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])
2
Q
what is the most common odontogenic cyst
A
periapical granuloma/cyst
3
Q
describe periapical granuloma/cyst
A
- inflammation in the pulp leading to involvement of the PA tissues (acute/chronic PA periodontitis)
4
Q
are acute cases of periapical granuloma/cyst painful or asymptomatic
A
painful
5
Q
are chronic cases of periapical granuloma/cyst painful or asymptomatic
A
asymptomatic
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
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
8
Q
a periapical granuloma/cyst typically causes what two things?
A
loss of lamina dura and can cause root resorption
9
Q
how big are periapical granuloma/cysts
A
most are < 1.5 cm in diameter
10
Q
can you distinguish a periapical granuloma from a periapical cyst by size or radiographic appearance?
A
nope
11
Q
where is a periapical granuloma/cyst less common
A
less commonly between teeth - lateral radicular cyst
12
Q
is there granulomatous inflammation in a periapical granuloma/cyst?
A
nope
13
Q
describe the histology of a periapical granuloma
A
acute/chronic inflammation and granulation tissue
- without an epithelial lining
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
15
Q
tx for a periapical granuloma/cyst
A
- enucleation, with either extraction or endo therapy of the involve tooth
16
Q
if a periapical granuloma/cyst lesion is not removed, what could occur?
A
a residual PA cyst
17
Q
is recurrence likely for a periapical granuloma/cyst?
A
recurrence is unlikely
18
Q
when should you worry for a periapical granuloma/cyst?
A
- multilocular - not odontogenic infection
- significant root resorption or movement of teeth - increases changes that could be something else
- does not respond to tx radiographically or clinically - think either inadequate tx or different diagnosis
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
20
Q
what kind of tissue is a parulis
A
granulation tissue
21
Q
a parulis contains drainage from what
A
drainage for a sinus tract related to a necrotic tooth
22
Q
where is a parulis usually found
A
- typically facial gingiva/alveolar mucosa apical or near tooth of origin
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
24
Q
describe asymptomatic lesions of a parulis
A
often patent and pus can be expressed from the center of the lesion
25
list all the developmental cysts
- dentigerous cyst/hyperplastic dental follicle
- eruption cyst
- lateral periodontal cyst
- odontogenic keratocyst
- nasopalatine duct cyst
- simple bone cyst (not a true cyst but mimics)
26
define a cyst
- abnormal sac or cavity lined by epithelium with is enclosed in CT
27
what is a cyst lined by
epithelium
28
what is a cyst enclosed in
CT
29
what does cyst enlargement come from
fluid accumulation inside
30
what are the types of cysts
- developmental
- inflammatory
31
describe developmental cysts in general
- may be inside bone (intraosseous) or soft tissue (extraosseous)
- odontogenic (related to tooth development)
- nonodontogenic
32
which cysts are inflammatory
- PA cyst
- residual cyst
33
where do odontogenic cysts/tumors come from?
1. dental lamina rests (rests of Serres)
2. rests of malassez
3. reduced enamel epithelium
34
define a dentigerous cyst
a cyst that forms around the crown of an impacted tooth (i.e. pericoronal)
35
what is the second most common odontogenic cyst
dentigerous cyst
36
what kind of cyst is a dentigerous cyst
developmental cyst
37
what does a dentigerous cyst arise from and what does it show?
- arises from reduced enamel epithelium
- shows a thin, non-keratinized strat. squam. epithelium
38
how big is a dentigerous cyst
- >3-4 mm pericoronal RL
39
smaller lesions of a dentigerous cyst are virtually identical to what
a hyperplastic dental follicle (lacks a true epithelial lining)
40
what is the tx for a dentigerous cyst
enucleation
41
what is the prognosis for a dentigerous cyst
excellent - minimal tendency to recur
42
for a dentigerous cyst should tissues be submitted to exclude other possible diagnoses?
yes they should
43
when is it not a dentigerous cyst?
1. not around the crown
2. multilocular
3. any sign of opacity; this changes the differential completely
44
when is it less likely to be a dentigerous cyst?
1. impacted tooth other than 3rd molar or canine
2. larger lesions
45
dentigerous cyst diff dx (mimics)
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
if you biopsy a large dentigerous cyst-appearing lesions, what do you need to be sure of?
- get an uninflamed area
- may need multiple spots as solid areas would indicate tumor
47
describe an eruption cyst
essentially represents a dentigerous cyst that forms in the soft tissue overlying the crown of an erupting tooth
48
how does a eruption cyst appear clinically
- somewhat translucent swelling, but may be blueish because of blood accumulation
49
who is generally affected by an eruption cyst
children
50
what do you do to confirm it is an eruption cyst
take a radiograph
51
what is the tx for an eruption cyst
- usually ruptures spontaneously or can excise the roof to allow the tooth to erupt
52
a lateral periodontal cyst is derived from what
dental lamica rests
53
who do you see a lateral periodontal cyst in
middle aged adults
54
is a lateral periodontal cyst symptomatic or asymptomatic
asymptomatic - adjacent teeth are vital
55
how does a lateral periodontal cyst look radiographically
usually unilocular RL; can look multilocular (grape-like called botryoid odontogenic cyst)
56
a lateral periodontal cyst that looks multilocular is called
botryoid odontogenic cyst
57
where is a lateral periodontal cyst found
canine/premolar region, most often mandibular
58
how large is a lateral periodontal cyst
< 1 cm
59
lateral periodontal cyst tx
excision is curative
60
what is identical to a lateral periodontal cyst but occurs w/in gingival soft tissues, not w/in bone
gingival cyst of the adult
61
describe the appearance of a gingival cyst of the adult
bluish to translucent/clear swelling, often centered in attached gingiva (can mimic a mucocele but there are no salivary glands on the gingiva)
62
gingival cyst of the adult tx
excision is curative
63
a nasopalatine duct cyst is aka
incisive canal cyst
64
where is a nasopalatine duct cyst located and what does it cause
- w/in the incisive canal (in bone)
- causes a palatal swelling over the foramen
65
where is a nasopalatine duct cyst found on a x-ray
RL between apices of #8-9
66
who is a nasopalatine duct cyst found in
middle aged adults
67
does a nasopalatine duct cyst have vital or non-vital teeth
vital
68
what is the tx for a nasopalatine duct cyst
surgical removal
69
is recurrence of a nasopalatine duct cyst common or rare
rare
70
describe an odontogenic keratocyst
benign but locally aggressive developmental odontogenic cyst
71
where does a odontogenic keratocyst arise from
dental lamina rests
72
who does a odontogenic keratocyst affect
wide age range
73
where is an odontogenic keratocyst seen
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
is an odontogenic keratocyst symptomatic or asymptomatic
- asymptomatic
75
what can an odontogenic keratocyst cause when large
sweling
76
when a odontogenic keratocyst is small how does it appear radiographically
unilocular
77
when an odontogenic keratocyst enlarges, how does it appear radiographically
multilocular develops as the lesion enlarges
78
what is an odontogenic keratocyst lined by
uniform, thin strat. squam. epithelial lining
79
what does an odontogenic keratocyst produce
luminal parakeratin
80
how do the basal cell nuclei appear for an odontogenic keratocyst
palisaded ("picket fence") appearance
81
features are altered for a odontogenic keratocyst with what?
features are altered with inflammation
82
what formation can be seen with an odontogenic keratocyst
satellite cyst formation may be seen
83
tx for a small lesion of an odontogenic keratocyst
excision with curettage
84
tx for a large lesion of an odontogenic keratocyst
resection, marsupilazation followed by surgical excision of residual cystic epithelium
85
what is the overall recurrence rate for an odontogenic keratocyst
33%
86
are small or large odontogenic keratocysts more likely to recur
larger lesions are more likely to recur
87
for odontogenic keratocysts: with occurence in the first decade, or with multiple OKC's, what should be ruled out?
nevoid basal cell carcinoma syndrome (Gorlin syndrome) should be ruled out
88
nevoid basal cell carcinoma syndrome (Gorlin syndrome) is what kind of condition
autosomal dominant
89
what is a characteristic finding of nevoid basal cell carcinoma syndrome (Gorlin syndrome) and when do they arise
- OKCs of the jaw
- often arise at an early age and may be multiple
90
cutaneous features of nevoid basal cell carcinoma syndrome (Gorlin syndrome)
- basal cell carcinomas, early onset
- palmar/plantar pitting
91
skeletal features of nevoid basal cell carcinoma syndrome (Gorlin syndrome)
- calcified falx cerebri
- increased cranial circumference
- bifid ribs
92
tx/management of nevoid basal cell carcinoma syndrome (Gorlin syndrome)
- sun screens
- excision of basal cell carcinomas as needed
- monitor for an excise OKCs
- genetic counseling
93
a simple bone cyst is aka
"traumatic bone cysts" - though trauma isn't present in most cases - theory
94
who is a simple bone cyst seen in
young patients (age 10-20)
95
where is a simple bone cyst found
in jaws, mandible only - molar/premolar region
96
what is seen in 25% of cases of a simple bone cyst
painless, expansion/swelling
97
are teeth vital or nonvital in a simple bone cyst
teeth are vital
98
what is seen on a radiograph for a simple bone cyst
well-defined RL that "scallops" between adjacent roots
99
simple bone cyst diagnosis
biopsy - no cyst lining, just a hole in the bone
100
simple bone cyst treatment
- scrape (curettage) inside of bony cavity to promote bleeding and regeneration of bone
- follow-up radiographs to confirm bone fill
