Glandular odontogenic cyst

Other names: sialo-odontogenic cyst, mucoepidermoid odontogenic cyst or polymorphous odontogenic cyst. These appear to be odontogenic in origin and present as a well-defined radiolucent swelling of the jaws with a tendency to recur following conservative treatment. The cyst is possibly derived from rests of dental lamina and comprises both secretory elements and stratified squamous epithelium.

Clinical features

• The age of occurrence ranges from 10–90 years with the mean of 49.5 years.
• Glandular odontogenic cyst is commonly seen in the anterior mandible. Occasionally maxillary involvement has been reported.
• The usual complaints are swelling, pain or discomfort in the involved area.
• It is usually seen as a slow-growing swelling. Pain is very unusual.

Radiographic features

Radiographically it may be a unilocular or multilocular well-circumscribed radiolucency usually displacing the roots of teeth.

Histologic Features

• Histologically, glandular odontogenic cyst is lined in parts by a nonkeratinized stratified epithelium of varying thickness.
• The epithelium has a glandular or pseudoglandular structure, with goblet mucous producing cells as well as intraepithelial crypts or microcysts containing mucus. These microcysts may open onto the surface of the epithelium giving a papillary or corrugated appearance. Some cells may also be ciliated.
• Occasionally the epithelium is thinner, similar to reduced enamel epithelium. Epithelial thickenings or plaques may be present either in this thin epithelium or in the stratified epithelium.
• Interface between epithelium and connective tissue is flat.
• The diagnosis of glandular odontogenic cyst should be considered when observing a lateral periodontal multilocular radiolucency. The diagnosis is essentially microscopic.

Management and prognosis

• Glandular odontogenic cysts can be treated conservatively by enucleation and curettage.
• It is believed that almost 55% of the cases show recurrence. The recurrence rate is high because the thin cyst wall, tendency of epithelium to separate from connective tissue or growth through cancellous spaces of bone and presence of microcysts makes complete removal of the cyst nearly impossible.
• Local block excision is recommended.
• Follow up the patient for several years to assess any form of recurrence.

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