Odontogenic cysts Flashcards
(102 cards)
1
Q
What is the most common cyst of the jaws?
A
periapical cyst
2
Q
What are other names for periapical cysts?
A
also known as radicular cysts or apical periodontal cysts
3
Q
How do periapical cyst originate?
A
due to inflammatory stimulation of the epithelial rests of Malassez
4
Q
A periapical cyst has a round to ovoid radiolucency at ___ with loss of ___ ___.
A
apex; lamina dura
5
Q
Periapical cyst is ___ (symptomatic/asymptomatic) and associated with a ___ (vital/nonvital) tooth.
A
asymptomatic; nonvital (pulp test!)
6
Q
If a periapical cysts develops on the lateral aspect of the root, presumably due to the prescence of a lateral canal in the area, this is called ___ ___ cyst.
A
lateral radicular
7
Q
Describe a periapical cysts microscopically.
A
inflamed granulation tissue or fibrous connective tissue lined by non-keratinized stratified squamous epithelium
8
Q
If no cyst lining is seen, it is a “___ ___”.
A
periapical granuloma
9
Q
How are periapical cysts treated?
A
root canal therapy, apicoectomy, extraction with curettage
10
Q
The prognosis of a periapical cyst is ___, but if the cyst is not removed, it may persist as a ___ ___.
A
excellent; residual cyst
11
Q
What is a well-defined radiolucency in the site of a previous extraction?
A
residual cyst
12
Q
How is a residual cyst treated? What is the prognosis?
A
enucleation with excellent prognosis
13
Q
A buccal bifurcation cyst usually occurs in ___ in their ___ ___.
A
children; mandibular molars
14
Q
BBC are thought to be due to proliferation of ___ epithelium associated with ___ extensions in the ___ area.
A
crevicular; enamel; furcation
15
Q
BBC has localized swelling where and is associated with what?
A
buccal aspect of alveolar process +/- pain, possible foul taste
16
Q
What is another term for BBC?
A
paradental cyst
17
Q
T/F. BBCs may be difficult to detect radiographically or may see a well-defined radiolucency in the furcation area superimposed over the roots.
A
True
18
Q
BBC root apices are typically tipped to ___ cortex - can be seen on ___ radiograph.
A
lingual; occlusal
19
Q
___ ___ might be seen with BBCs and single or multiple layers of bone formation.
A
Proliferative periostitis
20
Q
T/F. Microscopically, BBCs look like a periapical cyst
A
True
21
Q
What is the prognosis of BBC?
A
prognosis is good, but may need recontouring of furcation or perio surgery and involved tooth may be lost due to bone destruction
22
Q
What is the most common developmental odontogenic cyst?
A
Dentigerous cyst
23
Q
What is the second most common cyst overall (after periapical)?
A
Dentigerous cyst
24
Q
Dentigerous cyst develop due to an accumulation of fluid between the ___ of the tooth and the ___ ___ epithelium, which eventually forms the epithelial lining of the cyst.
A
crown; reduced enamel
25
T/F. By definition, a dentigerous cyst is associated with the crown of an erupted tooth.
False, by definition, a dentigerous cyst is associated with the crown of an UNERUPTED tooth.
26
If the radiolucency around the crown is greater than ___, it is safe to call it a cyst. If it is smaller, it probably represents a hyperplastic dental ___ - the two are histologically indistinguishable.
5; follicle
27
T/F. Any impacted tooth can potentially develop a dentigerous cyst.
True.
28
What is the 1st, 2nd, and 3rd most common site of a dentigerous cyst?
1st - mandibular third molar
2nd - maxillary canine
3rd - maxillary third molar
29
When do dentigerous cysts present? What are the symptoms?
2nd and 3rd decades
usually asymptomatic, but can produce swelling or resorption of adjacent tooth roots
30
Microscopically, an ___ fibrous CT wall is lined by a thin layer of ___ ___ ___ epithelium with a few scattered ___ cells in the lining of a dentigerous cyst.
uninflamed; non-keratinized, stratified squamous; mucous
31
How is a dentigerous cyst treated?
removal of the tooth and enucleation of the cyst
32
T/F. The prognosis of a dentigerous cyst is poor and the tissue should be examined microscopically to rule out OKC, ameloblastoma, or (rarely) squamous cell carcinoma or intraosseous mucoepidermoid carcinoma.
False, The prognosis of a dentigerous cyst is EXCELLENT but the tissue should be examined microscopically to rule out OKC, ameloblastoma, or (rarely) squamous cell carcinoma or intraosseous mucoepidermoid carcinoma.
33
What represents a dentigerous cyst that forms in the soft tissue overlying the crown of an erupting tooth?
eruption cyst
34
An eruption cyst has a ___ swelling and is termed "___ ___".
bluish; eruption hematoma
35
T/F. Children are usually affected with an eruption cyst.
True.
36
A primoridal cyst is a ___ (common/rare) lesion that is thought to be histogenetically derived from degenerating tooth ___ epithelium.
rare; bud
37
___ cysts develop in place of a tooth, before any ___ material is deposited.
Primordial; mineralized
38
T/F. A history of extraction or surgery in the area is mandatory for a diagnosis of Primordial cyst.
False, NO history of extraction or surgery in the area is mandatory for a diagnosis of Primordial cyst.
39
T/F. Primordial cyst can arise from any tooth in the dentition including (theoretically) supernumeraries.
True
40
Primordial cysts are usually detected as ___ radiolucencies in the area of a ___ tooth.
unilocular; missing
41
Some controversy exists, but the majority of primordial cysts have the microscopic features of ___ ___.
odontogenic keratocyst
42
Primordial cysts are treated with ___ and the prognosis is ___, although if the histology is that of an ___, the lesion will have the ___ recurrence rate of that lesion.
enucleation; good; OKC; increased
43
Odontogenic Keratocyst is a relatively ___ developmental odontogenic cyst that is ___ but more aggressive than other odontogenic cysts.
common; benign
44
What syndrome is OKC associated with?
nevoid basal cell carcinoma syndrome
45
With OKC, virtually no cases are seen under ___ yo unless the patient has the syndrome. The peak incidence is usually seen in the ___ decade.
10; 3rd
46
OKC prefers the what site?
mandible (2:1 ration over the maxilla)
47
With OKC, mandibular lesions usually develop in the ___ quadrants or the ___.
posterior; ramus.
48
With OKC, the ___ ___ is favored in patients after 70yo.
anterior maxilla
49
T/F. OKCs are typically asymptomatic and resemble primordial cyst, dentigerous cyst, residual cyst or lateral periodontal cyst.
True.
50
Up to ___% of OKCs present as ___ radiolucencies with well-demarcated margins and ___ sclerotic borders.
80; unilocular; thin
51
T/F. OKCs can hollow out the mandible without expansion.
True.
52
What percentage of OKCs exhibit the classic multilocular, expansile radiolucent appearance, which is probably related to the size of the lesion?
20%
53
With OKCs, what is noted at time of surgery?
cheesy material
54
What three histopathologically criteria are met for OKC?
1. uniformly thin epithelial lining - stratified squamous (8-10 cells thick)
2. corrugated surface layer of parakeratin
3. palisaded basal cell layer
55
With OKC, the CT wall is usually ___. If inflammation is present, this will markedly alter the histology of the ___.
uninflamed; epithelium
56
___ alters the appearance of the cyst lining with OKC.
Inflammation
57
How are OKCs treated?
treatment is controversial and depends on size
if small, enucleate in one piece
if larger, marsupialization followed by enucleation
58
The prognosis for OKC is guarded and recurrence rates range from ___-___%, but the average is approximately ___%.
3-62%; 30%
59
If they are going to recur, most OKCs do so within ___ years. Patients should be followed ___ for at least __ years post-surgery in order to detect potential recurrent lesions.
5; annually; 7
60
What is a complex hamartoneoplastic/malformation syndrome exhibiting over 100 different signs and symptoms related to the skin, CNS, and skeletal system?
Nevoid basal cell carcinoma syndrome
61
What condition can be seen if a pt has multiple OKCs arising at an early age?
Nevoid basal cell carcinoma syndrome
62
What are alternative names for Nevoid basal cell carcinoma syndrome?
Gorlin syndrome and Gorlin-Goltz syndrome (europe)
63
Nevoid basal cell carcinoma syndrome is an autosomal ___ disease of chromosome ___, with ___ ___ and extremely variable ___.
dominant; 9; complete penetrance; expressivity
64
In NBCC, ___% of cases are new mutation related to ___ gene.
40%; PTCH
65
What are the craniofacial features of NBCC?
1. enlarged occipitofrontal circumference (60cm or more in adults)
2. heavy brow ridges - frontal bossing
3. broad nasal root
4. mild ocular hypertelorism
66
What are the skin findings for NBCC?
BCCs
1. are multiple
2. occur in unexposed and exposed skin
3. develop earlier (puberty - 35yo)
4. show melanin pigmentation
5. quiescent, with few being aggressive
67
In NBCC, ___% have milia and multiple epidermal cysts and ___% have 1-2mm shallow pits of the palms and/or soles.
50%: 65%
68
___% of NBCC shows lamellar calcification of the ___ ___ and ___% have bifid, fused or hypoplastic ___.
85%; falx cerebri; 60%; ribs
69
In patients with NBCC, OKCs of the jaws develop in at least ___% of affected patients. This may begin in the 1st decade after age ___.
75%; 7
70
T/F. OKCs in NBCC syndrome can be single or multiple but the patient is more likely to have multiple.
True.
71
How is NBCC treated?
1. genetic counseling
2. remove OKCs as needed
3. remove basal cell Ca's as needed
4. use sunscreen and reduce sun exposure to decrease risk of basal cell CA
72
T/F. The prognosis of NBCC is guarded and usually BCCs are relatively small and not very aggressive, but this may be variable.
True.
73
When biopsying a newborns ___ ___ in gingival cyst of the newborn, numerous ___ structures appear to represent an enlarged version of the normal structures that arise from ___ ___ ___ (rest of Serres).
alveolar ridge; microcystic; dental lamina rests
74
What are other names for gingival cyst of the newborn?
dental lamina cyst and alveolar cyst of the newborn
75
Similar to gingival cyst of the newborn, if cysts are found on the ___ ___ it is called Epstein's pearls) or if they are found laterally along the ___ and ___ ___ they are known as Bohn's nodules.
What term encompasses all these lesions?
palatal raphe; hard and soft palate
palatal cyst of the newborn
76
Gingival cyst of the newborn presents a 1-2mm yellow-white ___ often multiple on the ___ ___ of the ___ in a newborn infant.
papules; alveolar ridge; maxilla
77
Gingival cyst of the newborn has a thin, uniform stratified squamous epithelial lining and the cyst lumen is packed with ___ debris.
keratin
78
How is gingival cyst of the newborn treated?
None, it will either self-marsupialize or involute/degenerate spontaneously.
79
Gingival cyst of the adult is related to ___ ___ cyst and it probably arises from the rests of ___ ___ (___) found in gingival CT.
lateral periodontal; dental lamina (Serres)
80
What gives rise to the gingival cyst of the adult?
cystic degeneration of the rests
81
T/F. Gingival cyst of the adult is usually found in men over 70 in the posterior segments of the jaw.
False, Gingival cyst of the adult has NO SEX predilection, found over 40 in the ANTERIOR segments of the jaw.
82
T/F. Gingival cyst of the adult is only found above the mucoginigival junction on the facial side.
False, it can be above or below the mucogingival junction. often on the facial but can be seen on the lingual as well
83
Gingival cyst of the adult presents as a ___-surfaced, ___ shaped elevation affecting the ___ gingiva that is usually ___cm in diameter and tense upon palpation.
smooth; dome; attached: 1cm
84
In early lesions, no color change is noted, but larger ones have a ___ or ___ quality.
bluish; translucent
85
T/F. In gingival cyst of the adult, the gingival CT contains a cystic cavity lined by thin, uniform layer of cuboidal or attenuated stratified squamous epithelium.
True.
86
What is the treatment and prognosis of gingival cyst of the adult?
tx: conservative excision
prognosis: excellent
87
What is a non-keratinized developmental cyst occurring adjacent or lateral to the root of a tooth, probably arising from rests of dental lamina (rests of Serres)?
lateral periodontal cyst
88
What does the majority of lateral periodontal cysts occur?
mandibular premolar area with a few developing in the maxillary lateral incisor region
89
Lateral periodontal cyst peaks in the ___th or ___th decades and presents as an ___ (symptomatic/asymptomatic) unilocular radiolucency on the ___ root surface of the tooth typically less than ___cm in diameter.
5; 6; asymptomatic; lateral; 1
90
Lateral periodontal cyst has a thin, uniform stratified squamous epithelium lining uninflamed fibrous CT that is identical microscopically to what condition?
gingival cyst of the adult
91
What is the treatment, prognosis and recurrence of lateral periodontal cyst?
tx: curettage
prognosis: excellent
recurrence: rare, but follow-up with radiographs
92
What is also known as a "Gorlin Cyst"?
Calcifying Odontogenic cyst
93
Calcigying Odontogenic cyst arises from where?
rests of dental lamina (rests of Serres)
94
T/F. Calcifying Odontogenic cysts are mostly found in the maxilla in the first decade.
False, it is equally found between the maxilla and mandible in the second or third decade (33yrs)
95
___% of calcifying odontogenic cysts are found in the incisor/canine region.
65%
96
Calcifying odontogenic cysts are usually ___ but from ___-___% have been reported in the gingival soft tissues and called "___".
intrabony; 13-21%; peripheral
97
With COC, there may be expansion of the ___ bone, a well-defined unilocular radiolucency but ___% may be multilocular and scattered radiopacities is seen in about ___% of cases.
alveolar; 10%; 50%
98
What percentage of COCs is associated with an impacted tooth? Odontoma?
30%
20%
99
T/F. Resorption and divergence of adjacent roots is often seen with COCs.
True.
100
Microscopically, COCs appear similar to odontogenic tumors and ameloblastomas and peripheral ___ cells and ___ ___-like areas are seen.
palisading; stellate reticulum
101
In COC, some of the lesional cells undergo a process termed "___ ___" when they change (keratinization?) and may calcify.
Describe these cells.
ghost cell
They are pale and eosinophilic with a swollen cytoplasm with loss of the nucleus that exhibits a faint "ghostly" remnant of a nuclear membrane outline.
102
How are COCs treated? What is the recurrence rate?
tx: enucleation with curretage
recurrence: not common, but does occur so follow-up recommended.
