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cysts Flashcards

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1
Q

What is cyst

A

A pathological cavity having fluid, semi-fluid, or gaseous contents and which is not created by the accumulation of pus

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2
Q

What signs and symptoms are there for cysts

A

Often asymptomatic unless infected

Numbness if its affecting a nerve

Mobile tteth

Discoloration of tooth or superficial soft tissues

Slow growing

Discomfort when pressed

Pt may say it wa hard but now it feels like egg shell cracking

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3
Q

Can cysts be benign

A

Almost all are

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4
Q

What initial radiographs would you want to investigate

A

Periapical radiograph

Occlusal radiograph

Panoramic radiograph

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5
Q

What supplemental radiographs would you want for a cyst

A

Cone beam CT (CBCT)

Facial radiographs
-PA mandible view
-Occipitomental view

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6
Q

What is the main problem of radiographs for investigatig cysts

A

They are 2D so wont know true extent

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7
Q

When looking at a radiograph of a cyst what are key features you are looking for

A

the location as certain cysts appear in certain areas

Shape
-Often spherical or egg shaped

Margins
-Often well defined
-Often corticated

Locularity
-Often unilocular
-Can be multiocular

Multiplicity
-Single, bilateral, multiple
-Multiple cysts may indicate a syndrome

Effects on the 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

Does it include unerupted teeth

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8
Q

How do most cysts grow

A

By hydrostatic pressure

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9
Q

How could a cyst loose its corticated margins

A

They may lose definition and corticated margins if it becomes secondarly infected

Normally associated with symptoms

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10
Q

What classifications are there for cysts

A

Structure
-Epithelium lined
-Non epithelium lined

Origin
-Odontogenic
-Non odontogenic

Pathogenesis
-Developmental
-inflammatory

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11
Q

What odontogenic developmental cysts are there

A

Dentigerous cyst (& eruption cyst)

Odontogenic keratocyst

Lateral periodontal cyst

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12
Q

What odontogenic inflammatory cysts are there

A

Radicular cyst (& residual cyst)

Inflammatory collateral cysts
-Paradental cyst
-Buccal bifurcation cyst

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13
Q

What non-odontogenic developmental cysts are there

A

nasopalatine duct cyst

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14
Q

What non-odontogenic other cysts are there

A

Solitary bone cyst

Aneurysmal bone cyst

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15
Q

What is a dentigerous cyst and how does it form

A

An epithelial-lined developmental cyst formed by accumulation of fluid between the reduced enamel epithelium and the crown of an unerupted tooth

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16
Q

What is the difference between a developmental and inflammatory cyst

A

Inflammatory odontogenic cysts have proliferative epithelium, and developmental odontogenic cysts have uniformly thin epithelium

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17
Q

What is the most common cause of a bony swelling in the jaws

A

Odontogenic cysts

> 90% of all cysts in the oral & maxillofacial region

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18
Q

What are odontogenic cysts

A

Cysts that occur in tooth bearing areas and are epithelium lined

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19
Q

What are the possible sources of epithelium for odontogenic cysts

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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20
Q

What joins together to form the reduced enamel epithelium

A

The outer and the inner enamel epithelium

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21
Q

What are the rest of serres and malassez and wher are they found

A

They are remnants of odontogenic epithelium that remain in the periodontal ligament and gingiva forever

In the gingiva they are called epithelial rests of Serres

In the periodontal ligament they are known as the rests of Malassez

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22
Q

What does the reduced enamel epithelium do and what does it form into

A

The reduced enamel epithelium forms the remains of the ameloblast cell layer and protects the enamel during eruption

After eruption it becomes the junctional epithelium

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23
Q

What are the most common odontogenic cysts

A

Radicular (& residual) cysts 60%

Dentigerous (& eruption) cysts 18%

Odontogenic keratocyst 12% of cysts in the maxillofacial region

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24
Q

What are radicular cysts always associated with

A

Non-vital tooth

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25
What is a radicular cyst and how is it initiated
A inflammatory odontogenic cyst that is initiated by chronic inflammation at apex of tooth due to pulp necrosis
26
What is the incidence of radicular cysts
Most common in 4th and 5th decades 60% in maxila 40% in mandible
27
What would a patient with a radicualr cyst present with
Often asymptomatic but may become infected which will result in pain Typically slow growing with limited expansion
28
What are the steps of Radicular cyst forming
Pulpal necrosis-periapical periodontitis-periapical granuloma-Radicular cyst
29
What are the radiographic features of a radicular cyst
Well defined round/oval radiolucency Unilocular Corticated margin CONTINUOUS WITH LAMINA DURA of a non-vital tooth Larger lesions may displace adjacent structures Long standing lesions may cause external root resorption or dystrophic calcification
30
What is the difference between a radicular cyst and a periapical granuloma and how can you tell
Radiographically hard to tell, Radicular cyst are normally larger If radiolucency >15mm 2/3rd of cases will be a cyst
31
What is the histology of a radicular cyst
Non-keratinised squamous epithelial lining (often incomplete) Connective tissue capsule Inflammation in the capsule deposits of cholesterol Variable inflammation, mucous metaplasia, hylaine/rushton bodies
32
What is a granuloma
A mass of granulated tissue that attaches to a non-vital tooth
33
How does a radicular cyst form from a granuloma
The epithelial rests of malassez proliferate in periapical granuloma in a balloning type growth that grows at the same time rate and time They'll form by proliferating epithelium with central necrosis OR epithelium surrounds the fluid area The continued growth happens with a osmotic effect with a semi-permeable wall and cytokine mediated growth
34
Why could a pt be suffering from numbness
Cyst, tumour, direct damage, pressure, infection
35
What variants of radicular cysts are there
Residual cyst -When radicular cyst persists after loss of tooth (or after successful RCT) Lateral radicular cyst -Radicular cyst associated with an accessory canal -Located at side of tooth instead of apex
36
What are inflammatory collateral cysts associated with
A vital tooth
37
What type of cyst is a inflammatory collateral cyst
A inflammatory odontogenic cyst
38
What cysts fall under inflammatory collateral cysts
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
39
What is the inflammatory stimulus for a paradebtal cyst
Pericoronitis
40
What are inflammatory collateral cysts lined by
Non-keratinised epithelium
41
What is a dentigenerous cyst and what causes it
Developmental odontogenic cyst that is associated with a crown of a unerupted(& normally impacted) tooth A cystic change in the dental follicle
42
Where is the epithelium that lines dentigerous cysts derived from
The Reduced enamel epithelium from the enamle organ
43
What is always in a dentigerous cyst
A crown with the tooth maybe being displaced
44
What is the incidence of dentigerous cysts
Most common 2-4th decades Male>female Mandible>maxilla
45
What are the radiographic features of a dentigerous cysts
Corticated margins attached to the cemento-enamel junction of tooth -larger ones may envelope root Tend to be symmetrical but larger may expand unilaterally Wll defined unilocular uniform radiolucency Variable displacement of cortical bone
46
What is the histology of a dentigerous cyst
Thin non-keratinised stratified squamous epitelium If inflamed it may ressemble a radicular cyst
47
What is a enlarged follicle formed by
Remenants of reduced enamel epithelium
48
How do you tell the difference between a dentigerous cyst and a enlarged follicle
Radiograpgically consider it a cyst ifg the follicular space is 5mm or more measured from the surface of the crown to edge of the follicle assume cyst if >10mm and if radiolucency is asymmetrical
49
What is the normal radiographic follicular space of a tooth
2-3mm
50
What is a eruption cyst
A variant of a dentigerous cyst that is contained in soft tissues not bone and is associate with a erupting tooth
51
What teeth are normally associatd with eruption cyst and how could you treat
More commonly incisors and to treat you could make a small incision to allow eruption
52
Whats the cyst you definetly dont want
Odontogenic keratocyst
53
What is the main problem of a odontogenic keratocyst
High recurrence rate and difficult to remove
54
What is a odontogenic keratocyst
A developmental odontogenic cyst with no specific relation to teeth
55
Where does a OKC arise from
Cell rests of serres
56
What is the incidence of a odontogenic keratocyst
Most common in 2nd and 3rd decades Third most common odontogenic cyst,12% of all cysts occurring in maxillofacial region Male>female Mandicle>maxilla Posterior>anterior
57
Whatare the radiographic features of a odontogenic keratocyst
Oval well defined unifrom radiolucency uni or multilocular Often dispalcement of teeth but root resorption uncommon Grows along bone Has a characterisitc expansion of enlarging markedly in emdullary bone space before displacing cortical bone (i.e. significant mesio-distal expansion before bucco-lingual expansion)
58
What diagnostic test could you do for a odontogenic keratocyst
A cyst asdpirate will contain squames and has low soluble protein content
59
What is the histology of a odontogenic keratocyst
Very distinct thin folded parakerastinised stratisfied squamous epithelial lining basal palisading (cells are elongated into columns and are stacked side by side) If it becomes inflamed it looses the keratin
60
Why does a odontogenic keratocyst have a high recurrence rate
Thin friable lining making it hard to remove daughter cysts and cell nests
61
What is basal cell naevus syndrome and what it does it present as
Caused by changes in a tumor suppressor gene, called PTCH1 Presentation -Multiple odontogenic keratocysts -Multiple basal cell carcinomas -Palmar & plantar pitting -Calcification of intracranial dura mater Alsso called Gorlin-Goltz syndrome; bifid rib syndrome Cysts histologically identical to non-syndromic form but often occur at a younger age (e.g. 15 years)
62
What other terms is there for basal cell naevus syndrome
Gorlin-Goltz syndrome Bifid rib syndrome
63
What is a sign the cyst is more likely to be odontogenic
Above the IAN canal
64
What is a nasopalatine cyst, what is another name for it
Developmental non-odontogenic cyst that arrises from the nasopalatine duct epithelial remnants Occurs in the anterior maxilla Incisive canal cyst
65
What would a pt with a nasopalatine duct present with
Often asymptomatic May notice a salty discharge Larger cyst can displace teeth or cause swelling in palate Always involves the midline but may not be symmetrical
66
What is the histology of a nasopalatine cyst
Variable epithelium Non-keratinised stratisfied squamous as well as modified respiratory
67
What does a nasopaltine cyst look like radiographically
In a periapical &/or MO -Corticated radiolucency between/over roots of central incisors -Often unilocular -May appear “heart shaped” due to superimposition of anterior nasal spine
68
Radiographically how to tell the difference between a cyst and the incisive fossa
Incisve fossa -Midline oval shaped typically not visibly corticated Look at the transverse diameter: <6mm assume incisive fossa 6-10mm consider monitoring >10mm suspect cyst
69
What is a solitory bone cyst what is its incidence and presentation
A non-odontogenic non-epithelial lined cyst most common; 2nd decade, in males, mandible Asymptomatic usually a incidental finding
70
What are the radiographic features of a solitary bone cyst
Majority in premolar/molar region of mandible may (also occur in non-tooth-bearing areas) Variable definition & cortication Scalloping prominent feature May project up between the roots of adjacent teeth
71
What is a stafne cavity and what is its presentation
A depression in the bone that can be mistaken as a cyst Only occurs in mandible lingually and contains salivary or fatty tissue Presentation: -Most common in 5th & 6th decades -Often in angle or posterior body -Often inferior to IANC -Asymptomatic -Well defined, often corticated radiolucency -Rarely displaces adjacent structures
72
What methods are there for obtaining material from cysts for histology
Aspiration biopsy -drainage of contents Incisional biopsy -partial removal Excisional biopsy -complete removal
73
What is a aspiration biopsy carried out with and what is obtained
Wide bore needle 5-10ml syringe Can get: -Air -Blood -Pus -Cyst fluid
74
What is the purpose of a incisional biopsy and how is it carried out
To obtain a sample of the lining for histological analysis method: -Select place where lesion appears superficial -Raise mucoperiosteal flap -Remove bone as required -Incise & remove a section of lining
75
What surgical treatment options are there
Enucleation, All of lesion removed Marsupialisation-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
76
What does the marsupialisation of a cyst encourage and what can it be combined with
Encourages the cyst to decrease in size & may be followed by enucleation at a later date May be combined with a incisional biopsy
77
What are the Adv and DisAdv of enucleation
Advantages -Whole lining can be examined pathologically -Primary closure -Little aftercare needed Disadvantages -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
78
When would you consider marsupialisation
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
79
What are the Adv and DisAdv of marsupialisation
Advantages -Simple to perform -May spare vital structures 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
80
How is a marsupialisation window kept open
Through the use of a obturator
81
what cysts have no epithelial lining
Solitary bone cyst Aneurysmal bone cyst Stafnes bone cavity
82
What is a orthokeratinised odontogenic cyst
Uncommon developmental cyst used to be considered a variant of OKC Similar clinical presentation to OKC but histologically distinct: -orthokeratinisation and flattened basal cell layer -No nuclei   Unilocular without epithelial proliferations or satellite cysts No recorded case of occurrence with naevoid basal cell carcinoma syndrome
83
What is a lateral periodontal cyst
odontogenic devlopmental cyst Assoc. with lateral surface of tooth root -PreM & canines in mandible -Ant. in maxilla Well demarcated radiolucency Thin lining of stratisfied squamous epithelium
84
What variation of a lateral periodontal cyst is there
Botryoid odontogenic cyst: -Multi-locular variant of LPC -Often larger -More likely to recur than lateral periodontal cyst
85
What are gingival cysts
odontogenic devlopmental cyst Derived from remnants of dental lamina (Rests of Serres) in gingival or alveolar soft tissues
86
What 2 type of gingival cysts are there
Gingival cysts of adults: -Mandibular attached gingivae as <1cm pink/bluish sessile swellings -Histology shows a thin lining of stratified squamous epithelium Gingival cysts of infants: -Bohn’s nodules -Up to 90% of neonates -Small yellow nodules on edentulous alveolar mucosa -Similar cysts present on palate Epstein’s pearls but aren’t odontogenic -Naturally degenerate, no treatment required

BDS4-oral Surgery (13 decks)

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