Chapter 15 Flashcards
(145 cards)
1
Q
What are the 9 odontogenic cysts?
A
Dentigerous, eruption, odontogenic keratocyst, orthokeratinized odontogenic, gingival cyst of the adult, lateral periodontal, calcifying odontogenic, glandular odontogenic, buccal bifurcation
2
Q
What are the 5 odontogenic tumors of epithelial origin?
A
Ameloblastoma, ameloblastic carcinoma, adenomatoid odontogenic tumor, calcifying epithelial odontogenic tumor
3
Q
What are the 5 mixed odontogenic tumors?
A
ameloblastic fibroma, ameloblastic fibro-odontoma, ameloblastic fibrosarcoma, odontoma, odontogenic tumors
4
Q
What are the 4 odontogenic ectomesenchyme tumors?
A
Central odontogenic fibroma, peripheral odontogenic fibroma, odontogenic myxoma, cementoblastoma
5
Q
What is the most common developmental cyst?
A
Dentigerous cyst
6
Q
What does a dentigerous cyst originate from?
A
Originates by separation of the follicle from around the crown of an unerupted tooth (fluid accumulation between REE and crown)
7
Q
Where is a dentigerous cyst attached to a tooth?
A
Encloses the crown of the unerupted tooth and is attached to the CEJ
8
Q
What teeth are most commonly involved in a dentigerous cyst?
A
Mandibular 3rd molars
9
Q
What is the clinical presentation of dentigerous cysts?
A
Asyptomatic, they are discovered on routine xray –> they can grow to considerable size and cause facial asymmetry but this is rare
10
Q
What is radiographic presentation of dentigerous cysts?
A
Unilocular radiolucency associated with the crown of an unerupted tooth, with a well defined and usually sclerotic border
11
Q
What is the treatment for a dentigerous cyst?
A
Enucleation of the cyst and unerupted tooth (and any other affected teeth)
12
Q
What is the prognosis and recurrence rate of dentigerous cysts?
A
Prognosis is good and recurrence is rare
13
Q
What term describes the soft tissue analogue of the dentigerous cyst?
A
Eruption cyst
14
Q
What is the cause of an eruption cyst?
A
Develops as a result of separation of the dental follicle from around the crown of an erupting tooth
15
Q
What is the clinical appearance of an eruption cyst?
A
Appears as a soft, translucent/blue to purple swelling in the gingival mucosa overlying the crown of an erupting tooth
16
Q
In what population is an eruption cyst most common?
A
In children younger than 10
17
Q
What is another name for eruption cyst?
A
Eruption hematoma
18
Q
What is the treatment for an eruption hematoma?
A
Cyst usually ruptures spontaneously, but if this doesn’t occur, excision of the roof of the cysts permits eruption of the totoh
19
Q
What term describes a cyst that arises from the dental lamina?
A
Odontogenic keratocyst
20
Q
What are the 2 most important things about an odontogenic keratocyst?
A
30% recurrence rate and is it associated with Gorlin syndrome
21
Q
What is another name for odontogenic keratocyst?
A
Keratocystic odontogenic tumor
22
Q
When are most cases of odontogenic keratocysts diagnosed?
A
Between the ages of 10-40
23
Q
What is the most common location of odontogenic keratocyss?
A
The posterior mandible
24
Q
What is the clinical presentation of odontogenic keratocysts?
A
They tend to grow in an anterior-posterior direction, may cause bone expansion
25
What is the radiographic presentation of odontogenic keratocysts?
Small lesions are well defined, unilocular RL with corticated margins. Large lesions can be mulitlocular. An unerupted tooth is involved in 1/3 of cases
26
What is the histopathology of odontogenic keratocysts?
Thin, friable wall; epithelial lining is a uniform 6-8 layers thick with parakeratinization; basal cell layer shows palisading and is hyperchromatic; may have satellite/daughter cysts; filled with keratin debris
27
Why is the recurrence rate of odontogenic keratocysts 30%?
Complete removal is challenging due to the friable nature of the cyst wall! Reurrence may happen 10 are more years after surgery
28
When should a patient with an odontogenic keratocyst be evaluated for Gorlin's syndrome?
If they are younger than 20
29
What is another name for Gorlin syndrome?
Nevoid Basal Cell Carcinoma Syndrome
30
What causes nevoid basal cell carcinoma syndrome?
Is it a autosomal dominant syndrome associated with the PTCH gene on chromosome 9
31
What is the prevalence of nevoid basal cell carcinoma syndrome?
1:60,000
32
What are the characteristics associated with nevoid basal cell carcinoma syndrome?
multiple basal cell carcinomas, odontogenic keratocysts, calcification of the falx cerebri, rib anomalies -- these characteristics are not usually life threatening
33
When do basal cell carcinomas occur in nevoid basal cell carcinoma syndrome?
Appear around puberty and appear on skin not exposed to sunlight
34
What are one of the most constant features of nevoid basal cell carcinoma syndrome?
The odontogenic keratocysts -- there are frequently multiple, but may result in jaw deformity from operations to remove them
35
What is the prognosis of nevoid basal cell carcinoma syndrome?
Depends on the behavior of the basal cell carcinomas
36
What term describes an odontogenic cyst with orthokeratinized linging and no basal palisading?
Orthokeratinized odontogenic cyst
37
In what population does orthokeratinized odontogenic cysts occur?
In young adults and more commonly in males
38
Where doe orthokeratinized odontogenic cysts usually occur?
In the posterior mandible, typically unilocular and appear identical to a dentigerous cyst around a 3rd molar
39
What is the recurrence of orthokeratinized odontogenic cysts?
Recurrence is rare
40
What term describes the soft tissue counterpart of the lateral periodontal cyst?
Gingival cyst of the adult
41
What are gingival cysts of the adult derived from?
Derived from rests of dental lamina (rests of serres)
42
Where do gingival cysts of the adult occur?
Striking predilection for the mandibular canine and premolar area, in the facial gingiva or alveolar mucosa
43
In what age population is a gingival cyst of the adult common?
ADULTS, but between 40-50
44
What is the clinical presentation of a gingival cyst of the adult?
painless, dome like swellings (fluid filled) which are less than 5 mm, and may be blue in color -- looks like a mucocele but is on the gingiva!
45
What term describes a developmental odontogenic cyst which typically occurs along the lateral root surfaces?
Lateral Periodontal Cyst
46
What does a lateral periodontal cyst arise from?
Rests of the dental lamina
47
Lateral periodontal cysts are the intrabony counterpart to the ______ ______ ___ ___ _______/
Gingival cyst of the adult
48
In what age population do lateral periodontal cysts occur?
Between 40 - 60 (gingival cyst of the adult is 40-50)
49
Where do lateral peridontal cysts occur?
Striking predilection to occur in the mandibular premolar-canine-lateral-incisor area
50
Are teeth vital in lateral peridontal cysts?
Yes
51
What term describes multilocular/polycystic variant of lateral periodontal cysts?
Botryoid odontogenic cyst -- occurs when multiple rests are stimulated
52
What are the other names for calcifying odontogenic cyst?
Calcifying cystic odontogenic tumor, or gorlin cyst
53
Where do most calfifying odontogenic cysts occur?
65% in the incisor canine area
54
In what age population do calcifying odontogenic cysts occur?
Average age is 35
55
What are 20% of calcifying odontogenic cysts associated with? And what are 1/3 associated with?
Odontomas, an unerupted tooth (usually canine)
56
What are some radiographic features of calcifying odontogenic cysts?
Unilocular, radioloucency with radio-opaques flecks
57
What are the histopathologic feature of calcifying odontogenic cysts?
Have ghost cells, which can calcify
58
What is the treatment and prognosis of calcifying odontogenic cysts?
Enucleation, rare recurrence, good prognosis
59
What term describes a developmental cyst with glandular and/or salivary gland features?
Glandular odontogenic cyst
60
What is the average age of patients that develop glandular odontogenic cysts?
50
61
Where do glandular odontogenic cysts occur?
75% of cases occur in the mandible, with a predilection for the anterior jaws
62
What are some radiographic features of glandular odontogenic cysts?
Either unilocular or multilocular, with well defined margins and sclerotic rim
63
What is the treatment for glandular odontogenic cysts?
Enucleation, or curettage, but multilocal lesions can recur so sometimes en bloc resection is used
64
What term describes an inflammatory cyst with uncertain pathogenesis that usually develops in the bifurcation?
Buccal bifucration cyst
65
Where do buccal bifurcation cysts commonly develop?
Buccal aspect of the mandibulat 1st permanent molar
66
What is the average age of the patient with a buccal bifurcation cyst?
Average age is 10
67
What are some clinical features of buccal bifurcation cysts?
May have tenderness, swelling, foul tasting discharge or usually have a pocket
68
How many cases of buccal bifurcation cysts will have bilateral involvement?
1/3 have bilateral involvement
69
What are some radiographic features of buccal bifurcation cysts?
well circumscribed, unilocular RL involving the buccal bifurcation and root, average size is 1.5 cm, and root apices are tipped to the lingual
70
How are buccal bifurcation cysts treated?
Enucleation, no need to extract the tooth
71
What is the pathogenesis of odonotgenic carcinomas?
The pathology is unknown; it has to do with something abnormal that has been left for decades, and then progressed into something else
72
What are the 2 most common symptoms of odontogenic carcinomas?
Pain and swelling
73
What are some radiographic features of odontogenic carcinomas?
The mimic odontogenic cysts, except the margins are irregular and ragged
74
What does histology usually show in odontogenic carcinomas?
Well-differentiated SCCA
75
What is the treatment for odontogenic carcinomas, and what is the prognosis?
Treatment varies based on the type, and spread. Approximately 50% survive after treatment
76
What must be ruled out before calling an odontogenic carcinoma a true primary intraosseous carcinoma?
Must rule out metastatic spread -- carcinoma arising within bone is rare and essentially limited to the jaws
77
What is the most common clinically significant odontogenic tumor?
Ameloblastoma
78
What does an ameloblastoma arise from?
It is a tumor of odontogenic epithelial origin
79
What are the 3 different types of ameloblastoma?
Conventional solid or multicystic (85%), unicystic (15%), peripheral (1%)
80
At what age do ameloblastomas usually occur?
Between the 3rd and 7th decade
81
Is there a sex predilection associated with ameloblastomas?
No sex predilection
82
Where do ameloblastomas occur?
85% occur in the mandible, usually in the molar-ascending ramus area
83
What is the clinical presentation of an ameloblastoma?
They are asymptomatic, only a painless swelling. Because of this they can go untreated and grow to grotesque portions
84
What are the radiographic features of an ameloblastoma?
Multilocular radiolucency
- either "soap bubble" if RL's are large, or "honeycombed" if they are small;
Buccal and lingual cortical expansion is frequently present; resorption of roots is common; unerupted tooth may be associated with the defect
85
What form does not share features of the other forms?
Desmoplastic ameloblastoma
86
What is desmoplastic ameloblastoma?
Predilection for the anterior maxilla, may be mixed RL/RO due to osseous metaplaisa
87
What are the histopathological features of ameloblastomas?
Palisading, hyperchromatic basal layer; reverse polarity; apical vacuolization
88
What is the treatment for an ameloblastoma? What is the most widely used treatment?
Variety of treatments from simple enucleation and curettage to en bloc resection. Marginal resection is the most widely used treatment (1.5 cm margins)
89
What type of bone do ameloblastomas infiltrate?
Infiltrate between cancellous bone, at lesion periphery
90
Can ameloblastomas recur?
Yes, curettage has recurrence rates anywhere from 50-90%, but recurrence takes years
91
What is the recurrence rate of marginal resection of ameloblastomas?
Recurrence rate is 15%
92
What are peripheral ameloblastomas?
Painless, non-ulcerated, sessile gingival ameloblastomas (LOOKS LIKE A BUMP ON THE GUMS)
93
What is the average age of patients with peripheral ameloblastomas?
Average age is 50
94
Where are peripheral ameloblastomas most commonly found?
On the posterior gingival mucosa, usually in the mandible
95
How is the treatment for a peripheral ameloblastoma different than other types of ameloblastomas?
The peripheral variant is innocuous (not harmful), and only 15% recur
96
What term describes an ameloblastoma that has histologic features of conventional ameloblastoma, but show metastatic deposits?
Malignant Ameloblastoma
97
What is the most common site of malignant ameloblastoma?
The lung
98
What term describes an ameloblast variant that has cytologic malignant featuers and follows an aggressive course?
Ameloblastic carcinoma
99
When does ameloblastic carcinoma usually develop?
Later in life than conventional ameloblastomas
100
What are the radiographic features of ameloblastic carcinoma?
Ill defined margins and cortical destruction
101
What term describes an odontogenic tumor than is almost identical to a dentigerous cyst, but the lesion may contain fine, snowflake calcifications on radiographs?
Adenomatod odontogenic tumor
102
In what age population do adenomatoid odontogenic tumors usually occur?
In young patients, ages 10-20, and more often females (2:1)
103
Where doe adenomatoid odontogenic tumors usually occur?
Have a striking tendency for the anterior jaws, in the maxilla
104
Why is it easy to mistake an adenomatoid odontogenic tumor for a dentigerous cyst?
In 75% of cases, the tumor is circumscribed, unilocular RL involving the crown of an unerupted tooth -- most often a canine
105
What can help differentiate an adenomatoid odontogenic tumor from a dentigerous cyst?
The lesion may extend apically past the CEJ and may contain snowflake calcifications
106
What is the treatment, recurrence and prognosis for an adenomatoid odontogenic cyst?
Enucleation -- the tumor has a thick, fibrous capsule that makes enucleation easy; recurrence doesn;t occur, and prognosis is good
107
What term describes a RL with calcifications around the crown in a "drive snow" pattern?
Calcifying Epithelial Odontogenic Tumor
108
What is another name for a calcifying epithelial odontogenic tumor?
Pindborg tumor
109
What is the average age of patients with calcifying epithelial odontogenic tumors?
Around 40
110
Where do calcifying epithelial odontogenic tumors occur?
Usually in the posterior mandible
111
What is the most common presenting sign of calcifying epithelial odontogenic tumor?
Painless, Slow growing swelling
112
What are some radiographic features of calcifying epithelial odontogenic tumors
Margins can be scalloped/well defined or ill defined, frequently associated with an impacted tooth (mandibular molar), and has a snow driven pattern around the crown
113
What are the histopathologic features of calcifying epithelial odontogenic tumors?
Nuclear pleomorphism and atypia, amyloid like extracellular material (+ congo red --> apple green birefringence under polarized light); calcifications with concentric rings form in the amyloid like areas (Liesegang rings)
114
What is the treatment of choice for calcifying epithelial odontogenic tumors? What is the recurrence and prognosis?
conservative local resection; recurrence is 15% (highest with curettage); prognosis is typically good but some lesions can be malignant or aggressive
115
What term describes a true mixed tumor of both epithelial and mesenchymal tissues?
Ameloblastic fibroma
116
When do ameloblastic fibromas usually occur?
In younger patients, before age 20
117
Where do ameloblastic fibromas usually occur?
70% occur in the posterior mandible
118
How many cases of ameloblastic fibromas are associated with an unerupted tooth?
75% are associated with an unerupted tooth
119
What is the treatment for ameloblastic fibromas?
Conservative initial therapy but 50% of ameloblastic fibrosarcomas develop in recurrent ameloblastic fibromas so recurrences require mroe aggressive surgery
120
How is an ameloblastic fibro-odontoma different from an ameloblastic fibroma?
It also has enamel and dentin
121
What is the average age of patients with ameloblastic fibro-odontomas?
Average age is 10
122
Where do ameloblastic fibro-odontomas usually occur?
In the posterior jaws
123
What are the radigraphic features of ameloblastic fibro-odontomas?
Contains varying amounts of calcified amterial, typically associated with an unerupted tooth, a unilocular RL
124
What is the treatment and recurrence for ameloblastic fibro-odontoma?
Conservative curettage with rare recurrences
125
What term describes the malignant counterpart of the ameloblastic fibroma?
Ameloblastic fibrosarcoma
126
On what portion do ameloblastic fibrosarcomas shows features of malignancy?
Typically on the mesenchymal portion of the elsion
127
In what population does ameloblastic fibrosarcoma usually occur?
Average age is 25-30, and in males more than females
128
Where do ameloblastic fibrosarcomas usually occur?
80% occur in the mandible
129
What is different about the clinical presenation of ameloblastic fibrosarcoma?
Patients complain of pain and swelling
130
What are the radiographic featuers of an ameloblastic fibrosarcoma?
Ill-defined, destructive RL lesion
131
What is the treatment and prognosis of ameloblastic fibrosarcomas?
radical surgical excision, and 20% will succumb to the disease usually due to uncontrolled local growth
132
What is the most common odontogenic tumor?
Odontoma
133
What are odontomas considered to be rather than true neoplasms?
Considered to be developmental anomlaies (hamartomas)
134
What are the 2 types of odontomas?
Compound and complex
135
What are the characteristics of compound odontomas?
They are composed of multiple, small, toothlike structures surrounded by a narrow RL and occur in the anterior maxilla
136
What are the characteristics of complex odontomas?
They are a conglomerate mass of enamel and dentin and occur in the molar region
137
What is the average age of patients with odontomas?
Average age is 15
138
What is the clinical presentation of odontomas?
They are asymptomatic
139
What are some radiographic featuers of odontomas?
They have narrow RL rims, and are usually asssociated with and unerupted tooth.
140
What is the treatment for odontomas?
Simple local excision
141
What term describes a RL that may displace or cause resorption of teeth and may with thin wispy trabecular?
Odontogenic myxoma
142
Where do myxomas occur?
Only in the jaws
143
What is the treatment for odonogenic myxomas?
Small = curettage, and large need more extensive resection since myxomas tend to infiltrate the surround bone
144
In what age population do odontogenic myxomas occur?
ages 25-30
145
Where do odontogenic myxomas usually occur?
In the mandible
