cysts tutorial Flashcards
1) Cysts
a. What is a cyst?
b. What are the two main categories of cysts?
c. What 3 epithelial remnants are linked to development of odontogenic cysts?
a. Pathological cavity having fluid / gaseous contents not created by accumulation of pus
b. Odontogenic, non-odontogenic
c. WRests of Malassez = Hertwigs epithelial root sheath Rests of Serres = dental lamina Reduced enamel epithelium = dental follicle
2) Odontogenic cysts
a. Radicular cyst
i. What teeth are they most commonly associated with?
ii. Give the radiographic signs.
iii. How do you differentiate between a radicular cyst and periapical granuloma?
iv. Give some histological signs.
v. What would you expect a syringe aspirate to look like?
a. Radicular cyst
i. Non-vital teeth
ii. Radiolucency, round, well-defined, unilocular, corticated, margins continuous with lamina dura of non-vital tooth
iii. 2/3 of radicular cysts >15mm
iv. Epithelial lining, connective tissue capsule w/ inflammation
v. Clear straw coloured fluid
2) Odontogenic cysts
b. Inflammatory collateral cysts
i. Most common location of paradental cyst
ii. Most common location of buccal bifurcation cyst
b. Inflammatory collateral cysts
i. Distal aspect of partially erupted lower 3M
ii. Buccal aspect of lower 1M
2) Odontogenic cysts
c. Dentigerous cyst (DC)
i. Describe how DC’s arise.
ii. What is the most common tooth associated?
iii. Give the radiographic signs.
iv. Give some histopathological signs.
v. What would you expect a syringe aspirate to look like?
vi. What is the normal size of follicular space?
vii. What 2 radiographic signs would you look out for to consider a cyst to be dentigerous rather than an enlarged follicle?
i. Cystic change of dental follicle - reduced enamel epithelium not fully resorbed, fluid accumulation, “large balloon”
ii. Lower 3M, U3
iii. Radiolucency, well defined, unilocular, corticated, bony expansion, margins associated with CEJ of unerupted crown, displacing teeth
iv. Thin non-keratinised stratified squamous epithelium
v.Clear straw coloured fluid
vi. 2-3mm
vii. >10mm size, asymmetrical radiolucency
2) Odontogenic cysts
d. Odontogenic keratocyst (OKC)
i. What cells are linked to formation of OKC’s?
ii. Give the radiographic signs.
iii. Give some histological signs.
iv. What would you expect a syringe aspirate to look like? What lab test may you perform on this aspirate?
v. sWhat is the reason for the high recurrence rates of OKC’s?
vi. What syndrome is associated with multiple OKC’s? Give 2 more signs of this syndrome.
i. Rests of Serres, reduced enamel epithelium
ii. . Radiolucency, well-defined, multilocular, scalloped, characteristic growth (disto-mesial, rarely thins cortical bone), displacing teeth
iii. Thin keratinised stratified squamous epithelium w/ parakeratosis, daughter cysts, palisading basal cells
iv. White creamy thick aspirate; protein test shows low protein content
v. Infiltrative growth means enucleation may leave clumps of cells behind, thin friable lining, daughter cysts
vi. Basal cell naevus / Gorlin-Goltz syndrome; Calcification of falx cerebri, multiple basal cell carcinomas on skin
3) Non-odontogenic cysts
a. Nasopalatine duct cyst (NDC)
i. What cells are linked to formation of NDC’s?
ii. Give the radiographic signs.
iii. What is the normal size of the incisive fossa? When should you assume the radiographic presentation is a NDC?
a. Nasopalatine duct cyst (NDC)
i. Nasopalatine duct epithelial remnants
ii. Radiolucency, well-defined, unilocular, corticated, irregular, over roots of maxillary incisors / anterior maxilla, “heart shaped” from superimposed ANS
iii. Normal = <6mm, assume NDC = >10mm
3) Non-odontogenic cysts
b. Non-epithelial non-odontogenic cysts
i. Solitary bone cyst = Give the radiographic signs.
ii. Stafne cavity = Give the radiographic signs.
i. Solitary bone cyst = Radiolucency, well defined, irregular, corticated, scalloped, spreads between roots / furcations of adjacent teeth
ii. Stafne cavity = . Radiolucency, below IAN canal, lingually
4) Management
a. Give 3 radiographs that can be taken for cyst management.
b. Give 3 biopsy methods for cyst management.
c. Enucleation
i. What is the goal of this treatment?
ii. What are 3 advantages of this treatment option?
iii. What are 3 disadvantages of this treatment option?
a. OPT, CBCT, MRI
b. Aspiration from cyst, incisional biopsy, enucleation
c. Enucleation
i. Remove whole cyst in single appointment
ii. Whole lining pathologically examined, primary closure, little aftercare required
iii. Risk of damage to anatomy (IAN canal, unerupted teeth), mandible fracture, recurrence
4) Management
d. Marsupialisation
i. What is the goal of this treatment?
ii. Which cysts are most likely to require marsupialisation?
iii. What are 3 disadvantages of this treatment option?
e. Segmental resection
i. What does this involve?
ii. Give a pathological condition where this may be useful.
d. Marsupialisation
i. Create surgical window for decompression of cyst + suturing of cyst wall to surrounding epithelium, reducing size of cyst before enucleation to preserve anatomy
ii. OKCs
iii. Whole lining cannot be examined pathologically, requires good maintenance by patient, closure risks cyst re-forming
e. Segmental resection
i. Removal of cyst +1mm surrounding bone commonly done for odontogenic tumours
ii. . Ameloblastoma, odontogenic myxoma
5) Periradicular surgery
a. What are 5 ways in which endodontic treatment can fail?
b. What are 2 aims of peri-radicular surgery?
c. What flap designs are used in peri-radicular surgery?
d. Give 2 instruments used in root-end preparation.
e. Give 3 retrograde root filling materials.
f. Give 5 reasons for failure of peri-radicular surgery.
a. Obstruction of instrumentation, root filling error, secondary pathology, post placement, lateral perforation
b. Remove existing infection, achieve apical seal
c. Semilunar flap, triangular flap, rectangular flap
d. Rotary bur, ultrasonic
e. Amalgam, ZOE, MTA
f. Inadequate seal Inadequate support Poor healing response Apical third fracture Too much apex removed
