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Mandible & maxilla

Cysts of the jaw

Lateral periodontal cyst and botryoid odontogenic cyst

Authors: Annie S. Morrison, M.D., Kelly Magliocca, D.D.S., M.P.H.

Last author update: 1 December 2013

Last staff update: 5 December 2021

Copyright: 2004-2024, PathologyOutlines.com, Inc.

PubMed Search: Lateral periodontal cyst [title]

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Table of Contents

Cite this page: Morrison A. Lateral periodontal cyst and botryoid odontogenic cyst. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/mandiblemaxillalateralperiodontalcyst.html. Accessed November 27th, 2024.

Definition / general

Non-keratinizing, developmental odontogenic cyst which occurs along the lateral tooth root surface within bone

Terminology

Epithelial rest of Malassez:
- Derived from Hertwig epithelial root sheath
- Small spherules of 6 - 8 epithelial cells with high nuclear to cytoplasmic ratio; little or no reverse polarity of cells
Reduced enamel epithelium:
- Enamel is normally composed of two cell layers: inner layer of reduced or atrophied ameloblasts and external layer, probably stratum intermedium cells
- Reduced enamel epithelium is normally found overlying an unerupted, otherwise developed tooth
Dental lamina:
- Band of epithelial tissue derived from ectoderm that initiates tooth development in utero
- After tooth development, the dental lamina disintegrates into small nests, most of which are reabsorbed, but some persist as dental lamina rests (rests of Serres)
Gingival cyst:
- Lateral periodontal cyst (LPC) has been pathogenetically linked to the gingival cyst of the adult
- The former is believed to arise from dental lamina remnants within bone and the latter from dental lamina remnants in soft tissue between the oral epithelium and the periosteum (rests of Serres)
- The close relationship between the two entities is further supported by their similar distribution in sites containing a higher concentration of dental lamina rests and their identical histology
Botryoid odontogenic cyst:
- Multicystic variant of lateral periodontal cyst (LPC), generally larger (5 - 45 mm) with higher recurrence rates (up to 33%) than LPC
- Controversial: some regard the botryoid odontogenic cyst (BOC) as a variant of LPC, others view BOC as distinct entity because it can be larger in size, has a polycystic radiographic appearance (occasionally can be unilocular) and has higher rate of recurrence

Epidemiology

Usually 5th to 7th decade of life
Rare in patients less than 30 years of age
Favor males 2:1
Accounts for less than 2% of all jaw cysts
Very rarely multifocal

Sites

Most common adjacent to roots of cuspid or bicuspid teeth
60 - 80% occur in mandibular premolar-canine-lateral incisor area, but favors premolar-canine region
When occur in maxilla, usually involve this same tooth region but favors incisor area

Pathophysiology

Origin of LPC still debated with histologic and developmental evidence from various researchers providing support for the lesion developing from either dental lamina, reduced enamel epithelium or epithelial rests of Malassez
Most sources regard the cyst as originating from rests of dental lamina

Clinical features

Usually asymptomatic
Can cause painless expansion of bone
Rarely perforates bone to communicate with gingival surface
Associated with vital teeth, however prior endodontic treatment or tooth extraction can confound the diagnosis

Radiology description

Radiographic appearance is not specific for LPC
Well demarcated, round to elongated tear drop shaped radiolucent lesion associated with lateral aspect of tooth root
Rare to exceed 1.0 cm in size
Root divergence uncommon
Most commonly is a solitary lesion, rarely affects multiple sites (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;111:225)
Most cysts are unilocular but occasionally appear polycystic
When polycystic, have been termed botryoid odontogenic cysts

Radiology images

Images hosted on other servers:

Tear dropshaped radiolucency

Orthopantamograph

Healing after 6 months

Radicular triangular radiolucency

Prognostic factors

Good prognosis with rare recurrence
Recurrence reported with botryoid odontogenic cyst

Case reports

13 year old girl with unusual clinicoradiographic presentation (J Dent (Tehran) 2012;9:265)
14 year old boy with bilateral lateral periodontal cyst (BMJ Case Rep 2013 May 10;2013)
38 year old man with pigmented lateral periodontal cyst and other pigmented odontogenic lesions (Oral Dis 1996;2:299)

Treatment

Enucleation, curettage or excision with preservation of adjacent teeth is adequate for conventional LPC

Clinical images

Images hosted on other servers:

Intra oral swelling

Buccal cortical plate perforation

Gross description

Thin walled cyst with nodular excrescences within cyst wall

Microscopic (histologic) description

Thin, generally non-inflamed fibrous connective tissue wall
Non-keratinized epithelial lining of cuboidal to stratified squamous cells
Epithelium is 2 - 5 cells thick in most areas
Foci of PAS+ glycogen rich clear cells interspersed among lining epithelial cells
Focal nodular areas of epithelial thickening that may have a whorled, swirling architecture and appear in continuity with the epithelial lining
These mural epithelial plaques extend into the fibrous connective cyst wall or may protrude into cyst lumen
Epithelial rests (may or may not be clear cells) can be seen in fibrous wall
LPC may be histologically unicystic or multicystic; microscopic presence of multiple cystic spaces may not correlate with the typical radiographic finding of a unilocular radiolucency
Botryoid odontogenic cyst has more pronounced mural thickenings / protrusions, comprised of multilocular cysts with thin fibrous septations and typically has a multilocular, often larger radiographic appearance

Microscopic (histologic) images

Contributed by Kelly Magliocca, D.D.S., M.P.H.