cyst - basics Flashcards
What is a cyst?
A pathological cavity containing, fluid, semi-fluid or gaseous contents which has not been created by accumulation of pus
What are the different epithelial cysts?
Odontogenic - inflammatory and developmental
Non-odontogenic
What are the different inflammatory odontogenic cysts?
Radicular cyst - and residual cyst
Inflammatory collateral cysts:
- paradental cyst
- mandibular buccal bifurcation cyst
What are the different odontogenic developmental cysts?
Dentigerous cyst - and eruption cyst
OKC
Lateral periodontal cyst
Gingival cysts
What are the different non-odontogenic epithelial cysts?
Nasolabial cyst
Nasopalatine cyst
what are the different non-epithelial cysts?
Solitary bone cyst
Aneurysmal bone cyst
Stafne’s bone cavity
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
How do radicular cysts present radiographically?
Round or ovoid radiolucency at apex
Unilocular
Well defined
Uniform radiolucency
How to radicular cysts present histopathologically?
Regular lining of non-keratinised squamous epithelium
Deposits of cholesterol
Vascular capsule
What is the content of radicular cysts?
Varies from watery, straw coloured fluid to semi-solid brownish material
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
What are mandibular buccal bifurcation cysts?
> 35% of inflammatory colateral cysts
Occur in children
Usually buccal of erupting FPM
What lines dentigerous cysts?
Epithelium derived from REE from enamel organ
What is the clinical presentation of dentigerous cysts?
Males > females
2-3 decade - M3M and upper 3s
Asymptomatic - incidental finding
Tooth missing from arch
What is the radiographic presentation of dentigerous cysts?
Round/ovoid
Well-defined
Unilocular
Uniform radiolucency
Usually attach at the CEJ
How do dentigerous cysts present histopathologically?
Thin, regular layer of non-keratinising stratified squamous epithelium
What are the contents of dentigerous cysts?
Proteinaceous, yellowish fluid
Cholesterol crystals common
What are eruption cysts?
Odontogenic developmental
Overlying an erupting tooth
Histopathologically same as dentigerous
Tooth often erupts
Most commonly deciduous incisors or FPM
How common are dentigerous cysts?
20% of all odontogenic cysts
How common are OKCs?
3rd most common odontogenic cyst after radicular and dentigerous
What lines OKCs?
Cell rests of Serres - originates from remnants of dental lamina
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
