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Lateral Periodontal Cyst Pathology

Definition

Lateral periodontal cysts (LPCs) are now considered to be an independent entity since the World Health Organization (WHO) classified them as such in the 1992 monograph on “The Histological Typing of Odontogenic Tumors.”
Lateral periodontal cysts are defined as nonkeratinized and noninflammatory developmental cysts located adjacent or lateral to the root of a vital tooth.
These cysts arise along the lateral periodontium or within the bone between the roots of erupted vital teeth.

The first well-documented case of a lateral periodontal cyst was reported by Standish and Shafer in 1958.
In the past, the term lateral periodontal cyst was used to describe any cyst that developed along the lateral root surface, including lateral radicular cysts and odontogenic keratocysts. The diagnosis of lateral periodontal cyst is primarily based on histopathologic features, as certain characteristic histologic features separate it from other odontogenic cysts.
Some authors have postulated that the lateral periodontal cyst is the intrabony counterpart of the gingival cyst in the adult.

The Botryoid odontogenic cyst (BOC) is a polycystic variant of the lateral periodontal cyst.
In 1973, Weathers and Waldron reported the first case of a multilocular lesion of the jaws, which they called a Botryoid odontogenic cyst.
Clinically, the age group affected with Botryoid odontogenic cyst ranges from 23 to 85 years, with a mean age of 53.8 years.
Most often Botryoid odontogenic cysts are multilocular, but unilocularity has also been reported.
Botryoid odontogenic cysts are larger than lateral periodontal cysts, ranging between 5 mm and 45 mm and often extending into the periapical region of involved teeth.

Clinical symptomatology of Botryoid odontogenic cysts can vary from lesions that are asymptomatic to lesions that are exceedingly painful. Paresthesia and tumefaction have also been reported.
Although the histopathologic features of Botryoid odontogenic cysts are similar to lateral periodontal cysts, the recurrence rate is higher, ranging from 15% to 33%.
It is estimated that over 67 cases of Botryoid odontogenic cysts have been reported in the literature.

Some controversy exists about the relationship of Botryoid odontogenic cysts to lateral periodontal cysts, as some authors prefer to define a Botryoid odontogenic cyst as a “multicystic odontogenic lesion with histological characteristics of lateral periodontal cyst,” or “cystic lesion similar to lateral periodontal cyst.”
High et al proposed the term “polymorphic odontogenic cyst” to include lesions like Botryoid odontogenic cysts, glandular odontogenic cysts, and intraosseous mucoepidermoid carcinoma,
suggesting with this classification that careful histologic evaluation is necessary to confirm a diagnosis of Botryoid odontogenic cyst and separate it from any of these other possible lesions.

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