4 - odontogenic infections Flashcards
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
developmental cyst
odontogentic keratocyst
Odontogenic keratocyst (developmental)
common/uncommon
benign/malignant
symph/asymph
relatively common
benign - but more aggressive compared to other odontogenic cysts
usually asymptomatic
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
OKC - odontogenic keratocyst
developmental
mandible 2:1
cheesey material usually noted at time of surgery
odontogenic keratocyst
odontogenic keratocyst most common to least common locations
49% - posterior mandible 20% - posterior maxilla 13% - anterior maxilla (70) 9% - anterior mandible 7% - premolar mandi 2% - premolar maxilla
2:1 mandible
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
OKC - odontogenic keratocyst
histopathologic features
uniformly thin epithelial lining of stratified squamous epithelium 8-10 cells thick
corrugated parakeratin surface
palisaded basal cell layer
devlopmental odontogetic keratocyst
need these 3 histo features
CT wall usually not inflammed - if inflammation is present - history of epi markedly altered
tx for odontogenic keratocyst
controversial and depends on size of lesion
smaller - enucleate in one piece
larger - marsupialization followed by enucleation
odontogenic keratocyst Px and recurrence
guarded px
3-62% recurrence
average - 30% recurrence
most recurrences within 5 years and follow annually at least 7years
a complex hamartoneoplastic/malformation syndrome exhibiting over 100 different signs and symptoms related to the skin, CNS and skeletal system
Nevoid basal cell carcinoma syndrome
NBCCS - nevoid basal cell carcinoma syndrome
multiple basal cell carcinomas and odontogenic keratocysts arising at an early age
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
Nevoid basal cell carcinoma syndrome
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)
nevoid basal cell carcinoma syndrome
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%
Nevoid basal cell carcinoma carcinoma syndrome
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
nevoid basal cell carcinoma syndrome
radiographic features
lamellar calcification of the falx cerebri 85%
bifid, fused or hypoplastic ribs 60%
multiple OKCs maxilla, mandible or both
nevoid basal cell carcinoma syndrome
tx for nevoid basal cell carcinoma
genetic counseling
remove OKCs as needed
remove BCCs as needed
sunscreen and reduce sun exposure to decrease risk of BCC
Px or Nevoid basal cell carcinoma syndrome
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
developmental cyst
“dental lamina cyst”
biopsy of normal newborn alveolar ridge shows numerous microcystic structures that arise from dental lamina rests (rests of Serres)
gingival cyst of the newborn
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
gingival cyst of the newborn
1-2mm yellow-white papules
often multiple, on alverolar ridge of newborn
usually maxillary
gingival cyst of the newborn
similar cysts found on palatal raphe (epstein’s pearls)
or laterally along hard/sot palate(Bohn’s nodules
developmental cysts - gingival cyst of the newborn
tx
Px
tx - none - self-marsuplialize or involute/degenerate spontaneously
Px - excellent, rarely found after 3 months
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
gingival cyst of the adult
no gender predilection adult over 40 anterior segments of jaws above or below MGJ usually facial. sometime lingual
gingival cyst of the adult
male/female
young/old
anterior/posterior jaw
facial/lingual
no gender predilection adult over 40 anterior segments of jaws above or below MGJ usually facial. sometime lingual
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
gingival cyst of the adult
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
gingival cyst of the adult
gingival cyst of the adult
tx or px
tx - converative excision
px - excellent
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
lateral periodontal cyst
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
lateral periodontal cyst
histopathological features
cyst lined by thin, uniform stratified squamous epi within fibrous CT
identical appearance to gingival cyst of the adult
lateral periodontal cyst
lateral periodontal cyst
tx and px
tx - curettage
excellent - rarely recurs but requires periodontic radiographic follow-up
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
calcifying odontoggenic cyst (Gorlin cyst)
Calcifying odontogenic cyst - Gorlin cyst
most common locations
38% - anterior maxilla 27 - anterior mandible 12- maxilla premolar 11- posterior mandi 10-mandi PM 2-posterior maxilla
developmental cysts
usually intrabony
13-21% have been reported in gingival soft tissue “peripheral calcifying odonotgenic cyst”
may expand alveolar bone
Calcifying odontogenic cyst - Gorlin cyst
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
odontogenic cysts - calcifying odontogenic cyst Gorlin cyst
tooth test vital
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
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
tx and px of calcifying odontogenic cyst
tx - enucleation with curettage
px - good
recurrence not common but occurs, requires periodoic radiogrpahic follow up
