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My BDS4 > Cysts of the Jaw > Flashcards

Cysts of the Jaw Flashcards

1
Q

What is a cyst?

A

A pathological cavity having fluid, semi-fluid or gaseous contents & which is not created by the accumulation of pus.
Allows it to gradually increase in size

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2
Q

What is the diagnosis if there is pus within the pathological cavity?

A

an infected cyst

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3
Q

what are the signs and symptoms of a cyst? (7)

A

often asymptomatic

most have mild symptoms:
- Swelling
Characteristic feature: slow growing swelling
- Pain & Tenderness
- Gradual tooth movements/spacing
- Mobility
- Prevented tooth eruption
- Discolouration of the tooth

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4
Q

How do you know if the cyst is coming from odontogenic origin or from the periodontium?

A

Assess the vitality
If vital = coming from the periodontium

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5
Q

What initial radiographs do you take if you suspect a cyst? (3)

A

Initial – start simple
* Periapical radiograph
* Occlusal radiograph (if larger)
* Panoramic radiograph (if very large lesion suspected)
- Don’t use for (esp upper) anterior cysts as anatomical features superimposed.

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6
Q

What follow-up radiographs do you take if you suspect a cyst? (4)

A
  • Cone beam CT (CBCT)

others:
* Facial radiographs
* PA mandible view
* Occipitomental view

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7
Q

what important features must we assess if we suspect a cyst?

A
  1. Location
    Has it risen for tooth tissues – situated in alveolar process
    Odontogenic origin = location never above maxillary sinus or below IDN
  2. Shape
    - Often spherical or egg-shaped (Most grow by hydrostatic pressure)
  3. Margins
    - Often well defined
    - Often corticated
    Exception is when they are infected = lose definition
  4. Locularity
    - Often unilocular
    - Can be multilocular (or pseudolocular - appears like this as it pushes up against other structures)
  5. Multiplicity (how many of them are they)
    - Single (common) , bilateral, multiple (usually because of a syndrome)
  6. Inclusion of unerupted teeth
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8
Q

How do most cysts grow?

A

hydrostatic pressure

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9
Q

What is the most likely cause of a pathological lesion if the margins are undefined and it appears uncorticated?

A

infection (secondary)
- usually symptoms present

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10
Q

what 3 ways can you classify cysts?

A

structure - epithelium lined vs no ep lining

origin - odontogenic vs non-odontogenic

pathogenesis - developmental vs inflammatory

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11
Q

Where are odontogenic cysts present?

A

tooth-bearing areas
- as they arise from tooth material/teeth

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12
Q

What type of cysts are responsible for 90% of cysts in the oro-maxillofacial region?

A

Odontogenic cysts

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13
Q

Are all odontogenic cysts lined with epithelium?

A

yes

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14
Q

Briefly describe the 3 source of odontogenic cysts.

A
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15
Q

List the types of odontogenic cysts. (5)

What is the most common?

which one recurs the most?

A

Developmental:
Dentigerous cyst
(& eruption cysts)

Odontogenic keratocyst
(most commonly recurrs)

lateral periodontal cyst

Inflammatory:
Radicular cyst - most common
(& residual cyst)

inflammatory collateral cysts

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16
Q

What is a radicular cyst?

what are these always asosciated with

A

an Inflammatory odontogenic cyst
- Always associated with a non-vital tooth and always attached to a tooth
(if tooth vital = not this cyst)
- Initiated by chronic inflammation at apex of tooth due to pulp necrosis

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17
Q

Why do radicular cycts not COMMONLY occur in children/primary teeth? (2)

A

Teeth not in the mouth for long enough
Higher chance of dental disease in older patients
However can happen to any teeth that are non-vital – sensibility test to assess

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18
Q

In what jaw do radicular cysts most commonly present?

A

upper jaw

(in males more commonly than females)

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19
Q

How do radicular cycts present? (3)

A
  • Often asymptomatic
  • Cysts may become infected = pain
  • Typically slow-growing with limited expansion
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20
Q

Describe how radicular cysts form.

A

Always associated with a non-vital tooth and always attached to a tooth

  • Initiated by chronic inflammation at apex of tooth due to pulp necrosis
  • pulpal necrosis then causes periapical periodontitis which then leads to the formation of a PA granuloma and then eventually a radicular cyst.
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21
Q

How do we tell the difference between a radicular cyst and a PA granuloma? (2)

A

Size:
Radicular cysts typically larger
- If radiolucency diameter >15mm = 2/3’s of cases will be radicular cysts

  • Granuloma corrects after RCT, cyst may not
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22
Q

List the radiographic features of a radicular cyst. (4)

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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23
Q

Name and describe briefly the 2 types of growth of cysts.

A
  • Unicentric growth
  • all parts expand at the same rate = unicentric ballooning of the cyst
  • swelling = buccal lingual/palatal
  • multicentric growth
  • parts of epithelium more active = finger like processes = grow in an A/P direction along the length of the jaw bone = less clinical swelling
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24
Q

Name and describe variants of a radicular (inflammatory odontogenic) cysts.

A

residual cyst
- When radicular cyst (usually around apex of the NV tooth) persists after loss of tooth (or after tooth is successfully root canal treated)
- Encapsulated collection of fluid after the source of infection has been removed.

  • Lateral radicular cyst
  • Radicular cyst associated with anlateral/accessory canal (not the apex)
  • Located at side of tooth instead of apex
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25
Q

What are inflammatory odontogenic collateral cysts?

List the types.

A

Inflammatory odontogenic cysts associated with a vital tooth

paradental cyst
buccal bifurcation cysts.

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26
Q

What is the main difference between a paradental cyst and a buccal bifurcation cyst?
Describe

A

They are the same type of cysts (Inflammatory odontogenic cysts associated with a vital tooth)
the difference is where they are occurring

  • Paradental cyst - Typically occurs at distal (behind) aspect of partially-erupted mandibular third molar
  • Buccal bifurcation cyst – Similar however typically occurs at buccal (buccal bifurcation) aspect of mandibular first molar
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27
Q

What is a dentigerous cyst?

what tooth are the most commonly associated with?

A

Developmental odontogenic cyst associated with crown of unerupted (& usually impacted) tooth
Cystic change of dental follicle

mandibular third molars,

28
Q

In what jaw does dentigerous cysts most commony occur?

A

mandible

(males more than females)

29
Q

List the radiographic signs of a dentigerous cyst. (6)

A
  • Radiolucent with well-defined corticated margins which are attached to cemento-enamel junction of tooth (neck of the tooth)
  • Has associated impacted lower right 3rd molar
  • Larger cysts may begin to envelope root of tooth
  • May displace the involved tooth
  • Tend to be symmetrical initially - Larger cysts may begin to expand unilaterally
  • Variable displacement of cortical bone (i.e. bony expansion)
30
Q

What are the signs & symptoms of a dentigerous cyst? (2)

A
  • mobility of the 7
  • Lip is numb (cyst pushing on the IDN)
31
Q

How can we tell the difference between a dentigerous cyst and an enlarged follicule? (3)

A

Histological Indicators of dentigerous cyst:
- Cuboidal epithelium
- Walls have islands of lamina

Clinical considerations:
Measure from surface of crown to edge of follicle
- Assume cyst if >10mm
- Consider cyst if radiolucency is asymmetrical

32
Q

List a variant of a dentigerous cyst.

What are the differences between this and a dentigerous cyst. (3)

A

Eruption cyst.

  • Contained within soft tissue rather than bone
  • Associated with an erupting tooth (More commonly incisors)
  • Almost exclusive to children
33
Q

What is an odontogenic keratocyst?

A

A developmental odontogenic cyst - No specific relationship to teeth

may not be near/touching a tooth but arises from tooth tissue

34
Q

What is the main way we differentiate a keratocyst from other odontogenic cysts?

A

may not be near/touching a tooth but arises from tooth tissue

35
Q

In what jaw does a odontogenic keratocysts most commonly occur in?

A

mandible - esp posterior

(males more than females)

36
Q

What are the radiographic & clinical characteristics of an odontogenic keratocyst? (5)

A
  • Appears truly multilocular (don’t get multiocular radicular, dentigerous etc cysts) - 25% are.
  • Often have scalloped margins
  • associated Root resorption uncommon
  • Often cause displacement of adjacent teeth
  • High recurrence rate
37
Q

Describe the characteristic expansion of a odontogenic keratocyst.

A

Can enlarge markedly in medullary bone space before displacing cortical bone
i.e. can have significant mesio-distal expansion without bucco-lingual expansion.
looks long like a sausage

38
Q

What investigation do we carry out if we suspect an odontogenic keratocyst?

what are we testing for? (2)

A

aspirate biopsy

  • Contains squames
  • Low soluble protein content ( <4g per decilitre)
39
Q

List 2 characteristics appearances of the histology of a keratocyst.

A

Palisading arrangement (basal cells at same height)
- If infection present = lose characteristic appearance

Daughter/satellite cysts found within the wall – if left behind they form a new keratocyst

40
Q

Describe the type of growth keratocysts undergo.

A

Multicentric growth – parts of epithelial lining grows faster than other sites and have finger like projections (not a nice balloon shape)
- If projections left behind = reoccurrence

41
Q

How do we exclusively treat keratocysts and why.

A

marsupialisation:
1. Cut a hole and allow it to drain slightly = reduces in size and moves away from the canal and reduces risk of mandibular fracture and can be removed easier.

  1. Remove tooth/source too to prevent recurrence
  2. Close monitoring for years post surgery
42
Q

What syndrome is associated with multiple keratocysts?

A

Basal cell naevus syndrome:

43
Q

How does Basal cell naevus syndrome present? (4)

A
  • Multiple odontogenic keratocysts
  • Multiple basal cell carcinomas
  • Palmar & plantar pitting
  • Calcification of intracranial dura mater
44
Q

List non-odontogenic cysts. (4)

A

Developmental
nasopalatine duct cysts

other:
solitary bone cysts
aneurysmal bone cysts

45
Q

What is a nasopalatine duct cyst?

where does it occur?

A

A developmental non-odontogenic cyst that arises from nasopalatine duct epithelial remnants
- Occurs in anterior maxilla

46
Q

how does a nasopalatine duct cyst present? (3)

A
  • Often asymptomatic
  • Patient may note “salty” discharge (similar to infection)
  • Larger cysts may displace teeth or cause swelling in palate
  • Always involve midline but not always symmetrical (can grow off to one side)
47
Q

Describe the epithelium lining the nasopalatine duct cyst. (2)

A

Variable epithelial lining;
- Non-keratinised stratified squamous
- modified respiratory

48
Q

what radiographs do we use to image nasopalatine duct cysts? (2)

A

Periapical &/or standard maxillary occlusal

49
Q

what are the radiographic features if a nasopalatine duct cyst? (3)

A
  • Corticated radiolucency between/over roots of central incisors
  • Often unilocular
  • May appear “heart shaped” due to superimposition of anterior nasal spine
50
Q

What radiographic feature can be used for diagnosis of a nasopalatine duct cysts in the absence of clinical signs/symptoms?

A

consider the transverse diameter;
* <6mm: assume incisive fossa
* 6-10mm: consider monitoring and take another x-ray in 6 months time
* >10mm: suspect cyst

51
Q

In what patient do solitary bone cysts (non-odontogenic non-epithelial lined cyst) occur?

A

young adults/teenagers

52
Q

what is a solitary bone cyst?

A

A Non-odontogenic cyst without an epithelial lining
a.k.a. simple/traumatic/haemorrhagic bone cyst

53
Q

in what jaw do solitary bone cysts commonly occur in?

A

mandible ++

males more than females

54
Q

How do we differentiate a solitary bone cyst and a keratocyst? (2)

A

SBC:
- Age (younger px)
- Larger finger like projections in-between teeth

55
Q

What are the radiographic signs of a solitary bone cyst? (4)

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
56
Q

What is a Staphne cavity?

A

Not a cyst but commonly mistaken as one, is actually a depression in the bone (Cortical bone preserved)
can have an Ingrowth of salivary or fatty tissue

57
Q

What are the characteristics of a staphne cavity. (5)

A
  • Often in angle or posterior body
  • Often inferior to inferior alveolar canal
  • Asymptomatic
  • Well-defined, often corticated radiolucency
  • Rarely displaced adjacent structures
58
Q

How can we further investigate cysts of the jaw? (3)

A
  1. Aspiration biopsy – drainage of contents
    - Can do in GDP
    - Can tell you if it’s a cavity or mass
  2. Incisional biopsy – partial removal
    - Can help differential diagnosis of ameloblastoma
  3. Excisional biopsy – complete removal
59
Q

What kind of fluid is collected from an inflammatory/developmental cyst during aspirational biopsy?

A

clear/straw coloured fluid

60
Q

What kind of fluid is collected from a keratocyst during aspirational biopsy?

A

White or cream semi-solid

61
Q

What is the purpose of an incisional biopsy?

A

To obtain a sample of the lining for histological analysis

62
Q

List and describe the 2 treatment options for cysts.

A

enucleation
All of the cystic lesion is removed (entire cyst lining removed with the associated tooth/root if present)
- Treatment of choice for most cysts

marsupialisation (less invasive and can be done under LA however Requires cooperation)
- 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
- Always a window present with something inside for up to 6 months e.g. an obturator to prevent tissues growing back over it

63
Q

What are the advantages of enucleation? (3)

A
  • Whole lining can be examined pathologically
  • Primary closure
  • Little aftercare needed
64
Q

What are the disadvantages/contraindications of enucleation? (7)

A
  • Risk of mandibular fracture with very large cysts
  • (Dentigerous cyst) wish to preserve tooth
  • Old age/ill health can’t be put under GA
  • Clot-filled cavity may become infected
  • Incomplete removal of lining may lead to recurrence
  • Damage to adjacent structures
  • Daughter cysts in the keratocyst lining – to remove all of these would cause damage to adjacent structures/anatomy = have to use marsupialisation
65
Q

What are the advantages of marsupialisation? (2)

A
  • Simple to perform
  • May spare vital structures
66
Q

What are the disadvantages/contraindications of marsupialisation? (4)

A
  • 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
67
Q

what are the indications for marsupialisation? (7)

A
  • If enucleation would damage surrounding structures (e.g. ID canal)
  • 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

My BDS4 (57 decks)

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