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BDS4 SCR > Oral surgery and histopathology > Flashcards

Oral surgery and histopathology Flashcards

1
Q

What are the signss in head and neck cancer that require referral?

A
  • persistent lumps - more than 3 weeks
  • unexplained ulceration and swelling for more than 3 weeks
  • unexplained persistent hoarsness for more than 3 weeks
  • Pain in throat or swallowing for more than 3 weeks
  • difficulty chewing, speaking , tasting
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2
Q

What are the red flags of squamous cell carcinoma?§

A
  • non healing ulcers
  • non homogenous leukoplakia
  • erythroplakis
  • induration
  • tooth mobility (unexplained)
  • pathological fracture (unexplained)
  • Pathological fracture (unexplained)
  • Cervical lymphadenopathy
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3
Q

What are the symptoms of oral squamous cell carcinoma?

A
  • discomfort and pain
  • loss of sensation over the distribution of CNV
  • Difficulty eating, swallowing and speaking
  • loss of apetite, weight loss and fatigue
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4
Q

What do odontogenic cysts and tumours arise from?

A

tooth-forming epithelium and mesenchyme in the jaw bones during development

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5
Q

Most common odontogenic tumour?

A

Ameloblastoma

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6
Q

Epithlial lined odontogenic cysts?

A

radicular cyst
residual cyst
dentigerous cyst
eruption cyst
odontogenic keratocyst
lateral periodontal cyst
gingival cysts

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7
Q

Non odontogenic epithelial lined cysts

A
  • nasopalatine duct cyst
  • nasolabial cyst
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8
Q

What are some non epithelial lined jaw cysts?

A
  • solitary bone cyst
  • aneurysmal bone cyst
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9
Q

Cyst definition

A

A pathological cavity which can be filled with fluid, semi-fluid or gaseous contents that has not been created by the accumulation of pus

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10
Q

Location of a radicular cyst

A
  • associated with a non-vital tooth
  • peri-apical region
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11
Q

Clinical features of a radicular cyst?

A
  • most common jaw cyst
  • often symptomless
    -incidental finding
  • slowly expanding
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12
Q

Histopathology of radicular cyst

A
  • thick inflamed fibrous capsule
  • non keratinised squamous epithelial lining
  • cholestrol nodules present
  • rushton’s bodies
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13
Q

Location of a residual cyst

A

At site of previously extracted mandibular tooth (most common in mandibular premolar area)

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14
Q

Clinical features of a residual cyst

A
  • slowly enlarging swelling
  • symptomless
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15
Q

Histopathology of a residual cyst

A
  • Thick fibrous capsule
    non keratinised squamous epithelial lining
  • Cholestrol nodules
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16
Q

Discuss the location of a dentigerous cyst

A

Associated with a non erupted tooth

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17
Q

Discuss the clinical features of a dentigerous cyst

A
  • develop around crowns of unerupted teeth
  • may displace tooth
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18
Q

Histopathology of a dentigerous cyst

A
  • Capsule resembles dental follicle
  • myxoid (mucous substance) areas and odontogenic rests
  • lined by reduced enamel epithelium
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19
Q

Discuss the location of a odontogenic keratocyst

A
  • angle of mandible
  • posterior maxilla
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20
Q

Clinical features of a odontogenic keratocyst

A
  • multilocular radiolucency
  • expands through medullary bone
  • minimal cortical expansion
  • can recurr
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21
Q

Histopathology of a odotogenic keratocyst

A
  • Thin fibrous capsule
    lined by parakeratotic squamous epithelium
  • basal cell palisade
  • satellite cysts
  • occurs commonly in basal cell nevus syndrome
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22
Q

What syndrome are multiple odontogenic keratocysts associated with?

A

basal cell nevus syndrome (gorlin-goltz syndrome)

23
Q

Discuss the location of a nasopalatine duct cyst

A

Floor of nose to incisive papilla

24
Q

Discuss the clinical features of a nasopalatine duct cyst

A
  • swelling
  • displacement of central incisors
  • salty taste
  • radiolucency>6mm
  • vital adjacent teeth
25
Q

Discuss the histopathology of a nasopalatine duct cyst

A
  • Fibrous capsule
  • lined by respiratory or simple squamous cell
26
Q

Where does the epithelial lining of odontogenic cysts originate from?

A
  • epithelial rests of serres
  • reduced enamel epithelium
  • epithelial rests of malassez
27
Q

What are epithelial rests of serres and what cysts do they give rise to?

A
  • remnants of dental lamina
  • odontogenic keratocyst
  • lateral periodontal cyst
  • gingival cyst
28
Q

What is reduced enamel epithelium and what cysts does it give rise to?

A
  • derived from enamel organ and covers the fully formed crown of unerupted tooth
  • dentigerous cysts
  • paradental cysts
29
Q

What are epithelial rests of malassez and what cysts do they give rise to?

A
  • from fragmentation of herwig’s epithelial root sheath
  • Radicular cyst
30
Q

Most common type of jaw cyst

A

Radicular

31
Q

How does the expansion of a cyst present clinically?

A

Egg shell cracking on palpation due to thinning of bone cortex

32
Q

How does a radicular cyst present radiographically

A

Round or ovoid radiolucency at the root apex - corticated margins continuous with lamina dura of tooth

33
Q

What is the pathogenesis of radicular cysts?

A

Proliferation of the epithelial rests of malassez within chronic periapical granulomas due to necrotic pulp

34
Q

Discuss the contents of a radicular cyst if it were to be aspirated

A
  • Watery straw coloured fluid
    OR
  • semi solid brownish material
    This may contain:
  • breakdown products of degenerating epithelial and inflammatory cells and connective tissue components
  • Serum proteins
  • water and electrolytes
  • cholestrol crystals
35
Q

Radiographic findings of a dentigerous cyst

A

well defined , unilocular radiolucency associated with the crown of an unerupted tooth
- the tooth may be displaced

36
Q

Describe the histopathological findings of a dentigerous cyst?

A
  • lined by non-keratinised stratified squamous or cuboidal epithelium
  • resembles reduced enamel epithelium
  • fibrous capsule containing loose myxoid areas resembling dental follicle
37
Q

Findings of dentigerous cyst if you will aspirate it?

A
  • proteinaceous, yellow fluid
  • chlestrol crystals are common
38
Q

How common are odontogenic keratocysts?

A

5-10% of jaw cysts

39
Q

When is the peak age/incidence of development of an odontogenic keratocyst?

A

2nd to 3rd decade

40
Q

Where is the most common site for development of an odontogenic keratocyst

A

mandible in the third molar region

41
Q

Why do patients with odontogenic keratocyst tend to present so late?

A

Because the symptoms associated with these cysts are very few

42
Q

How do odontogenic keratocysts appear radiographically?

A

They are commonly multilocular

43
Q

How is gorlin-goltz syndrome inherited?

A

autosomal dominant trait

44
Q

What is the important feature of odontogenic keratocyst?

A

it has high recurrance rate

45
Q

Discuss the growth pattern of the odontogenic keratocyst

A

destructive pattern of growth ( moves through cancellous bone in an AP direction)

46
Q

What is the aetiology of the nasopalatine duct cyst?

A

Arises from epithelial remnants of the nasopalatine duct that connects the oral and nasal cavities

47
Q

What are the clinical features of a nasopalatine duct cyst?

A

Present as a slowly enlarging swelling in anterior midline of palate (discharge may cause salty taste)

48
Q

Discuss the radiographic findings of a nasopalatine duct cyst

A

Well defined round/ovoid/heart shaped radiolucencies with corticated margins

49
Q

Discuss the histopathological findings of a nasopalatine duct cyst

A

It is a combination of
- stratified squamous
- pseudostratified ciliated columnar
- cuboidal and columnar epithelium
with connective tissue capsule

50
Q

What provisional diagnoses might be associated with nasopalatine duct cyst?

A
  • nasolabial cyst
  • median palatal cyst
51
Q

What type of cyst presents on a radiograph as “scalloping around & between the roots of standing teeth, most frequently in the premolar/molar regions” and it has clear/blood stained fluid on aspiration:

A

solitary bone cyst

52
Q

Do solitary bone cysts have an epithelial lining?

A

No (non-odontogenic cyst)

53
Q

What is staphne cavity?

A

Idiopathic developmental bone cavity located on mandible
- round, well demacated radiolucency between premolar region and angle of jaw
- usually below IAN canal

BDS4 SCR (22 decks)

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