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Oral Pathology Exam 2 > 1 Odontogenic Cysts > Flashcards

1 Odontogenic Cysts Flashcards

1
Q

encountered commonly in dental practice

A

odontogenic cysts

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2
Q

cause of odontogenic cysts

A

stimulation and proliferation of odontogenic epithelium, either inflammatory or developmental

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3
Q

an epithelium-lined cavity, often fluid-filled

A

odontogenic cyst

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4
Q

What happens when pressure builds up inside of the cyst?

A

resorption of surrounding bone or growth of the cyst

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5
Q

inflammatory (2) vs developmental (7) odontogenic cysts

A

Inflammatory: periapical (radicular) cyst, residual cyst

Developmental: dentigerous cyst, OKC, orthokeratinized odontogenic cyst, lateral periodontal cyst, gingival (alveolar) cyst of the newborn, calcifying odontogenic cyst, glandular odontogenic cyst

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6
Q

most common developmental odontogenic cyst, 2nd most common cyst of the jaws

A

dentigerous cyst

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7
Q

most common cyst of the jaws

A

periapical cyst

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8
Q

NAME THAT CYST: ONLY occurs with unerupted (impacted) teeth

A

dentigerous cyst

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9
Q

NAME THAT CYST: classic presentation = cyst lining attaches to tooth at the CEJ and encircles the crown

A

dentigerous cyst

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10
Q

NAME THAT CYST: accumulation of fluid causes separation of the follicle (REE) from the crown, some extend further down the tooth root or more laterally

A

dentigerous cyst

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11
Q

most common location of dentigerous cysts

A

mandibular 3rd molars (65%), then maxillary canines, maxillary 3rd molars, mandibular 2nd PMs

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12
Q

NAME THAT CYST: wide age range, but most often diagnosed between 10-30 yo

A

dentigerous cyst

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13
Q

NAME THAT CYST: depending on size, may be asymptomatic (incidental radiographic finding) or cause painless expansion of the bone in the area, can become very large in size

A

dentigerous cyst

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14
Q

NAME THAT CYST: unilocular radiolucency associated with the crown of an unerupted tooth, well-defined, corticated

A

dentigerous cyst

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15
Q

Potential things that dentigerous cysts can cause:

A
  • displacement of the impacted tooth

- root resorption of adjacent teeth

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16
Q

tx for dentigerous cyst

A
  • enucleate cyst along with tooth
  • marsupialization/decompression for large lesions
  • recurrence is rare
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17
Q

NAME THAT CYST: small risk for malignant transformation of the cyst lining if not treated

A

dentigerous cyst

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18
Q

NAME THAT CYST (histo): non-keratinized stratified squamous epithelium lining, fibrous CT wall, may see secondary inflammation

A

dentigerous cyst

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19
Q

Marsupialization vs decompression

  • Function?
  • Poor surgery candidates?
  • Difference between them
  • Negtive?
A

When the cyst is exposed to the oral cavity, there is a reduction in osmotic pressure –> slow decrease in size so it can be removed later when a less extensive surgery (preserve bone, teeth, and vital structures.

Large lesions and kids are poor surgery candidates.

Marsupialization- cyst lining directly sutured to oral mucosa
Decompression- drainage tube place

Both require extensive patient/family compliance.

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20
Q

NAME THAT CYST: soft tissue counterpart of a dentigerous cyst, soft swelling of the gingiva

A

eruption cyst

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21
Q

NAME THAT CYST: separation of follicle from the crown of an erupting tooth (primary or permanent)

A

eruption cyst

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22
Q

most common teeth affected by eruption cyst

A
  • primary central incisors (MC)

- permanent first molars

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23
Q

NAME THAT CYST: translucent to blue/purple in color, surface trauma –> blood in cystic fluid

A

eruption cyst

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24
Q

Why are eruption cysts blue/purple in color?

A

surface trauma –> blood in cystic fluid

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25
Q

NAME THAT CYST: usually ruptures spontaneously, allowing tooth to erupt

A

eruption cyst

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26
Q

history of OKC

A
  • recently was called keratocystic odontogenic tumor
  • classified as a cystic neoplasm by the WHO in 2005
  • now reclassified back to a developmental cysr in 2017
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27
Q

3rd most common cyst of the jaws

A

OKC

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28
Q

NAME THAT CYST: different biologic behavior and growth mechanism than dentigerous cyst, arises from rests of dental lamina

A

OKC

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29
Q

NAME THAT CYST: wide age range

A

OKC

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30
Q

NAME THAT CYST: can occur anywhere, but posterior mandible and ramus are most common

A

OKC

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31
Q

most common locations of OKC

A

posterior mandible and ramus

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32
Q

X-ray:

  • well defined radiolucency
  • unilocular or multilocular
A

OKC

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33
Q

25-40% of these cysts are associated with an impacted tooth

A

OKC

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34
Q

OKCs tend to grow in what direction within the medullary bone?

A

anterior-posterior

35
Q

NAME THAT CYST: can become very large without any expansion, but can still be expansile!

A

OKC

36
Q

Which tends to cause more significant bone expansion? periapical and dentigerous cyst or OKC (of similar size)

A

periapical and dentigerous cyst

37
Q

term used for a cyst that occurs in place of a tooth (tooth never developed)

A

“primordial cyst”

38
Q

NOT an actual diagnosis, most of these are OKCs when biopsied

A

“primordial cyst”

39
Q

Histo:

  • thin, uniform epithelial lining (6-8 cell layers thick)
  • production of corrugated/wavy parakeratin
  • palisaded basal cell layer
  • no rete ridges
A

OKC

40
Q

tx of OKC (small vs large)

A

If small: enucleation and curettage

If large: marsupialization/decompression followed by enucleation or resection

41
Q

complete removal of this is difficult due to thin, friable lining

A

OKC

42
Q

adjunctive techniques for tx of OKCs

A
  • peripheral ostectomy

- chemical cautery (Carnoy’s solution) –> somewhat controversial

43
Q

recurrence rate of OKCs

A

30%

44
Q

most recur within first 5 years, so long-term radiographic follow-up necessary

A

OKC

45
Q

How long should OKC lesions be followed for?

A

at least 7-10 years post surgery to detect recurrences

46
Q

multiple OKCs =

A

nevoid basal cell carcinoma

47
Q

another name for nevoid basal cell carcinoma syndrome

A

Gorlin syndrome

48
Q

genetics of nevoid basal cell carcinoma syndrome

A
  • autosomal dominant
  • mutation of patched (PTCH1), a tumor suppressor gene
  • variable expression among family members
49
Q
  • begins developing during puberty

- sun-exposed AND non-sun-exposed areas

A

multiple basal cell carcinomas of the skin

50
Q

most common location of basal cell carcinomas of the skin

A

mid-face

51
Q

Why is nevoid basal cell carcinoma syndrome called “nevoid?”

A

because many behave less aggressively (more like a nevus) than traditional basal cell carcinomas

52
Q

clinical associations with nevoid basal cell carcinoma syndrome (5)

A
  • palmar/plantar pitting
  • bifid ribs
  • calcified falx cerebri (fold of dura that divides the brain into R and L sides)
  • epidermoid cysts of the skin
  • enlarged head cuircumference (frontal bossing, hypertelorism)
53
Q

increased space between the eyes, associated with nevoid basal cell carcinoma syndrome

A

hypertelorism

54
Q

NOT a variant of OKC, 2/3 of cases surround the crown of an impacted tooth (usually third molars)

A

orthokeratinized odontogenic cyst

55
Q

x-ray: radiolucency, usually unilocular

A

orthokeratinized odontogenic cyst

56
Q

most common location of orthokeratinized odontogenic cyst

A

posterior jaws, mandible > maxilla

57
Q

In orthokeratinized odontogenic cyst, the cyst lining produces orthokeratin. What does this mean?

A

no palisading of the basal layer

58
Q

recurrence is rare (2%) after enucleation/curettage

A

orthokeratinized odontogenic cyst

59
Q

a developmental odontogenic cyst that occurs along the lateral root surface of an erupted tooth

A

lateral periodontal cyst

60
Q

source of odontogenic epithelium of lateral periodontal cyst

A

not certain –> dental lamina, REE, rests of Malassez

61
Q
  • asymptomatic, usually an incidental radiographic finding

- adults, rarely before age 30

A

lateral periodontal cyst

62
Q

associated teeth are VITAL, helps distinguish from lateral radicular cyst

A

lateral periodontal cyst

63
Q

most common teeth associated with lateral periodontal cyst (75-80%)

A

mandibular premolar/canine area

64
Q

X-ray:

  • well circumscribed radiolucency along the lateral aspect of a tooth root
  • unilocular (most)
A

lateral periodontal cyst

65
Q

multilocular appearance can se seen with a variant of lateral periodontal cyst called _______

A

botryoid odontogenic cyst

66
Q

tx of lateral periodontal cyst

A

biopsy, enucleation/curretage

67
Q

Histo:

  • thin, nonkeratinized squamous epithelial lining
  • focal, nodular thickenings of the lining
A

lateral periodontal cyst

68
Q

soft tissue counterpart of lateral periodontal cyst, blue/translucent, fluid-filled

A

gingival cyst of the adult

69
Q
  • tiny, superficial, keratin-filled cysts
  • 2-3 mm in diameter
  • usually multiple
  • alveolar ridge
  • yellow/white, round
A

gingival cyst of the newborn

70
Q

gingival cysts of the newborn arise from?

A

remnants of the dental lamina

71
Q

50% of newborns but seldom noticed, rupture and disappear spontaneously, rarely seen after 3 months of age

A

gingival cyst of the newborn

72
Q

another name for calcifying odontogenic cyst (COC)

A

Gorlin cyst

73
Q

most common location of COC (65%)

A

anterior jaws

74
Q

maxilla = mandible

A

COC

75
Q

can occur in association with odontogenic tumors, especially odontoma

A

COC

76
Q

1/3 of COCs are associated with an impacted tooth, but which tooth is most common?

A

maxillary canine

77
Q

X-ray:

  • well-defined radiolucency
  • usually unilocular
  • up to 1/2 have irregular calcifications within
  • may cause divergence of teeth, root resorption
  • 1/3 are associated with an impacted tooth (maxillar
A

COC

78
Q

about 10% are peripheral (extraosseous, develop on the gingiva)

A

COC

79
Q

tx of COC

A

enucleation and curettage

80
Q

histology is characterized by “ghost cells” within the cystic epithelium

A

COC

81
Q

altered epithelial cells that have retained their outline but lost their nucleus, may become calcified

A

ghost cells (associated with COC)

82
Q

odontogenic origin, but cyst lining has glandular features

A

glandular odontogenic cyst

83
Q
  • adults
  • mandible (75%)
  • predilection of anterior jaws
  • unilocular or multilocular
  • 30% recurrence rate after enulceation/curettage (follow like OKC, some recommend more aggressive tx, resection, for multilocular lesions)
A

glandular odontogenic cyst

84
Q

Histo:

  • mucous cells, columnar ciliated cells
  • microcysts within the epithelial lining
A

glandular odontogenic cyst

Oral Pathology Exam 2 (8 decks)

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