Introduction
Different cysts of the jaws can form in children, young adults, or later in life due to developmental disturbances. These cysts can cause significant oral health issues if not properly diagnosed and treated. Read the article to learn about the etiology, clinical features, and management of various fissural cysts occurring in the jaws across different age groups, as provided by the oral surgeon. Understanding these aspects is crucial for timely intervention and effective treatment.
What Are True Fissural Jaw Cysts?
A true cyst is defined in oral pathology literature as a pathologic cavity lined by epithelium, usually containing a semisolid or fluid material. The oral cavity and the jaws are common sites where developmental origin cysts, that is, those arising during embryonic development, occur. This is particularly true when such developmental cysts form along the union lines or embryonic processes of bones, where superficial or epithelial cells become trapped. These cysts occur along the fusion lines and are thus, called fissural cysts of the jaw. They are also referred to as inclusion cysts in many cases. These developmental cysts are mainly derived from embryonic structures or faults that commonly involve the oral epithelium trapped at the fusion lines or adjacent soft tissue epithelium in the oral cavity, leading to cyst formation.
What Are Different Fissural Cysts Types, Clinical Features, and Management?
Some of the major fissural cysts occurring in the jaws include:
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Incisive Canal Cyst: Also known as the nasopalatine duct cyst (NPDC), this cyst primarily forms within the incisive canal located within our palatine bones. The approximate location of the cyst is behind the alveolar process of the maxillary or upper central incisors. These cysts can also occur in the soft tissue of the palate (roof of the mouth). Although the etiology of this cyst remains elusive in medical literature, the most common causes are attributed to trauma, infection, or clogged salivary gland ducts causing mucous retention in the oral cavity. Males are affected 18 to 20 times more than females, and the cyst commonly occurs in patients aged between 40 to 60 years, that is, between the fourth and sixth decade of life. Clinically, these cysts present as bluish, dome-shaped, translucent swellings on the palate or the incisive papilla (small bump on the roof of the mouth, just behind the front teeth) at the anterior portion of the hard palate. According to dental research, approximately 78 percent of patients exhibit slow but progressive growth with the potential to displace the adjacent upper central incisors due to the accumulation of cystic contents or fluid. Smaller cysts may be asymptomatic, while larger cysts can cause pain, swelling, and tooth displacement. These cysts are commonly treated by surgical enucleation via the palatine or buccal approach.
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Median Palatal Cyst: These cysts occur along the fusion lines of the maxillary (upper) palatal processes, located at the midline of the hard palate between the lateral palatal processes. The exact cause of this developmental fissural cyst is unknown, but these cysts can persist for prolonged periods with a distinctive feature of palatal swelling. Dentists or oral surgeons can easily diagnose the median palatal cyst by observing it on a radiograph, which shows a well-circumscribed and radiolucent area surrounded by a clear area of sclerotic bone opposite the maxillary premolar or molar region. The treatment for the median palatal cyst involves surgical removal and thorough curettage to prevent recurrence.
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Median Mandibular Cyst: This is a rare developmental cyst occurring along the midline of the mandible and is often asymptomatic. Dentists or oral surgeons typically observe these cysts during routine radiographic examinations, where they appear as unilocular or multilocular well-circumscribed radiolucencies. Conservative surgical excision while preserving the teeth involved in the cyst is the main focus of treatment.
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Nasolabial Cyst: Also known as Klestadt's cyst, this presents clinically as a swelling in the nasolabial fold (creases in the skin extending from both sides of the nose to the corners of your mouth) at the floor of the nose. This fissural cyst involves three fusion lines at the junction of the globular process, lateral nasal, and maxillary processes. Approximately 75 percent of cases occur in women aged 41 to 46 years. The cyst requires complex surgical excision by a maxillofacial surgeon, with care taken to prevent postoperative complications and avoid mucosal perforation and lesion collapse.
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Palatal and Alveolar Cysts of the Newborn: These odontogenic developmental cysts are found in nearly 80 percent of newborn infants. They present either on the posterior surface of the hard palate or, rarely, along the midline. No treatment is required as these are self-limiting cysts that eventually rupture and spill their contents into the oral or pharyngeal mucosa.
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Thyroglossal Duct Cyst: This is a rare but benign midline neck mass or lesion involving the secretory glands and branches at the level of the hyoid bone. It primarily occurs in individuals under 20 years of age, though older cases are documented. Clinically, these are palpable asymptomatic masses at the midline of the neck and can cause severe infections, throat pain, swelling, and difficulty swallowing. In case of infection, antibiotics may be recommended, but the mainline treatment is surgical excision of the cyst and its branches. Preoperative thyroid scans and thyroid function tests may be scheduled to ensure normal thyroid tissue positioning.
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Epidermal Inclusion or Fissural Cyst: This is an asymptomatic and slow-progressing fissural cyst of the jaw unless secondarily infected, which can cause oral discomfort. These cysts appear as firm, round, subcutaneous white, yellow, or flesh-colored nodules in the oral cavity, potentially interfering with feeding, swallowing, and speaking. The average onset is in the third or fourth decade of life, with men affected twice as much as women. This cyst is significant in dental literature because malignancies or cancers, though rare, have been identified in some cases of epidermoid cysts. Surgical elimination or resection of the cyst is the primary treatment strategy by oral and maxillofacial surgeons.
Conclusion
Fissural or inclusion cysts are developmental embryonic disturbances caused by entrapped epithelium at the fusion lines of jaw bones. Timely diagnosis and management of small cysts by an oral surgeon or dentist can prevent oral discomfort and infectious sequelae in affected individuals, providing long-term relief and reducing the likelihood of recurrence. Early intervention is crucial as it allows for less invasive treatment options and minimizes the risk of complications. Regular dental check-ups and radiographic examinations are essential for the early detection of these cysts. Additionally, educating patients about the signs and symptoms of fissural cysts can lead to prompt treatment and better overall oral health outcomes.
