Glandular odontogenic cysts are very rare cysts in the jaw. They cause little or no discomfort to the patient for long periods of time, but if left untreated, they can lead to bone damage. They require surgical treatment, with options ranging from conservative to aggressive depending on the number and location of the cysts. Glandular odontogenic cysts have a high risk of recurrence.
What is a glandular odontogenic cyst?
Odontogenic cysts are generally the most common cysts found in the jaw. They are defined as pathologic cavities that are fully or partially lined with epithelial tissue and are embryologically derived from the dental structures. They can be basically divided into inflammation-related and development-related cysts. Among the six known developmental odontogenic cysts, glandular odontogenic cysts are the rarest (0.2 percent of all odontogenic cysts; as of 2008, 111 cases had been described in the literature over a 20-year period). They differ from other odontogenic cysts in the presence of glandular tissue in the lumen. The epithelium is cuboidal or cylindrical and contains goblet cells and crypts. Glandular odontogenic cysts are also found in the English-language literature under the names sialo-odontogenic cyst, mucoepidermoid odontogenic cyst, or as polymorphous odontogenic cyst. They occur in both the maxilla and mandible, but are more frequently found in the mandible. Approximately 70 percent of all glandular odontogenic cysts are located there. The anterior region is more frequently affected than the posterior. The average age of patients is about 45 years, although most diagnoses are made between the second and third decades of life. Men are affected slightly more often than women.
Causes
As the name implies, developmental odontogenic cysts are due to maldevelopment of the tissue. They originate from the tooth systems. The exact developmental mechanism of glandular odontogenic cysts, as with all developmental odontogenic cysts, is currently unknown.
Symptoms, complaints, and signs
Glandular odontogenic cysts are often uncovered only as incidental findings, because the cysts are usually symptomless and the teeth in the affected area are vital. Often, the only symptom is a nonpainful swelling in the area of the jaw affected by the cyst. Because the cysts sometimes exhibit vigorous and aggressive growth, these swellings may be externally noticeable as facial asymmetries. No other symptoms or complaints have been described.
Diagnosis and course
Because glandular odontogenic cysts as described above are, on the one hand, very rare and, on the other hand, often do not cause any symptoms for a long time, they are sometimes only noticed as incidental findings in radiological examinations. If glandular odontogenic cysts are specifically examined, a panoramic radiograph (orthopantomogram) is the best method. The cysts show up on the images as sharply defined lightenings that stand out clearly from the bone. Dislocations or root resorptions may be seen on the adjacent teeth due to the sometimes aggressive growth of the cysts. However, there are no clear pathognomonic radiological signs for glandular odontogenic cysts. Therefore, the diagnosis can only be confirmed by histological examination. Immunohistochemical markers as well as the typical glandular tissue of glandular cysts may be helpful. Differential diagnoses to consider include ameloblastoma, odontogenic myxofibroma, central giant cell granuloma, keratocystic odontogenic tumor, follicular cyst, lateral periodontal cyst, and plasmocytoma. Glandular odontogenic cysts, if undetected and thus untreated, can lead to bone damage by osteolysis of the cortical bone.
Complications
In most cases, the patient does not experience any particular discomfort or complications from the odontogenic cyst. For this reason, this cyst is usually discovered by chance and treatment is often initiated late. Swelling of the jaw may occur. If the odontogenic cyst continues to grow, it can lead to asymmetries in the face, which have a negative effect on the patient’s esthetics and can lead to complications.Not infrequently, those affected suffer from feelings of shame or inferiority complexes and the patient’s quality of life is reduced. In the case of a tumor, it can spread to other regions of the body and cause damage and discomfort there. Treatment of odontogenic cyst does not cause discomfort or complications in most cases. It is simple and quickly leads to a positive course of the disease. However, in many cases, the patient will need a new treatment and it cannot be excluded that the odontogenic cyst will appear again at a later time. Furthermore, the affected person is dependent on regular check-ups. A reduction in life expectancy generally does not occur.
When should one go to the doctor?
Irregularities in the mouth should be clarified by a doctor, If there is the formation of swelling, ulcers or lumps in the mouth, a doctor should be consulted. If the affected person can detect changes in the gums with the tongue, a check-up visit is recommended. Since the glandular odontogenic cyst often remains asymptomatic and unnoticed for a long time, a visit to the doctor should be made at the first uncertain perceptions. If there is a slight perception of pain in the jaw or a pulling sensation in the mouth when moving the jaw, a doctor should be consulted. If teeth loosen or shift, there is reason for concern. If there is a feeling of pressure in the mouth, discomfort when cleaning the teeth, or an unusual taste in the mouth, a doctor should be consulted. If asymmetries in the face or deformities of the face or neck can be perceived, a visit to the doctor is necessary. If the visual changes cause emotional or mental discomfort, a doctor should be contacted. Persistent feelings of shame or decreased self-confidence should be discussed with a physician. If swallowing difficulties, changes in phonation or impairment occur during food intake, a doctor should be consulted. If discomfort sets in while wearing braces or if problems occur with existing dentures, a dentist should be consulted as soon as possible.
Treatment and therapy
Glandular odontogenic cysts can only be treated surgically. Within the surgical options, both conservative and aggressive or resective measures can be found. Conservative suggestions include: cystectomy alone, marsupialization for hard-to-reach cysts, cystectomies or curettage combined with partial peripheral ostectomy. The combination of cystectomies or curettages with adjuvant application of Carnoy’s solution, cryotherapy, and continuity resections. In the case of aggressive surgical approach by resection, reconstruction should be performed immediately. The method of choice in each case depends on the parameters of the specific case, such as the location, size, and number of cysts. For example, cystectomies may be used particularly for small, single cysts affecting only one or two adjacent teeth. Multilocular lesions, on the other hand, require more aggressive approaches to prevent recurrences as much as possible. In many cases, therapy cannot be considered complete, as the recurrence rate of up to 35.9 percent often necessitates repeated treatments. Cases treated by resection have the rarest recurrences. Conservative surgical therapeutic approaches are complicated by the presence of microcysts; in addition, the often extremely thin cyst bellows prevent complete removal. The risk of recurrence is particularly high in very large and multilocular cysts associated with cortical perforation. Therefore, regular check-ups after surgical treatment are indispensable. They should be performed after three, six, and 12 months and should be continued by annual radiologic surveillance.
Outlook and prognosis
The prognosis of glandular odontogenic cyst should be evaluated according to individual circumstances. However, in most cases, it is documented as favorable. In some patients, there is no significant impairment or interference from the cyst. Its removal is performed conservatively and subsequently the affected person can be discharged from treatment as symptom-free. Although this favorable prognosis is present, cyst recurrence may occur later in life.If it is noticed early and is in a favorable position, the prognosis is again good. If the cyst is difficult to locate and its size increases, the effort required to remove it increases. In addition, complications may increase. Tooth displacement and damage to the bones are possible. Although the removal of the cyst is usually successful, necessary corrections are often advised. Surgical interventions are used to repair and fix the teeth so that no further complications occur. The larger a cyst is, the more likely it is to recur. Although the initial prognosis is favorable, repeated disturbances and new formations of a cyst may nevertheless occur in the further course over the patient’s lifetime. For the patient, this means that he or she should undergo regular checkups to ensure that recurrence is noticed as soon as possible.
Prevention
Because the mechanism of origin of glandular odontogenic cysts is unknown, it is not possible to prevent their occurrence by preventive measures. However, regular dental screening increases the likelihood of detecting the cysts early, before they can cause discomfort to the patient. Because of the high risk of recurrence, regular radiological checkups are strongly recommended after glandular odontogenic cysts have already been diagnosed and treated.
Follow-up
In this disease, few to hardly any measures and options of follow-up care are available. In this regard, the patient is primarily dependent on early diagnosis and detection of this disease to prevent further compilations or other damage to the bones. Therefore, the early detection and also the subsequent treatment of this disease is in the foreground. Further and regular examinations should be carried out even after successful treatment in order to detect and remove other tumors. Possibly, this cyst also reduces the life expectancy of the affected person. The treatment of this disease is carried out with the help of various therapies and also by surgical removal of the cysts. The affected person should definitely recover and rest his body after such an operation. They should refrain from exertion or other physical activities so that the body is not unnecessarily stressed. Regular examinations are necessary in order to detect the recurrence of this complaint at an early stage, even several years after the removal. As a rule, no further measures of aftercare are necessary for this disease.
What you can do yourself
Glandular odontogenic cysts often do not cause any noticeable discomfort for a long time and therefore remain unnoticed by the affected person at first. However, there is a risk that they can damage the bones, which is why a doctor should be consulted immediately if the patient notices the glandular odontogenic cyst. By doing so, the affected person will prevent their quality of life from deteriorating in the long run due to the condition. After the doctor removes the Glandular odontogenic cyst in a surgical procedure, the patient usually suffers from temporary discomfort such as pain and difficulty in eating. Initially, after glandular odontogenic cyst surgery, the patient takes special care to get long periods of rest with plenty of sleep or sedentary activities every day. This is because sufficient rest is important for the body to regenerate after the stress of surgery. The patient spends a lot of time at home and takes care not to expose himself to physical or psychological stress. If there are problems with eating due to the pain, the patient adjusts the type of food he eats in consultation with the doctor and prefers soft foods for a certain period of time. Thorough dental and oral hygiene is equally important, as the susceptibility to infections is increased after the operation.
