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oral path 2 > 4 - odontogenic infections > Flashcards

4 - odontogenic infections Flashcards

1
Q

odontogenic cysts

can occur singly or can be associated with nevoid basal cell carcinoma syndrome (NBCCS)
may mimic a primordial cyst, dentigerous cyst, residual cyst or lateral periodontal cyst

A

developmental cyst

odontogentic keratocyst

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2
Q

Odontogenic keratocyst (developmental)

common/uncommon
benign/malignant
symph/asymph

A

relatively common

benign - but more aggressive compared to other odontogenic cysts

usually asymptomatic

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3
Q

developmental cysts - odontogenic cysts

peak incidence 3rd decade - slight declining incidence in subsequent decades

anterior maxilla favored after 70 years old

no cases under 10 year olf unless patient has syndrome

A

OKC - odontogenic keratocyst

developmental

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4
Q

mandible 2:1

cheesey material usually noted at time of surgery

A

odontogenic keratocyst

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5
Q

odontogenic keratocyst most common to least common locations

A 
49% - posterior mandible 
20% - posterior maxilla 
13% - anterior maxilla (70)
9% - anterior mandible 
7% - premolar mandi
2% - premolar maxilla

2:1 mandible

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6
Q

radiographic features

majority (80%) unilocular radiolucences with well-demarcated margins and a thin sclerotic border

can hollow-out mandi without expansion, however can be expansile and symptomatic
only 20% exhibit multiocular appearance

A

OKC - odontogenic keratocyst

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7
Q

histopathologic features

uniformly thin epithelial lining of stratified squamous epithelium 8-10 cells thick

corrugated parakeratin surface

palisaded basal cell layer

A

devlopmental odontogetic keratocyst

need these 3 histo features

CT wall usually not inflammed - if inflammation is present - history of epi markedly altered

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8
Q

tx for odontogenic keratocyst

A

controversial and depends on size of lesion
smaller - enucleate in one piece
larger - marsupialization followed by enucleation

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9
Q

odontogenic keratocyst Px and recurrence

A

guarded px

3-62% recurrence
average - 30% recurrence

most recurrences within 5 years and follow annually at least 7years

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10
Q

a complex hamartoneoplastic/malformation syndrome exhibiting over 100 different signs and symptoms related to the skin, CNS and skeletal system

A

Nevoid basal cell carcinoma syndrome

NBCCS - nevoid basal cell carcinoma syndrome
multiple basal cell carcinomas and odontogenic keratocysts arising at an early age

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11
Q

Gorlin and Goltz published a paper that brought attention to the condition
condition known as Gorlin syndrome or Gorlin-Goltz syndrome (Europe)
Autosomal Dominant, chromosome 9, with complete penetrance and extremely variable expressivity

A

Nevoid basal cell carcinoma syndrome

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12
Q

40% of cases are new mutations related to PTCH gene
500+ cases reported
OKCs of the jaws develop in at least 75% of affected patients (may begin in 1st decade, affter age 7)(may be single or multiple - more likely to have syndrome if multiple)

A

nevoid basal cell carcinoma syndrome

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13
Q

enlarged occipitofrontal circumference (60cm or more in adults)
heavy brows ridges - frontal bossing
broad nasal root
mild ocular hypertelorism (wide-set)

skin - milia and multiple epidermal cysts 50%
1-2mm shallow pits of the palms and/or soles 65%

A

Nevoid basal cell carcinoma carcinoma syndrome

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14
Q

basal cell carcinomas that

  • are multiple
  • occur in unexposed, as well as exposed skin
  • develop at an earlier age (puberty- 35 years)
  • often show melanin pigmentation
  • are usually quiescent, with a few being aggressive
A

nevoid basal cell carcinoma syndrome

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15
Q

radiographic features

lamellar calcification of the falx cerebri 85%

bifid, fused or hypoplastic ribs 60%

multiple OKCs maxilla, mandible or both

A

nevoid basal cell carcinoma syndrome

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16
Q

tx for nevoid basal cell carcinoma

A

genetic counseling
remove OKCs as needed
remove BCCs as needed
sunscreen and reduce sun exposure to decrease risk of BCC

17
Q

Px or Nevoid basal cell carcinoma syndrome

A

guarded

usually the basal cell carcinomas are small and not very aggressive, but this is variable

Gorlin sign - if you can lick tip of nose

18
Q

developmental cyst

“dental lamina cyst”
biopsy of normal newborn alveolar ridge shows numerous microcystic structures that arise from dental lamina rests (rests of Serres)

A

gingival cyst of the newborn

19
Q

developemental cyst

similar cysts found on palatal raphe (epstein’s pearls) or laterally along hard/sot palate(Bohn’s nodules)
palatal cyst of the newborn is terminology encompassing all these lesions

A

gingival cyst of the newborn

20
Q

1-2mm yellow-white papules
often multiple, on alverolar ridge of newborn
usually maxillary

A

gingival cyst of the newborn

similar cysts found on palatal raphe (epstein’s pearls)

or laterally along hard/sot palate(Bohn’s nodules

21
Q

developmental cysts - gingival cyst of the newborn

tx

Px

A

tx - none - self-marsuplialize or involute/degenerate spontaneously

Px - excellent, rarely found after 3 months

22
Q

developmental cyst
related to the lateral periodontal cyst, this lesion robably arises from the rests of fental lamina (serres) found in the gingiva CT

cystic degeneration fo the rests give rise to thigne gingival cyst

A

gingival cyst of the adult

no gender predilection 
adult over 40
anterior segments of jaws 
above or below MGJ
usually facial. sometime lingual
23
Q

gingival cyst of the adult

male/female
young/old
anterior/posterior jaw
facial/lingual

A 
no gender predilection 
adult over 40
anterior segments of jaws 
above or below MGJ
usually facial. sometime lingual
24
Q

smooth-surfaced, dome shape
usually less than 1cm
feels tense to palpation
asymptomatic
no color change with early lesions
bluish or translucent with larger lesions
anterior segments of jaw usually, facial over lingual

radiographic - minimal, if any, radiolucent change: cyst is within the CT

A

gingival cyst of the adult

25
Q

histopathologic features

cyst lined by thin, uniform layer of cuboidal or attenuated (thinned) stratified squamous epithelium within the CT
may see localized nodular thickening

cystic degeneration of rests of Serres

A

gingival cyst of the adult

26
Q

gingival cyst of the adult

tx or px

A

tx - converative excision

px - excellent

27
Q

developemental cysts
non-keratinized developmental cyst occurring adjacent or lateral to the root of a tooth, probably arising from rests of dental lamina (rests of serres)
usually found incidentally on radiograph
5-7th decade
asymptomatic
always vitality test

A

lateral periodontal cyst

28
Q

radiographic features

mandibular premolar/canine/lateral incisor area most common
similar areas of maxilla
radiolucent, usually unilocular but can apear multi
usualy less than 1 cm diameter

A

lateral periodontal cyst

29
Q

histopathological features

cyst lined by thin, uniform stratified squamous epi within fibrous CT

identical appearance to gingival cyst of the adult

A

lateral periodontal cyst

30
Q

lateral periodontal cyst

tx and px

A

tx - curettage

excellent - rarely recurs but requires periodontic radiographic follow-up

31
Q

developemental cyst

probably arise from rests of dental lamina (rest of serres)

equal distribution between maxilla and mandible
any age, peak 2-4
decade ~30 year old

65% incisor-canine regin

A

calcifying odontoggenic cyst (Gorlin cyst)

32
Q

Calcifying odontogenic cyst - Gorlin cyst

most common locations

A 
38% - anterior maxilla
27 - anterior mandible 
12- maxilla premolar
11- posterior mandi
10-mandi PM
2-posterior maxilla
33
Q

developmental cysts
usually intrabony
13-21% have been reported in gingival soft tissue “peripheral calcifying odonotgenic cyst”
may expand alveolar bone

A

Calcifying odontogenic cyst - Gorlin cyst

34
Q

radiographic features

well-defined unilocular radiolucency
10% multiocular
resorption and divergence of adjacent roots often seen

scattered radiopacities in ~50% cases
assoicated with impacted tooth 30% of cases
assoicated with odontoma 20% of cases

A

odontogenic cysts - calcifying odontogenic cyst Gorlin cyst

tooth test vital

35
Q

histopathological features

peripheral palisading cells and stellate reticulum-like areas
similar to the odontogenic tumor ameloblastoma

some lesional cells undergo “ghost cell” change then may calcify

A

calcifying odontogenic cyst

ghost cells are pale eosinophilic, with swollen cytoplasm, loss of the nucleus that exhibits a faint ghostly remnant of a nuclear membrane outline

36
Q

tx and px of calcifying odontogenic cyst

A

tx - enucleation with curettage

px - good
recurrence not common but occurs, requires periodoic radiogrpahic follow up

oral path 2 (7 decks)

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