• Also called follicular cyst
• Separation of follicle around the crown of an
unerupted/impacted tooth
• Most common developmental odont cyst

• Encloses the crown of tooth attached at CEJ
• Crowns fully formed
• Cyst develops by accumulation of fluid
between reduced enamel ep and crown

• Most common ‐ lower thirds
• Upper canines ‐ second most common
• Most frequent between 10‐30 yrs
• Can grow to large sizes
• May cause painless expansion bone

• Typically ‐ unilocular lucency
• Never multilocular, or show calcifications
• May displace tooth for a considerable distance
• Root resorption of adjacent teeth possible
• Lucency should be at least 3‐4 mm in diameter,
otherwise enlarged follicle

• Careful enucleation with removal of the
unerupted tooth
• Prognosis ‐ very good

Differential Diagnosis
• Primarily
– Unilocular ameloblastoma
– OKC
• Many other lesions may be associated with an
impacted or unerupted teeth
• Hence, biopsy is mandatory

• Also called eruption hematoma
• Soft tissue analogue of the dentigerous cyst
• Blood in the cystic fluid ‐ imparts a purplish or
brown color
• Usually ruptures spontaneously
• Usually no treatment required

• Developmental odontogenic cyst
• Deserves special consideration because of its
specific histopathologic features and clinical
behavior
• Arises from cell rests of the dental lamina

• Usually between 10‐40 yr of age
• Mandible ‐ 60‐80%
• Tendency to involve post body & ramus
• Tend to grow in AP direction within the
medullary cavity without causing obvious
bone expansion
• Multiple _______ ‐ suspect nevoid basal cell Ca
(Gorlin‐Goltz) syndrome

• Usually well‐defined radiolucency
• Smooth and often corticated margins
• Large lesions, esp in the post body and ramus
appear multilocular
• 25‐40% ‐ unerupted tooth involved

• Thin, friable wall
• Lining composed of uniform layer of
stratified sq ep 6‐8 cells in thickness
• Lining shows thin layer of wavy or
corrugated parakeratin
• Basal layer shows palisaded layer of
cuboidal or columnar darkly staining ep
cells

• High recurrence after treatment
– Due to friable lining
– Or remaining “cystlets”
• Recurrence rate of approx 30%
• Significant number of recurrences may not be
manifested until 10 or more yrs
• Long‐term follow‐up is necessary

Differential Diagnosis
(multilocular)
• Ameloblastoma
• Odontogenic myxoma
• Central giant cell granuloma
• Cherubism
• Hyperparathyroidism

Differential Diagnosis
(unilocular)
• Gorlin cyst or calcifying odontogenic cyst
• Dentigerous cyst (with impacted tooth)
• Lateral periodontal cyst (location)

• Also called Nevoid Basal Cell Carcinoma Syndrome
• Autosomal dominant trait
• Chief features include
– Multiple basal cell carcinomas of the skin
– OKCs
– Rib anomalies
– Vertebral anomalies
– Intracranial calcification

• OKCs ‐ most constant feature, at least 75% of
patients have these cysts
• Cysts are frequently multiple

• Rare developmental cyst < 2% of jaw cysts
• Diagnosis reserved for cysts in the lateral
periodontal region in which inflammatory cyst
or OKC has been excluded

• Asymptomatic, detected on routine X‐ray
• Most occur in the lower canine‐premolar area
• Frequent in 5th ‐7th decade
• No gender predilection

• Well‐circumscribed oval lucency located
laterally to the roots
• Occasionally, multilocular appearance ‐
botryoid odontogenic cysts

Differential Diagnosis
• OKC
• Ameloblastoma

• Common finding ‐ small, superficial, keratinfilled
cysts on alveolar mucosa of infants
• Arise from remnants of the dental lamina
• Disappear spontaneously by rupture into the
oral cavity
• Seldom noticed or sampled for biopsy
• Epstein's pearls, Bohn's nodules found in the
midline of palate or laterally on H & S palate

• Uncommon lesion
• Soft tissue counterpart of LPC
• Derived from rests of the dental lamina
• Striking predilection for lower canine‐premolar area
(60 to 75%)
• Often bluish or bluish‐gray
• May cause a superficial "cupping‐out" of the alveolar
bone

• Non‐neoplastic cyst
• May be associated with other recognized
odontogenic tumors, most commonly odontomas

• Predominantly intraosseous lesion
• Rarely, peripheral or extraosseous
• Mean age of occurrence is 33
• No gender predilection
• 65% in the incisor‐canine areas

• Unilocular, well‐defined lucency
• Opaque structures within lesion, either
irregular calcifications or tooth‐like, in about
50%

• Characteristically ‐ variable numbers of ghost
cells within the epithelial component
• Ghost cells ‐ altered ep cells with loss of nuclei
but preservation of basic cell outline

Treatment & Prognosis
• Simple enucleation
• Prognosis is good
• Few recurrences after treatment

Differential Diagnosis
• OKC
• Dentigerous cyst (with impacted tooth)
• Ameloblastoma
• Calcfying Epithelial Odontogenic Tumor (CEOT)

• Not cystic
• Designated as dentinogenic ghost cell tumors, epithelial odontogenic ghost cell umors, or ghost cell tumors
• May be infiltrative or even malignant
• Regarded as neoplasms
• Very different prognosis

• Most arise in odontogenic cysts
• Rare – less than 100 cases in literature
• Carcinomatous transformation of the lining
of a cyst may be more common

• Seen in older patients (mean 59 years)
• Pain and swelling ‐ most important complaints
• Many have no symptoms
• Diagnosis made upon biopsy
• Xray: irregular and ragged margins of a radiolucency

• Local block excision to radical resection
• With or without radiation/chemo