Cyst of Jaw

Question 1

What are the 4 options for management of cyst?

Answer 1

Enucleation
Curettage
Resection
Marsupialisation

Question 2

What is enucleation?

Answer 2

Removal as cyst in entirety w/o cutting

Question 3

What is curettage?

Answer 3

Removal of tissue by scraping or scooping

Question 4

What is resection?

Answer 4

Removal of part of organ - takes pathology and margin in normal tissue

Question 5

What is marsupilisation?

Answer 5

Creating of a pouch by suturing cyst lining to external surface

Question 6

What are 5 main types of cysts?

Answer 6

Radicular
Dentigerous 
Odontogenic keratocyst
Mucocele
Sebaceous

Question 7

What cysts are potentially manageable in dental practice?

Answer 7

Radicular

Dentigerous

Question 8

What is a radicular cyst?

Answer 8

Cyst develop around non-vital tooth

Question 9

Features of radicular cyst on radiograph?

Answer 9

Larger 1cm

Corticated margin

Question 10

Differential of radicular cyst?

Answer 10

Apical granuloma

Question 11

Management of radicular cyst?

Answer 11

RCT - if apical granuloma will resolve

XLA causative tooth then enucleate cyst

Question 12

When could apicetomy be used for radicular cyst?

Answer 12

If anterior tooth
Acceptable orthograde
RCT
Pt accept risks

Question 13

What are 2 main indications of apicetomy?

Answer 13

1. Persistent symptoms/ pathology in non-vital tooth

2. (RE)RCT is unfeasible

Question 14

What persistent symptoms could indicate apicetomy?

Answer 14

Cyst, swelling, infection, discharge of pus, excessive mobility or pain

Question 15

Why would (re)rct be unfeasible?

Answer 15

Established cyst
Scleroritc canals
Unfavourable morphology - curvature, accessory 
Fractured roots
Perforations
Unretrivable instruments
Post-core can't be removed

Question 16

What are relative contraindications of apicetomy?

Answer 16

Previous apicetomy
Molars - more complicatied
Poor OH
Active caries
Sinus disease
Implants
High mobility
Advanced perio

Question 17

What are absolute contraindications of apicetomy?

Answer 17

Severe bleeding risk
Endocarditis risk
Unrestorable

Question 18

What are 3 flap designs used for apicetomy?

Answer 18

Mucoperiosteal
Semilunar
Leubke-Oschenbein

Question 19

Adv/disadv? mucoperiosteal flap?

Answer 19

Follow ginigval contour = best access and minimal scaring

Risk gingival recession

Question 20

Why are semilunar flaps no longer used?

Answer 20

Scarring

Potential to leave margin of incision overlying cyst cavity = void

Question 21

How is Leubke-Oschenbein carried out?

Answer 21

4mm below gingival margin but on attached mucosa

Question 22

When can Leubke-Oschenbein not be used?

Answer 22

If thin mucosa

Question 23

Why do you want to removal 3mm of apical tissue during apicetomy
?

Answer 23

apical delta = front like distribution of canal towards apex last 3mm of tooth

Question 24

Why do you want to cut at 90 degree during apicetomy?

Answer 24

If cut at angle will leave delta or remove too much tissue and lose support

Question 25

What is the best procedure following flap - ideally?

Answer 25

Enucleate cyst, apicect, retrograde filling

Question 26

What material can be used for retrograde filling?

Answer 26

MTA

Question 27

What syndrome is associated w/ keratocyst?

Answer 27

Gorlin goltz

Question 28

What is gorlin goltz?

Answer 28

Basal cell naevus syndrome - autosomal dominant condition

Question 29

What syndrome would you see multiple osetomas?

Answer 29

Gardner's

Question 30

What are the features seen in GG's?

Answer 30

``` Multiple keratocysts Multiple basal cell carcinoma Skeletal defect - bifid ribs Cranial defect - frontal bossing Calcified fall cerebri Predisposed to epilepsy ```

Question 31

What is the best tx for keratocyst - but why is this not used?

Answer 31

Resection - 0% recurrence | But unfavourable due to removal of tissue

Question 32

What is the risk associated w/ Carnoy's

Answer 32

Risk of fixing surrounding tissue - risk of damage to nerves

Question 33

What is Vorschmidt's technique?

Answer 33

Enucleate cyst after being fixed w/ Carnoy's Content of cyst removed and carnoy's placed Lining turns rubbery - can be removed

Question 34

What is management of dentigerous cyst?

Answer 34

Unerupted tooth - enucleate and XLA tooth If risk of ID damage/ fracture jaw - coronectomy

Question 35

What is mucous extravasation cyst?

Answer 35

Type of mucocele - not true cyst as doesn't have cyst lining

Question 36

Why are mucous extravasatiom cysts hard to remove?

Answer 36

Housed in soft tissue - no border Issue scarring/ fibrosis Need to remove surrounding salivary glands that may contribute to cyst

Question 37

What is a sebaceous cyst?

Answer 37

Contain keratin due to trauma of epithelium in sub-epithelial layers

Question 38

What is punctum?

Answer 38

Induration of cyst around cyst surface where trauma has occurred

Question 39

Cause of sebaceous cyst?

Answer 39

Acquired | Traumatic implantation of skin

Question 40

How many mm of root removed in apicectomy?

Answer 40

3mm

Question 41

What angle should apicectomy be performed at?

Answer 41

90 degree

Question 42

What in management of eruption cyst?

Answer 42

Conservative advice and review

Question 43

Difference between MTA and Portland cement?

Answer 43

MTA has 20% bismuth oxide added q

Question 44

What do sebaceous cyst contain?

Answer 44

Keratin