Mandible & maxilla
Cysts of the jaw
Inflammatory collateral cyst
Last author update: 1 February 2014
Last staff update: 13 October 2023
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PubMed Search: Paradental cyst [title]
Table of Contents
Definition / general | Terminology | Epidemiology | Sites | Pathophysiology | Clinical features | Diagnosis | Radiology description | Radiology images | Prognostic factors | Case reports | Treatment | Clinical images | Gross description | Microscopic (histologic) description | Microscopic (histologic) images | Differential diagnosis | Additional referencesCite this page: Morrison A. Inflammatory collateral cyst. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/mandiblemaxillaparadental.html. Accessed April 24th, 2024.
Definition / general
- Inflammatory odontogenic cyst occurring at the crown or root of a partially or fully erupted tooth
- Includes paradental cyst and buccal bifurcation cyst
- Is a term applied to a spectrum of clinicoradiographic entities - see terminology
Terminology
- Reduced enamel epithelium (REE): ameloblastic and epithelial cells from the outer enamel that overly an unerrupted tooth, as the REE degenerates the underlying tooth is exposed
- Crevicular epithelium: epithelium lining the inner aspect of the gingival sulcus
- Epithelial rests of Malassez: discrete clusters of residual cells from Hertwig epithelial root sheath
- Inflammatory odontogenic cysts: distinguished from developmental odontogenic cysts by their association with inflammation
- Clinicoradiographic variants include:
- Apical radicular cyst
- Lateral radicular cyst
- Residual cyst
- Paradental cyst
- Clinicoradiographic variants include:
- Buccal bifurcation cyst (BBC):
- Aka paradental cyst, juvenile paradental cyst or mandibular infected buccal cyst
- Occurs along the buccal root surface of partially erupted mandibular molar of children and young adults
- Affected tooth is vital
- Paradental cyst:
- After excluding cysts occurring along the lateral / buccal surface of a partially impacted mandibular molar of a young individual, the term paradental cyst also refers to a variant of the dentigerous cyst with an inflammatory, rather than developmental pathogenesis
- The two most common scenarios include vital (non-necrotic) teeth:
- A dentigerous cyst that develops around the crown of an unerupted permanent tooth as a result of periapical inflammation from an overlying primary tooth
- A partially erupted mandibular third molar that develops an inflamed cystlike lesion along the distal aspect associated with inflammation or recurrent pericoronitis
- These are often called dentigerous cyst, as it is impossible to determine histopathologically whether the inflammatory component is primary or secondary in nature
Epidemiology
- 1 - 5% of odontogenic cysts
Sites
- Buccal >> Mesial surface
- Erupted or partially erupted teeth
- Molars >> premolars > cuspids
- 3rd molar (wisdom teeth) >> 1st / 2nd molars
- Mandibular teeth >> Maxillary teeth
- ~24% of paradental cysts in 1st or 2nd molars are bilateral
Pathophysiology
- Theorized to arise from one of the following, however, each can be debatable given the specified location of paradental cysts:
- Reduced enamel epithelium
- Epithelial rests of Malassez
- Crevicular epithelium
- Epithelial remnants of dental lamina
Clinical features
- Recurring periodontal inflammatory process (pericoronitis)
- Symptoms: discomfort, swelling, tenderness, pain
- Often Asymptomatic
Diagnosis
- Based on location, radiography, pathology, root vitality studies
Radiology description
- Periosteal reaction common
- Onion skin deposition of bone appears as parallel opaque layers
Radiology images
Images hosted on other servers:
Well defined semilunar shaped radiolucency
Expansion of vestibular cortical bone
Radiolucency in distal follicular space of first permanent molar
Hypodense area in vestibular region
Axial CT
Expansion of vestibular bone
Radiolucency demarcated by fine radiopaque line
Well defined ovoid radiolucency
Buccal bifurcation cyst
Prognostic factors
- Good prognosis
- No reports of recurrence to date
Case reports
- 8 year old boy with paradental cyst of first molar (J Indian Soc Pedod Prev Dent 2012;30:343)
- Two cases involving paradental cysts (J Periodontol 2006;77:1602)
- Paradental cyst mimicking a radicular cyst on the adjacent tooth (J Endod 2003;29:73)
Treatment
- Curettage
Clinical images
Images hosted on other servers:
Intraoral preoperative view
Intraoperative view of enucleation
Gross description
- A cyst-like soft tissue (may or may not be intact) attached to the cementoenamel junction, or along the root of the tooth
Microscopic (histologic) description
- The microscopic findings are not specific and cannot distinguish between the variants of inflammatory odontogenic cysts, or a markedly inflamed developmental dentigerous cyst
- Clinical and radiographic correlation essential
- Connective tissue wall
- Heavy mononuclear inflammatory cell infiltrate
- Hyperplastic nonkeratinizing stratified squamous epithelium
- Often with hemosiderin pigment or cholesterol clefts
Microscopic (histologic) images
Contributed by Kelly Magliocca, D.D.S., M.P.H.
Inflammatory collateral cysts
Images hosted on other servers:
Various images
Differential diagnosis
- Apical radicular cyst
- Dentigerous cyst, markedly inflamed
- Inflamed periodontal pocket / periodontal tissues
- Lateral radicular cyst
- Residual cyst
Additional references
