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Oral pathology > bone RLs part 1 > Flashcards

bone RLs part 1 Flashcards

1
Q

acronym for describing bone lesions

A

New Students See Past Description Loving Education

  • Number (one, two, multiple)
  • Size (small, large, measure X by X cm)
  • Periphery (well defined [corticated or non-corticated], ill defined, blending with normal bone)
  • Density (RL, RP, mixed, altered bone pattern)
  • Location (ID epicenter, sup., inf., M., or D., associated with crown of apex, bilateral, or generalized)
  • Effect (on surrounding structures [bone & teeth])
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2
Q

what is the most common odontogenic cyst

A

periapical granuloma/cyst

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3
Q

describe periapical granuloma/cyst

A
  • inflammation in the pulp leading to involvement of the PA tissues (acute/chronic PA periodontitis)
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4
Q

are acute cases of periapical granuloma/cyst painful or asymptomatic

A

painful

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5
Q

are chronic cases of periapical granuloma/cyst painful or asymptomatic

A

asymptomatic

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6
Q

acute exacerbation of a chronic lesion of a periapical granuloma/cyst can cause what?

A

an abscess (neutrophils at the apex of a nonvital tooth) with or without swelling

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7
Q

how does a periapical granuloma/cyst present radiographically

A

as a round to ovoid RL at the apex of a non-vital tooth

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8
Q

a periapical granuloma/cyst typically causes what two things?

A

loss of lamina dura and can cause root resorption

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9
Q

how big are periapical granuloma/cysts

A

most are < 1.5 cm in diameter

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10
Q

can you distinguish a periapical granuloma from a periapical cyst by size or radiographic appearance?

A

nope

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11
Q

where is a periapical granuloma/cyst less common

A

less commonly between teeth - lateral radicular cyst

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12
Q

is there granulomatous inflammation in a periapical granuloma/cyst?

A

nope

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13
Q

describe the histology of a periapical granuloma

A

acute/chronic inflammation and granulation tissue
- without an epithelial lining

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14
Q

describe the histology of a periapical cyst

A

acute/chronic inflammation and granulation tissue
- with a variably thick, non-keratinized stratified squamous epithelial lining

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15
Q

tx for a periapical granuloma/cyst

A
  • enucleation, with either extraction or endo therapy of the involve tooth
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16
Q

if a periapical granuloma/cyst lesion is not removed, what could occur?

A

a residual PA cyst

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17
Q

is recurrence likely for a periapical granuloma/cyst?

A

recurrence is unlikely

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18
Q

when should you worry for a periapical granuloma/cyst?

A
  1. multilocular - not odontogenic infection
  2. significant root resorption or movement of teeth - increases changes that could be something else
  3. does not respond to tx radiographically or clinically - think either inadequate tx or different diagnosis
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19
Q

describe a parulis

A
  • yellowish/red nodule of granulation tissue representing an intraoral point of drainage for a sinus tract related to necrotic tooth
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20
Q

what kind of tissue is a parulis

A

granulation tissue

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21
Q

a parulis contains drainage from what

A

drainage for a sinus tract related to a necrotic tooth

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22
Q

where is a parulis usually found

A
  • typically facial gingiva/alveolar mucosa apical or near tooth of origin
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23
Q

what are the exceptions for where a parulis is found

A
  • palatal bone
  • max. lateral incisors
  • lingual plate - mand. 2nd and 3rd molars
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24
Q

describe asymptomatic lesions of a parulis

A

often patent and pus can be expressed from the center of the lesion

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25
Q

list all the developmental cysts

A
  • dentigerous cyst/hyperplastic dental follicle
  • eruption cyst
  • lateral periodontal cyst
  • odontogenic keratocyst
  • nasopalatine duct cyst
  • simple bone cyst (not a true cyst but mimics)
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26
Q

define a cyst

A
  • abnormal sac or cavity lined by epithelium with is enclosed in CT
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27
Q

what is a cyst lined by

A

epithelium

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28
Q

what is a cyst enclosed in

A

CT

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29
Q

what does cyst enlargement come from

A

fluid accumulation inside

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30
Q

what are the types of cysts

A
  • developmental
  • inflammatory
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31
Q

describe developmental cysts in general

A
  • may be inside bone (intraosseous) or soft tissue (extraosseous)
  • odontogenic (related to tooth development)
  • nonodontogenic
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32
Q

which cysts are inflammatory

A
  • PA cyst
  • residual cyst
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33
Q

where do odontogenic cysts/tumors come from?

A
  1. dental lamina rests (rests of Serres)
  2. rests of malassez
  3. reduced enamel epithelium
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34
Q

define a dentigerous cyst

A

a cyst that forms around the crown of an impacted tooth (i.e. pericoronal)

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35
Q

what is the second most common odontogenic cyst

A

dentigerous cyst

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36
Q

what kind of cyst is a dentigerous cyst

A

developmental cyst

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37
Q

what does a dentigerous cyst arise from and what does it show?

A
  • arises from reduced enamel epithelium
  • shows a thin, non-keratinized strat. squam. epithelium
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38
Q

how big is a dentigerous cyst

A
  • > 3-4 mm pericoronal RL
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39
Q

smaller lesions of a dentigerous cyst are virtually identical to what

A

a hyperplastic dental follicle (lacks a true epithelial lining)

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40
Q

what is the tx for a dentigerous cyst

A

enucleation

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41
Q

what is the prognosis for a dentigerous cyst

A

excellent - minimal tendency to recur

42
Q

for a dentigerous cyst should tissues be submitted to exclude other possible diagnoses?

A

yes they should

43
Q

when is it not a dentigerous cyst?

A
  1. not around the crown
  2. multilocular
  3. any sign of opacity; this changes the differential completely
44
Q

when is it less likely to be a dentigerous cyst?

A
  1. impacted tooth other than 3rd molar or canine
  2. larger lesions
45
Q

dentigerous cyst diff dx (mimics)

A
  1. odontogenic keratocyst (most common)
  2. unicystic ameloblastoma (infrequent)
  3. odontogenic myxoma (uncommon)
  4. central giant cell granuloma - ant. of the first molar (don’t expect in the post. mandible/ramus)
46
Q

if you biopsy a large dentigerous cyst-appearing lesions, what do you need to be sure of?

A
  • get an uninflamed area
  • may need multiple spots as solid areas would indicate tumor
47
Q

describe an eruption cyst

A

essentially represents a dentigerous cyst that forms in the soft tissue overlying the crown of an erupting tooth

48
Q

how does a eruption cyst appear clinically

A
  • somewhat translucent swelling, but may be blueish because of blood accumulation
49
Q

who is generally affected by an eruption cyst

A

children

50
Q

what do you do to confirm it is an eruption cyst

A

take a radiograph

51
Q

what is the tx for an eruption cyst

A
  • usually ruptures spontaneously or can excise the roof to allow the tooth to erupt
52
Q

a lateral periodontal cyst is derived from what

A

dental lamica rests

53
Q

who do you see a lateral periodontal cyst in

A

middle aged adults

54
Q

is a lateral periodontal cyst symptomatic or asymptomatic

A

asymptomatic - adjacent teeth are vital

55
Q

how does a lateral periodontal cyst look radiographically

A

usually unilocular RL; can look multilocular (grape-like called botryoid odontogenic cyst)

56
Q

a lateral periodontal cyst that looks multilocular is called

A

botryoid odontogenic cyst

57
Q

where is a lateral periodontal cyst found

A

canine/premolar region, most often mandibular

58
Q

how large is a lateral periodontal cyst

A

< 1 cm

59
Q

lateral periodontal cyst tx

A

excision is curative

60
Q

what is identical to a lateral periodontal cyst but occurs w/in gingival soft tissues, not w/in bone

A

gingival cyst of the adult

61
Q

describe the appearance of a gingival cyst of the adult

A

bluish to translucent/clear swelling, often centered in attached gingiva (can mimic a mucocele but there are no salivary glands on the gingiva)

62
Q

gingival cyst of the adult tx

A

excision is curative

63
Q

a nasopalatine duct cyst is aka

A

incisive canal cyst

64
Q

where is a nasopalatine duct cyst located and what does it cause

A
  • w/in the incisive canal (in bone)
  • causes a palatal swelling over the foramen
65
Q

where is a nasopalatine duct cyst found on a x-ray

A

RL between apices of #8-9

66
Q

who is a nasopalatine duct cyst found in

A

middle aged adults

67
Q

does a nasopalatine duct cyst have vital or non-vital teeth

A

vital

68
Q

what is the tx for a nasopalatine duct cyst

A

surgical removal

69
Q

is recurrence of a nasopalatine duct cyst common or rare

A

rare

70
Q

describe an odontogenic keratocyst

A

benign but locally aggressive developmental odontogenic cyst

71
Q

where does a odontogenic keratocyst arise from

A

dental lamina rests

72
Q

who does a odontogenic keratocyst affect

A

wide age range

73
Q

where is an odontogenic keratocyst seen

A

most commonly seen in the post. mandible, but any segment of the jaw can be affected - clinically may mimic a wide variety of jaw cysts

74
Q

is an odontogenic keratocyst symptomatic or asymptomatic

A
  • asymptomatic
75
Q

what can an odontogenic keratocyst cause when large

A

sweling

76
Q

when a odontogenic keratocyst is small how does it appear radiographically

A

unilocular

77
Q

when an odontogenic keratocyst enlarges, how does it appear radiographically

A

multilocular develops as the lesion enlarges

78
Q

what is an odontogenic keratocyst lined by

A

uniform, thin strat. squam. epithelial lining

79
Q

what does an odontogenic keratocyst produce

A

luminal parakeratin

80
Q

how do the basal cell nuclei appear for an odontogenic keratocyst

A

palisaded (“picket fence”) appearance

81
Q

features are altered for a odontogenic keratocyst with what?

A

features are altered with inflammation

82
Q

what formation can be seen with an odontogenic keratocyst

A

satellite cyst formation may be seen

83
Q

tx for a small lesion of an odontogenic keratocyst

A

excision with curettage

84
Q

tx for a large lesion of an odontogenic keratocyst

A

resection, marsupilazation followed by surgical excision of residual cystic epithelium

85
Q

what is the overall recurrence rate for an odontogenic keratocyst

A

33%

86
Q

are small or large odontogenic keratocysts more likely to recur

A

larger lesions are more likely to recur

87
Q

for odontogenic keratocysts: with occurence in the first decade, or with multiple OKC’s, what should be ruled out?

A

nevoid basal cell carcinoma syndrome (Gorlin syndrome) should be ruled out

88
Q

nevoid basal cell carcinoma syndrome (Gorlin syndrome) is what kind of condition

A

autosomal dominant

89
Q

what is a characteristic finding of nevoid basal cell carcinoma syndrome (Gorlin syndrome) and when do they arise

A
  • OKCs of the jaw
  • often arise at an early age and may be multiple
90
Q

cutaneous features of nevoid basal cell carcinoma syndrome (Gorlin syndrome)

A
  • basal cell carcinomas, early onset
  • palmar/plantar pitting
91
Q

skeletal features of nevoid basal cell carcinoma syndrome (Gorlin syndrome)

A
  • calcified falx cerebri
  • increased cranial circumference
  • bifid ribs
92
Q

tx/management of nevoid basal cell carcinoma syndrome (Gorlin syndrome)

A
  • sun screens
  • excision of basal cell carcinomas as needed
  • monitor for an excise OKCs
  • genetic counseling
93
Q

a simple bone cyst is aka

A

“traumatic bone cysts” - though trauma isn’t present in most cases - theory

94
Q

who is a simple bone cyst seen in

A

young patients (age 10-20)

95
Q

where is a simple bone cyst found

A

in jaws, mandible only - molar/premolar region

96
Q

what is seen in 25% of cases of a simple bone cyst

A

painless, expansion/swelling

97
Q

are teeth vital or nonvital in a simple bone cyst

A

teeth are vital

98
Q

what is seen on a radiograph for a simple bone cyst

A

well-defined RL that “scallops” between adjacent roots

99
Q

simple bone cyst diagnosis

A

biopsy - no cyst lining, just a hole in the bone

100
Q

simple bone cyst treatment

A
  • scrape (curettage) inside of bony cavity to promote bleeding and regeneration of bone
  • follow-up radiographs to confirm bone fill

Oral pathology (7 decks)

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