Globulomaxillary cyst

Last updated April 04, 2019

The globulomaxillary cyst is a cyst that appears between a maxillary lateral incisor and the adjacent canine. It exhibits as an "inverted pear-shaped radiolucency" on radiographs, or X-ray films.

A cyst is a closed sac, having a distinct membrane and division compared with the nearby tissue. Hence, it is a cluster of cells that has grouped together to form a sac ; however, the distinguishing aspect of a cyst is that the cells forming the "shell" of such a sac are distinctly abnormal when compared with all surrounding cells for that given location. It may contain air, fluids, or semi-solid material. A collection of pus is called an abscess, not a cyst. Once formed, sometimes a cyst may resolve on its own. When a cyst fails to resolve, it may need to be removed surgically, but that would depend upon its type and location.

The maxillary lateral incisors are a pair of upper (maxillary) teeth that are located laterally from both maxillary central incisors of the mouth and medially from both maxillary canines. As with all incisors, their function is for shearing or cutting food during mastication, commonly known as chewing. There are generally no cusps on the teeth, but the rare condition known as talon cusps are most prevalent on the maxillary lateral incisors. The surface area of the tooth used in eating is called an incisal ridge or incisal edge. Though relatively the same, there are some minor differences between the deciduous (baby) maxillary lateral incisor and that of the permanent maxillary lateral incisor. The maxillary lateral incisors occlude in opposition to the mandibular lateral incisors.

In mammalian oral anatomy, the canine teeth, also called cuspids, dog teeth, fangs, or eye teeth, are relatively long, pointed teeth. However, they can appear more flattened, causing them to resemble incisors and leading them to be called incisiform. They developed and are used primarily for firmly holding food in order to tear it apart, and occasionally as weapons. They are often the largest teeth in a mammal's mouth. Individuals of most species that develop them normally have four, two in the upper jaw and two in the lower, separated within each jaw by incisors; humans and dogs are examples. In most species, canines are the anterior-most teeth in the maxillary bone.

The globulomaxillary cyst often causes the roots of adjacent teeth to diverge.

This cyst should not be confused with a nasopalatine cyst.

The developmental origin has been disputed. Today, most literature agree based on overwhelming evidence that the cyst is predominantly of tooth origin (odontogenic), demonstrating findings consistent with periapical cysts, odontogenic keratocysts or lateral periodontal cysts.^[1]

The periapical cyst is the most common odontogenic cyst. Periapical is defined as "the tissues surrounding the apex of the root of a tooth" and a cyst is "a pathological cavity lined by epithelium, having fluid or gaseous content that is not created by the accumulation of pus." Most frequently located in the maxillary anterior region, it is caused by pulpal necrosis secondary to dental caries or trauma. The cyst has lining that is derived from the epithelial cell rests of Malassez which proliferate to form the cyst. Highly common in the oral cavity, the periapical cyst is asymptomatic, but highly significant because a secondary infection can cause pain and damage. In radiographs, it appears a radiolucency around the apex of a tooth's root.

The lateral periodontal cyst is a non-inflammatory developmental cyst that arises from the epithelial post-functional dental lamina, which is a remnant from odontogenesis. It is more common in middle-aged males. Usually asymptomatic, it presents as a regular well-corticated radiolucency on the side of a mandibular canine or premolar root. Histologically, the cyst appears similar to the gingival cyst of the adult, having a non-keratinized squamous epithelial lining. The involved tooth is usually vital and has no indication for root canal treatment unless the signs of non-vital or necrotic pulpal tissue were confirmed. The cysts arise from epithelial rest cells in the periodontal ligament, although it is unknown whether from the cell rests of Malassez, reduced enamel epithelium or dental lamina remnants, and are generally treated by surgical enucleation.

Treatment

Treatment is usually by enucleation.

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Central giant-cell granuloma (CGCG) is a localised benign condition of the jaws. It is twice as common in females and is more likely to occur before age 30. Central giant-cell granulomas are more common in the anterior mandible, often crossing the midline and causing painless swellings.

An eruption cyst, or eruption hematoma, is a bluish swelling that occurs on the soft tissue over an erupting tooth. It is usually found in children. The fluid in the cyst is sometimes clear creating a pale-coloured cyst although often they are blue. An eruption cyst is a developmental soft-tissue cyst of odontogenic origin that forms over an erupting tooth.

A primordial cyst is a developmental odontogenic cyst. It is found in an area where a tooth should have formed but is missing. Primordial cysts most commonly arise in the area of mandibular third molars. Under microscopes, the cyst looks like an odontogenic keratocyst whereby the lesions displays a parakeratinized epithelium with palisading basal epithelial cells.

An odontogenic keratocyst is a rare and benign but locally aggressive developmental cyst. It most often affects the posterior mandible and most commonly presents in the third decade of life. Odontogenic keratocysts make up around 19% of jaw cysts.

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Calcifying odotogenic cyst is a benign odontogenic tumor of cystic type most likely to affect the anterior areas of the jaws. It is most common in people in their second to third decades but can be seen at almost any age. On radiographs, the calcifying odontogenic cyst appears as a unilocular radiolucency. In one-third of cases, an impacted tooth is involved. Microscopically, there are many cells that are described as "ghost cells", enlarged eosinophilic epithelial cells without nuclei.

The glandular odontogenic cyst is a rare odontogenic cyst. In 85% of cases, it is found in the mandible, especially in anterior areas. It is more common in adults in their fifth and sixth decades. On radiographs, it can appear as a unilocular or multilocular radiolucency. Since the glandular odontogenic cyst can range in size, treatment can be as simple as enucleation and curettage to en bloc resection of the affected jaw.

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An odontogenic infection is an infection that originates within a tooth or in the closely surrounding tissues. The term is derived from odonto- and -genic. Odontogenic infections may remain localized to the region where they started, or spread into adjacent or distant areas.

Odontogenic cyst are a group of jaw cysts that are formed from tissues involved in odontogenesis. Odontogenic cysts are closed sacs, and have a distinct membrane derived from rests of odontogenic epithelium. It may contain air, fluids, or semi-solid material. Intra-bony cysts are most common in the jaws, because the mandible and maxilla are the only bones with epithelial components. That odontogenic epithelium is critical in normal tooth development. However, epithelial rests may be the origin for the cyst lining later. Not all oral cysts are odontogenic cyst. For example, mucous cyst of the oral mucosa and nasolabial duct cyst are not of odontogenic origin.
In addition, there are several conditions with so-called (radiographic) 'pseudocystic appearance' in jaws; ranging from anatomic variants such as Stafne static bone cyst, to the aggressive aneurysmal bone cyst.

A cyst is a pathological epithelial lined cavity that fills with fluid or soft material and usually grows from internal pressure generated by fluid being drawn into the cavity from osmosis. The bones of the jaws, the mandible and maxilla, are the bones with the highest prevalence of cysts in the human body. This is due to the abundant amount of epithelial remnants that can be left in the bones of the jaws. The enamel of teeth is formed from ectoderm, and so remnants of epithelium can be left in the bone during odontogenesis. The bones of the jaws develop from embryologic processes which fuse together, and ectodermal tissue may be trapped along the lines of this fusion. This "resting" epithelium is usually dormant or undergoes atrophy, but, when stimulated, may form a cyst. The reasons why resting epithelium may proliferate and undergo cystic transformation are generally unknown, but inflammation is thought to be a major factor. The high prevalence of tooth impactions and dental infections that occur in the bones of the jaws is also significant to explain why cysts are more common at these sites.

A median mandibular cyst is a type of cyst that occurs in the midline of the mandible, thought to be created by proliferation and cystic degeneration of resting epithelial tissue that is left trapped within the substance of the bone during embryologic fusion of the two halves of the mandible, along the plane of fusion later termed the symphysis menti. A true median mandibular cyst would therefore be classified as a non-odontogenic, fissural cyst. The existence of this lesion as a unique clinical entity is controversial, and some reported cases may have represented misdiagnosed odontogenic cysts, which are by far the most common type of intrabony cyst occurring in the jaws. It has also been suggested that the mandible develops as a bilobed proliferation of mesenchyme connected with a central isthmus. Therefore, it is unlikely that epithelial tissue would become trapped as there is no ectoderm separating the lobes in the first instance.

References

↑ Developmental defects of the oral and maxillofacial region. In Neville, B, et al. editors: Oral & Maxillofacial Pathology, 2nd Ed. Saunders 2002, page 27.

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[1] Developmental defects of the oral and maxillofacial region. In Neville, B, et al. editors: Oral & Maxillofacial Pathology, 2nd Ed. Saunders 2002, page 27.