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OMS x OMOPOR > Cystic Lesions of the Jaw > Flashcards

Cystic Lesions of the Jaw Flashcards

1
Q

What is the definition of a cyst

A

Pathological cavity lined by epithelium
Fluid, semi-fluid or gaseous content, but not created by accumulation of pus

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2
Q

What is a pseudocyst?

A

Like a cyst but without epithelial lining

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3
Q

Elements of a cyst

A

Wall/capsule : fibrous CT w collagen fibers, BV, inflammatory cells

Epithelial lining

Cystic fluid in lumen

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4
Q

Common features of cysts

A

Most common chronic swelling of jaws
Jaws > bones due to presence of odontogenic epithelial remnants
Slow and expansile growth
May resorb and displace teeth
Asymptomatic unless large or infected
If extending to soft tissues forms a compressible and fluctuant swelling

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5
Q

Radiographical presentation of cysts

A

Well-defined round RL w smooth, corticated borders

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6
Q

Major factors of cyst expansion

A

1) Proliferation of epithelial lining and fibrous capsule
2) Resorption of surrounding bone
3) Hydrostatic pressure of cystic fluid as epithelium desquamates into the lumen, increasing protein content, causing osmosis into the lumen

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7
Q

Types of inflammatory odontogenic cysts

A

Radicular/periapical cysts
Paradental/buccal bifurcation cyst

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8
Q

Types of developmental odontogenic cysts

A

Bohn’s nodules, epstein pearls
Dental lamina cysts/gingival cyst of the newborn
Eruption cyst
Dentigerous cyst
Odontogenic keratocyst
Lateral periodontal cyst

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9
Q

Non-odontogenic cysts

A

Nasopalatine duct cysts

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10
Q

Types of pseudocysts

A

Simple bone cavity
Stafne bone defect
Aneurysmal bone cyst

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11
Q

What is a radicular cyst

A

Most common type of odontogenic cyst
PA granuloma that stimulated cell rests, forming a PA cyst
Derived from epithelial cell rests of Malassez in PDL fibers

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12
Q

Demographics of radicular cysts

A

Male > female
Usually 40-50yo

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13
Q

Types of radicular cysts

A

Apical
Lateral
Residual (inflammatory tissue not curetted after exo, removal of cyst incomplete)

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14
Q

Clinical presentation of radicular cysts

A

Max > mand
Slowly progressive swelling
Asymptomatic unless large or infected
Associated with a non-vital tooth, usually discolored permanent tooth
May cause adjacent teeth mobility

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15
Q

Radiographic presentation of radicular cysts

A

Well-defined ovoid unilocular RL
May have RO margin
Similar to granuloma but generally larger, >1cm
Loss of lamina dura
Can cause root resorption or bony expansion

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16
Q

Histopathologic findings of radicular cysts

A

Wall: collagenous/fibrous CT, chronic inflammatory infiltrate (lymphocytes, histiocytes, plasma cells), and cholesterol clefts

Epithelial lining: non-keratinized SSE from epithelial cell rests of Malassez

Cystic fluid: watery, opalescent liquid with cholesterol crystals

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17
Q

Diagnosis of radicular cyst

A

Vitality testing
Radiographic presentation

BUT clinical and radiographic findings are identical to periapical granuloma
Differentiating factor is histopathology

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18
Q

Management of radicular cysts

A

Non-surgical endodontic therapy
Exo
Recurrence uncommon, but if persistent then exo and curette or do apicoectomy and curettage

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19
Q

What is a buccal bifurcation cyst

A

Uncommon odontogenic cyst
Lining derives from epithelial cell rests of Malassez in PDL fibers
Usually in young px (5-13yo)
Often presents with buccal enamel extension into bifurcation, predisposing towards pocket formation

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20
Q

Clinical presentation of buccal bifurcation cysts

A

Swelling
Tender
Foul tasting discharge
Mand 1M > 2M
Occasionally bilateral

Identical presentation to periodontal abscess

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21
Q

Radiographic presentation of buccal bifurcation cysts

A

Well defined unilocular RL
Tipping of molar to make lingual cusps more prominent
Mand occ radiographs shows buccal location

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22
Q

Histopathologic findings of buccal bifurcation cysts

A

Nonspecific findings

Wall: chronic inflammatory cell infiltrate

Epithelial lining: SSE with areas of hyperplasia

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23
Q

Management of buccal bifurcation cysts

A

Enucleation without exo
Usually get complete healing within 1 year

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24
Q

What are palatal cysts (bohn’s nodules vs epstein pearls)

A

Found in 50-85% of neonates

Bohn’s nodules originate from epithelial remnants from development of minor salivary glands of palate

Epstein pearls originate from epithelial entrapment between the palatal shelves

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25
Q

Clinical presentation of palatal cysts

A

Usually multiple small (1-3mm) white or yellow-white papules

Bohn’s nodules found at junction of hard and soft palate or rarely at vestibular region

Epstein pearls found along midpalatal raphae

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26
Q

Histopathologic findings of of palatal cysts

A

Keratin-filled cysts lined by SSE
May have communication with mucosal surface

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27
Q

Management of palatal cysts

A

No treatment needed as the epithelium gradually degenerates OR cysts rupture into mucosal surface and eliminate keratin contents

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28
Q

What are dental lamina cysts

A

Derived from cell rests of Serres, remnants of dental lamina

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29
Q

Clinical presentation of dental lamina cysts

A

Multiple small (2-3mm) white papules with smooth surfaces
Along crest of alveolar ridge
Max > mand

30
Q

Histopathologic findings of dental lamina cysts

A

Keratin-filled cysts with a thin, flattened epithelial lining with a parakeratotic luminal surface
Lumen contains keratinaceous debris

31
Q

Management of dental lamina cysts

A

No treatment needed as they spontaneously involute and rupture

32
Q

What are eruption cysts

A

Soft tissue variant of dentigerous cysts
Common in children <10yo
Develop from the separation of the dental follicle from the crown of the erupting tooth, within soft tissue overlying alveolar bone

33
Q

Clinical presentation of eruption cysts

A

Single, soft, round pink/blue translucent swelling
Painless unless infected or traumatized
Traumatized cysts may have blue coloration (eruption hematoma)

Found on gingival mucosa overlying the crown of a erupting primary/permanent tooth, often max and mand incisors and permanent 1M

34
Q

Histopathologic findings of eruption cysts

A

Surface oral epithelium
Underlying CT shows variable inflammatory cell infiltrate
Roof shows thin SSE

35
Q

Management of eruption cysts

A

No treatment needed
Naturally marsupializes as tooth erupts
If symptomatic or causing delayed eruption, remove roof of cyst to release fluid and allow normal eruption

36
Q

What is a dentigerous cyst

A

2nd most common odontogenic cyst after radicular cyst
Most common developmental odontogenic cyst
Develops from the separation of the dental follicle from the crown of the erupting tooth
Cyst lining develops from REE
Usually in 10-30yo, male > female

37
Q

Pathogenesis of dentigerous cysts

A

Accumulation of fluid between the REE and tooth

Hypotheses as to WHY:
1) Follicle compressed by impacted tooth, increasing pressure and causing increased fluid transudation, accumulating between REE and tooth
2) PA inflammation from deciduous tooth causes inflammation of REE of permanent tooth, causing accumulation of inflammatory exudate between REE and crown

38
Q

Clinical presentation of dentigerous cysts

A

Missing tooth or delayed eruption
Slow growing, but can be expansile
Small: often asymptomatic, incidental radiographic discovery
Large: painless, hard bony swelling, can cause facial asymmetry
Infected: pain and swelling

Associated with the crown of unerupted/impacted teeth, esp mand 3M, max 3M, max canines, mand 2PM
May be associated with supernumeraries or odontomas, uncommon in deciduous teeth

39
Q

Radiographic presentation of dentigerous cysts

A

Unilocular RL (large cysts may have trabeculations and appear multilocular)
Well defined corticated RO borders (unless infected, where its ill-defined)
Pericoronal to impacted tooth, attached to CEJ

Can have displacement of adjacent bony borders and structures, teeth, or even root resorption

40
Q

Histopathologic presentation of dentigerous cysts

A

Wall: collagenous/fibrous. If non-inflamed, minimal inflammatory infiltrate, loosely arranged. If inflamed, heavy inflammatory infiltrate, more collagenised, hyperplastic, rete ridges present

Epithelial lining: originates from REE, non-keratinized SSE to cuboidal, non inflamed, thin and flattened

Cystic fluid: yellow fluid

41
Q

Management of dentigerous cysts

A

Surgical enucleation and exo of involved tooth
Recurrence is rare

If large, excisional biopsy of dentigerous cyst lining due to potential for odontogenic tumours

42
Q

What is an odontogenic keratocyst

A

Arises from cell rests of Serres
Behavior different from other odontogenic cysts - infiltrative, aggressive growth, high recurrence rate, associated with nevoid basal cell carcinoma syndrome

Usually in 10-40yos
Male > female

43
Q

Pathogenesis of odontogenic keratocysts

A

Active epithelial growth, high cell proliferation rate
Over-expression of proteolytic enzymes causing bone resorption
Hydrostatic pressure plays a minimal role!

44
Q

Types of odontogenic keratocysts

A

Parakeratinized (aggressive) = OKC
Orthokeratinized (non-aggressive) = ortho-keratinized odontogenic cyst

45
Q

Clinical presentation of odontogenic keratocysts

A

A-P growth, extensive bone destruction with expansion within medullary cavity of bone
Small: asymptomatic, found on routine radiographs
Large/infected: pain, swelling, drainage

Mand > max
Posterior > anterior
May be associated with unerupted teeth
Epicenter superior to IDN

46
Q

Radiographic presentation of odontogenic keratocysts

A

Often unilocular but can be multilocular esp in large lesions in post mand
Well-defined corticated RL with smooth scalloped borders

Tunnels in bone rather than expanding
Less likely to cause bony expansion, tooth displacement and root resorption than dentigerous cysts and ameloblastomas

47
Q

Histopathologic findings of odontogenic keratocysts

A

Wall: thin, fragile, hard to enucleate intact. Loose collagenous/myxoid presentation, no inflammation, can have satellite/daughter cysts, potential for recurrence

Epithelial lining: parakeratinized stratified epithelium. Weakly attached to underlying CT, remnants remain after cyst enucleation so potential for recurrence
Fingerlike extensions into cancellous bone so hard to remove lining

Fluid: thick, yellow, creamy/cheesy keratin debris

Unique! So diagnosed histologically

48
Q

Management of odontogenic keratocysts

A

Surgical enucleation and curettage
High recurrence rate (25-60%)
Long term clinical and radiographic follow up

49
Q

What is a lateral periodontal cyst

A

Uncommon odontogenic cyst occurring along a lateral root surface
Usually in 50-70yo
Male > female
Arises from cell rests of Serres
Soft tissue variant is gingival cyst of the adult

50
Q

Clinical presentation of lateral periodontal cysts

A

Asymptomatic, found on routine radiographs
Teeth still vital

Mand > max
PM-canine-LI region!

51
Q

Histopathological findings of lateral periodontal cysts

A

Wall: thin, non-inflamed, fibrous

Epithelial lining: non-keratinized and thin with focal nodular thickenings

Diagnosed histologically!

52
Q

Radiographic features of lateral periodontal cysts

A

Well-defined ovoid unilocular RL lateral to roots of VITAL teeth
Usually small, <1cm
Can cause root divergence

Polycystic variant is multilocular

53
Q

Management of lateral periodontal cysts

A

Conservative enucleation, recurrence unusual

54
Q

What is a nasopalatine duct cyst

A

Most common non-odontogenic cyst
Intraosseous developmental cyst caused by spontaneous degeneration of remnants of the nasopalatine duct
Arises from remnants of the nasopalatine canal!

Usually 40-60yo, male > female

55
Q

Clinical presentation of nasopalatine duct cysts

A

Slow growing dome-shaped fluctuant swelling
May be bluish if near surface
Asymptomatic
May penetrate labial cortex, showing swelling below maxillary labial frenum
May drain into oral cavity - salty taste

Midline of anterior palate, overlying incisive canal, posterior to CIs and palatine papilla

56
Q

Radiographic presentation of nasopalatine duct cysts

A

Well-defined round/heart-shaped unilocular RL
In midline between roots of max CIs

May push root apices of CIs apart
May expand labial/palatal cortex of maxilla
May displace CIs
Root resorption is rare

57
Q

Histopathologic findings of nasopalatine duct cysts

A

Wall: neurovascular bundles, may have small mucous glands and small islands of hyaline cartilage. Mild to heavy chronic inflammatory infiltrate

Epithelial lining: varies from SSE to pseudostratified columnar epithelium, may have cilia/goblet cells

58
Q

Management of nasopalatine duct cysts

A

Surgical enucleation, avoid nasopalatine nerve
Cyst large and risk of devitalization of CIs or creating a oral-antral fistula = marsupialization
Low recurrence rate

59
Q

What is a simple bone cavity

A

Empty bone cavity with no epithelial lining (pseudocyst)
Usually in 20yo
Trauma causes intraosseous hematoma, breakdown of bloodclot creates an empty bone cavity

60
Q

Clinical presentation of a simple bone cavity

A

Asymptomatic
May have pain and paresthesia

Mand > max
Posterior > anterior

61
Q

Radiographic presentation of simple bone cyst

A

Well defined irregular unilocular RL with scalloped/rounded borders
1-10cm in size
Tooth displacement and root resorption are rare

May be ill-defined and multilocular!

62
Q

Histopathologic findings of simple bone cyst

A

Lacks epithelial lining

Wall: thin layer of vascular fibrous CT, may have fibrin, erythrocytes, giant cells or lace-like dystrophic calcifications

63
Q

Management of simple bone cyst

A

Surgical exploration and curettage to induce bleeding and healing by secondary intention
Periodic radiographic review until complete resolution

64
Q

What is a stafne bone defect

A

Depression on lingual surface of mand lined by lingual cortex
No epithelial lining (pseudocyst)
Usually in middle aged and older adults
Male > female

65
Q

Clinical presentation of stafne bone defects

A

Asymptomatic
Remains stable in size, but may increase slightly over time
Mand post (below IDN canal) around submand area
Mand ant (apex of anterior teeth) around sublingual area

66
Q

Radiographic presentation of stafne bone defects

A

Well circumscribed ovoid RL with sclerotic border, usually unilateral

67
Q

Management of stafne bone defects

A

No treatment needed

68
Q

What is an aneurysmal bone cyst

A

Intraosseous accumulation of blood-filled spaces
No epithelial lining (pseudocyst)
Usually in <30yo
Female > male

69
Q

Clinical presentation of aneurysmal bone cysts

A

Fairly rapid bony swelling, usually buccal or labial
May have pain or be tender on palpation

Mand > max
Posterior > anterior

70
Q

Radiographic presentation of aneurysmal bone cysts

A

Well-defined unilocular circular RL
May have tooth displacement or root resorption
Larger lesions may be multilocular with wispy septae and dramatic expansion and thinning of bone cortices

71
Q

Histopathologic findings of aneurysmal bone cysts

A

RBC filled space of varying sizes
Lacks epithelial lining
Surrounded by fibrous CT and reactive bone

72
Q

Management of aneurysmal bone cysts

A

Surgical curettage (20-50% recurrence)
Partial resection (10% recurrence)
Clinical and radiographic follow-up for recurrence

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