Odontogenic Cysts and tumors- Dr. Flores Flashcards Preview

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Flashcards in Odontogenic Cysts and tumors- Dr. Flores Deck (48)
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1

Ectomesenchyme

  • derived from Neural Crest cells
  • Dentin, Cementum, and Pulp

2

Epithelium-Ectomesenchyme interaction in tooth development

  • Ectomesenchyme is derived from neural crest cells
  • Oral ectoderm & ectomesenchyme interact to start Tooth development 
    • epithelium and ectomesenchyme interact to form tooth

3

Epithelium

Enamel

4

What are the 2 prominent structures of odontogenic epithelium

Rests of Serres

Rests of Malassez

5

Characterize the rests of serres

  • rests of dental lamina found in gingival soft tissues
  • round to ovoid aggregates of epithelial cells
    • clear cytoplasm (Glycogen rich)
  • result from early breakup of dental lamina during bell stage

6

Characterize the rests of malassez

  • result from breakup of Hertwig's root sheath during root formation

7

What is a cyst

  • pathologic cavity
  • lined by epithelium 
  • filled with fluid or keratin

8

What do cysts and tumors share in common

  • occupy space and may displace or replace normal tissues
  • Resorb adjacent teeth or push teeth out of their normal alignment
  • Cause expansion of the bone, usually painless
  • compress nerves and cause numbness
  • tooth vitality unaffected
    • cysts do not interrupt blood supply to teeth
    • most tumors
  • some cysts and tumors are radiographically similar

9

what are the differences between tumors and cysts

  • cysts 
    • central lumen
  • Tumors
    • solid growth 

10

characterize the etiology/development of cysts

  • inflammatory:
    • Periapical (radicular) cyst
    • Residual periapical (radicular) cyst
    • Buccal bifurcation cyst
    • paradental cyst
  • Developmental
    • Dentigerous cyst
    • Primordial cyst
    • Odontogenic Keratocst (keratocystic odontogenic tumor)
    • Orthokeratinized odontogenic cyst
    • Gingival (alveolar) cyst of the newborn
    • Gingival cyst of the adult
    • lateral periodontal cyst
    • Glandular odontogenic cyst

11

Characterize the etiology/development of tumors

  • Tumors of odontogenic epithelium
    • Ameloblastoma
      • malignant amelobalstoma 
      • ameloblastic carcinoma
    • Clear cell odontogenic carcinoma
    • Adenomatoid odontogenic tumor
    • Calcifying epithelial odontogenic tumor
    • Squamous odontogenic tumor
  • Mixed Odontogenic tumors
    • Ameloblastic fibroma
    • Ameloblastic fibrosarcoma
    • Ameloblastic fibro-odontoma
    • Odontoameloblastoma
    • Compound odontoma
    • Complex odontoma
    • Calcifying cystic odontogenic tumor/dentinogenic ghost cell tumor
    • Ghost cell odontogenic carcinoma
  • Tumors of odontogenic ectomesenchyme
    • Odonotogenic fibroma
    • Central granular cell odontogenic tumor
    • Odontogenic myxoma 

12

What tumors and cysts arise from Rests of Malassez:

  • Origin: Hertwig's Root sheath
  • Radicular cyst
  • Ameloblastoma
  • Squamous Odontogenic Tumor

13

What tumors and cysts arise from Reduced Enamel Epithelium:

  • Paradental Cyst
  • Calcifying Odontogenic Cyst
  • Dentigerous Cyst
  • Eruption Cyst
  • Ameloblastoma

14

What tumors and cysts arise from Rest of Serres

  • Origin: Dental lamina in gingiva
  • Odontogenic Keratocyst
  • Lateral periodontal Cyst
  • Gingival Cyst
  • Glandular Odontogenic cyst
  • Ameloblastoma
  • Squamous odontogenic Tumor
  • Calcifying Epithelial Odontogenic tumor
  • Adenomatoid Odontogenic Tumor

15

What is the etiology of Odontogenic Cysts

inflammatory

Development

16

Periapical Cyst (Radicular Cyst)

  • from Rests of Malassez
  • Related to inflammation
  • Empty cyst cavity w/epithelial lining

17

Residual Cyst

  • appears after tooth extraction

18

Buccal Bifurcation Cyst

  • Develops on buccal aspect of mandibular 1st perm molar
  • occurs in 5-13 y.o.
  • Clinical swelling and foul-tasting discharge
  • Radigraphically
    • root apices of molar tipped toward lingual mandibular cortex
  • associated with proliferative periostitis

19

Paradental Cyst

  • Distal or buccal of partially erupted tooth w/history of pericoronitis
  • confused w/lateral dentigerous cyst

20

Dentigerous Cysts

  • Aka Follicular Cyst
  • radiolucency surrounding the crown of an impacted tooth, attached to tooth at CEJ
  • Mandibular & Maxillary 3rd molars
  • Histology
    • mucous, ciliated, and sebaceous elements
  • Tx:
    • enucleation
    • marxupialization

21

What are the 3 things you can get in a Dentigerous cell wall?

  • Squamous Cell Carcinoma
  • Intraosseous Mucoepidermoid carcinoma
  • Ameloblastoma

22

Eruption Cyst

  • Aka Eruption Hematoma
  • soft tissue analog of dentigerous cyst (follicular Cyst)
  • Develops as a result from:
    • separation of dental follicle from crown of erupting tooth 
      • within soft tissue
      • overlyalveolar bone
  • Appears as soft translucent swelling in gingival mucosa over crown of erupting tooth

23

Odontogenic Keratocyst

  • Aka Keratocystic Odontogenic Tumor
  • Common Developmental Odontogenic cysts
  • Locally aggressive potential 
  • high recurrence rate
  • PTCH gene mutation
    • associated with:
      •  NBCCS or Gorlin syndrome
      • sporadic OKCs
  • ⅔ of cases occur in mandible
    • molar/ramus region

23

Odontogenic Keratocyst: histology

  • Uniform layer of stratified squamous epithelium
    • 6-8 layers thick
  • Basal Epithelial layer composed of:
    • cuboidal to columnar cells
      • palisaded and hyperchromatic
  • Corrugated (wavy) layer of parakeratin

24

Odontogenic Keratocyst: Treatment

  • Surgical Enucleation
    • Peripheral osteotomy w/bone bur to reduce chance of recurrence
    • Use Carnoy's solution
  • Good Prognosis
    • 25%-305 Recur

25

Nevoid Basal Cell Carcinoma

  • aka Gorlin Syndrome
  • Autosomal Dominant
  • PTCH Gene mutation
  • Clinical:
    • multiple OKCs (Odontogenic Keratocysts)
    • Multi basal cell carcinomas
    • Bifid ribs
    • calcified fall cerebri
    • Palmar pits
    • Epidermal cysts on skin
    • Hypertolerism
    • Spina Bifida

26

What is a Primordial Cyst

  • odontogenic cyst that appears to grow
  • no associated with impacted teeth

27

Orthokeratinized Odontogenic Cyst

  • 66%-90% occur in mandible
  • lesion shows predilection for posterior of both jaws
  • 2:1 males
  • ⅔ of cases w/impacted teeth
    • resemble dentigerous cyst radiographically
  • 2% recur

28

Gingival Cyst of Newborn

  • Bohn's Nodules
  • Epstein Pearls

29

Lateral Periodontal Cyst

  • Can occur partially within bone and partially in soft tissue
    • in bone b/w roots of teeth
  • ⅔ cases- canine/premolar of mandible
    • same for maxillary
  • Painless expansion of alveolar bone
  • if polycystic=Botryoid odontogenic cyst