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4 - oral surgery > cysts of the jaws > Flashcards

cysts of the jaws Flashcards

1
Q

What is a 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 are the symptoms of cysts?

A

Mobility of teeth
Loss of tooth vitality
Numbness/altered sensation
Usually slow growing
Noise when pressing like an ‘egg shell crackling
Often asymptomatic unless infected

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3
Q

What initial radiographs can be taken for cysts?

A

Periapical
Occlusal
Panoramic

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4
Q

What supplemental radiographs can be used for cysts?

A

CBCT
Facial radiographs:
- PA mandible view
- Occipitomental view

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5
Q

What are the radiographic features of cysts to look out for?

A

Location
Shape - often spherical or egg-shaped
Margins - often well defined and corticated
Locularity - often unilocular, can be multi or pseudo
Multiplicity - single, bilateral, multiple
Effect on surrounding anatomy - displacement of teeth, inferior alveolar canal, maxillary sinus, root resorption
Inclusion of unerupted teeth

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6
Q

How may cysts present radiographically if infected?

A

Cysts may lose definition and cortication of margins if secondarily infected

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7
Q

How are cysts classified?

A

Structure - epithelium lined vs no epithelial lining
Origin - odontogenic vs non-odontogenic
Pathogenesis - developmental vs inflammatory

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8
Q

What are the different types of odontogenic cysts?

A

Developmental or inflammatory

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9
Q

Name 3 types of odontogenic developmental cysts

A

Dentigerous cyst (and eruption cyst)
Odontogenic keratocyst
Lateral periodontal cyst

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10
Q

Give 3 examples of odontogenic inflammatory cysts

A

Radicular cyst (and residual cyst)
Inflammatory collateral cysts:
- paradental cyst
- buccal bifurcation cyst

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11
Q

What are the different types of non-odontogenic cysts?

A

Developmental cysts
Other

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12
Q

What is the most common non-odontogenic developmental cyst?

A

Nasopalatine duct cyst

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13
Q

Name 2 non-odontogenic other cysts and what they have in common

A

Solitary bone cyst
Aneurysmal bone cyst
Neither of these have an epithelium lining

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14
Q

Where do odontogenic cysts occur?

A

In tooth-bearing areas

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15
Q

Describe the incidence of odontogenic cysts

A

Most common cause of bony swelling in the jaws
>90% of all cysts in the oral and maxillofacial region
2nd ost common group of oral and maxillofacial lesions in adults - 14-15%

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16
Q

What are the 3 odontogenic sources of epithelium?

A

Rests of Malassex - 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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17
Q

What are the 3 most common odontogenic cysts and how common are they?

A

Radicular cyst (and residual cyst) - 60%
Dentigerous cyst (and eruption cyst) - 18%
Odontogenic keratocyst - 12%

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18
Q

What is a radicular cyst?

A

An inflammatory odontogenic cyst
Always associated with a non-vital tooth
Initiated by chronic inflammation at apex of tooth due to pulp necrosis

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19
Q

Describe the incidence of radicular cysts

A

Most common in 4th and 5th decade
Male and female prevalence the same
60% maxilla, 40% mandible
Can involve any tooth

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20
Q

How do radicular cysts present?

A

Often asymptomatic - may become infected and then painful

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21
Q

How can you differentiate between radicular cysts and periapical granulomas?

A

Difficult radiographically - radicular cysts usually larger
If radiolucency diameter >15mm then 2/3 of these cases will be radicular cysts

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22
Q

How can pulpal necrosis lead to radicular cyst formation?

A

Pulpal necrosis will lead to periapical periodontitis which can cause a periapical granuloma and lead to radicular cyst formation

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23
Q

What are the radiographic features of radicular cysts?

A

Well-defined
Round/oval radiolucency
Corticated margins continuous with lamina dura of non-vital tooth
Larger lesions may displace adjacent structures
Long-standing lesions may cause external root resorption and/or contain dystrophic calcification

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24
Q

Describe the histological findings of radicular cysts

A

Epithelial lining which is often incomplete
Connective tissue capsule with inflammation in the capsule

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25
Q

How do radicular cysts developing from granulomas?

A

Epithelial rests of Malassez proliferates in periapical granuloma
Radicular cysts then forms by proliferating epithelium or the epithelium surrounds a fluid area
Growth continues by osmosis and cytokine mediated growth
Describe as a ballooning type of growth

26
Q

What is a granuloma?

A

A mass of granulation tissue which attaches itself to the root of a non-vital tooth

27
Q

What is mucous metaplasia?

A

When epithelial cells become mucous secreting cells

28
Q

What are the 2 variants of radicular cysts?

A

Residual cyst - when radicular cyst persists after loss of tooth or successful RCT
Lateral radicular cyst - radicular cyst associated with an accessory canal, located at side of tooth instead of apex

29
Q

What are inflammatory collateral cysts and what percentage of odontogenic cysts do they account for?

A

Inflammatory odontogenic cysts with the association of a vital tooth
2-7% of odontogenic cysts

30
Q

What are inflammatory odontogenic cysts a collective term for?

A

Paradental cyst - typically occurs at distal aspect of PE M3M
Buccal bifurcation cyst - typically occurs at buccal aspect of M3M

31
Q

What is a dentigerous cyst?

A

A developmental odontogenic cyst associated with the crown of an unerupted and usually impacted tooth eg - M3M, maxillary canines
There is a cystic change of the dental follicle

32
Q

Describe the incidence of a dentigerous cyst

A

Most common in 2nd-4th decades
Males affected more than females
Mandible affected more than the maxilla

33
Q

What are the radiographic findings of a dentigerous cyst?

A

Corticated margins attached to CEJ of tooth - larger cysts may envelop root
May displace involved tooth
Tend to be symmetrical initially
Crown usually found inside the cyst
Variable displacement of cortical bone ie - bony expansion

34
Q

Describe the histology of dentigerous cysts

A

Thin, non-keratinised stratified squamous epithelium
May resemble a radicular cyst if inflamed

35
Q

How can you differentiate a dentigerous cyst from an enlarged follicle?

A

Consider cyst if follicular space is 5mm or more
Normal follicular space typically is 2-3mm
Assume cyst if >10mm
Consider cyst if radiolucency

36
Q

What is an eruption cyst?

A

A variant of a dentigerous cyst - contained within soft tissue rather than bone
Associated with an erupting tooth - more commonly incisors
Almost exclusive to children

37
Q

What is an odontogenic keratocyst (OKC) and what is its key feature?

A

A developmental odontogenic cyst with no specific relationship to teeth
Very difficult to remove and commonly recur

38
Q

Describe the incidence of OKC?

A

Most common in 2nd-3rd decades
Affects males more than females
Affects mandible more than maxilla (3:1)
Found posteriorly more than anteriorly

39
Q

What are the radiographic findings of OKCs?

A

Often have scalloped margins
25% are multilocular
Often cause displacement of adjacent teeth - root resorption uncommon
Characteristic expansion - can have significant mesio-distal expansion without buccal-lingual expansion

40
Q

What pre-op diagnostic test is used for OKCs?

A

Cyst aspirate - contains squamous cells and low soluble protein content

41
Q

Describe the histology of OKCs

A

Linings of the cyst is epithelial lining with keratin formation - the majority of cysts don’t have keratin
The keratin is parakeratosis

42
Q

How does basal cell naevus syndrome present?

A

Multiple OKCs
Multiple basal cell carcinomas
Palmar and plantar pitting
Calcification of intracranial dura mater

43
Q

What are the other names for basal cell naevus syndrome?

A

Goblin-Goltz syndrome
Bifid rib syndrome

44
Q

What are nasopalatine duct cysts and where do they occur?

A

Developmental non-odontogenic cysts arising from the nasopalatine duct epithelial remnants
Occur in the anterior mandible

45
Q

What is the other name for nasopalatine cysts?

A

Incisive canal cysts

46
Q

Describe the incidence of nasopalatine duct cysts

A

Most common in 4th-6th decade
Affects males more than females

47
Q

How do nasopalatine duct cysts present?

A

Often asymptomatic
Pt may note salty discharge
Larger cysts may displace teeth or cause swelling in palate
Always involve midline but not always symmetrical

48
Q

Describe the histology of nasopalatine duct cysts

A

Variable epithelial lining - non-keratinised stratified squamous and modified respiratory epithelium

49
Q

How do nasopalatine duct cysts present radiographically?

A

Corticated radiolucency between/over roots of central incisors
Often unilocular
May appear ‘heart shaped’ due to superimposition of anterior nasal spine

50
Q

How can you differentiate nasopalatine cysts from the incisive fossa?

A

Incisive fossa may or may not be present, is an oval-shaped radiolucency in the midline and typically is not visibly corticated
If no clinical issues look at the diameter:
- <6mm - assume incisive fossa
- 6-10 mm - consider monitoring
- >10mm - suspect cyst

51
Q

What is a solitary bone cyst and what can it also be called?

A

A non-odontogenic cysts without an epithelial lining
Also called simple/traumatic/haemorrhagic bone cyst

52
Q

Describe the incidence of solitary bone cysts?

A

Most common in 2nd decade
Affects males more than females
Affects mandible much more than maxilla
Can occur in association with other bone pathology eg - fibro-osseous lesions

53
Q

How do solitary bone cysts present clinically?

A

Usually asymptomatic and an incidental finding
Rarely pain or swelling

54
Q

How do solitary bone cysts present radiographically?

A

Majority in premolar/molar region of mandible
Can also occur in non-tooth bearing areas
May have scalloped margins giving a pseudolocular appearance
May project up between the roots of adjacent teeth

55
Q

What is a stafne cavity, where do they occur and what do they contain?

A

Not a cyst but commonly mistaken as one
A depression in the bone - cortical bone is preserved
Only occur in the mandible, almost exclusively lingual
Contains salivary or fatty tissue

56
Q

Describe the incidence of stafne cavities

A

Most common in 5th and 6th decades
Often in angle or posterior body of mandible
Often inferior to inferior alveolar canal

57
Q

How do stafne cavities present clinically and radiographically?

A

Clinically - asymptomatic
Radiographically:
- well-defined, often corticated radiolucencies
- rarely displaces adjacent structures

58
Q

What are the 2 surgical options for cysts?

A

Enucleation - all of the cystic lesion is removed - most common tx choice
Marsupialisation - creation of a surgical window in the wall of the cyst, removing the contents of the cyst and suturing the cyst wall to the surrounding epithelium. This encourages the cyst to decrease in size and may be followed by enucleation at a later date

59
Q

What are the advantages of enucleation?

A

Whole lining can be examined pathologically
Primary closure
Little aftercare needed

60
Q

Name 4 contraindications or disadvantages to enucleation

A

Any from:
- risk of mandibular fracture with very large cysts
- if dentigerous cyst may wish to preserve tooth
- old age and ill health
- clot-filled cavity may become infected
- imcomplete removal of lining may lead to recurrence
- damage to adjacent structures

61
Q

Give 4 indications of marsupialisation

A

Any from:
- if enucleation would damage surrounding structures eg - ID canal
- difficult to access area
- may allow eruption of teeth affected by a dentigerous cyst
- elderly or medically compromised pts 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

62
Q

Give 4 contraindications or disadvantages of marsupialisation

A

Opening may close and cuts may reform
Complete lining is not available for histology
Difficult to keep clean and lots of aftercare needed
Takes a long time to fill in

4 - oral surgery (19 decks)

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