Dentigerous cyst
Updates to Article Attributes
Dentigerous cysts, also calledfollicular cysts, are benign, non-inflammatoryodontogenic cysts that are thought to be developmental in origin.
Epidemiology
Dentigerous cysts are the second most common odontogenic cysts after those related to the roots of the teeth (periapical cysts) 3. They usually present in the 2nd to 4th decades of life and are rarelyuncommonly seen in childhood because they almost exclusively occur in secondary dentition 1-3.
Clinical presentation
Typically, dentigerous cysts are painless and discovered during routine radiographic examination, however they may be large and result in a palpable mass. Additionally as they grow they displace adjacent teeth2.
Several cases of dentigerous cysts presenting as recurrent head and neck infection or as a deep neck space abscess have been described.
Pathology
A dentigerous cyst is formed by the hydrostatic force exerted by the accumulation of fluid between reduced enamel epithelium and the tooth crown of unerupted teeth 1-3,5. As such the cyst encloses the crown and is attached at the neck at the cemento-enamel junction 5. They almost exclusively occur in permanent dentition. The cyst is lined by stratified stratified squamous nonkeratinising epithelium.
Over 75% of all cases are located in themandible, with the most commonly involved teeth being1,3:
- mandibular third molar (most common)
- maxillary third molar (2nd most common)
- maxillary canine
- mandibular second premolar
Associations
Dentigerous cysts are usually solitary, however multiple cysts are recognised to occur in association with syndromes such as:
Radiographic features
Dentigerous cysts are frequently seen on OPGs, and often require no further imaging to make the diagnosis. CT and MRI give additional information, and help in distinguishing this entity from other cystic lesions of the mandible and maxilla.
When small, it is difficult to differentiate a dentigerous cyst from a large but normal dental follicle. A working definition is that a dentigerous cyst exists when the distance between the crown and dental sac is greater than 2.5-3.0 mm 5-6.
Plain film (OPG)
Radiographically, dentigerous cysts appear as unilocular well defined pericoronal radiolucencies centred on an impacted or unerupted tooth. They have a thin regular sclerotic margin and expand the overlying cortex without cortical breach (unless superimposed fracture or infection). Their size is extremely variable, ranging from only slightly greater in size than a normal follicle to very large, appearing to hollow-out the majority of the jaw 1-4.
Erosion or resorption of the roots of adjacent teeth is sometimes seen 6.
CT
CT appearances mirror those of plain film. The relationship to the unerupted tooth can often be better appreciated, and the cyst cavity is filled with water density fluid. Maxillary lesions may project superiorly into the paranasal sinuses or nasal cavity 3-4.
MRI
The main role of MRI is help distinguish these lesions from other cystic lesions of the jaw, when appearances are atypical.
- T1: low signal, similar to water/CSF
- T2: high signal, similar to water/CSF
- T1 C+ (Gd): no solid component or enhancement, except for potentially a thin peripheral rim of enhancement 1,3
Treatment and prognosis
Treatment usually involves removal of the entire cyst and the associated unerupted tooth. In patients with very large lesion or who are unfit medically, marsupialisaiton is an option 6.
Recurrence is uncommon, but may occur if parts of the cyst lining are left in situ 6.
Complications
- pathological jaw fracture: if large enough
- very rarely dentigerous cysts may develop into a muralameloblastoma 2
- there is a potential of development of squamous cell carcinoma in the context of chronic infection
Differential diagnosis
When small, it is difficult to differentiate a dentigerous cyst from a large but normal dental follicle 5-6.
When larger, the differential is essential that of lytic lesions of the jaw and includes:
- periapical cyst (radicular cyst)
- aneurysmal bone cyst (ABC)
- ameloblastoma
- keratocystic odontic tumour (odontogenic keratocyst)
- cherubism (fibrous dysplasia)
- Stafne cyst
-<p><strong>Dentigerous cysts</strong>, also called <strong>follicular cysts</strong>, are benign, non-inflammatory <a href="/articles/odontogenic-cysts">odontogenic cysts</a> that are thought to be developmental in origin.</p><h4>Epidemiology</h4><p>Dentigerous cysts are the second most common odontogenic cysts after those related to the roots of the <a href="/articles/teeth">teeth</a> (<a href="/articles/periapical-cyst">periapical cysts</a>) <sup>3</sup>. They usually present in the 2<sup>nd</sup> to 4<sup>th</sup> decades of life and are rarely seen in childhood because they almost exclusively occur in <a href="/articles/secondary-dentition">secondary dentition</a> <sup>1-3</sup>. </p><h4>Clinical presentation</h4><p>Typically, dentigerous cysts are painless and discovered during routine radiographic examination, however they may be large and result in a palpable mass. Additionally as they grow they displace adjacent teeth <sup>2</sup>.</p><p>Several cases of dentigerous cysts presenting as recurrent head and neck infection or as a deep neck space abscess have been described.</p><h4>Pathology</h4><p>A dentigerous cyst is formed by the hydrostatic force exerted by the accumulation of fluid between reduced enamel epithelium and the tooth crown of unerupted teeth <sup>1-3,5</sup>. As such the cyst encloses the crown and is attached at the neck at the cemento-enamel junction <sup>5</sup>. They almost exclusively occur in permanent dentition. The cyst is lined by stratified squamous nonkeratinising epithelium.</p><p>Over 75% of all cases are located in the <a href="/articles/mandible">mandible</a>, with the most commonly involved teeth being <sup>1,3</sup>:</p><ul>- +<p><strong>Dentigerous cysts</strong>, also called <strong>follicular cysts</strong>, are benign, non-inflammatory <a href="/articles/odontogenic-cysts">odontogenic cysts</a> that are thought to be developmental in origin.</p><h4>Epidemiology</h4><p>Dentigerous cysts are the second most common odontogenic cysts after those related to the roots of the <a href="/articles/teeth">teeth</a> (<a href="/articles/periapical-cyst">periapical cysts</a>) <sup>3</sup>. They usually present in the 2<sup>nd</sup> to 4<sup>th</sup> decades of life and are uncommonly seen in childhood because they almost exclusively occur in <a href="/articles/secondary-dentition">secondary dentition</a> <sup>1-3</sup>. </p><h4>Clinical presentation</h4><p>Typically, dentigerous cysts are painless and discovered during routine radiographic examination, however they may be large and result in a palpable mass. Additionally as they grow they displace adjacent teeth <sup>2</sup>.</p><p>Several cases of dentigerous cysts presenting as recurrent head and neck infection or as a deep neck space abscess have been described.</p><h4>Pathology</h4><p>A dentigerous cyst is formed by the hydrostatic force exerted by the accumulation of fluid between reduced enamel epithelium and the tooth crown of unerupted teeth <sup>1-3,5</sup>. As such the cyst encloses the crown and is attached at the neck at the cemento-enamel junction <sup>5</sup>. They almost exclusively occur in permanent dentition. The cyst is lined by stratified squamous nonkeratinising epithelium.</p><p>Over 75% of all cases are located in the <a href="/articles/mandible">mandible</a>, with the most commonly involved teeth being <sup>1,3</sup>:</p><ul>
-<li><a href="/articles/gorlin-goltz-syndrome-1">basal cell nevus syndrome</a></li>- +<li>
- +<a href="/articles/gorlin-goltz-syndrome-1">basal cell nevus syndrome</a> <sup>7</sup>
- +</li>
-<li>very rarely dentigerous cysts may develop into a mural <a href="/articles/ameloblastoma">ameloblastoma</a> <sup>2</sup>- +<li>very rarely dentigerous cysts may develop into a mural <a href="/articles/ameloblastoma">ameloblastoma</a> <sup>2</sup>
References changed:
- 7. Head and Neck Imaging: Upper Aerodigestive Tract and Neck. Sect. VI. Upper Aerodigestive Tract. 27. Anatomy and Imaging of the Oral Cavity and Pharynx. (2011) ISBN: 9780323053556 - <a href="http://books.google.com/books?vid=ISBN9780323053556">Google Books</a>
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