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F - SCR > BDS4 Cysts of the Jaws > Flashcards

BDS4 Cysts of the Jaws Flashcards

1
Q

what is a cyst?

A

-cavity fluid, semi-fluid or gaseous contents
- not created by the accumulation of pus

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2
Q

signs and symptoms of cysts?

A

Often asymptomatic unless infected

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3
Q

what is radiograph investigation of cyst?

A
  • Initial
    *Periapical radiograph
    *Occlusal radiograph
    *Panoramic radiograph
  • Supplemental
    *Cone beam CT (CBCT)
    *Facial radiographs
    **PA mandible view
    **Occipitomental view
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4
Q

what are radiographic features of cysts?

A
  • Location
  • Shape
    *Often spherical or egg-shaped
    *Most grow by hydrostatic pressure
  • Margins
    *Often well defined
    *Often corticated
  • Locularity
    *Often unilocular
    *Can be multilocular (or pseudolocular)
  • Multiplicity
    *Single, bilateral, multiple
    *Multiple cysts may indicate a syndrome
  • Effect on surrounding anatomy
    *Displacement of cortical plates, adjacent
    teeth, maxillary sinus, inferior alveolar canal
    *Variable degree & pattern of growth
    *Root resorption may occur with chronic
    cysts
  • Inclusion of unerupted teeth
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5
Q

what happens to secondary infection cysts?

A
  • Cysts may lose definition & cortication of
    margins if secondarily infected
  • Typically associated with clinical
    signs/symptoms
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6
Q

what are 2 classes of cysts?

A
  • odontogenic
  • non-odontogenic
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7
Q

what are types of odontogenic and non-odontogenic cysts

A

odontogenic
- developmental
*Dentigerous cyst (& eruption cyst)
*Odontogenic keratocyst
*Lateral periodontal cyst
- inflammatory
*Radicular cyst (& residual cyst)
*Inflammatory collateral cysts
**Paradental cyst
**Buccal bifurcation cyst

non-odontogenic
- developmental
*Nasopalatine duct cyst
- other
*Solitary bone cyst
*Aneurysmal bone cyst
both no epithelial lining

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8
Q

what are odontogenic cysts?

A
  • occur in tooth bearing areas
  • most common cause of bony swelling in jaws
  • all lined with epithelium
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9
Q

what are the sources of odontogenic epithelium

A
  • Rests of Malassez
    *Remnants of Hertwig’s epithelial root sheath
  • Rests of Serres
    *Remnants of the dental lamina
  • Reduced enamel epithelium
    *Remnants of the enamel organ
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10
Q

what are most common odontogenic cysts?

A
  1. Radicular cyst (& residual cyst)
    * 60% of odontogenic cysts
  2. Dentigerous cyst (& eruption cyst)
  3. Odontogenic keratocyst
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11
Q

what is radicular cyst? and incidence

A
  • Inflammatory odontogenic cyst
    *Always associated with a non-vital tooth
    *Initiated by chronic inflammation at apex of tooth due to
    pulp necrosis
  • incidence
    *most common in 4th and 5th decades
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12
Q

what is presentation of radicular cyst?

A

presentation
- often asymptomatic
*may become infected ->pain
- typically slow growing with limited expansion

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13
Q

what is difference between radicular cyst and periapical granulomas

A
  • difficult to differentiate radiographically
  • radicular cyst typically larger
  • if radiolucency diameter>15mm -> 2/3’s of cases will be radicular cysts
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14
Q

what is path to radicular cyst?

A

pulpal necrosis -> periapical periodontitis -> periapical granuloma -> radicular cyst

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15
Q

what are radiographic features of radicular cyst?

A
  • Well-defined, round/oval radiolucency
  • Corticated margin continuous with lamina dura
    of non-vital tooth
  • Larger lesions may displace adjacent structures
  • Long-standing lesions may cause external root
    resorption &/or contain dystrophic calcification
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16
Q

what is histology of radicular cyst?

A
  • Epithelial lining (often incomplete)
  • Connective tissue capsule
  • Inflammation in capsule
  • variable inflammation
  • cholesterol clefts
  • mucos metaplasia
  • hyaline/rushton bodies
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17
Q

what is radicular cyst from granuloma?

A
  • Epithelial rests of Malassez proliferates in periapical granuloma
  • Radicular cysts may form by:
    *Proliferating epithelium with central necrosis
    *OR epithelium surrounds fluid area
  • Continued growth
    *Osmotic effect with semi-permeable wall
    *Cytokine mediated growth
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18
Q

what are variants of radicular cyst?

A
  • Residual cyst
    -radicular cyst persists after loss of tooth or RCT
  • Lateral radicular cyst
    -Radicular cyst associated with an accessory canal
    -Located at side of tooth instead of apex
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19
Q

what are inflammatory collateral cysts?

A
  • associated with vital tooth
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20
Q

what is inflammatory collateral cyst collective term for?

A
  • Paradental cyst
    *Typically occurs at distal aspect of partially-erupted mandibular third molar
  • Buccal bifurcation cyst
    *Typically occurs at buccal aspect of mandibular first molar
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21
Q

what is this?

A

dentigerous cyst

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22
Q

what is dentegous cyst

A
  • Developmental odontogenic cyst
    *Associated with crown of unerupted (& usually impacted) tooth
    *Cystic change of dental follicle
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23
Q

what is incidence of dentigerous cyst?

A
  • common 20-40
  • male and mandible more
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24
Q

explain features of dentigerous cyst?

A
  • Corticated margins attached to cemento-enamel
    junction of tooth
    *Larger cysts may begin to envelope root of tooth
  • May displace involved tooth
  • Tend to be symmetrical initially
    *Larger cysts may begin to expand unilaterally
  • Variable displacement of cortical bone (i.e.
    bony expansion)
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25
Q

what is histology of dentigerous cyst?

A
  • Thin non-keratinised stratified squamous epithelium
    *May resemble radicular cyst if inflamed
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26
Q

what is difference between dentigerous cyst and enlarged follicle?

A
  • Consider cyst if follicular space 5mm or more
    *Measure from surface of crown to edge of follicle
    *Normal follicular space typically 2-3mm
    *Assume cyst if >10mm
  • Consider cyst if radiolucency is asymmetrical
27
Q

what is this?

A

eruption cyst

28
Q

what is eruption cyst?

A
  • Variant of dentigerous cyst
    *Contained within soft tissue rather than bone
  • Associated with an erupting tooth
    *More commonly incisors
    *Almost exclusive to children
29
Q

what is this?

A

Odontogenic keratocyst (OKC)

30
Q

what is odotongeic keratocyst? incidence?

A
  • Developmental odontogenic cyst
    *No specific relationship to teeth
    incidence
  • 20 and 30s
  • male and mandible and posterior more
31
Q

what are features of odonotgenic kertocyst?

A
  • Often have scalloped margins
  • 25% are multilocular
  • Often cause displacement of adjacent
    teeth
    *Root resorption uncommon
  • Characteristic expansion
    *Can enlarge markedly in medullary bone
    space before displacing cortical bone
32
Q

what are pre-op diagnostic tests of okc?

A
  • Cyst aspirate
    *Contains squames
    *Low soluble protein content
33
Q

what is okc histology?

A
  • parakeratosis
  • basal palisading
  • loss of keratin if inflammed
34
Q

what is recurrence of okc?

A

thin firable lining -> difficulty of surgery

  • daughter cysts
  • cell nests
35
Q

what is basal cell naevus syndrome?

A
  • Presentation
    *Multiple odontogenic keratocysts
    *Multiple basal cell carcinomas
    *Palmar & plantar pitting
    *Calcification of intracranial dura mater
  • Cysts histologically identical to non-syndromic form but often occur at a younger age (e.g. 15 years)
36
Q

what are example of non-odontogenic cysts?

A

Nasopalatine duct cyst
*Most common
* Solitary bone cyst
* Aneurysmal bone cyst

37
Q

what is nasoplaatine duct cyst? incidence

A
  • Developmental non-odontogenic cyst
    *Arises from nasopalatine duct epithelial remnants
    *Occurs in anterior maxilla
    incidence
  • most common 40-60
  • males
38
Q

what this

A

naso palatine duct cyst

39
Q

what is presentation of naso palatine duct cyst?

A
  • Often asymptomatic
  • Patient may note “salty” discharge
  • Larger cysts may displace teeth or cause swelling
    in palate
  • Always involve midline but not always symmetrical
40
Q

what is histology features of nasopalatine duct cyst?

A
  • Variable epithelial lining
    *Non-keratinised stratified squamous
    & modified respiratory
41
Q

what is radiography of nasopalatine duct cyst?

A
  • Periapical &/or standard maxillary occlusal
    *Corticated radiolucency between/over roots of central incisors
    *Often unilocular
    *May appear “heart shaped” due to superimposition of anterior nasal spine
  • Cone beam CT
    *Indicated if better visualisation of cyst needed for surgical planning
42
Q

what is difference between cyst and incisive fossa

A
  • Incisive fossa
    *May or may not be visible on radiographs
    *Midline, oval-shaped radiolucency
    *Typically not visibly corticated
  • In the absence of clinical issues, consider the
    transverse diameter
    *<6mm: assume incisive fossa
    *6-10mm: consider monitoring
    *>10mm: suspect cyst
43
Q

what is this line

A

tranverse diamete

44
Q

what is solitary bone cyst? incidence

A
  • Non-odontogenic cyst without an epithelial lining
    incidence
  • 20s
  • male, mandible more and occur in assocaition with other bone pathology
45
Q

what is presentation of solitary bone cyst?

A

Clinical
* Usually asymptomatic → incidental finding
* Rarely pain or swelling

46
Q

what is solitary bone cyst radiolographically?

A
  • Majority in premolar/molar region of mandible
    *Can also occur in non-tooth-bearing areas
  • Variable definition & cortication
  • May have scalloped margins giving a pseudolocular appearance
  • May project up between the roots of adjacent teeth
47
Q

what is this?

A

solitary bone cyst

48
Q

what is stafne cavity?

A
  • Not a cyst but commonly mistaken as one
    *Actually a depression in the bone
    *Only occur in mandible, almost exclusively lingual
    *Contains salivary or fatty tissue
49
Q

what is presentation stafne cavity?

A
  • Most common in 5th & 6th decades
  • Often in angle or posterior body
  • Often inferior to inferior alveolar canal
  • Asymptomatic
  • Well-defined, often corticated radiolucency
  • Rarely displaces adjacent structures
50
Q

what is this

A

stafne cavity

51
Q

how to obtain material for cyst investigation?

A
  • Aspiration biopsy – drainage of contents
  • Incisional biopsy – partial removal
  • Excisional biopsy – complete remova
52
Q

for aspiration biopsy what do you need and can get?

A
  • 5-10ml syringe
  • Can get:
    *Air
    *Blood
    *Pus
    *Cyst fluid
    *Clear straw coloured fluid in inflammatory or developmental cysts
    *White or cream semi-solid may indicate keratocyst
53
Q

what is purpose and methodology for incisonal biopsy?

A

purpose
* To obtain a sample of the lining for histological analysis
methodology (usually under LA)
* Select place where lesion appears superficial
* Raise mucoperiosteal flap
* Remove bone as required – using rongeurs or a round bur
* Incise & remove a section of lining

Procedure may be combined with marsupialisation (a treatment option)

54
Q

what is treatment options of cysts?

A
  1. Enucleation
  2. Marsupialisation
55
Q

what is enucleation?

A
  • All of the cystic lesion is removed
  • Treatment of choice for most cysts
56
Q

what is advantages and disadvantages/contraindications of enucleation?

A

adv
* Whole lining can be examined pathologically
* Primary closure
* Little aftercare needed

diadv/contraindic
* Risk of mandibular fracture with very large cysts
* For dentigerous cyst, may wish to preserve tooth
* Old age / ill health
* Clot-filled cavity may become infected
* Incomplete removal of lining may lead to recurrence
* Damage to adjacent structures

57
Q

what is marsuplisation?

A
  • Creation of a surgical window in the wall of the cyst, removing the contents of the cyst & suturing the cyst wall to the surrounding epithelium
  • Encourages the cyst to decrease in size & may be followed by enucleation at a later date
58
Q

whats is indications of Marsupialisation

A
  • If enucleation would damage surrounding structures (e.g. ID nerve)
  • Difficult access to the area
  • May allow eruption of teeth affected by a dentigerous cyst
  • Elderly or medically compromised patients unable to withstand extensive surgery
  • Very large cysts which would risk jaw fracture if enucleation was performed
  • Can combine with enucleation as a later procedure
59
Q

what is advantages and disadvanatges/cintraindications of Marsupialisation?

A
  • Advantages
    *Simple to perform
    *May spare vital structures
  • Contraindications/disadvantages
    *Opening may close & cyst may reform
    *Complete lining not available for histology
    *Difficult to keep clean & lots of aftercare needed
    *Long time to fill in
60
Q

what is obturator for?

A
  • Used to keep marsupialisation window open
61
Q

1) What does a dentigerous cyst develop from?
2) How does it appear histologically?
3) How does it appear radiographically?
4) Where is it most commonly seen?

A

1) Dentalfollicleatreducedenamel epithelium and crown.
2) Thin, non-k epithelium, capsule with NO inflammation.
3) Attached at ACJ, may encompass whole tooth, unilocular.
4) Unerupted 8s and 3s

62
Q

1) Where does a KCOT develop from
2) How does it appear histologically
3) How does it appear radiographically?
4) Why is it problematic?
5) What condition is it associated with

A

1) RestsofSerresfromdentallamina.
2) Thin epithelium, parakeratosis, pallasading basal layer, thin capsule, daughter cysts/satellite cysts.
3) Multilocular, scalloped.
4) Recurs due to thin capsule and daughter cysts, late
presentation as grows mesio-distally.
5) Gorlin-Goltz Sydrome.

63
Q

Cysts
1) - What is a cyst?
2) - Give 2 inflammatory cysts
3) - Give 2 developmental cysts
4) - Give 2 non-odontologenic cysts
5) Give 2 common treatment options with advantages and disadvantages for both?

A

1) A pathological cavity with fluid, semi-fluid or gaseous contents, not created by pus accumulation

2) o Radicular cysts
o Residual cyst (cysts left after extraction)
o Paradental cyst

3) o Dentigerous cyst
o Odontogenic keratocyst odontogenic tumour (KCOT)
o Eruption cyst

4) o Simple bone cyst
o Nasopalatine cyst
o Nasolabial cyst

5) o Enucleation:
▪ All of the cystic lesion is removed
▪ Advantages – whole lining examined; little after care; allows
primary closure
▪ Disadvantages – risk of mandible fracture, incomplete removal can lead to recurrence, damage to adjacent structure risk, clot filled cavity may become infected, tooth loss can occur.
o Marsupialisation
▪ Creation of a surgical window in the wall of the cyst removing
the contents and suturing the cyst wall to surrounding epithelium
▪ It encourage the cyst to decrease in size and may be followed by
enucleation at a later date.
▪ Advantages – simple to perform and may spare vital structures
▪ Disadvantages – cyst may reform, complete lining not available
for histology sampling, difficult to keep clean and lots of
aftercare required

64
Q

6) - How does a radicular cyst develop?
7) - How does it appear histologically and radiographically?

A

6) o These are dental or periapical cysts associated with the roots of the teeth and generally non-vital teeth
o It usually has an inflammatory aetiology and is sequel to pulpitis and periapical granuloma
o Develops from epithelial rests of Malassez from Hertwig’s root sheath.

7) o Radiographically:
▪ Well defined radiolucency around the apex of a tooth/teeth
▪ Unilocular
▪ Corticated margins of the lesion continuous with lamina dura on
either side of the root o Histologically:
▪ epithelial lining often incomplete; CT capsule with related inflammation in capsules; may form by proliferating epithelium with central necrosis or epithelium surrounded fluid area.
▪ Rests of malassez,
▪ Cholesterol clefts usually associated with epithelial
discontinuities and project into the cyst lumen found in the cyst
fluid
▪ variable inflammation; mucous metaplasia
▪ Hyaline/Rushton bodies represent some type f epithelial product
as they are eosinophilia bodies.

F - SCR (32 decks)

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