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BDS4 Radiology > 7 - Cysts of the jaw > Flashcards

7 - Cysts of the jaw Flashcards

1
Q

Define a cyst.

A

Pathological cavity having fluid, semi-fluid or gaseous contents and which is not created by the accumulation of pus (not infection or malignant by origin)

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2
Q

What are common symptoms that present with cysts?

A
  • mobility of teeth
  • swelling
  • discolouration of superficial areas
  • pain
  • sensitivity
  • numbness
  • “egg shell crackling”
  • often asymptomatic unless infected
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3
Q

What imaging can be used for initial assessment of cysts?

A
  • PA
  • occlusal
  • OPT
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4
Q

What imaging can be used for supplemental assessment of cysts?

A
  • CBCT
  • facial radiographs (PA mandible/OM view)
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5
Q

How do most cysts grow?

A

Hydrostatic pressure

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6
Q

How do cysts with secondary infection present on a radiograph?

A
  • loss of definition and corticated margin
  • appear like malignancy
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7
Q

Define pseudolocular.

A

Scalloped edges without septae within (otherwise multilocular)

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8
Q

How can cysts be classified?

A
  • structure (epithelium or not)
  • origin (odontogenic or not)
  • pathogenesis (developmental or inflammatory)
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9
Q

What is an odontogenic cyst?

A
  • occurs in tooth bearing area
  • most common cause of bony swelling in jaw
  • lined with epithelium
  • all found above IAN
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10
Q

What are odontogenic sources of epithelium?

A
  • rests of malassez
  • rests of serres
  • reduced enamel epithelium
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11
Q

What are rests of malassez?

A
  • remnants of Hertwig’s epithelium root sheath
  • can be found in PDL dormant
  • can be activated by infection
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12
Q

What are rests of serres?

A

Remnants of dental lamina

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13
Q

What is the reduced enamel epithelium?

A
  • remnants of enamel organ
  • covers crown before eruption
  • commonly produces dentigerous cysts
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14
Q

What are the common odontogenic cysts?

A
  • radicular
  • dentigerous
  • odontogenic keratocyst
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15
Q

What is a radicular cyst?

A
  • inflammatory odontogenic cyst
  • always associated with non-vital tooth
  • initiated by chronic inflammation at apex of tooth due to pulp necrosis
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16
Q

What is the incidence of radicular cysts?

A
  • 30-40 years
  • M=F
  • 60% maxilla
  • any tooth
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17
Q

Describe the presentation of a radicular cyst.

A
  • asymptomatic
  • if infected, pain
  • slow growing with limited expansion
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18
Q

Describe the difference between radicular cysts and periapical granulomas.

A
  • periapical granuloma is a precursor to a radicular cyst
  • if >15mm diameter on radiograph, consider a radicular cyst
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19
Q

Describe the radiographic features of a radicular cyst.

A
  • well defined and corticated margins
  • round, oval radiolucency
  • corticated margin is continuous with lamina dura of a non-vital tooth
  • long term cyst can cause displacement or root resorption
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20
Q

Describe the histology of a radicular cyst.

A
  • epithelial lining is often incomplete
  • connective tissue capsule
  • inflammation within capsule
  • cholesterol clefts present
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21
Q

How does a radicular cyst develop from a granuloma?

A
  • cytokines stimulate rests of malassez to proliferate
  • draws fluid in and expands
  • interleukins stimulate osteoclasts to destroy local bone
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22
Q

What are the variants of radicular cysts?

A
  • residual cyst (when tooth XLA)
  • lateral radicular cyst (associated with accessory canal)
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23
Q

What is a inflammatory collateral cyst?

A
  • inflammatory odontogenic cyst
  • associated with vital tooth
  • collective term for paradental and buccal bifurcation cysts
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24
Q

What is a paradental cyst?

A

Occurs at distal aspect of partially-erupted M3M

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25
Q

What is a buccal bifurcation cyst?

A

Occurs at buccal aspect of M1M

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26
Q

What is a dentigerous cyst?

A
  • developmental odontogenic cyst
  • associated with crown of unerupted (± impacted) tooth
  • cystic change of dental follicle
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27
Q

What is the incidence of dentigerous cysts?

A
  • 10-30 years
  • M>F
  • mandible>maxilla
28
Q

Describe the radiographic appearance of a dentigerous cyst.

A
  • corticated margins which attach at the CEJ
  • larger cysts can envelop root of tooth
  • usually symmetrical
  • can displace involved tooth
29
Q

Describe the histology of dentigerous cysts.

A
  • thin non-keratinsed stratified squamous epithelium
  • develops from reduced enamel epithelium and fluid accumulates
30
Q

How do you differentiate between a dentigerous cyst and an enlarged follicle?

A
  • consider cyst if follicular space >5mm (crown to margin)
  • normal follicular space is 2-3mm
  • consider cyst if radiolucency asymmetrical
31
Q

What is an eruption cyst?

A
  • variant of dentigerous cyst found in children
  • contained in soft tissue rather than bone
  • associated with erupting tooth (commonly incisors)
32
Q

What is the management of an eruption cyst?

A
  • incise
  • allow tooth to erupt
33
Q

What is an odontogenic keratocyst?

A
  • developmental odontogenic cyst
  • no specific relationship to teeth
  • recurrence very common
  • aka OKC
34
Q

What is the incidence of OKC?

A
  • 10-20 years
  • M>F
  • mandible>maxilla 3:1
  • posterior>anterior
35
Q

Describe the radiographic appearance of OKC.

A
  • scalloping margins with thin lining
  • 25% multilocular
  • displacement of adjacent teeth (resorption uncommon)
  • expansion through medullary bone (antero-posterior) before displacing cortical bone (bucco-lingual)
36
Q

What are the pre-operative diagnostic tests for OKC?

A
  • cyst aspirate
  • low soluble protein
  • OKC <4
  • other cysts >11
37
Q

Describe the histology of OKC.

A
  • parakeratosis
  • basal palisading (nuclei at same level like soldiers)
  • corrugated lining
  • no rete pegs so lining easily torn
38
Q

Why is recurrence common in OKC?

A
  • thin friable lining often tears in surgery
  • daughter cysts present
  • cell nests (retromolar area)
39
Q

What systemic condition is associated with OKC?

A
  • basal cell naevus syndrome
  • aka Gorlin-Goltz syndrome
40
Q

What is basal cell naevus syndrome?

A
  • aka Gorlin-Goltz syndrome
  • multiple OKC
  • multiple basal cell carcinomas
  • pitting on hands and feet
  • calcification of dura mater
41
Q

What are common non-odontogenic cysts found in max-fac?

A
  • nasopalatine duct cyst
  • solitary bone cyst
  • aneurysmal bone cyst
42
Q

What is a nasopalatine duct cyst?

A
  • developmental non-odontogenic cyst
  • arises from nasopalatine duct epithelial remnants
  • occurs in anterior maxilla
43
Q

Describe the incidence of nasopalatine duct cysts.

A
  • 30-50 years
  • M>F
44
Q

Describe the radiographic appearance of nasopalatine duct cyst.

A
  • corticated radiolucency between or over roots of central incisors
  • unilocular
  • can appear heart shaped
  • always involve the midline but can be asymmetrical
45
Q

Describe the presentation of nasopalatine duct cyst.

A
  • asymptomatic (incidental finding)
  • patient may note salty taste
  • large cyst can displace teeth or cause swelling in palate
46
Q

Describe the histology of a nasopalatine duct cyst.

A
  • variable epithelial lining
  • nonkeratinised stratified squamous
  • modified respiratory
47
Q

How do you differentiate between a nasopalatine duct cyst and the incisive fossa?

A
  • incisive fossa present as a midline, oval shaped radiolucency, not corticated
  • measure transverse diameter
  • <6mm assumes incisive fossa
  • > 10mm assumes cyst
  • between should be monitored
48
Q

What is a solitary bone cyst?

A
  • non-odontogenic cyst without epithelial lining
  • aka simple/traumatic/haemorrhagic bone cyst
  • can occur in association with other bone pathology eg fibro-osseous lesions
49
Q

What is the incidence of a solitary bone cyst?

A
  • teenagers
  • M>F
  • mandible>maxilla
50
Q

Describe the clinical presentation of a solitary bone cyst.

A
  • asymptomatic (incidental finding)
  • rarely associated with pain or swelling and usually resolve on their own
51
Q

Describe the radiographic appearance of a solitary bone cyst.

A
  • premolar/molar region of mandible
  • can occur in non-tooth bearing areas
  • variable in definition and cortication
  • can have scalloped edges and may protect between roots of teeth
52
Q

What is a Stafne cavity?

A
  • not a cyst but commonly mistaken for one
  • depression in bone (cortical bone preserved)
  • occurs in mandible
  • contains salivary or fatty tissue
53
Q

Describe the radiographic appearance of a Stafne cavity.

A
  • well defined, corticated radiolucency
  • inferior to IAN
  • rarely displaces adjacent structures
54
Q

What does clear straw coloured fluid from an aspiration biopsy indicate?

A
  • inflammatory or developmental cysts
  • may “sparkle” from cholesterol clefts
55
Q

What does white/creamy semi solid fluid from an aspiration biopsy indicate?

A
  • OKC
  • keratin present
56
Q

If you cannot withdraw plunger in an aspiration biopsy, what does this mean?

A

Lesion is solid ie tumour

57
Q

What type of cyst requires an incisional biopsy?

A

OKC

58
Q

What are the treatment options for cysts?

A
  • enucleation
  • marsupialisation
59
Q

What is enucleation?

A

All of cystic lesion is removed in one (lining fully removed)

60
Q

What is marsupialisation?

A
  • creation of surgical window in wall of cyst to create negative pressure
  • walls of cyst are sutured to surrounding epithelium
  • allows cyst contents to drain and cyst decrease in size
  • should be followed by enucleation at later date as not ultimate treatment
61
Q

What are the advantages of enucleation?

A
  • whole lining can be examined by pathology
  • primary closure
  • little aftercare
62
Q

What are the disadvantages of enucleation?

A
  • risk of mandibular fracture in large cysts
  • incomplete removal can lead to recurrence
  • damage to adjacent structures
  • clot filled cavity can become infected
63
Q

What are the indications for marsupialisation?

A
  • possible damage to adjacents structures
  • difficult access
  • may allow eruption of adjacent teeth
  • elderly or medically compromised patients
  • large cysts in which mandibular fracture is a risk
64
Q

What are the advantages of marsupialisation?

A
  • simple to perform
  • may spare vital structures
65
Q

What are the disadvantages of marsupialisation?

A
  • opening may close and cyst reforms
  • complete lining not available for pathology
  • difficult to keep clean and extensive aftercare
  • take a long time to fill in
66
Q

What is used to ensure the surgical window in marsupialisation stays open?

A

Obturator

67
Q

What follow up is require for OKC?

A
  • at least 10 years
  • CBCT

BDS4 Radiology (12 decks)

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