Cyst Management Flashcards
Define cyst
A pathological cavity containing fluid or gas and which is not created by the accumulation of pus
Most cysts are lined by epithelium
What is pus an indication for
Infection
Talk through the mechanism of cyst growth
Inflammation causes epithelial proliferation
Cells in the cyst centrally break down
There is an increase in osmotic pressure leading to water being drawn in which increases the size of the cyst
List some key features of cysts
- Sharp defined radiolucencies
- Grow slowly displacing than resorbing teeth
- Usually symptomless and more radiographic findings
- Can appear bluish when close the mucosal surface
- Form compressible and fluctuant swellings if extending into soft tissues
How can cysts affect bone
Can lead to thinning of the bone and in very rare cases pathological fractures
How can we classify cysts
- Odontogenic
- Non odontogenic
- Non epithelial lined bone cyst
What can odontogenic cysts be further classified into
Inflammatory
Developmental
Give examples of inflammatory odontogenic cysts
- Radicular cysts
- Paradental cysts
Give examples of developmental odontogenic cysts
- Dentigerous cysts
- Odontogenic keratocysts
- Eruption cyst
- Lateral periodontal cyst
Give examples of developmental non odontgenic cysts
- Nasopalatine cysts
- Nasolabial cyst
Give examples of no epithelial lined bone cysts
- Solitary bone cyst
- Aneurysmal bone cyst
Give examples of soft tissue cysts
- Salivary gland cyst
- Dermoid cyst
- Epidermoid cyst
- Thyroglossal duct cyst
- Cystic hygroma
- Anterior midline lingual cyst
- Nasolabial cyst
Name the most common odontogenic cyst
Radicular cysts
Describe the epidemiology of cysts
More common in males than females
More commonly found in the maxilla than mandible
Usually affects 20-60 yr olds
What do radicular cysts arise due to
Chronic inflammation around apex of non vital tooth
Describe radicular cysts
They are a slow painless swelling (unless infected)
Sometimes bluish in colour
Always associated with a non vital tooth
can cause bone resorption
What are radicular cysts derived from
Epithelial cell remnants of the mallasez within the PDL
How do we manage a small radicular cyst
RCT and monitor the tooth associated with the cyst
How do we manage larger radicular cysts
Enucleation, histopathology and primary closure
What is a residual cyst
A radicular cysts which persists after XLA of the associated tooth
In whom are residual cysts more common
In the elderly to those with edentulous jaws
Describe lateral periodontal cysts
Often asymptomatic
Commonly afec the canine and premolar
Found adjacent to a vital tooth
How does a lateral periodontal cyst present on a radiograph
As a unilocular radiolucent on the side of the tooth
What to lateral periodontal cysts arise from
Epithelial cell rests of malassez
How do we treat lateral periodontal cysts
Enucleation
Rare occasions we may extract the adjacent tooth if there was evidence of it being involved in the cyst
In whom are dentigerous cysts commonly found in
More males than females
Usually in pts around the age of 20-50
Describe dentigfeorus cysts
asymptomatic incidental findings on a radiograph
surrounds the crown of the an unerupted or partially erupted tooth
What are dentigerous cysts associated with
Unerupted third molars and Canines
What can dentigerous cysts associated with
Unerutped or partially erupted teeth that can prevent their eruption or displace the tooth
Describe how a dentigerous cyst may present on a radiogrpah
- Well circumscribed
- Rounded
- Unilocular
- Contains crown of a tooth which is displaced from its natural position
How do we treat dentigerous cysts
- marsupialisation
- Enucleation and XLA of tooth
What is marsupialisation
the surgical technique of cutting a slit into a cyst and suturing the edges of the slit to form a continuous surface from the exterior surface to the interior surface of the cyst
What are eruption cysts
Benign cysts that appear on the mucosa of the tooth prior to eruption
How do we manage eruption cyst
Usually first on their own spontaneous
May need to remove cyst roof in rare cases of infection
What do odontogenic keratocysts prudes from
Remnants of the dental lamina
Describe odotngenic keratocysts
- Lined by thin parakeratinised stratified squamous epithelium
- Characteristic corrugated surface
- Basal cell layer is well defined
In whom are odontogenic keratocysts more commonly seen in
20-30 yr old is peak age (can be seen in 50-70s)
More commonly found in the mandible usually the angle of the mandible
Describe odontogenic keratocysts
Often asymptomatic until swelling
Low pressure
Present late
Describe how odotogenic keratocysts present radiographically
Well defined radiolucency
Round/ scalloped margins
Can envelop a tooth or displace adjacent teeth
can be unilocular or multilocular
What are odotongenic keratocysts associated with
Gorlin Goltz syndrome
How do we trat odotnogenic keratocysts
Enucleation
What is a risk after treating odotogenic keratocysts
Risk of recurrence is 5-60% due to the presence of satellite cysts which may not be removed
In whom re ameloblastomas seen
Usually between 30-60 year olds
More Riley in the mandible at the ramus
Describe an ameloblastoma
Symptomless until swelling
Describe how an ameloblastoma may present on a radiograph
- Rounded
- Cyst like
- Radiolucent
- Moderately well defined margins
- Typically mupltilocualr but can be uni cystic
- Honey comb pattern
What is a calcifying epithelial odontogenic tumour also known as
Pindborg tumour
Describe a calcifying epithelial odontogenic tumour
Asymptomatic until swelling occurs
found commonly t the posterior body of the mandible
Common in those around the age of 40
Describe how a calcifying epithelial odontogenic tumour may appear on a radiograph
Radiolucent area with poorly defined margins
Can be complete radiolucent or develop radiopacity as it develops
How do we treat calcifying epithelial odontogenic tumour
Excise with small clear margins
What is a stafne bone cyst
A developmental inclusion of salivary glands in the mandible leadign to cyst formation
Where are stafne bone cysts found
Below the Inferior alveolar nerve canal
How do we treat stafne bone cysts
Conservative management
Describe aneurysmam bone cysts
Slowly expands and can be aggressive
Typically Contain blood filled spaces interspersed with giant cells and fibroblasts
They are non epithelial line lesions (not true cysts)
More commonly fount in the mandible than maxilla
How do we treat aneurysmam bone cysts
Enucleation
Describe solitary boen cysts
Often an incidental finding
Non epithelial lined (psydocyst)
Teeth usually vital
Aetiology unknown
Cyst can contain blood stained serous fluid or gas
How do we manage solitary bone cysts
Enucleation
Where are nasoplatine duct cysts found
At the nasoplatine duct/ canal
formed due to the remnants of the nasopalatine duct
What are naso palatine duct cyst formed
Epithelial remnants of the nasopalatine duct
What are naso palatine duct cyst formed
Epithelial remnants of theH nasopalatine duct
How are naso palatine duct cyst treated
Enucleation but recurrence is high due to poor technique
What assessments do we need to carry put before coming to a treatment plan for a cyst
- History
- Examination
- Radiogrpahs
- Special tests: vitality testing and biopsy
List some cyst red flags
- Altered sensation
- Neurological disorder
- Sudden mobility of teeth
- Sudden onset of swelling
Go through potential treatment options for a cyst from least to most invasive
- Conservative
- Decompression
- Enucleation
- Enucleation and curretage
- Resection and margin
In whom would we consider a conservative treatment option approach
- Patient unfit for surgery
- Pt at high risk of complication
- Smaller cysts
What is conservative managemetn
Wait and watch
What is decompressions
Marupialisation:
opening a window into the cavity ti allow pressure to reduce
Reduces size fo cyst to then enucleate
What are the advantages of decompression
Simple
protect vital structures
Preserve teeth
What are the disadvantages of decompression
Hygiene
Compliance
Can be lengthy
Takes 2 procedures
What are the advantages of enuclaetion
Entire specimen is removed
Is curative
What are the disadvantages of enuclation
- Technically challenging
- Can damage the vital structures
- There’s a risk of fracture with large cysts
What is enucleation
Removing the whole cyst
What is resection
Excision of lesion with margin of clinically nroaml looking tissue
