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OMOPOR > Cyst > Flashcards

Cyst Flashcards

1
Q

Cyst lining of Radicular Cyst is derived from?

A

Epithelial cell rests of Malassez

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2
Q

Etiology of Radicular Cyst

A
  1. Dental caries
  2. Pulp necrosis
  3. Apical periodontitis
  4. Formation of periapical granuloma
  5. Stimulation of epithelial rests of Malassez
  6. Periapical cyst formation
  7. Cyst expansion
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3
Q

Clinical Findings of a Radicular Cyst

A
  1. Non-vital tooth
  2. Slowly progressive, symptomless swelling
  3. Pain or sinus tract when infected
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4
Q

What is a Residual Cyst?

A

Radicular cyst may present after incomplete removal of involved tooth

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5
Q

Radiographic Findings of a Radicular Cyst

A

L: Root apex or lateral aspect of the tooth
E: Well-defined, well-circumscribed, corticated margin
S: Larger in size >1cm, round and unilocular
I: Radiolucent
O: Non-vital tooth, root resorption, bony expansion (erosion or bulging of buccal and lingual cortical plates)

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6
Q

Demographics of a Radicular Cyst

A
  1. Most common odontogenic cyst
  2. 4th-5th decade
  3. Males
  4. Maxilla
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7
Q

Histopathologic Findings of a Radicular Cyst

A

Epithelial Lining

Central cavity lined by non-keratinised, stratified squamous epithelium

Connective Tissue Stroma

  1. Collagenous
  2. Surrounding bone resorption
  3. Cholesterol clefts

Lumen (Cyst fluid)
1. Contents similar to periapical granuloma
2. Watery and opalescent fluid

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8
Q

Investigations of Radicular Cyst

A
  1. Correlate clinical and radiographic appearance
  2. Vitality testing
  3. Aspiration of cyst fluid
  4. Incisional biopsy for large lesion. Excisional biopsy can be performed following surgical excision
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9
Q

Differential Diagnosis of Radicular Cyst

A
  1. PA granuloma
  2. In anterior mandible: Early phase of PA cemento-osseous dysplasia
  3. In posterior mandible: Traumatic bone cyst
  4. Odontogenic tumours, giant cell lesions, metastatic disease and osseous tumours (vital teeth)
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10
Q

What is a Dentigerous Cyst?

A

The cyst surrounds the crown of tooth and is attached to the neck (CEJ)

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11
Q

The cyst lining of a Dentigerous Cyst is derived from?

A

Reduced enamel epithelium (REE)

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12
Q

What is the pathogenesis of a dentigerous cyst?

A
  1. Compression of follicle by impacted tooth
  2. Increased pressure on REE → Increase fluid transudation into REE → pooling of transudate between REE and enamel

OR

  1. Periapical inflammation from deciduous teeth
  2. Inflammation of REE of permanent tooth → Inflammatory exudate between REE and enamel
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13
Q

Clinical features of a Dentigerous Cyst

A
  1. Asymptomatic, hard bony swelling or facial swelling
  2. Infected lesion can be painful
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14
Q

Demographics of Dentigerous Cyst?

A
  1. Second most common type of odontogenic cyst
  2. 2nd to 3rd decade
  3. Males
  4. Mandible
  5. Commonly impacted teeth: 3rd molars and maxillary canines (Mand 8s > Max 8s > Max 3s)
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15
Q

Radiographic Findings of a Dentigerous Cyst

A

L: Pericoronal to impacted tooth, attached to CEJ
E: Well-defined, corticated borders
S: Unilocular
I: Radiolucent
O: Displacement of maxillary sinus floor, IDN and teeth, root resorption

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16
Q

Histopathological Findings of a Dentigerous Cyst

A

Epithelial Lining

Stratified squamous to cuboidal, non-keratinised

Connective tissue stroma
Collagenous

Cyst fluid
- Yellowish (straw-coloured fluid)
- Water and electrolytes
- Degenerating epithelial and inflammatory cells, serum proteins (from inflammatory exudate)

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17
Q

Investigation for Dentigerous Cyst

A
  1. Correlate with clinical and radiographic appearance
  2. Vitality testing to rule our radicular cyst
  3. Aspiration of cyst fluid
  4. Incisional biopsy for large lesion. Excisional biopsy can be performed following surgical excision
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18
Q

Differential Diagnosis of Dentigerous Cyst

A

Other unilocular pericoronal radiolucent lesions
1. Hyperplastic follicle
2. Unicystic ameloblastoma

Unilocular radiolucent lesions
3. OKC and odontogenic tumours

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19
Q

Management of Dentigerous Cyst

A
  1. Cyst enucleation and extraction of involved tooth
  2. Excisional biopsy

Rare recurrence

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20
Q

What is an Eruption Cyst?

A

Soft tissue variant of dentigerous cyst

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21
Q

What is the origin of an eruption cyst?

A

Separation of REE from crown of tooth

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22
Q

Demographics of Eruption Cyst

A
  1. Children <10 years old
  2. Deciduous mandibular central incisor, first permanent molar and deciduous maxillary incisor
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23
Q

Clinical features of an Eruption Cyst

A
  1. Soft, dome-shaped, bluish swelling in gingiva overlying erupting tooth
  2. Asymptomatic unless infected
  3. Fluctuant and sessile
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24
Q

Histopathological Findings of Eruption Cyst

A
  1. Thin stratified squamous epithelium, non-keratinizes
  2. Separated from oral mucosa by CT/lamina propria
  3. Cyst lumen filled with RBCs
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25
Q

Management of an Eruption Cyst

A
  1. Spontaneous rupture upon tooth eruption
  2. Removal of tissue overlying crown of tooth or roof of cyst
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26
Q

What is Odontogenic Keratocyst?

A

Cyst of odontogenic origin where lining epithelium is similar to developing tooth germ and uniformly produces keratin

27
Q

Unique Characteristics of OKC

A
  1. Peculiarly infiltrative growth
  2. Aggressive nature
  3. Strong tendency to recur after removal
  4. Associated with nevoid basal cell syndrome
28
Q

OKC is derived from?

A

Remnants of dental lamina (Cell rests of Serres)

29
Q

What is the pathogenesis of OKC?

A
  1. Active epithelial growth
    - Over-expression of anti-apoptotic protein (Bcl-2 staining) and mutation of PTCH tumour suppressor gene
  2. Bone resorbing factors
    - Overexpression of proteolytic enzymes (MMP 2 and MMP9)
  3. Hydrostatic pressure (Minimal role)
30
Q

Demographics of OKC

A
  1. 2nd to 3rd and 5th decade
  2. Males
  3. Posterior mandible (Maxillary 3rd molar)
  4. Unerupted teeth (25-40% of cases)
31
Q

Clinical Features of OKC

A
  1. Asymptomatic unless infected
  2. Infected OKCs may present with pain, swelling and/or drainage
  3. Grow in anterior-posterior direction within medullary cavity of bone
  4. Extensive bone destruction without obvious bone expansion
32
Q

Radiographic Features of OKC?

A

L: Posterior body or ramus of mandible
E: Well-defined, corticated, scalloped margins
S: Unilocular
I: Radiolucent
O: -

33
Q

Histopathological Findings of OKC

A

Epithelial lining
1. Parakeratinised aggressive type or Orthokeratinised non-aggressive type

  1. Stratified epithelium + Palisaded layer of tall columnar basal cells
  2. Parakeratinised type: Luminal surface is thin eosinophilic layer of parakeratin that has corrugated appearance
  3. Weakly attached to underlying connective tissue (Recurrence after enucleation)
  4. Thickness of 7-10 cells

Connective tissue stroma

  1. Thin friable wall and composed of loose collagenous (Difficult to enucleate)
  2. Presence of satellite cysts (Recurrence potential)

Lumen

Creamy or cheesy keratin debris

34
Q

Investigation for OKC

A

Diagnosis based on histological examination

35
Q

Differential Diagnosis of OKC

A
  1. Ameloblastoma
  2. Radicular cyst
36
Q

Management of OKC

A
  1. Aggressive behaviour and strong tendency to recur
  2. Enucleation with curettage
37
Q

What are the reasons for high recurrence rate of OKC after treatment?

A
  1. Thin friable cyst wall → Difficult to enucleate intact
  2. Epithelial lining is weakly attached to underlying connective tissue → Easily separates off
  3. Finger-like extensions into cancellous bone → Difficult to remove lining
  4. Satellite cysts in CT wall which may be left behind
  5. Active epithelial proliferation compared to other odontogenic cysts
38
Q

What is a Lateral Periodontal Cyst?

A

Slow-growing, non-expansile developmental odontogenic cyst on lateral root surface of tooth

39
Q

Where is lateral periodontal cyst derived from?

A

Rests of dental lamina

40
Q

Pathogenesis of Lateral Periodontal Cyst

A
  1. Proliferation of cell rests of Serres
  2. Epithelial islands
  3. Cystic degeneration
41
Q

Demographics of Lateral Periodontal Cyst

A
  1. 5th-6th decade
  2. Males
  3. Posterior mandible
  4. Premolar-canine region (80%)
42
Q

Clinical Features of Lateral Periodontal Cyst

A
  1. Asymptomatic
  2. Painful soft tissue swelling at mid-root area
43
Q

Radiographic Findings of Lateral Periodontal Cyst

A

L: Between roots of 2 vital teeth
E: Well-defined
S: Small, unilocular
I: Radiolucent
O: -

44
Q

Histopathological Findings of Lateral Periodontal Cyst

A

*Epithelial lining**

  1. Non-keratinised
  2. Thickness: Thin 2-3 cells
  3. Some areas may exhibit focal thickenings

Connective Tissue

Fibrous connective tissue stroma

45
Q

Management of Lateral Periodontal Cyst

A

Conservative enucleation

46
Q

What are some Odontogenic Cysts (Developmental)?

A
  1. Epstein’s pearls, Bohn’s nodule, Dental lamina cyst
  2. Dentigerous cyst
  3. OKC
  4. Lateral periodontal cyst
47
Q

What is a Nasopalatine Duct Cyst?

A

Intraosseous developmental cyst of the midline of anterior palate

48
Q

Where is Nasopalatine Duct Cyst derived from?

A

Remnants of embryonic nasopalatine duct within incisive canal

49
Q

Demographics of Nasopalatine Duct Cyst

A
  1. 4th-6h decade
  2. Males
50
Q

Clinical Features of Nasopalatine Duct Cyst

A
  1. Asymptomatic
  2. Slow growing
  3. Swelling on palate in midline
  4. Dome-shaped bluish enlargement overlying incisive canal
51
Q

Radiographic Findings of Nasopalatine Duct Cyst

A

L: Midline between roots of central incisors
E: Well-defined
S: Oval-heart-shaped, Unilocular
I: Radiolucency
O:-

52
Q

Histopathological Findings of Nasopalatine Duct Cyst

A

Epithelial Lining

Vary from pseudostratified columnar to stratified squamous epithelium

Connective Tissue

Fibrous CT stroma + Neurovascular bundle representative of nasopalatine nerves and vessels

53
Q

Investigations for Nasopalatine Duct Cyst

A

Biopsy

54
Q

Management of Nasopalatine Duct Cyst

A

Surgical enucleation

55
Q

What are some Cyst-like Lesions?

A
  1. Simple bone cyst
  2. Stafne bone defect
  3. Aneurysmal bone cyst
56
Q

Describe a Simple Bone Cyst

A

An empty bone cavity that lacks an epithelial lining

57
Q

Radiographics Findings of Simple Bone Cyst

A

L: Mandible
E: Well-defined but irregular edges
S: Interradicular scalloping
I: Radiolucent
O:-

58
Q

Management of Simple Bone Cyst

A

Induction of bleeding by scraping inside the cavity

59
Q

Describe a Stafne Bone Defect

A

Anatomic Indentation of posterior lingual surface that gives a false appearance of a cyst

Commonly due to submandibular gland pressing onto lingual surface of mandible

60
Q

Radiograph Findings of Stafne Bone Defect

A

L: Beneath IDN
E: Sharply circumscribed
S: Oval
I: Radiolucent
O: -

61
Q

Investigations of Stafne Bone Defect

A

Sialography reveals the presence of salivary gland within the defect

62
Q

What is a Primordial Cyst?

A

Developmental odontogenic cyst, located in area where a tooth should have formed but is missing

63
Q

Describe an Aneurysmal Bone Cyst

A

Intraosseous accumulation of variable-sized, blood-filled spaces surrounded by cellular fibrous CT and reactive bone

64
Q
A

OMOPOR (7 decks)

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