CYST (man &manag) Flashcards
a pathologic space lined with epithelium
CYSTS
T or F
pseudocysts are lined with epithelium
False
(pseudocysts are NOT lined with epithelium)
HOW IT STARTED
→ periapical infections
→ chronic and acute pathways that untreated infections and their
accompanying clinical lesions may take depending on the type of the ____, ____, _____
preceding pulpitis, virulence of the bacteria, and the presence or absence of drainage
origin/etiology
- dental lamina remnants
RUSHTON BODIES
origin/etiology
- sources of ameloblastoma
RUSHTON BODIES
Cysts derived from:
Rests of Malassez
Reduced Enamel Epithelium
Dental Lamina (Rests of Serres)
Unclassified
→ periapical cyst
→ residual cyst
A. Rests of Malassez
B. Reduced Enamel Epithelium
C. Dental Lamina (Rests of Serres)
D. Unclassified
A
→ dentigerous cyst
→ eruption cyst
A. Rests of Malassez
B. Reduced Enamel Epithelium
C. Dental Lamina (Rests of Serres)
D. Unclassified
B
→ odontogenic keratocyst
o multiple
→ lateral periodontal cyst
o polycystic (botryoid)
A. Rests of Malassez
B. Reduced Enamel Epithelium
C. Dental Lamina (Rests of Serres)
D. Unclassified
C
→ gingival cyst of the adult
→ dental lamina cyst of the newborn
→ glandular odontogenic cyst
A. Rests of Malassez
B. Reduced Enamel Epithelium
C. Dental Lamina (Rests of Serres)
D. Unclassified
C
paradental cyst
A. Rests of Malassez
B. Reduced Enamel Epithelium
C. Dental Lamina (Rests of Serres)
D. Unclassified
D
CLASSIFICATION OF CYSTS
→ odontogenic cysts
→ non-odontogenic
→ soft tissue cysts of the neck
→ pseudocysts
→ periapical cyst
→ dentigerous cyst
→ eruption cyst
→ lateral periodontal cyst
→ gingival cyst of the newborn
→ odontogenic keratocyst
→ calcifying odontogenic cyst
→ primordial cyst
→ residual cyst
Are what CLASSIFICATION OF CYSTS?
ODONTOGENIC CYSTS
also called radicular or apical periodontal cyst
PERIAPICAL CYST
their epithelial lining is from growth of Rests Cells of Malassez
PERIAPICAL CYST
ETIOLOGY AND PATHOGENESIS
→ develops from a periapical granuloma; this is a chronic inflammation
→ a product of necrotic pulp tissue
→ when the epithelial rest cells of malassez are stimulated in
response to inflammation, a cyst is formed
PERIAPICAL CYST
→ increase in fluid will increase the size of the cyst
→ osteoclasts will resorb bone, resulting to cyst expansion
→ other bone resorbing factors are:
o prostaglandins
o interleukins
o proteinases
PERIAPICAL CYST
CLINICAL FEATURES
→ almost half or 3⁄4 of cysts in the oral cavity
→ most affected are maxillary incisors
→ asymptomatic, discovered only by routine radiograph
→ cannot differentiate from granuloma by x-ray
→ round or ovoid
PERIAPICAL CYST
→ Russel bodies are round
→ Rushton bodies are hairpin-shaped; sign of previous
hemorrhage
PERIAPICAL CYST
TREATMENT AND PROGNOSIS
Of PERIAPICAL CYST
→ extraction
→ followed by curettage of apical area
→ RCT with apicoectomy if RCT does not resolve
→ if epithelium is left, residual cyst will form
also known as follicular cyst
DENTIGEROUS CYST
→ 2nd most common odontogenic cyst
→ associated with crown of unerupted or developing tooth
DENTIGEROUS CYST
DIFFERENCE FROM PRIMORDIAL CYST
→ both are attached to the crown of unerupted or developing tooth but the dentigerous cyst is attached on the _____
Cervical area
enamel organ (its remnants are called REE)
DENTIGEROUS CYST
CLINICAL FEATURES
→ common in 3rd molars & maxillary canines
→ late eruption of tooth
→ well-defined unilocular radiolucency
DENTIGEROUS CYST
HISTOPATHOLOGY
→ cyst lining is stratified squamous epithelium
→ 4-6 layers thick
DENTIGEROUS CYST
DENTIGEROUS CYST TREATMENT
→ remove tooth involved
→ enucleation
o complete removal of the whole lesion including the lining of the cyst; thus, exposing the adjacent bone
→ if cyst is too big, marsupialization is done
→ untreated dentigerous cyst can become ____
→ if mucous cells are present, cyst can become _____
ameloblastoma, mucoepidermoid carcinoma
a dentigerous cyst resulting from fluid accumulation within the follicular space of an erupting tooth
ERUPTION CYST
→ the epithelial lining is REE
→ trauma can cause blood to pool within the tissue space and is
called an “________”
eruption hematoma
(ERUPTION CYST)
ERUPTION CYST txt
none because the tooth will erupt through the cyst and it disappears
round or teardrop-shaped
LATERAL PERIODONTAL CYST
common in mandibular premolar and cuspids and maxillary
lateral incisors
LATERAL PERIODONTAL CYST
a lateral periodontal cyst which is multilocular
BOTRYOID ODONTOGENIC CYST
LATERAL PERIODONTAL CYST
Txt.
local excision
also known as dental lamina cyst of the newborn
GINGIVAL CYST OF THE NEWBORN
also known as Bohn’s nodules
GINGIVAL CYST OF THE NEWBORN
→ found along alveolar ridge
→ origin:
o remnants of dental lamina within alveolar ridge
GINGIVAL CYST OF THE NEWBORN
GINGIVAL CYST OF THE NEWBORN txt.
none; they degenerate or rupture into the cavity before 3 months of age
SIMILAR CYSTS
→ palatine cysts of the newborn or Epstein pearls
→ origin:
o remnants in the fusion lines between palatal shelves and nasal processes
GINGIVAL CYST OF THE NEWBORN
a cyst which occurs in place of a tooth owing to cystic degeneration of an enamel organ
PRIMORDIAL CYST
→ globulomaxillary lesions
→ nasolabial cyst
→ median mandibular cyst
→ nasopalatine canal cyst
Are CLASSIFICATION OF what CYSTS?
NON-ODONTOGENIC CYSTS
→ origin:
o odontogenic epithelium located between maxillary lateral
incisor and canine
o it shows a radiolucency between these 2 teeth
GLOBULOMAXILLARY LESIONS
pear-shaped
GLOBULOMAXILLARY LESIONS
→ pathogenesis:
o epithelial cells trapped at the fusion of globular portion of
the nasal & maxillary processes
o may also come from solid cord cells that forms the
nasolacrimal duct
NASOLABIAL CYST
origin:
o there is a mesenchyme tissue that gradually becomes lost as
the mandible develops and the embryonic processes does not fuse
MEDIAN MANDIBULAR CYST
also known as incisive canal cyst
NASOPALATINE CYST
located inside nasopalatine canal or inside palatal soft tissues at the opening of the canal; thus, may be termed as cyst of palatine papilla
NASOPALATINE CYST
heart-shaped
NASOPALATINE CYST
all of the above terms fall under the general term: ________
o many believe this term means the cyst is in the posterior area of the nasopalatine canal
o the median alveolar cyst is in the anterior area of the nasopalatine canal
median palatine cyst
DERMOID AND EPIDERMOID CYST
THYROGLOSSAL TRACT CYST
BRANCHIAL CYST
Classification?
SOFT TISSUE CYSTS
form of cystic teratoma
DERMOID AND EPIDERMOID CYST
→ derived from embryonic germinal epithelium
→ presumed to be derived from enclavement (retention due to
constriction) of epithelial debris in the midline during closure of
the mandibular and hyoid branchial arches
DERMOID AND EPIDERMOID CYST
looks like a golf ball
DERMOID AND EPIDERMOID CYST
→ majority occurs in young adults
→ a bulge in the floor of the mouth is seen and the tongue
becomes elevated
o because of elevation, there is difficulty in eating and
talking
→ when the cyst is palpated, it is dough-like or soft
DERMOID AND EPIDERMOID CYST
→ derived from embryonic germinal epithelium
→ presumed to be derived from enclavement (retention due to
constriction) of epithelial debris in the midline during closure of
the mandibular and hyoid branchial arches
DERMOID AND EPIDERMOID CYST
connective tissue wall:
o lined on the inner surface by a thin layer of stratified
squamous epithelium
contains:
o sebaceous glands
o hair follicles
o sweat glands
DERMOID AND EPIDERMOID CYST
lumen contains sebaceous material and keratin
A. Dermoid Cyst
B. Epidermoid Cyst
A
lumen contains only keratin
A. Dermoid Cyst
B. Epidermoid Cyst
B
DERMOID AND EPIDERMOID CYST txt.
→ surgical excision
→ does not recur
location:
o a developmental cyst that form anywhere along the
embryonic thryoglossal tract between the foramen caecum
of the tongue and the thyroid glands
→ as we grow old, it is supposed to be obliterated; however, in
cases it does not, the remnants of the tract become thyroglossal tract cyst
THYROGLOSSAL TRACT CYST
→ location:
o sometimes may lie to one side of the midline
o foramen cecum
o floor of the mouth
→ if formed near the tongue, usually cause difficulty in swallowing or dysphagia
THYROGLOSSAL TRACT CYST
THYROGLOSSAL TRACT CYST
if occurs:
Above Level of Hyoid Bone
A. lined by stratified squamous epithelium
B. lined by columnar or ciliated columnar epithelium
A
THYROGLOSSAL TRACT CYST
if occurs:
Below Level of Hyoid Bone
A. lined by stratified squamous epithelium
B. lined by columnar or ciliated columnar epithelium
TREATMENT of THYROGLOSSAL TRACT CYST
completed surgical excision
→ slowly growing soft tissue cysts of the neck
→ usually, asymptomatic
BRANCHIAL CYST
→ location:
o occurs on the lateral aspect of the neck
o may also occur in the angle of the mandible, submandibular
areas, preauricular area or parotid area
BRANCHIAL CYST
ETIOLOGY
→ originates through cystic transformation in tract in the cervical lymph nodes
BRANCHIAL CYST
HISTOLOGIC FEATURES
→ connective tissue wall is lined by stratified squamous or pseudostratified columnar epithelium
→ connective wall of the cyst exhibits lymphoid tissue and contains thin, watery fluid or thick gelatinous mucoid material
BRANCHIAL CYST
BRANCHIAL CYST txt.
→ through surgical excision
→ recurs if residual remnants are left or if lesion is just drained
→ false cysts
→ appears cystic but has no epithelial lining
PSEUDOCYSTS
CLINICAL FEATURES
→ generally, a lesion in young person’s mostly <20 years old
→ often, a history of traumatic injury is noted
→ usually a tender or painful which limits the movement of the
affected bone
ANEURYSMAL BONE CYST
→ swelling in the bone involved
→ resembles a blood-soaked sponge
ANEURYSMAL BONE CYST
RADIOGRAPHIC FEATURES
→ expanded bone
→ tooth may be displaced with or without root resorption
→ presence of osteolytic process (lysis of bone or bone destruction)
ANEURYSMAL BONE CYST
appears cystic with honeycomb or soap bubble appearance
ANEURYSMAL BONE CYST
HISTOLOGIC FEATURES
→ consists of fibrous connective tissue stroma containing cavernous spaces or sinusoidal blood-filled spaces
→ contains:
o young fibroblast
o multinucleated giant cells
→ presence of hemosiderin, new osteoid, and bone formation
ANEURYSMAL BONE CYST
ANEURYSMAL BONE CYST txt.
J
→ surgical excision with curettage with low doses of radiation
also called developmental Stafne defect or developmental lingual mandibular salivary gland depression
STATIC BONE CYST
→ rare change in size; sometimes doesn’t grow at all
→ usually asymptomatic
→ developmental defect = no treatment
→ often, salivary gland depression that lies below the mandibular
canal
STATIC BONE CYST
developmental depression of mandible secondary to:
*entrapment of salivary gland parenchyma during the development of mandible
*indentation along the lingual aspect of the mandible within which there’s extension of the submandibular gland
STATIC BONE CYST
most affected:
o usually seen in the 2nd or 3rd molar area
STATIC BONE CYST
→ also called simple bone cyst, big cyst
→ there is expansion or swelling
→ usually asymptomatic, though on some occasions, patients will
complain of pain
TRAUMATIC BONE CYST
→ even if the cyst is big, the teeth involved are usually vital
→ most affected:
o frequently occurs in the mandible (posterior area) lying below the mandibular canal
TRAUMATIC BONE CYST
ETIOLOGY
→ obstruction of the duct of the minor or accessory salivary glands due to traumatic severance of a salivary duct
→ if the duct is severed or traumatized, there would be spillage of the mucous to the connective tissue or mucin causing secondary inflammation reaction → granulation tissue formation which will now form around the mucin pool
MUCOCELE: MUCUS EXTRAVASATION PHENOMENON
CLINICAL FEATURES
→ location:
o usually found in the lower lip
→ has peripheral inflammatory change
→ painless mass that contains: o thick mucinous material
→ connective tissue wall:
o made of granulation
→ tissue and fibroblast not lined by epithelium and have a cavity containing mucin in the connective tissue and submucosa
MUCOCELE: MUCUS EXTRAVASATION PHENOMENON
→ usually asymptomatic
→ size is usually 3-10 mm
→ usually appears after 50 years old
→ normal color and there are intact overlying mucosa
MUCOCELE: MUCOUS RETENTION CYST
sometimes, it will involve the maxillary sinus and if that happens,
you’ll have a dome-shaped, semilunar radiopacity noted along the floor of the sinus
MUCOCELE: MUCOUS RETENTION CYST
→ on palpation:
o mobile
o non-tender
o no peripheral inflammatory change
→ location:
o palate
o cheeks
o floor of the mouth
MUCOCELE: MUCOUS RETENTION CYST
ETIOLOGY
→ obstruction of salivary flow
HISTOLOGIC FEATURES
→ connective tissue wall:
o lined by pseudostratified columnar or cuboidal epithelium
(true cyst)
→ lack of inflammatory cell infiltrate
→ cystic cavity lined by oncocytes (ductal epithelial cells
MUCOCELE: MUCOUS RETENTION CYST
MUCOCELE: MUCOUS RETENTION CYST txt.
→ surgical excision and mucus retention cyst
→ complete removal of associated lobules of minor salivary gland
elements
→ to prevent recurrence:
o remove the associated salivary gland acini
a mucocele on the floor of the mouth
RANULA
CLINICAL FEATURES
→ slowly enlarging painless mass
→ bluish-frog cystic lesion
→ usually fluctuant, unilateral soft tissue mass
RANULA
RANULA txt
TREATMENT
→ marsupialization may be performed before definitive surgical excision
→ because the mass is big, this compresses the lesion (the cyst) into a smaller size
