It is an honor to acknowledge and welcome the fifth edition of Cysts of the Oral and Maxillofacial Regions, or in today's vernacular, Cysts of the Oral and Maxillofacial Regions 5.0. The oral and maxillofacial region, because of its anatomic complexity, is home to a variety of cysts and tumors unique to this site. Many of these arise from the epithelial components that form our teeth and are known as odontogenic cysts. Many of these cysts have proved to be more biologically complex than originally thought as the molecular pathogenesis has been investigated and reported. This has blurred the distinction between cysts and cystic neoplasms and the significance of the molecular landscape characterizing some of these cysts is widely and energetically debated today.
The evolution of Cysts of the Oral and Maxillofacial Regions has been remarkable: first edition (1976), second edition (1983), third edition (1992), fourth edition (2007), fifth ed (2022); from a concise text focusing on clinical/radiographic features and standard histologic descriptions illustrated in black and white, to an exhaustive review of every aspect of these cystic lesions richly illustrated in color. Some of the historical literature has been eliminated, particularly where it lacked clinical relevance. The current literature is extensively recorded, as is the diversity of the histologic spectrum, including immunohistochemical phenotypes and molecular/genetic alterations. Two of the world's most experienced and respected oral pathologists are responsible for this text. The text was initiated by Professor Mervyn Shear from Johannesburg, and Professor Paul Speight of the UK joined as a co‐author in 2007, and he currently continues the legacy of this major contribution.
Cysts of the Oral and Maxillofacial Regions has become the definitive source of information about this complex group of lesions. No other contribution covers this topic more extensively and accurately than this text and there is something here for everyone. Clearly it is applicable for students, both predoctoral and postgraduate, as well as to radiologists, pathologists, researchers, surgeons, and other clinicians.
As scientific inquiry has exploded in recent years and the publication interval of the WHO series of classification of tumors has been shortened significantly, so too is it likely that the sixth edition of this text might be just over the horizon. But a lot has been learned since 2007, and detailed description and analysis of this new knowledge are finally available. One of the primary functions of a textbook is not just to convey what is new, but to analyze what has been published and then condense and summarize that information with an aim toward diagnostic and clinical relevancy. Professor Speight has done a masterful job of condensing our knowledge of these cysts into a readable and relevant format. This text is a must for anyone involved in the diagnosis and treatment of cysts of the head and neck. Improving our understanding of this group of lesions improves the quality of care we can provide our patients. And ultimately, that is what it's all about.
John M. Wright, DDS, MS Regents Professor Diagnostic Sciences Texas A&M University College of Dentistry Dallas, Texas USA
Acknowledgements
This edition is dedicated to the memory of Mervyn Shear, who must first be acknowledged for his research and scholarship over many years that laid the foundations for all the editions of this book. For this edition I specifically acknowledge Mervyn's support and permission to restructure the book and to undertake a complete rewrite of the text, with an increased emphasis on some basic principles and on histopathology and differential diagnosis that may broaden the scope of the book, making it more accessible to a wider range of students and clinicians.
As in previous editions, we have relied heavily on the support and assistance of colleagues and on the research and scholarship of our predecessors. In particular, I would like to draw attention to a number of outstanding giants of the subject on whose shoulders we stand, and who are heavily cited in the text or with whom, over many years, we have shared and discussed cases: Mario Altini, Jerry Bouquot, Roger Browne, Roman Carlos, Geoff Craig, Ricardo Gomez, Robert Gorlin, Malcolm Harris, Jos Hille, Fumio Ide, Ivor Kramer, TieJun Li, Hans Philipsen, Jens Pindborg, Finn Prætorius, Peter Reichart, Paul Stoelinga, Takashi Takata, Paul Toller, Willie van Heerden, Pablo Vargas, and John Wright. Some of these are no longer with us, some I have never met, but most have become good friends and colleagues.
For the preparation of this fifth edition I would like to thank my colleagues, past and present, in the Unit of Oral and Maxillofacial Pathology, University of Sheffield, for their patience, for many discussions and critical comments on the text, and for their assistance in retrieving and photographing cases. Daniel Brierley, Geoff Craig, Lisette Collins, Paula Farthing, Keith Hunter, and Ali Khurram have commented freely on my thoughts and ideas about cysts and have also provided assistance in finding appropriate cases for the illustrations. Chris Franklin and Adam Jones have allowed me access to their data on the incidence of cysts and oral biopsies.
Many colleagues have selflessly provided clinical pictures, radiographs, and photomicrographs, and a number of publishers have allowed us to reproduce figures that have been previously published. For this we are very grateful, and each has been acknowledged in the relevant figure legends.
A major aim of this new edition was to broaden the readership and make the text more accessible to students, trainees, and non‐specialist pathologists and clinicians. A number of colleagues have been kind enough to read early drafts of chapters and freely provided very helpful and constructive comments that have facilitated this aim: Daniel Brierley, Lisette Collins, Paula Farthing, Ali Khurram, Liam Robinson, Willie van Heerden, and John Wright.
I am also especially grateful to my colleague and friend Professor John Wright, who very kindly agreed to write the forward to this edition.
1 Classification and Frequency of Cysts of the Oral and Maxillofacial Regions
CHAPTER MENU
Cysts of the Jaws Odontogenic Cysts Odontogenic Cysts of Inflammatory Origin Odontogenic Cysts of Developmental Origin Non‐odontogenic Cysts and Pseudocysts Non‐odontogenic Cysts of the Jaws Pseudocysts of the Jaws
Cysts of the Salivary and Minor Mucous Glands Cysts of the Major and Minor Salivary Glands Cysts of the Maxillary Sinus
Developmental Cysts of the Head and Neck
Frequency of Cysts of the Oral and Maxillofacial Regions
There is no single satisfactory classification of cysts of the head and neck region. In part this is because terminology varies across the world, but also because classification systems may be developed to serve different purposes. Some authors have tried to subdivide lesions into multiple variants based on histological or clinical features, but this has little clinical utility in terms of planning management. Detailed classifications that include variants are nevertheless useful for research, and occasionally a reported variant may eventually emerge as a new entity. A well‐known example of this is the reporting of an orthokeratinised variant of the odontogenic keratocyst