cyst - basics Flashcards by David Jack

What is a cyst?

A pathological cavity containing, fluid, semi-fluid or gaseous contents which has not been created by accumulation of pus

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What are the different epithelial cysts?

Odontogenic - inflammatory and developmental
Non-odontogenic

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What are the different inflammatory odontogenic cysts?

Radicular cyst - and residual cyst
Inflammatory collateral cysts:
- paradental cyst
- mandibular buccal bifurcation cyst

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What are the different odontogenic developmental cysts?

Dentigerous cyst - and eruption cyst
OKC
Lateral periodontal cyst
Gingival cysts

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What are the different non-odontogenic epithelial cysts?

Nasolabial cyst
Nasopalatine cyst

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what are the different non-epithelial cysts?

Solitary bone cyst
Aneurysmal bone cyst
Stafne’s bone cavity

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How do radicular cysts present clinically?

4-5th decade (IC)
60% maxilla, frequent lateral incisors
Non-vital teeth
Often asymptomatic
Can produce alveolar bone expansion

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How do radicular cysts present radiographically?

Round or ovoid radiolucency at apex
Unilocular
Well defined
Uniform radiolucency

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How to radicular cysts present histopathologically?

Regular lining of non-keratinised squamous epithelium
Deposits of cholesterol
Vascular capsule

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What is the content of radicular cysts?

Varies from watery, straw coloured fluid to semi-solid brownish material

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What are paradental cysts?

60% of inflammatory collateral cysts
Associated with PE M3M, inflamed through pericoronitis
Well defined radiolucency related to neck and coronal 1/3 of tooth
Pathology resembled radicular cyst

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What are mandibular buccal bifurcation cysts?

> 35% of inflammatory colateral cysts
Occur in children
Usually buccal of erupting FPM

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What lines dentigerous cysts?

Epithelium derived from REE from enamel organ

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What is the clinical presentation of dentigerous cysts?

Males > females
2-3 decade - M3M and upper 3s
Asymptomatic - incidental finding
Tooth missing from arch

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What is the radiographic presentation of dentigerous cysts?

Round/ovoid
Well-defined
Unilocular
Uniform radiolucency
Usually attach at the CEJ

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How do dentigerous cysts present histopathologically?

Thin, regular layer of non-keratinising stratified squamous epithelium

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What are the contents of dentigerous cysts?

Proteinaceous, yellowish fluid
Cholesterol crystals common

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What are eruption cysts?

Odontogenic developmental
Overlying an erupting tooth
Histopathologically same as dentigerous
Tooth often erupts
Most commonly deciduous incisors or FPM

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How common are dentigerous cysts?

20% of all odontogenic cysts

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How common are OKCs?

3rd most common odontogenic cyst after radicular and dentigerous

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What lines OKCs?

Cell rests of Serres - originates from remnants of dental lamina

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What is the clinical presentation of OKCs?

Males > females
Wide age range
70-80% mandible - esp 3 molar region
Usually asymptomatic

How do OKC’s present radiographically?

Oval
Well defined
May have scalloped margins
Uni or multilocular
Large mesio-distal expansion without buccal-lingual expansion

How do OKCs appear histopathologically?

Thin connective tissue wall
Uninflamed
Lined by parakeratinised stratified squamous epithelium

What are the contents of OKCs?

Thick, grey/white cheesy material with keratinous debris

What is seen in basal cell naevus syndrome?

GORLIN-GOLTZ Multiple OKCs Multiple basal cell carcinomas Palmar and plantar pitting Calcification of intracranial dura mater

What are the symptoms of cysts?

Often asymptomatic Mobility of teeth Numbness/altered sensation Egg shell cracking feeling Loss of vitality

How common are lateral periodontal cysts?

0.4%

How do lateral periodontal cysts present clinically?

Middle aged May present with expansion Canine and premolar region of mandible, then anterior maxilla Vital tooth Usually asymptomatic and incidental finding

How do lateral periodontal cysts present radiographically?

Well-demarcated radiolucent area

How do lateral periodontal cysts present histopathologically?

Thin lining stratified squamous epithelium Similar to gingival cysts

What are gingival cysts and what are they derived from?

Rests of Serres - remnants of dental lamina Also called Bohn’s nodules Small yellow/cream nodules on edentulous alveolar mucosa No tx required - naturally degenerate

How common are nasopalatine duct cysts and what do they originate from?

5-10% of non-odontogenic cyst - most common one Epithelial remnants of naso-palatine duct

How do nasopalatine duct cysts present clinically?

Males >females 5th-6th decade (OP) Slowly enlarged swelling anterior palate

How do nasopalatine duct cysts present radiographically?

Well defined Round or ovoid or heart shaped Sclerotic margin Always involve midline

How to nasopalatine duct cysts present histopathologically?

Lined by stratified squamous and respiratory epithelium Neurovascular bundle found in capsule

How do solitary bone cysts present clinically?

Children and adults, no sex more than the other Premolar/molar region of mandible Asymptomatic, incidental finding Bony expansion often seen

How do solitary bone cysts present radiographically?

Radiolucency of variable size, irregular outline, moderately well defined Scalloped margins

What is a Stafne’s bone cavity?

Developmental anomaly of mandible Asymptomatic - incidental finding

How do Stafne’s bone cavities present radiographically?

Round or oval, well demarcated radiolucency Between premolar region and angle of mandible Usually below inferior dental canal

List 4 odontogenic tumours

Ameloblastoma Ameloblast if fibroma Malignant ameloblastoma Odontogenic myxoma

List 3 giant cell lesions

Peripheral and central giant cell granulomas Brown tumours of hyperparathyroidism Cherubism

List 2 fibro cemento-osseous lesions

Periapical cemento-osseous dysplasia Fibrous dysplasia

List 4 radiolucent non-odontogenic tumours

Chondroma Osteosarcoma SCC Central haemangioma

When is enucleation useful?

Radicular and residual cysts Dentigerous cysts OKCs

When is enucleation avoided specifically?

Ameloblastomas

What are the risks of enucleation?

Damage to IAN OAC Pathological fracture of mandible Recurrance risk if whole lining not removed

What is segmental resection and when is it carried out?

Removal of cyst with margin of normal bone Ameloblastoma Sarcoma

What are the risks of marsupialisation?

Lining not available for histopathology Chance of re-infection Needs further surgery for cyst removal Uncomfortable for patient

What is enucleation?

All of the cystic lesion is removed

What is marsupialisation?

Creation of a surgical window in wall of cyst Remove cyst contents Suture cyst wall to the surrounding epithelium Encourages cyst to decrease in size and can be followed by enucleation

What are the advantages of enucleation?

Whole lining can be examined histopathologically Primary closure Little aftercare needed

What are the indications of marsupialisation?

If enucleation would damage surrounding structures Difficult to access area May allow eruption of teeth affected by dentigerous cyst Elderly or medically compromised - can withstand surgery If large cyst would risk jaw fracture