RADICULAR CYST

[drmithila]

 Clinical Features:-

A) Frequency:- It is most common cystic lesion of jaw comprising about approximately 52.3% of jaw cystic lesions

B) Age:- Large no. of cases are found in 4th & 5th decades of life after which there is gradual decline.

C) Sex:- It is more common in males comprising about 58% & in females comprising about 42%.

D) Race:-White patients are involved with a frequency of about twice that of Black patients.

E) Site:- It occurs with frequency of 60% in Maxilla. Though it may occur in all tooth bearing areas of both the jaws but preferably it occurs in maxillary anterior region. Upper lateral Incisors and Dense in Dente are usually the offending teeth. It occurs most commonly at apices of involved teeth. They may however be found at lateral accessory root canals.

 

Gross Features:-

Gross Specimen may be spheroidal or ovoid intact cystic masses, but often they are irregular & collapsed. The walls vary from extremely thin to a thickness of about 5mm. The inner surface may be smooth or corrugated yellow mural nodules of cholesterol may project into the cavity. The fluid contents are usually brown from breakdown of blood and when cholesterol crystals are present they impart a shimmering gold or straw colour.

 

Clinical Presentation:-

Smaller radicular cysts are usually symptomless and are discovered when IOPAs are taken with non-vital teeth.

Larger lesions shows slowly enlarging swelling. At first the enlargement is bony hard but as cyst increases in size, the covering bone becomes very thin, despite subperiosteal deposition & swelling exhibits springiness, only when cyst has become completely eroded, the bone will show fluctuation.

In Maxilla, there may be buccal and palatal enlargement Whereas in mandible it is usually labial or buccal & only rarely lingual.

Pain & infection are other clinical features of some radicular cysts. These cysts are painless unless infected. However, complain of pain is also observed in patient without any evidence of infection.
Occasionally, a sinus may lead from cyst cavity to the oral mucosa
Quite often there may be more than one radicular cyst. Scientists believe that there are cyst prone individuals who show particular susceptibility to develop radicular cysts.
Radicular cysts arising from deciduous tooth are very rare.Deciduous tooth which had been treated endodontically with materials containing Formecresol which in combination with tissue protein is antigenic & may elicit a humoral or cell-mediated response like rapid buccal expansion of cyst.
On rare occasion, there may be occurrence of parasthesia or there may be pathologic fracture of jaw bone take place.
Radiographic Features:-
Intra Oral Peri Apical Radiographs i.e. IOPAs are common radiographs which are used as diagnostic aid from radiological point of view.

Radiographically , Radicular Cysts are round or ovoid radiolucent areas surrounded by a narrow radio-opaque margin, which extends from Lamina Dura of involved tooth. In infected or rapidly enlarging cysts, radio-opaque margins may not be seen. Root resorption is rare but may occur.

It is often difficult to differentiate radiologically between radicular cysts & apical granulomas.

Radiologic presentation of Radicular Cyst is given in detail as follows —

Periphery & Shape— Periphery usually have a well defined cortical border. If Cyst is secondarily infected, the inflammatory reaction of surrounding bone may result in loss of this cortex or alteration of cortex into more sclerotic border. The outline of radicular cyst usually is curved or circular unless it is influenced by surrounding structures such as cortical boundaries.

Internal structure— in most cases, internal structure of radicular cyst is radiolucent. Occasionally, dystrophic calcification may develop in long standing cysts appearing as sparsely distributed, small particulate radio-opacities.

Effects on surrounding structures— If a radicular cyst is large, displacement and resorption of roots of adjacent teeth may occur. The resorption pattern may have a curved outline. In rare cases, the cyst may resorb the roots of related non-vital teeth. The cyst may invaginate the antrum, but there should be evidence of a cortical boundary between contents of cyst and internal structure of antrum. The outer cortical plates of maxilla and mandible may expand in a curved or circular shape. Cyst may displace the mandibular alveolar nerve canal in an inferior direction.