1 Odontogenic Cysts Flashcards by Alexa Breaux

encountered commonly in dental practice

odontogenic cysts

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cause of odontogenic cysts

stimulation and proliferation of odontogenic epithelium, either inflammatory or developmental

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an epithelium-lined cavity, often fluid-filled

odontogenic cyst

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What happens when pressure builds up inside of the cyst?

resorption of surrounding bone or growth of the cyst

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inflammatory (2) vs developmental (7) odontogenic cysts

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

dentigerous cyst

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most common cyst of the jaws

periapical cyst

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

dentigerous cyst

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

dentigerous cyst

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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

dentigerous cyst

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most common location of dentigerous cysts

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

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

dentigerous cyst

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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

dentigerous cyst

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

dentigerous cyst

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Potential things that dentigerous cysts can cause:

displacement of the impacted tooth

- root resorption of adjacent teeth

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tx for dentigerous cyst

enucleate cyst along with tooth
marsupialization/decompression for large lesions
recurrence is rare

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

dentigerous cyst

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

dentigerous cyst

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Marsupialization vs decompression

Function?
Poor surgery candidates?
Difference between them
Negtive?

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

eruption cyst

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

eruption cyst

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most common teeth affected by eruption cyst

primary central incisors (MC)

- permanent first molars

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

eruption cyst

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Why are eruption cysts blue/purple in color?

surface trauma –> blood in cystic fluid

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

eruption cyst

history of OKC

- 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

3rd most common cyst of the jaws

OKC

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

OKC

NAME THAT CYST: wide age range

OKC

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

OKC

most common locations of OKC

posterior mandible and ramus

X-ray: - well defined radiolucency - unilocular or multilocular

OKC

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

OKC

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

anterior-posterior

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

OKC

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

periapical and dentigerous cyst

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

"primordial cyst"

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

"primordial cyst"

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

OKC

tx of OKC (small vs large)

If small: enucleation and curettage | If large: marsupialization/decompression followed by enucleation or resection

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

OKC

adjunctive techniques for tx of OKCs

- peripheral ostectomy | - chemical cautery (Carnoy's solution) --> somewhat controversial

recurrence rate of OKCs

30%

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

OKC

How long should OKC lesions be followed for?

at least 7-10 years post surgery to detect recurrences

multiple OKCs =

nevoid basal cell carcinoma

another name for nevoid basal cell carcinoma syndrome

Gorlin syndrome

genetics of nevoid basal cell carcinoma syndrome

- autosomal dominant - mutation of patched (PTCH1), a tumor suppressor gene - variable expression among family members

- begins developing during puberty | - sun-exposed AND non-sun-exposed areas

multiple basal cell carcinomas of the skin

most common location of basal cell carcinomas of the skin

mid-face

Why is nevoid basal cell carcinoma syndrome called "nevoid?"

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

clinical associations with nevoid basal cell carcinoma syndrome (5)

- 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)

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

hypertelorism

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

orthokeratinized odontogenic cyst

x-ray: radiolucency, usually unilocular

orthokeratinized odontogenic cyst

most common location of orthokeratinized odontogenic cyst

posterior jaws, mandible > maxilla

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

no palisading of the basal layer

recurrence is rare (2%) after enucleation/curettage

orthokeratinized odontogenic cyst

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

lateral periodontal cyst

source of odontogenic epithelium of lateral periodontal cyst

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

- asymptomatic, usually an incidental radiographic finding | - adults, rarely before age 30

lateral periodontal cyst

associated teeth are VITAL, helps distinguish from lateral radicular cyst

lateral periodontal cyst

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

mandibular premolar/canine area

X-ray: - well circumscribed radiolucency along the lateral aspect of a tooth root - unilocular (most)

lateral periodontal cyst

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

botryoid odontogenic cyst

tx of lateral periodontal cyst

biopsy, enucleation/curretage

Histo: - thin, nonkeratinized squamous epithelial lining - focal, nodular thickenings of the lining

lateral periodontal cyst

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

gingival cyst of the adult

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

gingival cyst of the newborn

gingival cysts of the newborn arise from?

remnants of the dental lamina

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

gingival cyst of the newborn

another name for calcifying odontogenic cyst (COC)

Gorlin cyst

most common location of COC (65%)

anterior jaws

maxilla = mandible

COC

can occur in association with odontogenic tumors, especially odontoma

COC

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

maxillary canine

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

COC

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

COC

tx of COC

enucleation and curettage

histology is characterized by "ghost cells" within the cystic epithelium

COC

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

ghost cells (associated with COC)

odontogenic origin, but cyst lining has glandular features

glandular odontogenic cyst

- 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)

glandular odontogenic cyst

Histo: - mucous cells, columnar ciliated cells - microcysts within the epithelial lining

glandular odontogenic cyst