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Flashcards in Mid term 2 Deck (28)
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1
Q

what is the typical appearance of true cysts?

A
  1. Radiolucent
  2. Well-defined, corticated, “etched” borders
  3. “Hydraulic” appearance
  4. May resorb tooth roots
  5. May displace tooth roots
2
Q

what are the 6 most common cysts in the oral cavity?

A

MOST COMMON “CYSTS” IN THE JAWBONES??? (the unscientific Packota opinion……)

  1. Mucous retention pseudocyst
  2. RADICULAR (DENTAL; PERIAPICAL) CYST* 3. Simple (traumatic) bone cyst
  3. DENTIGEROUS (FOLLICULAR) CYST*
  4. ODONTOGENIC KERATOCYST*
  5. NASOPALATINE (INCISIVE CANAL) CYST*
3
Q

what’s the most common type of cyst in the jaws?

A

radicular cyst

4
Q

where are radiuclar cysts located and what is a differential diagnosis?

A

most found in maxilla around incisors and canines

differential possibly KOT, lateral periodontal cyst

NON-VITAL TOOTH HIGH PROBABILITY IT IS RADIUCLAR CYST

LAMINA DURA IS CONTINUOUS WITH MARGIN

5
Q

What are the 4 odontogenic developmental cysts that we should be aware of?

A

i. DENTIGEROUS CYST (follicular cyst) - attaches to the CEJ - differential - hyperplastic follicle, if bigger than 5 mm probably dentigerous; KOT; ameloblastic fibroma; cystic ameloblastoma
ii. KERATOCYSTIC ODONTOGENIC TUMOUR
- posterior mandible - can be multilocular or unilocular - minimal expansion of cortical plates, grows more inside bone, can be related to Gorlin-Goltz syndrome - Differential - if in pericoronal position could be dentigerous cyst; could be early ameloblastoma (but this expands more than KOT); simple bone cyst (but this usually has more delicate and difficult to detect margins) ; IF SEVERAL MAY INDICATE BASAL CELL NEVUS SYNDROME.
iii. Lateral periodontal cyst - 50 - 75% are in mandible from lateral incisor to second premolar - differential - small KOT; mental foramen; small neurofibroma
iv. Calcifying odontogenic cyst (Gorlin cyst) - most appear anterior to the first molar, especially associated with cuspids and incisors - differential - adenomatoid odontogenic tumor; ameloblastic fibro-odontoma, calcifying epithelial odontogenic tumor. long standing cysts may also gain dystrophic calcifications.

6
Q

what are the 3 odontogenic inflammatory cysts that we should be aware of?

A

i. RADICULAR CYST (dental cyst, periapical cyst)
ii. Residual cyst - differential KOT
iii. “Paradental” cyst - AKA buccal bifurcation cyst - mandibular first and second molars, roots protruding through lingual plate, first two decades of life - differential - periodontal abscess or Langerhans’ cell histiocytosis - ONLY THE PARADENTAL CYST WILL TIP THE TOOTH THOUGH

7
Q

what is the most important non-odontogenic cyst to remember?

A

nasopalatine duct cyst - incisive canal cyst

differential - large incisive foramen (if displacement of teeth , obviously cyst); possibly radicular cyst or granuloma associated iwth central incisor

8
Q

what are 2 non-epithelial lined cysts?

A
  1. SIMPLE BONE CYST (traumatic bone cyst, simple bone cavity) - first two decades of life, almost all in mandible, often expands around roots but leaves cortical bone of roots untouched - differential - KOT;
  2. MUCOUS RETENTION PSEUDOCYST of the maxillary antrum (benign mucosal cyst of the maxillary antrum)
9
Q

what are the most important points in identifying a cyst?

A
  1. well defined corticated borders
  2. radiolucent because htye are filled iwth fluid (exception is if they are in the maxillary sinus because hte sinus is air filled and the cyst will then be more dense
  3. hydraulic appearance - rounded or ovoid - exception being KOT

FIRST THREE ARE MOST IMPORTANT FOR CYSTS

  1. because of slow growth - large cysts may displace roots or cause resorption of roots
  2. clinical history can be important, cysts will often be present for a long period of time before causing any symptoms
  3. age may be important - KOT not common in children
10
Q

what are two benign tumors of Odontogenic epithelium without odontogenic mesenchyme?

A

Ameloblastoma - honeycomb appearance, multilocular, thick internal bony septa, average age 40 yrs, usually well defined corticated border, but curved - differential -
KOC, giant cell granuloma (except this is usually in young patients and more granular appearance); odontogenic myxoma; ossifying fibroma (except this usually has one or two straight thin, sharp septa, which is characteristic of the myxoma)
Calcifying epithelial odontogenic tumor (Pindborg tumor) - predilerction for mandible, 52% associated with unerupted or impacted tooth, unilocular or multilocular with numerous scattered, radiopaque foci of various size and density, average age 42 - differential - if completely radiolucent could be dnetigerous cyst or ameloblastoma, radiopque foci could be adenomatoid odontogenic tumor, ameloblastic fibro-odontoma, and calcifying odontogenic cyst,

11
Q

what are 6 benign tumors of Odontogenic epithelium with odontogenic mesenchyme, with or without dental hard tissue formation?

A

a. Ameloblastic fibroma - average age of 15 yrs; premolar, molar area of the mandible, area where tooth didn’t develop, or in follicular relationship with unerupted tooth; more commonly UNILOCULAR (radiolucent), but may be multilocular with internal septa. differential - may seem like ameloblastoma but occurs at an EARLIER AGE THAN ameloblastoma, and septa in ameloblastoma are more defined and coarse; giant cell granuloma may appear multilocular, but these tumors usually have an epicenter anterior to the first molar in young patients, and the septa are characteristically granular and ill defined; odontogenic myxomas have sharp straight septa characteristic of myxomas.
b. Ameloblastic fibro-odontome - same as ameloblastic fibroma but with scattered colelctions of enamel and dentin
c. Adenomatoid odontogenic tumor - UNCOMMON, average age of 16 years, 75% in maxilla, incisor-canine0premolar region, may have follicular relationship but does not connect to the CEJ, may have pebble like radiopacities - differentials - wh
d. Calcifying odontogenic cyst (Gorlin cyst) e. Complex odontome
f. Compound odontome

12
Q

what are 2 benign tumors of Odontogenic mesenchyme with or without included odontogenic epithelium?

A
Odontogenic myxoma - uncommon, mandible, premolar and molar area. most septa area curved and corase, but the finding of one or two of these traight septa helps to identify - differential - ameloblastoma, giant cell granuloma, central hemangioma
Benign cementoblastoma (true cementoma) - attached to the apex of a tooth root, usually younger patients 12 to 65, tooth is vital and often painful, mandible, roots of premolar or first molar - differential - periapical sclerosing osteitis, dense bone island BUT cementoblastoma has a soft tissue capsule.
13
Q

how to know if it’s odontogenic or not for benign tumors?

A
  1. above IAN canal
  2. radiopaque lesions with a well-defined soft tissue capsule
  3. lesions being found close to teeth or roots
14
Q

what are giant cell granulomas like?

A

it is a benign tumor - 60% occur in less than 20 yrs old, anterior to first molar in the mandible and anterior to the cuspid in the maxilla, can be radiolucent completely, or granular pattern, or ill0defined wispy septa, can be multilocular, expansion is undulating in nature which may give appearance of a DOUBLE BOUNDARY when expansion is viewed from occlusal, can diverge the roots of teeth. Giant cell granulomas are expansive.

15
Q

what is an osteoma like?

A

most common mesenchymal neoplasm in the paranasal sinuses.

more in mandible - attached to the cortex of the bone by a pedicle or along a wide base. uniformly radiopaque

16
Q

what is an ossifying fibroma (cementifying fibroma - cemento-ossifying fibroma)?

A

facial bones and commonly in the mandible, inferior to the premolars and molars and superior to the IAN canal. soft tissue capsule present, usually found in young adults, internal structure is a mixed radiolucent-radiopaque density with a pattern that depends on the amount and form of the manufactured calcified material. Differential could be giant cell granuloma, calcifying odontogentic cyst, calcifying epthelial odontogenic, and adenomatoid odontogenic tumor.

17
Q

what is a neurofibroma like?

A

usually found in young patients, may produce pain or paresthesia, unilocular usually, vascular lesions enlarge the whole canal, with this it is just a part of the canal.

18
Q

what is a neurilemoma like?

A

mandible and sacrum most common. usually round multiloculations and in IAN canal

19
Q

what is hemangioma like?

A

most common in first decade, rarely found in jaws, mandible, posterior body and ramus and within the inferior alveolar canal. whole canal shape is altered, phleboliths if soft tissue is involved

20
Q

what is an osteochondroma like?

A

occurs where cartilage is (coronoid process)

21
Q

what are three points to remember about benign tumors?

A
  1. Smooth, well-defined borders which may be corticated. Borders are usually more irregular than cysts.
  2. Tendency to displace teeth and other structures, although root resorption can occur .
  3. With jaw expansion, periosteum usually maintains an intact bony covering (as with any benign lesion).
22
Q

What is a squamous cell carcinoma like?

A

more in mandible, ill-defined borders, possibly thinned cortical bone and pathological fractures; totally radiolucent.

23
Q

what is metastatic carcinoma?

A

posterior area of the jaws more commonly affected.

24
Q

what is leukemia like?

A

very young or very old patients, ill-defined patchy radiolucent areas, but radiographic evidence is extremely rare.

25
Q

what is lymphoma like?

A

primarily a disease of youth, the tumor can double in time in less than 24hrs. begins as multiple, ill-defined, noncorticated radiolucencies, which later coalesce into larger, ill-defined radiolucencies .

26
Q

what is multiple myeloma like?

A

between 35 and 70, may complain of dental pain, swelling, hemorrhage, more in mandible, may be ragged border or punhced out?

27
Q

what is osteogenic sarcoma like? what are three major types?

A

three major types are 1) chondroblastic 2) osteoblastic 3) fibroblstic….. sun ray spicules, normal trabecular structure of the jaw is gone.

28
Q

what is chondrosarcoma like?

A

more common in mean age 47,