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5th yr- CMS2- Facial trauma > Cyst Management > Flashcards

Cyst Management Flashcards

1
Q

Define cyst

A

A pathological cavity containing fluid or gas and which is not created by the accumulation of pus
Most cysts are lined by epithelium

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2
Q

What is pus an indication for

A

Infection

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3
Q

Talk through the mechanism of cyst growth

A

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

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4
Q

List some key features of cysts

A
  1. Sharp defined radiolucencies
  2. Grow slowly displacing than resorbing teeth
  3. Usually symptomless and more radiographic findings
  4. Can appear bluish when close the mucosal surface
  5. Form compressible and fluctuant swellings if extending into soft tissues
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5
Q

How can cysts affect bone

A

Can lead to thinning of the bone and in very rare cases pathological fractures

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6
Q

How can we classify cysts

A
  1. Odontogenic
  2. Non odontogenic
  3. Non epithelial lined bone cyst
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7
Q

What can odontogenic cysts be further classified into

A

Inflammatory
Developmental

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8
Q

Give examples of inflammatory odontogenic cysts

A
  1. Radicular cysts
  2. Paradental cysts
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9
Q

Give examples of developmental odontogenic cysts

A
  1. Dentigerous cysts
  2. Odontogenic keratocysts
  3. Eruption cyst
  4. Lateral periodontal cyst
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10
Q

Give examples of developmental non odontgenic cysts

A
  1. Nasopalatine cysts
  2. Nasolabial cyst
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11
Q

Give examples of no epithelial lined bone cysts

A
  1. Solitary bone cyst
  2. Aneurysmal bone cyst
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12
Q

Give examples of soft tissue cysts

A
  1. Salivary gland cyst
  2. Dermoid cyst
  3. Epidermoid cyst
  4. Thyroglossal duct cyst
  5. Cystic hygroma
  6. Anterior midline lingual cyst
  7. Nasolabial cyst
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13
Q

Name the most common odontogenic cyst

A

Radicular cysts

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14
Q

Describe the epidemiology of cysts

A

More common in males than females
More commonly found in the maxilla than mandible
Usually affects 20-60 yr olds

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15
Q

What do radicular cysts arise due to

A

Chronic inflammation around apex of non vital tooth

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16
Q

Describe radicular cysts

A

They are a slow painless swelling (unless infected)
Sometimes bluish in colour
Always associated with a non vital tooth
can cause bone resorption

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17
Q

What are radicular cysts derived from

A

Epithelial cell remnants of the mallasez within the PDL

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18
Q

How do we manage a small radicular cyst

A

RCT and monitor the tooth associated with the cyst

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19
Q

How do we manage larger radicular cysts

A

Enucleation, histopathology and primary closure

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20
Q

What is a residual cyst

A

A radicular cysts which persists after XLA of the associated tooth

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21
Q

In whom are residual cysts more common

A

In the elderly to those with edentulous jaws

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22
Q

Describe lateral periodontal cysts

A

Often asymptomatic
Commonly afec the canine and premolar
Found adjacent to a vital tooth

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23
Q

How does a lateral periodontal cyst present on a radiograph

A

As a unilocular radiolucent on the side of the tooth

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24
Q

What to lateral periodontal cysts arise from

A

Epithelial cell rests of malassez

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25
Q

How do we treat lateral periodontal cysts

A

Enucleation
Rare occasions we may extract the adjacent tooth if there was evidence of it being involved in the cyst

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26
Q

In whom are dentigerous cysts commonly found in

A

More males than females
Usually in pts around the age of 20-50

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27
Q

Describe dentigfeorus cysts

A

asymptomatic incidental findings on a radiograph
surrounds the crown of the an unerupted or partially erupted tooth

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28
Q

What are dentigerous cysts associated with

A

Unerupted third molars and Canines

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29
Q

What can dentigerous cysts associated with

A

Unerutped or partially erupted teeth that can prevent their eruption or displace the tooth

30
Q

Describe how a dentigerous cyst may present on a radiogrpah

A
  1. Well circumscribed
  2. Rounded
  3. Unilocular
  4. Contains crown of a tooth which is displaced from its natural position
31
Q

How do we treat dentigerous cysts

A
  1. marsupialisation
  2. Enucleation and XLA of tooth
32
Q

What is marsupialisation

A

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

33
Q

What are eruption cysts

A

Benign cysts that appear on the mucosa of the tooth prior to eruption

34
Q

How do we manage eruption cyst

A

Usually first on their own spontaneous
May need to remove cyst roof in rare cases of infection

35
Q

What do odontogenic keratocysts prudes from

A

Remnants of the dental lamina

36
Q

Describe odotngenic keratocysts

A
  1. Lined by thin parakeratinised stratified squamous epithelium
  2. Characteristic corrugated surface
  3. Basal cell layer is well defined
37
Q

In whom are odontogenic keratocysts more commonly seen in

A

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

38
Q

Describe odontogenic keratocysts

A

Often asymptomatic until swelling
Low pressure
Present late

39
Q

Describe how odotogenic keratocysts present radiographically

A

Well defined radiolucency
Round/ scalloped margins
Can envelop a tooth or displace adjacent teeth
can be unilocular or multilocular

40
Q

What are odotongenic keratocysts associated with

A

Gorlin Goltz syndrome

41
Q

How do we trat odotnogenic keratocysts

A

Enucleation

42
Q

What is a risk after treating odotogenic keratocysts

A

Risk of recurrence is 5-60% due to the presence of satellite cysts which may not be removed

43
Q

In whom re ameloblastomas seen

A

Usually between 30-60 year olds
More Riley in the mandible at the ramus

44
Q

Describe an ameloblastoma

A

Symptomless until swelling

45
Q

Describe how an ameloblastoma may present on a radiograph

A
  1. Rounded
  2. Cyst like
  3. Radiolucent
  4. Moderately well defined margins
  5. Typically mupltilocualr but can be uni cystic
  6. Honey comb pattern
46
Q

What is a calcifying epithelial odontogenic tumour also known as

A

Pindborg tumour

47
Q

Describe a calcifying epithelial odontogenic tumour

A

Asymptomatic until swelling occurs
found commonly t the posterior body of the mandible
Common in those around the age of 40

48
Q

Describe how a calcifying epithelial odontogenic tumour may appear on a radiograph

A

Radiolucent area with poorly defined margins
Can be complete radiolucent or develop radiopacity as it develops

49
Q

How do we treat calcifying epithelial odontogenic tumour

A

Excise with small clear margins

50
Q

What is a stafne bone cyst

A

A developmental inclusion of salivary glands in the mandible leadign to cyst formation

51
Q

Where are stafne bone cysts found

A

Below the Inferior alveolar nerve canal

52
Q

How do we treat stafne bone cysts

A

Conservative management

53
Q

Describe aneurysmam bone cysts

A

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

54
Q

How do we treat aneurysmam bone cysts

A

Enucleation

55
Q

Describe solitary boen cysts

A

Often an incidental finding
Non epithelial lined (psydocyst)
Teeth usually vital
Aetiology unknown
Cyst can contain blood stained serous fluid or gas

56
Q

How do we manage solitary bone cysts

A

Enucleation

57
Q

Where are nasoplatine duct cysts found

A

At the nasoplatine duct/ canal
formed due to the remnants of the nasopalatine duct

58
Q

What are naso palatine duct cyst formed

A

Epithelial remnants of the nasopalatine duct

59
Q

What are naso palatine duct cyst formed

A

Epithelial remnants of theH nasopalatine duct

60
Q

How are naso palatine duct cyst treated

A

Enucleation but recurrence is high due to poor technique

61
Q

What assessments do we need to carry put before coming to a treatment plan for a cyst

A
  1. History
  2. Examination
  3. Radiogrpahs
  4. Special tests: vitality testing and biopsy
62
Q

List some cyst red flags

A
  1. Altered sensation
  2. Neurological disorder
  3. Sudden mobility of teeth
  4. Sudden onset of swelling
63
Q

Go through potential treatment options for a cyst from least to most invasive

A
  1. Conservative
  2. Decompression
  3. Enucleation
  4. Enucleation and curretage
  5. Resection and margin
64
Q

In whom would we consider a conservative treatment option approach

A
  1. Patient unfit for surgery
  2. Pt at high risk of complication
  3. Smaller cysts
65
Q

What is conservative managemetn

A

Wait and watch

66
Q

What is decompressions

A

Marupialisation:
opening a window into the cavity ti allow pressure to reduce
Reduces size fo cyst to then enucleate

67
Q

What are the advantages of decompression

A

Simple
protect vital structures
Preserve teeth

68
Q

What are the disadvantages of decompression

A

Hygiene
Compliance
Can be lengthy
Takes 2 procedures

69
Q

What are the advantages of enuclaetion

A

Entire specimen is removed
Is curative

70
Q

What are the disadvantages of enuclation

A
  1. Technically challenging
  2. Can damage the vital structures
  3. There’s a risk of fracture with large cysts
71
Q

What is enucleation

A

Removing the whole cyst

72
Q

What is resection

A

Excision of lesion with margin of clinically nroaml looking tissue

5th yr- CMS2- Facial trauma (5 decks)

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