Mandible-Maxilla
Fissural and other non-odontogenic cysts
General

Author: Anthony Martinez, M.D. (see Authors page)
Editor: Kelly R. Magliocca, M.D.

Revised: 22 September 2015, last major update September 2015

Copyright: (c) 2004-2015, PathologyOutlines.com, Inc.

PubMed Search: Fissural [title] cysts
/ non-odontogenic [title] cysts
Definition / General
  • A cyst is a pathologic cavity lined by epithelium and may be located within the oral soft tissues or an intra-osseous location within the jaws
  • Cysts may be odontogenic or non-odontogenic in origin
    • Odontogenic cysts arise from tissues involved in tooth formation
    • Some non-odontogenic cysts were historically termed "fissural" as they were thought to arise from entrapped epithelium during embryogenesis
  • Some classifications, such as globulomaxillary cyst, are no longer considered valid and distinct entities, while others are highly controversial, such as median palatine cyst
Terminology
  • Dermoid cyst:
    • Lined by stratified squamous epithelium with adnexae (hair follicules, sweat glands, sebaceous glands)
  • Epidermoid cyst:
    • Stratified squamous epithelial lining without adnexae
  • Teratoma:
    • Can be cystic, but must have all three germinal layer represented within cyst wall, namely ectoderm (skin, hair, teeth), mesoderm (skeletal muscle, vasculature, CNS, peripheral nerves), endoderm (thyroid, GI tract components, lung, liver)
  • Globulomaxillary cyst:
    • Cyst that occurs between the maxillary lateral incisor and canine teeth
    • No longer considered a distinct, classifiable entity
  • Median palatine cyst:
    • Lined by stratified squamous or respiratory epithelium located in the midline of the hard palate, posterior to the incisive canal
    • Existence of this cyst as distinct from a variant of the nasopalatine duct cyst has been questioned
  • Nasolabial cyst:
    • Soft tissue cyst lined by multilayered or pseudostratified, cuboidal to columnar epithelium, located in the nasolabial region of the facial tissues
  • Nasopalatine duct cyst:
    • Variably lined by stratified squamous, pseudostratified columnar, columnar, or simple cuboidal epithelium, located in the anterior midline of the hard palate
  • Palatine cyst:
    • Lined by stratified squamous epithelium located within the midline palate soft tissue
  • Surgical ciliated cyst:
    • Post-operative "complication" with cystic expansion of respiratory epithelium within posterior maxilla, often with ciliated or mucous cells within cystic lining
  • Oral foregut duplication cyst:
    • Soft tissue cyst, likely congenital, within the oral cavity lined by a possible spectrum of epithelia
  • Lymphoepithelial cyst, intraoral:
    • Soft tissue cyst unrelated to branchial arches, with histologic features similar to 2nd branchial arch cyst
Epidemiology
  • Most common intraosseous, non-odontogenic cyst of the jaw is the nasopalatine duct cyst (~1% of the population)
  • Sites
    • Epidermoid cyst: floor of the mouth
    • Dermoid cyst/teratoma: most common site is soft tissue of floor of mouth
    • Globulomaxillary cyst: historically described between the maxillary lateral incisor and canine teeth
    • Median palatine cyst: midline of the hard palate, posterior to the incisive canal
    • Nasolabial cyst: nasolabial region of the facial soft tissues
    • Nasopalatine duct cyst: anterior midline of the hard palate
    • Palatine cyst: midline palate soft tissue
    • Surgical Ciliated Cyst: intraosseous, posterior maxilla; may be bilateral
    • Oral foregut duplication cyst: floor of mouth and ventral tongue
    • Lymphoepithelial cyst, intraoral: superficial mucosa of floor of mouth or posterior lateral oral tongue
    Etiology
  • Majority of the non-odontogenic cysts are thought to arise from either spontaneous proliferation of embryonic remnants or from epithelium that becomes entrapped at different anatomical locations during embryonic development
  • Prognostic Factors
  • The majority of the non-odontogenic cysts are benign, but the nasopalatine duct cyst has been reported to undergo malignant transformation to squamous cell carcinoma
  • Treatment
  • The majority are treated by surgical excision
  • Diagrams / Tables
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    Fissural cysts

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    Teeth and hard palate

    Micro Description
  • Variably epithelial-lined cysts, depends on cyst type
  • Differential Diagnosis