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Oral Surgery BDS4 > Cysts of the Jaws > Flashcards

Cysts of the Jaws Flashcards

1
Q

what is a cyst

A

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

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2
Q

when do cysts have pus

A

when they are infected

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3
Q

what are the characteristics signs of a cyst

A

egg shell crackling sound
absence of tooth
swelling
cause loss of vitality
discolouration
increasing in size
numbness
tooth mobility

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4
Q

what radiographs are initially taken for a cyst

A

periapical
occlusal
panoramic

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5
Q

what radiographs are supplementally taken for a cyst

A

CBCT
facial radiographs (PA mandible/occipitomental)

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6
Q

what are the features of a cyst we look at radiographically

A

location
shape
margins
locularity
multiplicity
effect on surrounding anatomy
inclusion of unerupted teeth

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7
Q

what shapes do cysts take

A

spherical or egg shaped

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8
Q

what are the margins of cysts like

A

well defined
corticated

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9
Q

what can locularity of cysts be like

A

often unilocular
sometimes multilocular

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10
Q

how can cysts affect the surrounding anatomy

A

displacement
root resorption with chronic cysts

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11
Q

what happens if a cyst becomes secondarily infected

A

lose definition and cortication of margins

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12
Q

how can cysts be classified

A

structure
origin
pathogenesis

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13
Q

what are the 2 main categories of cysts

A

odontogenic
non-odontogenic

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14
Q

where do odontogenic cysts occur

A

tooth bearing areas

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15
Q

what is the most common cause of bony swelling sin the jaws

A

odontogenic cysts

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16
Q

what are odontogenic cysts lined with

A

epithelium

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17
Q

where do the sources of the epithelium for odontogenic cysts come from

A

rests of malassez
rests of serres
reduced enamel epithelium

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18
Q

how are the rests of malassez activated to be part of a cyst

A

by infection or cytokines/idiopathic

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19
Q

where is odontogenic epithelium located

A

above IAN canal

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20
Q

what are the most common odontogenic cysts

A

radicular
dentigerous
odontogenic keratocyst

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21
Q

what is a radicular cyst

A

inflammatory odontogenic cyst

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22
Q

how do radicular cysts start

A

chronic inflammation at apex of tooth due to pulp necrosis

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23
Q

what jaw is more common to get a radicular cyst in

A

maxilla

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24
Q

how do radicular cysts present

A

asymptomatic but may become infected
slow growing with limited expansion

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25
Q

how do you differentiate between a radicular cyst or a periapical granuloma on a radiograph

A

if the radiolucency diameter is larger than 15mm then most likely a cyst

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26
Q

what is the pathway of disease to a radicular cyst

A

pulpal necrosis
periapical periodontitis
periapical granuloma
radicular cyst

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27
Q

what are the radiographic features of a radicular cyst

A

well-defined radiolucency
corticated margin continuous with lamina dura of non-vital tooth
may displace adjacent structures
external root resorption sometimes

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28
Q

what are the histological features of a radicular cyst

A

epithelial lining
connective tissue capsule
inflammation in capsule

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29
Q

how does a granuloma turn into a radicular cyst

A

proliferating epithelium with central necrosis
continues growing by osmotic effect with semi-permeable wall and cytokine mediated growth

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30
Q

what cells are found in radicular cysts

A

inflammatory
mucous metaplasia
cholesterol clefts
rushton bodies

31
Q

what are the causes of numbness of the lower lip

A

cyst
tumours
infection
trauma

32
Q

what is a residual cyst

A

when a radicular cyst persists after loss of tooth/RCT

33
Q

what is a lateral radicular cyst

A

radicular cyst associated with an accessory canal
located at the side of the tooth instead of apex

34
Q

what types of cyst does the term inflammatory collateral cyst cover

A

paradental cyst
buccal bifurcation cyst

35
Q

what are inflammatory collateral cysts associated with

A

vital teeth

36
Q

what is a dentigerous cyst

A

developmental odontogenic cyst

37
Q

what is a dentigerous cyst associated with

A

crown of unerupted tooth

38
Q

where are dentigerous cysts more commonly found

A

mandible
usually third molar

39
Q

what does a dentigerous cyst look like radiographically

A

corticated margins attached to ACJ of tooth
may displace involved tooth
tend to be symmetrical initially
variable displacement of cortical bone

40
Q

what is on the histology of a dentigerous cyst

A

thin non-keratinised stratified squamous epithelium

41
Q

how do you decide if a lesion is a dentigerous cyst or an enlarged follicle

A

based on follicular space
5mm+ consider cyst

cyst if radiolucency is asymmetrical

42
Q

what is the usual length of follicular space from crown to follicle edge

A

2-3mm

43
Q

what is an eruption cyst

A

variant of dentigerous cyst contained within soft tissue rather than bone

44
Q

where and in who do you normally get an eruption cyst

A

incisors
children

45
Q

what is an odontogenic keratocyst

A

developmental odontogenic cyst

46
Q

where do odontogenic keratocysts usually occur

A

mandible
posterior

47
Q

what are the radiographic features of odontogenic keratocyst

A

scalloped margins
25% mulitlocular
often displacement of teeth
enlarge in medullary bone space (along bone)

48
Q

what pre-operative diagnostic test is needed for odontogenic keratocysts

A

cyst aspirate biopsy

49
Q

what does an odontogenic keratocyst produce in a cyst aspirate biopsy

A

squames
low soluble protein content

50
Q

what is the histology features of an odontogenic keratocyst

A

epithelial lining with keratin
palisading
daughter cysts
no rete pegs

51
Q

why do odontogenic keratocysts recur

A

if any of the lining is left after surgery

52
Q

what condition may someone have if they present with multiple odontogenic keratocysts at a young age

A

basal cell naevus syndrome

53
Q

what are the 3 types of non-odontogenic cysts

A

nasopalatine duct cyst solitary bone cyst
aneurysmal bone cyst

54
Q

what do nasopalatine duct cysts arise from

A

nasopalatine duct epithelial remnants

55
Q

how do nasopalatine duct cysts present

A

asymptomatic
salty discharge
can displace teeth or cause swelling in palate
always involves midline

56
Q

what is the histology of a nasopalatine duct cysts

A

non-keratinised stratified squamous and modified respiratory epithelium

57
Q

what is seen on radiography of a nasopalatine duct cyst

A

corticated radiolucency between roots of central incisors
unilocular

58
Q

how do you decide between a cyst or the incisive fossa

A

if >10mm definitely cyst
if <6mm is incisive fossa
if between 6-10mm monitor

59
Q

what is a solitary bone cyst and who does it occur in and where

A

non-odontogenic cyst without epithelial lining
most common in teenagers
mandible

60
Q

what is a stafne cavity

A

depression in bone in mandible only

61
Q

where do stafne cavities present making them easy to separate from a cyst

A

inferior to inferior alveolar canal

62
Q

what methods are used for obtaining material for histology

A

aspiration biopsy
incisional biopsy
excisional biopsy

63
Q

if there is blood with an aspiration biopsy what type of cyst is this

A

aneurysmal bone cyst

64
Q

what type of fluid is present in inflammatory or developmental cysts

A

clear straw coloured

65
Q

what type of fluid indicates keratocyst

A

white or cream semi-solid

66
Q

what is the purpose of an incisional biopsy

A

obtain a lining for histological analysis

67
Q

what are the surgical options for cysts

A

enucleation
marsupialisation

68
Q

what are the advantages of enucleation

A

whole lining can be examined pathologically
primary closure
little aftercare

69
Q

what are the contraindications of enucleation

A

risk of mandibular fracture
dentigerous cyst
old age, ill health
clot filled cavity can become infected
incomplete removal = recurrence
damage to adjacent structures

70
Q

what are the indications for marsupialisation

A

if enucleation would damage surrounding structures
difficult to access area
may allow eruption of tooth affected by dentigerous cyst
elderly or medically compromised
very large cysts risking jaw fracture

71
Q

what are the advantages of marsupialisation

A

simple
can spare vital structures

72
Q

what are the contraindications/disadvantages for marsupialisation

A

opening may close and cyst reform
complete
complete lining not available for histology
difficult to keep clean and lots of aftercare needed
long time to fill in

73
Q

what is used to keep the window open after marsupialisation

A

obturator

Oral Surgery BDS4 (21 decks)

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