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CYSTS OF THE JAWS AND NECKBy: Julie Ann A. Lumague

Cystsy Odo nt o genic Cystsy N o n-odo nt o genic Cystsy P seu do cystsy N eck CystsODONTOGENIC CYSTSPeriapical (radicular) cysty A.k.a. peri odo ntal cystsy M o st c o mm o n cysts of the jawsy D erive their epithelial lining f ro m the pr o lif erati o n of small odo nt o genic

epithelial resi d ues (rests of M alassez) within the peri odo ntal ligamenty P eriapical CystEtiology and Pathogenesisy P eriapical cyst d evel o ps f ro m a preexisting periapical granuloma , which is a

fo cus of chr o nically in f lamme d granulati o n tissue in b o ne l o cate d at the apex of a n o nvital t oo th.y Cysts fo rmati o n o ccurs as a result of epithelial pr o lif erati o n, which helps t o separate the in f lammat o ry

stimulus (necr o tic pulp) f ro m the surr o un d ing b o ne.y W ith o ste o clastic b o ne res o rpti o n, the cyst expan d s.y O ther b o ne-res o rbing f act o rs, such as pr o staglan d ins, interleukins an d pr o teinases, f ro m in f lammat o ry cells

an d cells in the peripheral p o rti o n of the lesi o n permit a dd itio nal cyst enlargement.Clinical Features y M o st cysts are l o cate d in the maxilla, especially the anteri o r regi o n, fo llo we d by the maxillary p o steri o r

regi o n, the man d ibular p o steri o r regi o n an d f inally the man d ibular anteri o r regi o n.y P eriapical cysts are usually asympt o matic an d are of ten d isco vere d inci d entally d uring d ental ra d io graphic

examinati o n.y R ad io graphically, a periapical cyst cann o t be d iff erentiate d f ro m a periapical granul o ma.y The ra d io lucency ass o ciate d with a periapical cyst is generally r o un d to o vo id , with a narr o w, o paque margin

that is c o ntigu o us with the lamina d ura of the inv o lve d too th.y Cysts range f ro m a f ew millimeters t o several centimeters in d iameter, alth o ugh the maj o rity ten d s t o be

less than 1.5 cm.Differential diagnosisy P eriapical granul o may Surgical d e f ect o r periapical scary Earliest d evel o pmental phase of periapical cement o -o sse o us d ysplasiay Traumatic b o ne cystTreatment and Prognosisy A periapical lesi o n may be success f ully manage d by extracti o n of the ass o ciate d n o nvital t oo th an d

curettage of the apical z o ne.y R oo t canal f illing may be per fo rme d in ass o ciati o n with an apic o ect o myy P er fo rming r oo t canal f illing o nlyy Surgery is do ne fo r lesi o ns that are persistent, in d icating the presence of a cyst o r ina d equate r oo t canal

treatmentLateral Periodontal Cysty A no nkeratinize d d evel o pmental cyst o ccurring a d jacent o r lateral t o the

roo t of a t oo th.Etiology and Pathogenesisy The o rigin of the cyst is believe d to be relate d to pr o lif erati o n of rests of

d ental lamina.y The lateral peri odo ntal cyst has been path o genetically linke d to gingival

cyst of ad ult.

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Clinical Featuresy M ajo rity of lateral peri odo ntal cysts an d gingival cysts of the a d ult o ccur in the man d ibular prem o lar an d

cuspi d regi o n an d o ccasi o nally in the incis o r area.y A d istinct male pre d ilecti o n is n o te d fo r lateral peri odo ntal cysts, with a greater than 2-t o -1 d istributi o n.y G ingival cysts sh o w a nearly equal gen d er pre d ilecti o n.y Clinically, a gingival cyst appears as a small s of t tissue swelling within o r slightly in f eri o r t o the inter d ental

papilla.y It may assume a slightly bluish d isco lo rati o n when it is relatively large.y M o st cysts are less than 1 cm in d iameter. There are n o ra d io graphic f ind ings.y Lateral peri odo ntal cyst presents as an asympt o matic, well- d elineate d , ro un d o r tear d ro p-shape d unil o cular

(o ccasi o nally multil o cular) ra d io lucency with an o paque margin al o ng the lateral sur f ace of a vital t oo th r oo t.y R oo t d ivergence is rarely seen.y Botryoid odontogenic cyst is so metimes use d when the lesi o n is multil o cular.Differential Diagnosisy The lateral peri odo ntal cyst must be d istinguishe d f ro m a cyst resulting f ro m an in f lammat o ry stimulus

thr o ugh a lateral r oo t canal of a n o nvital t oo th (lateral ra d icular cyst)y A d iff erential d iagn o sis fo r gingival cyst w o uld inclu d e gingival muc o cele, F o rd yce s granules, parulis, an d

po ssibly a peripheral odo nt o genic tum o r.Treatment and Prognosisy Lo cal excisi o ny The multil o cular variant seems t o have increase d recurrence p o tential. F o llo w up is suggeste d fo r the

treate d variant.Gingival Cyst of the Newborny A.k.a. d ental lamina cysts of the newb o rn o r Bo hn s nod ulesy These cysts appear typically as multiple n od ules al o ng the alve o lar

rid ge in ne o nates.y It is believe d that f ragments of the d ental lamina that remain within

the alve o lar ri d ge muc o sa a f ter t oo th fo rmati o n pr o lif erate t o fo rmthese small, keratinize d cysts.

y These cysts d egenerate an d inv o lute o r rupture int o the o ral cavity.y H ist o lo gically, it is line d by a blan d strati f ie d squam o us epitheliumy Treatment is n o t necessary, because nearly all inv o lute sp o ntane o usly

o r rupture be fo re the patient is 3 m o nths of age.y P alatine cysts of the newb o rn o r Epstein s pearls may o ccur al o ng the mi d line of the palate.Dentigerous Cysty A.k.a fo llicular cysty Sec o nd m o st c o mm o n type odo nt o genic cyst, an d the m o st c o mm o n

d evel o pmental cysts of the jaws.y D entiger o us cyst is attache d to the t oo th cervix (enamel-cementum

juncti o n) an d encl o ses the cr o wn of the unerupte d too th.Etiology and Pathogenesisy

Ad

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us cystd

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om pr

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of the enamel

organremnant o r re d uce d enamel epithelium.

y As with o ther cysts, expansi o n of the d entiger o us cyst is relate d to epithelial pr o lif erati o n, release of bo ne-res o rbing f act o rs, an d an increasein cyst f luid o sm o lality.

Clinical Featuresy D entiger o us cysts are m o st c o mm o nly seen in ass o ciati o n with thir d m o lars an d maxillary canines, which are

the m o st c o mm o nly impacte d teeth.y The highest inci d ence of d entiger o us cysts o ccurs d uring the sec o nd an d thir d d eca d es.y Sympt o ms are generally absent, with d elaye d erupti o n being the m o st c o mm o n in d icati o n of d entiger o us

cyst fo rmati o n.

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y R ad io graphically, a d entiger o us cyst presents as a well- d e f ine d , unil o cular o r o ccasi o nally multil o cularra d io lucency with c o rticate d margins in ass o ciati o n with the cr o wn of an unerupte d too th.

y In the man d ible the ass o ciate d ra d io lucency may exten d superi o rly f ro m the thir d m o lar site int o the ramuso r anteri o rly an d in f eri o rly al o ng the b od y of the man d ible.

y In maxillary d entiger o us cysts inv o lving the canine regi o n, extensi o n int o the maxillary sinus t o the o rbitalf loo r may be n o te d .

y R es o rpti o n of roo ts of ad jacent erupte d teeth may o ccasi o nally be seen.y Paradental cyst or Buccal bifurcation cyst a variant of d entiger o us cyst arising at the bi f urcati o n of m o lar

teethy R ad io graphically characterize d as well-circumscribe d ra d io lucencies in the buccal bi f urcati o n regi o n. Of ten

there is buccal tipping of the cr o wn that can be d em o nstrate d by o cclusal ra d io graphy.Differential Diagnosisy Odo nt o genic kerat o cysty Amel o blast o may O ther odo nt o genic tum o rsy Amel o blastic trans fo rmati o n of a d entiger o us cyst liningy Ad en o mat o id odo nt o genic tum o r withanteri o r peric o ro nl ra d io lucenciesy Amel o blastic f ibr o maTreatmenty R em o val of the ass o ciate d too thy Enucleati o n of the s of t tissue c o mp o nenty Exteri o rizati o n o r marsupializati o n of the cysty P o tential c o mplicati o ns of untreate d d entiger o us cysts inclu d e trans fo rmati o n of the epithelial lining int o an

amel o blast o ma an d rarely, carcin o mat o us trans fo rmati o n of the epithelial lining.Eruption Cysty R esults f ro m f luid accumulati o n within the fo llicular space of an erupting t oo thy W ith trauma, bl ood may appear within the tissue space, fo rming an eruption

hematoma. y N o treatment is nee d e d because the t oo th erupts thr o ugh the lesi o n. Subsequent

to erupti o n, the cyst d isappears sp o ntane o usly with o ut c o mplicati o n.

Glandular Odontogenic Cysty A.k.a. sial oodo nt o genic cysty H as s o me hist o lo gic f eatures that suggest a mucus-pr od ucing salivary glan d tum o rClinical Featuresy A str o ng pre d ilecti o n is seen fo r the man d ible (80%), especially the anteri o r man d ibley M axillary lesi o ns ten d to be l o calize d to the anteri o r segment.y Jaw expansi o n is n o t unc o mm o ny G en d er rati o is ~ 1:1y M ean age is 50 yrs., with a wi d e age range f ro m the 2 n d thr o ugh 9 th d eca d es.R adiographic Featuresy M o st cases are ra d io graphically multil o culate d .y Lesio ns exhibite d a wi d e variati o n in size, f ro m less than 1 cm t o th o se inv o lving m o st

of the man d ible bilaterally.y R ad io graphic margins may be well d e f ine d an d scler o tic.y M o re aggressive lesi o ns have sh o wn an ill- d e f ine d peripheral b o rd er.Treatment and Prognosisy Surgical managementy P eripheral curettage o r marginal excisi o ny Lo ng-term fo llo w-up is essential given the l o cal aggressiveness an d recurrence rate (~25%) of this lesi o n.Odontogenic Keratocysty OK Cs may exhibit aggressive clinical behavi o r, a signi f icant recurrent rate, an d ass o ciati o n with nevoid basal

cell carcinoma syndrome (N BCCS).

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y They are fo un d anywhere in the jaws an d can ra d io graphically mimic o ther types of cysts.y M icro sco pically, they have a c o nsistent an d unique appearance.Etiology and Pathogenesisy OK Cs d evel o p f ro m d ental lamina remnants in the man d ible an d maxillay It has als o been suggeste d that an o rigin of this cyst f ro m extensi o n of

basal cells of the o verlying o ral epitheliumy P ath o genetic mechanisms that f av o r gr o wth an d expansi o n of OK Cs

inclu d e high pr o lif erati o n rate, o verexpressi o n of antiap o pt o tic pr o tein

Bcl-2, an d expressi o n of matrix metall o pr o teinases ( MMP s 2 an d 9)y The d e f ective gene ass o ciate d with N BCCS was f irst i d enti f ie d o n

chr o m o so me 9p22.3 an d fo un d to be h o m o lo go us t o the D rosophila(fruit fly ) patche d (PT CH ) gene.

y The pr o tein pr od uct of the P CTH gene (a tum o r suppress o r gene) is a c o mp o nent of the he d geh o g signalingpathway an d is essential fo r d evel o pment d uring embry o genesis an d cell signaling in the a d ult.

y M utati o ns of the P CTH gene are inv o lve d in the d evel o pment of human syn d ro mic basal cell carcin o mas an d

are als o present in a p o rti o n of sp o ra d ic basal cell carcin o mas (as well as me d ullo bast o mas)Clinical Featuresy OK Cs are c o mm o n jaw cysts.y O ccur at any age an d have a peak inci d ence within the 2 nd an d 3 rd d eca d es.y Lesio ns fo un d in chil d ren are of ten re f lective of multiple OK Cs as a c o mp o nent of N BCCS .y OK Cs are fo un d in the man d ible in ~ a 2:1 rati o .y In the man d ible, the p o steri o r p o rti o n of the b od y an d the ramus regi o n are m o st c o mm o nly a ff ecte d , an d

in maxilla the thir d m o lar area is m o st c o mm o nly a ff ecte d .y R ad io graphically, an OK C characteristically presents a well-circumscribe d ra d io lucency with sm oo th

ra d io paque margins.y M ultil o cularity is of ten present an d ten d s t o be seen m o re c o mm o nly in larger lesi o ns.y M o st lesi o ns are unil o cular, with as many as 40% n o te d ad jacent t o the cr o wn of an unerupte d

too th( d entiger o us cyst presentati o n).Differential Diagnosisy D entiger o us cysty Amel o blast o may Odo nt o genic myx o may Ad en o mat o id odo nt o genic tum o ry Amel o blastic f ibr o may Lucent, n o nodo nt o genic tum o rs such as central giant cell granul o ma, traumatic b o ne cyst an d aneurysmal

bo ne cystTreatment and Prognosisy Surgical excisi o n with peripheral o sse o us curettage o r o stect o myy U se of chemical cauterizati o n of the cyst using Carn o y s so luti o n ( bi o lo gic f ixative)y M arsupializati o n fo llo we d by enucleati o nCalcifying Odontogenic Cysty CO Cs are d evel o pmental odo nt o genic lesi o ns that o ccasi o nally exhibit

recurrencey A so lid variant, odontogenic ghost cell tumor, is believe d to po tentially

exhibit m o re aggressive clinical behavi o r.Etiology and Pathogenesisy CO Cs are believe d to be d erive d f ro m odo nt o genic epithelial remnants

within the gingiva o r within the man d ible o r maxilla.y G ho st cell keratinizati o n the characteristic micr o sco pic f eature of this

cyst, is als o a d e f ining f eature of the cutane o us lesi o n kn o wn as calcifyingepithelialoma of Malherbe or pilomatrixoma.

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y In the jaws, gh o st cells may als o be seen in o ther odo nt o genic tum o rs, inclu d ing odo nt o mas,amel o blast o mas, a d en o mat o id odo nt o genic tum o rs, amel o blastic f ibr oodo nt o mas, an d amel o blasticf ibr o mas.

Clinical Featuresy It usually appears in in d ivid uals y o unger than 40 yrs. of age an d has pre d ilecti o n fo r f emalesy M o re than 70% of CO Cs are seen in maxillay R arely C O Cs may present as l o calize d extra o sse o us masses inv o lving the gingivay R ad io graphically, C O Cs may present as unil o cular o r multil o cular ra d io lucencies with d iscrete, well-

d emarcate d marginsy W ithin the ra d io lucency there may be scattere d , irregularly size d calci f icati o ns.y Such o pacities may pr od uce salt-an d -pepper type of pattern, with an equal an d d iff use d istributi o n.Differential DiagnosisEarly stage: y D entiger o us cysty OK Cy Amel o blast o maLater stage: y Ad en o mat o id odo nt o genic tum o ry P artially mineralize d odo nt o may Calcif ying epithelial odo nt o genic tum o ry Amel o blastic f ibr oodo nt o maTreatment and Prognosisy Treatment is usually m o re aggressive than simple curettagey P atients sh o uld be m o nit o re d fo llo wing treatment because recurrences are n o t unc o mm o n.NONODONTOGENIC CYSTSGlobulomaxillary Cyst/ Lesiony G lo bul o maxillary cysts were o nce c o nsi d ere d f issural cysts, l o cate d between the gl o bular

an d maxillary pr o cesses.y Tod ay, gl o bul o maxillary can be justi f ie d o nly in an anat o mic sense, with d e f initive

d iagn o sis of lesi o ns l o cate d in this area ma d e by c o mbine d clinical an d micr o sco pic

examinati o n.y R ad io graphically, the lesi o n appears as a well- d e f ine d ra d io lucency, of ten pr od ucing

d ivergence of the r oo ts of maxillary lateral incis o r an d canine.Nasolabial/Nasoalveolar Cysty These are s of t tissue cysts of the upper lip.y P ath o genesis is unclear, alth o ugh it represents cystic change of the s o lid

co rd remnants of cells that fo rm the nas o lacrimal d uct.y P eak inci d ence is n o te d in 4 th an d 5 th d eca d es an d a d istinct f emale

pre d ilecti o n of near 4:1.y Chie f clinical sign is a s of t tissue swelling that may present in the s of t

tissue o ver the canine regi o n o r the muc o buccal fo ld .y T

reatment: curettagey Few recurrences are expecte d .M edian M andibular Cysty O nce c o nsi d ere d f issural cystsy Fissural o rigin was base d o n the n o -lo nger-tenable the o ry of epithelial entrapment in the mi d line of the

man d ible d uring the f usi o n of each hal f of man d ibular arch.y Case d iagn o se d clinically as me d ian man d ibular cysts represent a micr o sco pic spectrum of odo nt o genic cysts

an d tum o rs.Nasopalatine Canal Cysty A.k.a. incisive canal cysts

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y Lo cate d within the nas o palatine canal o r within the palatal s of ttissues at the p o int of the o pening of the canal, where the lesi o ns arecalle d cysts of the palatine papilla.

y Median palatine cyst is believe d to represent a m o re p o steri o rpresentati o n of a nas o palatine canal cyst rather than cysticd egenerati o n of epithelial rests in the line of f usi o n of the palatineshelves.

Etiology and Pathogenesisy It d evel o ps f ro m the pr o lif erati o n of epithelial remnants of paire d embry o nic nas o palatine d ucts within the

incisive canal.y M uc o us glan d s within the lining may cause cyst fo rmati o n as a result of mucin secreti o n.Clinical Featuresy This cyst may present as a symmetric swelling in the anteri o r regi o n of the palatal mi d line o r as a mi d line

ra d io lucency.y O ccur between 4 th an d 6 th d eca d es of lif ey M en are a ff ecte d m o re than w o meny M o st cases are asympt o matic, with clinical sign of swellingy S inus fo rmati o n an d d rainage o ccurs at the m o st pr o minent p o rti o n of palatine papilla.y R ad io graphically, nas o palatine cyst is purely ra d io lucent, with sharply d e f ine d margins.y The lesi o n may pr od uce d ivergence of the r oo ts of maxillary incis o r teeth an d ind uce external r oo t

res o rpti o n.y The anteri o r nasal spine is of ten centrally superimp o se d o n the lucent d e f ect, pr od ucing a heart shape.Differential Diagnosisy D etermining t oo th vitalityy N o rmal but wi d ene d canalTreatment and Prognosisy Surgical enucleati o ny Large cyst requires marsupializati o n be fo re enucleati o ny R ecurrence rate is very l o w.PSEUDOCYSTS

Aneurysmal Bone Cysty Aneurysmal b o ne cysts are pseu do cysts because they appear ra d io graphically a

cystlike lesi o n but micr o sco pically exhibit n o epithelial lining.y This lesi o n represents a benign lesi o n of bo ne that may arise in man d ible, maxilla

o r o ther b o nes.Etiology and Pathogenesisy The path o genesis is general regar d e d as reactive.y An unrelate d antece d ent primary lesi o n of bo ne, such as f ibr o us d ysplasia,

central giant cell granul o ma, n o no ssi f ying f ibr o ma, ch o nd ro blast o ma, an d o therprimary b o ne lesi o ns, is believe d to initiate a vascular mal fo rmati o n, resulting in a sec o nd ary lesi o n o raneurysmal b o ne cyst.

Clinical Featuresy Typically o ccur in pers o ns y o unger than 30 years of age. There is a slight f emale pre d ilecti o n.y W hen man d ible an d maxilla are inv o lve d , the m o st p o steri o r regi o ns are a ff ecte d .y P ain an d a f irm, n o npulsatile swelling is a c o mm o n clinical sign.y R ad io graphically, there is a presence of d estructive o r o ste o lytic pr o cess with slightly irregular margins.y A multil o cular pattern is n o te d in s o me instancesy W hen alve o lar segment of the jaws is inv o lve d , teeth may be d isplace d with o r with o ut c o nc o mitant

external r oo t res o rpti o n.Differential Diagnosisy Odo nt o genic kerat o cysty Central giant cell granul o ma

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y Amel o blastic f ibr o may Amel o blast o may Odo nt o genic myx o maTreatment and Prognosisy Excisio n o r curettage with supplemental cry o therapyy A relatively high recurrence rate has been ass o ciate d with simple curettage.y Traumatic ( S imple) B o ne Cysty An empty intrab o ny cavity that lacks an epithelial liningy Seen m o stly in the man d ibleTraumatic Bone CystPathogenesisy P ath o genesis is n o t kn o wn, alth o ugh s o me cases seem t o be

ass o ciate d with traumay Alternative d evel o pmental pathways inclu d e cystic d egenerati o n

of primary tum o rs of bo ne, such as central giant cell granul o ma,d iso rd ers of calcium metab o lism, an d ischemic necr o sis of bo nemarr o w.

Clinical Featuresy Teenagers are m o st c o mm o nly a ff ecte d y The m o st site of o ccurrence is the man d ibley The lesi o n may be seen in either anteri o r o r p o steri o r regi o ns. R are bilateral cases have been d escribe d .y Swelling is o ccasi o nally seen an d pain is in f requently n o te d y R ad io graphically, a well- d elineate d area of ra d io lucency with an irregular but d e f ine d e d ge is n o te d .

Interra d icular scall o ping of varying d egrees is characteristic an d o ccasi o nally slight r oo t res o rpti o n may beno te d .

y Of ten been seen in ass o ciati o n with f lo rid o sse o us d ysplasia.Treatment and Prognosisy O nce entry int o the cavity is acc o mplishe d , the clinician nee d merely establish blee d ing int o the lesi o n

be fo re cl o sure.y O rganizati o n of the b o ny cl o t results in c o mplete b o ny repair with o ut recurrence.

Static Bone Cyst (Stafne s Bone Defect) y An anat o mic in d entati o n of the p o steri o r lingual man d ible that

appears t o resemble a cyst o n ra d io graphic examinati o n.y This d epressi o n of the man d ible is believe d to be d evel o pmentaly Cause is unkn o wny Lo cate d bel o w the man d ibular canal in m o lar regi o ny Lesio n is entirely asympt o maticy It appears as a sharply circumscribe d o val ra d io lucency beneath the

level of the in f eri o r alve o lar canal, with encr o achment o n the in f eri o rbo rd er of the man d ible

y N o treatment is require d

Focal Osteoporotic Bone M arrow Defecty (hemat o po ietic b o ne marr o w d e f ect) are unc o mm o n lesi o ns that

typically present as asympt o matic, fo cal ra d io lucencies in areas wherehemat o po iesis is n o rmally seen (angle of the man d ible an d maxillarytuber o sity)

y P ath o genesis is unkn o wn, alth o ugh three the o ries have beenpr o po se d .

y N o f urther treatment is necessary.SOFT TISSUE CYSTS OF THE NECKBranchial/cervical Lymphoepithelial Cysty Clef t cysts are l o cate d in the lateral p o rti o n of the neck, usually

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anteri o r t o the stern o clei do mast o id muscle. It may als o appear in the subman d ibular area, a d jacent t o thepar o tid glan d , o r ar o un d the stern o clei do mast o id muscle.

y INTR AO R AL LYMPH O EPITHE LIAL CYST : f loo r of the m o uth is the m o st c o mm o n site fo r these lesi o ns,fo llo we d by p o steri o r lateral t o ngue

Clinical Featuresy U sually bec o me clinically apparent in late chil d hood o r yo ung a d ulth ood as a

result of enlargement.y D rainage may o ccur al o ng the anteri o r margin of the stern o clei do mast o id

muscle.Differential Diagnosisy Cervical lympha d enitisy Skin inclusi o n cysty Lymphangi o may Tum o r of the tail of the par o tid y Laterally thyr o glo ssal tract cysty D erm o id cystTreatmenty Surgical Excisio nDermoid Cysty Are d evel o pmental lesi o ns that may o ccur in many areas of the b od y.y In o ral cavity, the lesi o n is usually in the anteri o r p o rti o n of the f loo r of

the m o uth in the mi d line.y Cause is d evel o pmental entrapment of multip o tential cells o r p o ssibly

implantati o n of epithelium.Clinical Featuresy Abo ve the myl o hyo id muscle, it d isplaces the t o ngue anteri o rly an d

po steri o rly.y Belo w the myl o hy o id muscle, a mi d line swelling of the neck o ccurs.y P ainless an d slo w gr o wing; n o gen d er pre d ilecti o n.y O n palpati o n, the cysts are s of t an d do ughy because of keratin an d sebum in the lumen.

Treatmenty Surgical excisi o nThyroglossal Tract Cysty M o st c o mm o n d evel o pmental cyst of the necky Basis fo r this relates t o thyr o id glan d d evel o pmenty R esi d ual epithelial elements that do no t c o mpletely atr o phy may give rise t o cysts

in later li f e f ro m the p o steri o r p o rti o n of the t o ngue (lingual thyr o id ) to the mi d lineof the neck.

Clinical Featuresy 30% are fo un d in patients o ld er than 30 years of age, with a similar percentage in

patients y o unger than 10 years of agey T

hese cysts are generally asympto

maticy W hen attache d to the hy o id bo ne an d to ngue, the may retract o n swall o wing o r

extensi o n of the t o nguey If in f ecte d , d rainage thr o ugh a sinus tract may o ccur.Differential Diagnosisy D erm o id cysty Thyr o id ne o plasmy Branchial cysty Sebace o us cystTreatmenty Surgical excisi o n