Maxillofacial Cysts Prior to 1870

Dentigerous Cyst
Dermoid Cyst
Epidermoid Cyst

Eruption Cyst
Gingival Cyst of Newborn
Odontogenic Keratocyst

Periapical Cyst
First Reports

Dentigerous cyst in the maxilla of a horse. 
From: Forget, Dental Cosmos, 1860.



Periapical Cyst

Cysts of the jaws were noted only when they produced cortical expansion or some other visible alteration of surface tissues. The single exception was also the first cyst reported in a dental journal: the periapical cyst (see First Reports). These cysts were referred to simply as "sacs" and were a routine experience for busy dental surgeons extracting and examining carious teeth. By the 1830s dentists were almost as familiar with periapical pathoses as we are today, although many believed that the periapical lesion produced tooth death, rather than vice versa.[Brown,1839] Noncystic periapical lesions were described as inflammations, granulations, abscesses, and suppurations, and it was well known that facial or alveolar fistulae could result from them.



Dentigerous Cyst

Dentigerous cysts were described as early as 1778 in France, according to Shilletoe, but were not well delineated until 1842 (see First Reports), and were not illustrated in a journal until 1859.[Forget,1860;Harris,1842]  These cases were reported approximately a century after Scultet [1671] first described jawbone cysts as "liquid tumors."  The concept of a benign, epithelial-lined cystic space with internal pressures capable of producing bony expansion was formed during those early years. Neumann [1871] appears to be the first to make a clear distinction between the dentigerous cyst and the ameloblastoma.



Eruption Cyst

The eruption cyst held special significance for early dental surgeons.[Tomes,1848]   The anatomy of the trigeminal nerve had recently been described by the Englishman Charles Bell [1830] and a direct connection between teeth and the brain was proven for the first time -- a connection first proposed by Aetius soon after Galen's treatise on teeth.[Allen, 1844] Since many children suffered from viral or other encephalitis and meningitis attacks at a period of life similar to the eruption of teeth, it was assumed that tooth eruption, and particularly its "severe" forms (with eruption cysts), was the cause of "brain fever".[Canton, 1851] The universal acceptance of this concept is perhaps best illustrated in Charles Dicken's [1853] Bleak House, wherein a sickly child is assumed to be dying from "a difficult teething". The logical treatment for convulsions and stuporous fevers became, quite naturally, the surgical incision of gingival tissues overlying eruption cysts and erupting teeth. This treatment appeared to be successful, of course, because brain fevers typically lasted 7-14 days, presuming death did not intervene. Such treatment came to be known as "scarification" nd was used also on Epstein's pearls or gingival cysts of newborns.[Grey, 1843]


Odontogenic Keratocyst

Several cystic lesions were aggressive enough to be classified today as odontogenic keratocysts or unicystic ameloblastomas. The first large cyst was Dornbluth's 1844 description of a multilocular dentigerous cyst or "encysted tumor" which had entirely filled the antrum and distorted the orbital floor (see First Reports). This case has all the earmarks of an odontogenic keratocyst, but a microscopic description is lacking. The aggressive nature of such lesions is emphasized by contemporary diagnoses used, such as "cystic sarcoma" and "cystic carcinoma".[Wagstaffe,1871] It is probable that the multilocular cyst found by Salama and Hilmy [1951] in the mandibular ramus of a 2,800 B.C. Egyptian mummy was a keratocyst. It was not associated with an impacted tooth and had greatly expanded the overlying cortices, causing pathologic fracture. This skull also contained a dentigerous cyst around the crown of an impacted maxillary cuspid (Gorlin's syndrome, perhaps?).



Gingival Cyst of Newborn

AlThe first mention in the dental journals of a gingival cyst of newborn, i.e. the Epstein's pearls or Bohn's nodules, was that by Grey in 1843 (see First Reports). This was mentioned in a discussion about a very common medical practice, the deliberate cutting of the gingiva overlying erupting teeth in infants and children. This practice, called scarification, was intended to release disease-producing "vapors" surrounding the crown of the erupting tooth, in order to reduce risk of, or symptoms of, "brain fever." It does not seem to have been used to actually aid eruption of the embedded tooth. Scarification remained a standard treatment for many decades, and probably arose from the circumstance of a common age for tooth eruption and viral encephalitis and meningitis.



Dermoid Cyst (Teratoma)

Although not true odontogenic neoplasms, ovarian teratomas or dermoid cysts were well known to frequently contain teeth, almost always within bony "sockets."[Cone,1848]  In his article, Cone also referred to the fact that Brodie had already reported a case of "a jaw with full grown teeth" by 1848.



In: Allen J. Address delivered before the Mississippi Valley Association of Dental Surgeons. Am J Dent Sc 1844; 5:105-112.

Bell C. The nervous system of the human body. London, 1830.

Brown AM. Review of Burdell and Burdell's Observations on the structure, physiology, anatomy and diseases of the teeth. Am J Dent Sc 1839; 1:19-24.

Canton A. On teaching. From a treatise on the teeth. Am J Dent Sc (new series) 1851; 1:131-138.

Cone CO. Report on practical dentistry. Am J Dent Sc 1848; 9:3-82.

Dickens C. Bleak House. London, 1853.

Dornbluth. Cyst in the orbital cavity. Am J Dent Sc 1844; 4:296-297.

Forget A. Dental anomalies and their influence upon the production of diseases of the maxillary bones. Dent Cosmos 1860; 1:229-236, 283-289, 398-404, 451-457.

Grey WH. Lancing the hums in stridulous convulsions. Am J Dent Sc 1843; 3:228.

Harris CA. Book review of Ashburn J. On dentition and some coincident disorders (published 1834). Am J Dent Sc 1842; 2:294-297.

Neumann E. Ein Fall von Unterkiefergeschwulst bedingt durch Degeneration eines Zahnsackes. Langenbecks Arch f Chir 1867; 9:221-223.

Salama N, Hilmy A. An ancient Egyptian skull and a mandible showing cysts. Brit Dent J 1951; 90:17-18.

Scultet I. L'Arcenal de Chirurgie. Lyon: Antoine Cellier, 1671.

Shillitoe B. Fibrous tumor from near the angle of the lower jaw. Trans Pathol Soc London 1865; 16:223-224.

Tomes J. A course of lectures on dental physiology and surgery (lectures I-XV). Am J Dent Sc 1846-1848; 7:1-68, 121-134; 8:33-54, 120-147,313-350.

Wagstaffe WW. Case of cystic sarcoma of lower jaw. Trans Pathol Soc London 1871; 22:249-253.