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BDS4 SCR > cysts > Flashcards

cysts Flashcards

1
Q

what is a cyst

A

pathological cavity filled with fluid, semi-fluid or gaseous contents not created due to the accumulation of pus

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2
Q

what are the odontogenic developmental cysts (3)

A

odontogenic keratocyst
dentigerous cyst (eruption)
lateral periodontal cyst

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3
Q

what are the inflammatory odontogenic cysts

A

radicular cyst (and residual)
inflammatory collateral cysts (paradental, buccal bifurcation)

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4
Q

name 3 non odontogenic cysts

A

nasopalatine duct cyst
solitary bone cyst
aneurysmal bone cyst

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5
Q

what are the odontogenic sources of epithelium and what cysts may arise from each

A

rests of mallasez - radicular
rests of serres - OKCs, lateral periodontal
reduced enamel epithelium - dentigerous and eruption

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6
Q

epidemiology of radicular cysts
- gender
- age
-location

A

M>F
30s and 40s
maxilla 60%, mandible 40% and can affect any tooth

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7
Q

process of radicular cyst formation

A

pulp necrosis
periapical periodontitis
periapical granuloma
radicular cyst

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8
Q

how may a radicular cyst present if it perforates the cortex

A

bluish, fluctuant submucosal swelling

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9
Q

radiographic presentation of radicular cyst

A

always associated with non vital tooth
well defined round/ oval radiolucency
corticated margins continuous with lamina dura of non vital tooth
large lesions may displace adjacent structures

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10
Q

what may be seen radiographically in long standing radicular cysts

A

external root resorption
dystrophic calcification

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11
Q

dystrophic calcification

A

deposition of calcium salts in tissues in the absence of systemic mineral imbalance

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12
Q

2 suggested methods of how radicular cysts form

A

proliferation of rests of mallasez within chronic periapical granuloma then
1. proliferating epithelium sees central necrosis as no blood flow leaving behind a cavity
2. epithelium proliferates to surround an area of fluid

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13
Q

how do radicular cysts grow

A

hydrostatic pressure - all parts of cyst increase in size at same rate and same time (ballooning)

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14
Q

contents of radicular cyst

A

watery straw coloured fluid - semi solid brownish material

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15
Q

name 3 histological features of epithelium that may be seen in radicular cysts

A

cholesterol clefts
mucous metaplasia
rushton bodies

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16
Q

mucous metaplasia

A

epithelial cells become mucous secreting cells

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17
Q

rushton bodies
(hyaline)

A

only present in odontogenic cysts
no diagnostic significance
produce unusual red substance

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18
Q

cholesterol clefts

A

when biopsy is processed, cholesterol is dissolved out leaving spaces known as cholesterol clefts
cholesterol is released when RBCs are broken down. deposits of haemosiderin are commonly associated (iron storage after RBC breakdown)

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19
Q

lateral radicular cyst

A

associated with accessory canal
located at side of tooth rather than apex

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20
Q

residual cyst

A

radicular cyst which persists after loss of tooth or after tooth has been root treated

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21
Q

inflammatory collateral cysts

A

inflammatory odontogenic cysts
associated with a vital tooth
collective term for paradental cyst and buccal bifurcation cyst

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22
Q

paradental cyst

A

distal aspect of partially erupted M3Ms
inflammatory stimulus often pericoronitis
well defined radiolucency related to neck of tooth and coronal third of root

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23
Q

buccal bifurcation cyst

A

typically occurs at buccal aspect of mandibular 1st molar
occurs in children

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24
Q

epidemiology of dentigerous cysts
- age
- gender
- location

A
  • 10s-30s
    -M>F
  • mandible >maxilla
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25
Q

dentigerous cyst

A

developmental odontogenic cyst
associated with crown of unerupted and usually impacted tooth
cystic change of dental follicle

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26
Q

radiographic presentation of dentigerous cyst

A

corticated margins attach to CEJ
tooth involved may be displaced a considerable distance
tend to be symmetrical initially but larger cysts may expand unilaterally
variable displacement of cortical bone
well defined unilocular radiolucency

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27
Q

what epithelium lines dentigerous cysts

A

thin layer of non keratinised squamous epithelium

28
Q

what epithelium do dentigerous cysts arise from

A

reduced enamel epithelium

29
Q

normal size of dental follicle

A

2-3mm

30
Q

follicle vs cyst sizes

A

> 5mm consider cyst and monitor
10mm assume cyst
also consider cyst if radiolucency asymmetrical

31
Q

eruption cyst

A

variation of dentigerous cyst associated with erupting tooth
contained within soft tissue rather than bone - bluish translucent soft swelling
most commonly incisors and almost exclusively seen in children
often requires no treatment

32
Q

histology of eruption cyst

A

2 layers of epithelium -1 is gingiva, 1 is cyst epithelial lining
space between is connective tissue

33
Q

epidemiology of OKC
- age
- gender
- location

A

10s-30s
M>F
mandible>maxila , posterior >anterior

34
Q

radiographic presentation of OKCs

A

often scalloped margins
25% multilocular
often cause displacement of adjacent teeth
root resorption is uncommon
characteristic antero-posterior expansion> buccal lingual - can progress significantly before being noticed

35
Q

why do OKCs have a high recurrence rate

A

thin linining
daughter cysts
multiloclular

36
Q

pre op diagnostic test for OKC

A

cystic aspirate
OKC has characteristic low soluble protein content (<4g/decilitre)

37
Q

what epithelium are OKCs lined with

A

stratified parakeratinised squamous epithelium

38
Q

characteristic appearance of OKC basal cells

A

palasading appearance - nuclei all the same shape, size and at the same level (soldiers)

39
Q

why does OKC epithelium often break away during removal

A

weak attachment to underlying connective tissue
no rete pegs

40
Q

what epithelium do OKCs originate from

A

rests of serres

41
Q

3 characteristic histological signs of OKCs

A

palasading
daughter cysts
parakeratinisation

42
Q

basal cell naevus syndrome

A

inherited syndrome that sees multiple basal cell carcinomas
also multiple OKCs

43
Q

lateral periodontal cyst

A

rare
associated with lateral surface of vital tooth root

44
Q

gingival cysts

A

derived from rests of serres
adults: <1cm bluish/pink sessile swelling
infants: bohns nodules, small yellow/cream nodules on edentulous alveolar mucosa

45
Q

nasopalatine duct cyst

A

developmental non odontogenic cyst arises from nasopalatine duct epithelial remnants

46
Q

epidemiology of nasopalatine duct cysts
- gender
- age

A
  • M>F
  • 30s and 40s
47
Q

symptoms of nasopalatine duct cyst

A

usually asymptomatic
patient may report salty discharge
larger cysts may displace teeth or cause palatal swelling

48
Q

radiographic presentation of nasopalatine duct cyst

A

unilocular, well defined radiolucency with corticated margins
always involves midline but may not be symmetrical
may appear heart shaped due to superimposition of nasal spine

49
Q

radiographs for nasopalatine duct cyst

A

PA and standard maxillary occlusal

50
Q

histology of nasopalatine duct cyst

A

non keratinised squamous epithelium lining with modified respiratory
neurovascular bundles found within capsule

51
Q

cyst vs incisive fossa sizes

A

in absence of other clinical issues
<6mm assume fossa
6-10mm consider cyst and monitor
>10mm suspect cyst

52
Q

solitary bone cyst

A

non odontogenic cyst with no epithelial lining

53
Q

epidemiology of solitary bone cyst
- age
- gender
- location

A
  • teens
  • M>F
  • mandible >maxilla
54
Q

radiographical findings of solitary bone cyst

A

pre molar/ molar region of mandible
variable definition and cortication
may project up between roots of adjacent teeth

55
Q

stafne cavity

A

NOT a cyst
usually below IAC
indentation on lingual aspect of mandible

56
Q

aspiration biopsy

A

done using a wide bore needle and 5-10ml syringe
can retrieve air, blood, pus and cyst fluid

57
Q

incisional biopsy

A

done to obtain a sample of histopathological analysis
usually done under LA
may be combined wtih marsupialisation

58
Q

process of incisional biopsy

A

select point where lesion appears superficial
raise mucoperiosteal flap
remove bone as required using round bur
incise and remove a section of lining

59
Q

advantages of enucleation

A
  • whole lining can be examined
  • primary closure
  • little aftercare
60
Q

disadvantages of enucleation

A
  • risk of mandibular fracture if very large cyst
  • patient may wish to preserve associated tooth
  • old/age ill health
  • damage to adjacent structures
  • incomplete removal of lining may lead to recurrence
61
Q

indications for masupialisation

A

enucleation would damage adjacent structures
difficult to access to area
elederly or immunocompromised not able to withstand enucleation surgery
may allow eruption of associated teeth
can be combined with enucleation at later date
enucleation risks mandibular fracture

62
Q

advantages of marsupialisation

A

easy to perform
may spare vital structures

63
Q

how is marsupialisation window kept open

A

obturator

64
Q

disadvantages of marsupialisation

A

opening may close and cyst may reform
complete lining not available for histology analysis
difficult to keep clean
lots of aftercare

65
Q

treatment of nasopalatine duct cyst

A

enucleation

66
Q

process of enucleation

A
  1. raise mucoperiosteal flap
  2. thin bone covering cyst is removed
  3. cyst lining separated from bony wall using curettes or periosteal elevators
  4. lining sent for histopathological analysis
  5. after irrigating with saline, flap sutured back in place
67
Q

process of marsupialisation

A
  1. extract tooth or raise flap to expose cyst
  2. aspirate cyst contents then irrigate
  3. opening initially maintained with surgical pack then at a later date an obturator
  4. patient must irrigate cavity twice daily with saline

BDS4 SCR (7 decks)

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