of jaw cyst based on the cysts' symptoms, type, and growth stage. An oral and maxillofacial surgeon will formulate the treatment plan for the particular cyst and treats the lesion through surgery, medical therapy, or a combination of both.