Cystic lesions of the jaws in children

Cystic lesions of the jaws in children

1. Introduction
Journal Review
Cystic lesions of
the jaws in children
• Jaw cyst
– A pathological cavity having
fluid or semifluid content
– It is frequently but not always,
lined by epithelium
Bodner
-29
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Bodner L // Int
Int JJ Pediatr
Pediatr Otorhinolaryngol 62(2002) 2525-29
• True cyst
• False cyst
許修銘 Hsu Hsiu-Ming
Hsiu
Hsiu-Ming
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Cheng Kung
Kung University
University
Hospital
Hospital
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National Cheng
Cheng Kung
Kung University
University
Hospital
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1. Introduction
• Cystic lesions of the jaws may be
– epithelial or non-epithelial,
– odontogenic or non-odontogenic,
– developmental or inflammatory in origin
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1. Introduction
• The distribution of jaw cyst according to
diagnosis in a general population : (Shear, 1983)
– Radicular cysts
55%
– Dentigerous cysts
17%
– Nasopalatine cysts
12%
– Primordial cysts
11%
– Globulomaxillary cysts 1.3%
– Traumatic bone cysts 0.7%
– Eruption cyst
0.7%
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Cheng Kung
Kung University
University
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Cheng Kung
Kung University
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1
1. Introduction
• Several long term developmental processes are
taking place in the maxillofacial area during the
pediatric age period
– 3-dimensional growth of maxillofacial skeleton
– Odontogenesis of deciduous & permanent
dentition
(all of which may be associated with cyst formation)
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1. Introduction
• During a 10 year period,
69 patients (35 males and 34 females,
mean age 9.7 years and range 1 month–16 years)
with cystic lesions of the jaws,
were referred for consultation
• The purpose of this article is
– to follow the distribution, characteristics &
treatment outcome of jaw cyst
in a series of pediatric patients
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2. Materials and methods
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National Cheng
Cheng Kung
Kung University
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• Depending on the case, surgery was performed
under local or general anesthesia and included
one of the following treatment modalities:
marsupialization, enucleation
or enucleation with bone grafting.
• Age, sex, cyst type and cyst diameter were
recorded.
• Student–Newman–Keuls test was used for
statistical analysis at the P=0.05 level for
significant differences.
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Cheng Kung
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2. Materials and methods
• All patients underwent clinical examination &
plain film radiography (panoramic, periapical and
occlusal views).
• Some of them were also referred to C.T. with a
multiplanar reconstruction program.
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2. Materials and methods
• As most of the jaw cysts are odontogenic in
origin, it would be interesting to look at the
distribution of jaw cyst in children.
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Cheng Kung
Kung University
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11
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Cheng Kung
Kung University
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2
3. Results
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Cheng Kung
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Dentigerous cyst
13
13
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11 y/o boy
National
National Cheng
Cheng Kung
Kung University
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Hospital
Radicular cyst
14
14
9 y/o girl
S/P Enucleation & bone grafting / 6 months later
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National Cheng
Cheng Kung
Kung University
University
Hospital
Hospital
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15
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National Cheng
Cheng Kung
Kung University
University
Hospital
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16
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17
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National
National Cheng
Cheng Kung
Kung University
University
Hospital
Hospital
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S/P Marsupialization
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Cheng Kung
Kung University
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3. Results
• The M:F ratio was 1.
• The treatment modalities were:
– Marsupialization: 30 (43%) p’ts
– Enucleation: 24 (35%) p’ts
– Enucleation and bone grafting: 15 (22%) p’ts
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Cheng Kung
Kung University
University
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19
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3. Results
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4. Discussion
• Follow-up ranged from
a minimum duration of 1–5 years.
• Such follow-up consisted of annual examination
and the performance of periapical or panoramic
radiographs.
• All the patients were without evidence of disease
during a 1–5 year follow-up.
• In the present study on children
– Developmental: 70%
– Inflammatory: 13.3%
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• Distribution in a general population (Shear, 1983)
– Developmental: 40%
– Inflammatory: 55%
4. Discussion
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• Difference in distribution of inflammatory cysts
– Radicular cysts arising from primary teeth are
considered very rare.
– Radicular cysts arising from permanent teeth
are also infrequent in this age
• Arises from the epithelial residues in the PDL
as a result of inflammation
• Follows the necrosis of the dental pulp
• Recently erupted permanent teeth, as in the
pediatric age are usually intact
(all of which can be associated with cyst formation)
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4. Discussion
• The overt difference in distribution of
developmental cysts is probably related to the
fact that during the pediatric age period the
jaws are involved in profound developmental
processes.
– Growth of the maxillofacial skeleton
– Development of the primary and permanent
dentition
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4. Discussion
• In adult population, where there is a significant
sex difference with male predominance.
– more likely to neglect their teeth
– more likely to sustain trauma to teeth
(all of which may be the etiology for cyst formation)
• In this pediatric series
– most of cysts were developmental in origin
– apparently no sex dependence.
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• For most of the cysts, plain film radiography
(PFR) was an adequate imaging modality.
• In some of the cases C.T. with multiplanar
reconstruction program (MPR) was also
performed.
• The CT with MPR software program, originally
designed for implant dentistry, has proven to be
useful in the evaluation of jaw abnormality and
pathology.
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• Using this software program, anatomic
structures, such as the mandibular canal, mental
foramen, incisive canal and maxillary sinus may
be seen in cross-section.
• CT with MPR has also been shown to be superior
to PFR in demonstrating cystic lesions of the
jaws and in evaluating bone regeneration
following marsupialization of jaw cysts.
• The main advantage is that it allows to plan the
surgical approach with the least morbidity to the
adjacent anatomic structures.
• Despite the advantages, CT should not be used
routinely, but rather reserved for large lesions,
particularly those where extension into the nasal
cavity, orbit or pterygomaxillary space must be
assessed.
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• Treatment objective
– Restoring the morphology and function of the
affected area.
• Two basic surgical procedures
– Marsupialization (=decompression)
– Enucleation.
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• Marsupialization
– a comparatively simple procedure
– producing a ‘window’ in the cystic wall to
relieve intracystic tension
– cystic cavity slowly decreases in size
– lightly packed with a ribbon gauze until the
line of junction between the cystic lining and
the oral mucosa will have healed
– 3–6 months later, enucleation is performed
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• Disadvantages of marsupialization
(a) it is a two stage surgical procedure
(b) pathological tissue is left behind and a more
sinister pathological process (i.e. SCC) may
be overlooked
(c) in a large cystic cavity it takes a long period
of time for the bone to regenerate
• Modified marsupialization
– placing a catheter into the cyst for a few
months
– allows decompression of the lesion
with a subsequent reduction in lumen size
– a few months later, at enucleation the cyst
wall tends to be thicker & easier to remove
without tearing
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• Enucleation with primary closure
– one stage surgical treatment
– followed by periodic radiographic
examinations at regular intervals
– observe progress of bone regeneration
of the defect.
– allows pathologic examination of the entire
specimen for histopathologic diagnosis
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• Marsupialization was performed to all patients
with eruption cysts and for a few patients with
sizeable cysts.
• Enucleation without bone grafting was done to
the patients, with the smaller diameter cysts.
• Enucleation with bone grafting was performed to
those with the large cystic lesions.
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5. Conclusion
• The follow-up for patients with cystic lesions of
the jaws following surgery
– Yearly panoramic radiograph, at least up to
full bony regeneration of the affected area
• Primordial cysts (=odontogenic keratocyst),
should be followed up to a 5-year period, due to
the higher recurrence rate.
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• Cystic lesions of the jaws in children are mainly
developmental in origin.
• The treatment modality should be as
conservative as possible in order to decrease the
possible morbidity to the adjacent developing
structures.
• In large cysts enucleation with allogeneic bone
graft is recommended.
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Odontogenic cysts
Thanks for your
attention
• Developmental
– Gingival (keratin) cyst of the newborn
• Bohn’s nodules (alveolar ridge) dental lamina cyst …
• Epstein’s pearls (palatal mid-line)
–
–
–
–
Odontogenic keratocyst (Primordial)
Dentigerous (Follicular)
Eruption …
Gingival cyst of adults …
6/16 CC 改至 6/23 主題：小胖威利
6/22 端午節 吃粽子 划龍舟 不Meeting
• Inflammatory
– Radicular
– Residual
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Bohn’s nodules
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