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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
Clinical presentation of palatal cysts
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
26
Histopathologic findings of of palatal cysts
Keratin-filled cysts lined by SSE May have communication with mucosal surface
27
Management of palatal cysts
No treatment needed as the epithelium gradually degenerates OR cysts rupture into mucosal surface and eliminate keratin contents
28
What are dental lamina cysts
Derived from cell rests of Serres, remnants of dental lamina
29
Clinical presentation of dental lamina cysts
Multiple small (2-3mm) white papules with smooth surfaces Along crest of alveolar ridge Max > mand
30
Histopathologic findings of dental lamina cysts
Keratin-filled cysts with a thin, flattened epithelial lining with a parakeratotic luminal surface Lumen contains keratinaceous debris
31
Management of dental lamina cysts
No treatment needed as they spontaneously involute and rupture
32
What are eruption cysts
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
Clinical presentation of eruption cysts
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
Histopathologic findings of eruption cysts
Surface oral epithelium Underlying CT shows variable inflammatory cell infiltrate Roof shows thin SSE
35
Management of eruption cysts
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
What is a dentigerous cyst
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
Pathogenesis of dentigerous cysts
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
Clinical presentation of dentigerous cysts
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
Radiographic presentation of dentigerous cysts
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
Histopathologic presentation of dentigerous cysts
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
Management of dentigerous cysts
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
What is an odontogenic keratocyst
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
Pathogenesis of odontogenic keratocysts
Active epithelial growth, high cell proliferation rate Over-expression of proteolytic enzymes causing bone resorption Hydrostatic pressure plays a minimal role!
44
Types of odontogenic keratocysts
Parakeratinized (aggressive) = OKC Orthokeratinized (non-aggressive) = ortho-keratinized odontogenic cyst
45
Clinical presentation of odontogenic keratocysts
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
Radiographic presentation of odontogenic keratocysts
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
Histopathologic findings of odontogenic keratocysts
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
Management of odontogenic keratocysts
Surgical enucleation and curettage High recurrence rate (25-60%) Long term clinical and radiographic follow up
49
What is a lateral periodontal cyst
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
Clinical presentation of lateral periodontal cysts
Asymptomatic, found on routine radiographs Teeth still vital Mand > max PM-canine-LI region!
51
Histopathological findings of lateral periodontal cysts
Wall: thin, non-inflamed, fibrous Epithelial lining: non-keratinized and thin with focal nodular thickenings Diagnosed histologically!
52
Radiographic features of lateral periodontal cysts
Well-defined ovoid unilocular RL lateral to roots of VITAL teeth Usually small, <1cm Can cause root divergence Polycystic variant is multilocular
53
Management of lateral periodontal cysts
Conservative enucleation, recurrence unusual
54
What is a nasopalatine duct cyst
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
Clinical presentation of nasopalatine duct cysts
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
Radiographic presentation of nasopalatine duct cysts
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
Histopathologic findings of nasopalatine duct cysts
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
Management of nasopalatine duct cysts
Surgical enucleation, avoid nasopalatine nerve Cyst large and risk of devitalization of CIs or creating a oral-antral fistula = marsupialization Low recurrence rate
59
What is a simple bone cavity
Empty bone cavity with no epithelial lining (pseudocyst) Usually in 20yo Trauma causes intraosseous hematoma, breakdown of bloodclot creates an empty bone cavity
60
Clinical presentation of a simple bone cavity
Asymptomatic May have pain and paresthesia Mand > max Posterior > anterior
61
Radiographic presentation of simple bone cyst
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
Histopathologic findings of simple bone cyst
Lacks epithelial lining Wall: thin layer of vascular fibrous CT, may have fibrin, erythrocytes, giant cells or lace-like dystrophic calcifications
63
Management of simple bone cyst
Surgical exploration and curettage to induce bleeding and healing by secondary intention Periodic radiographic review until complete resolution
64
What is a stafne bone defect
Depression on lingual surface of mand lined by lingual cortex No epithelial lining (pseudocyst) Usually in middle aged and older adults Male > female
65
Clinical presentation of stafne bone defects
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
Radiographic presentation of stafne bone defects
Well circumscribed ovoid RL with sclerotic border, usually unilateral
67
Management of stafne bone defects
No treatment needed
68
What is an aneurysmal bone cyst
Intraosseous accumulation of blood-filled spaces No epithelial lining (pseudocyst) Usually in <30yo Female > male
69
Clinical presentation of aneurysmal bone cysts
Fairly rapid bony swelling, usually buccal or labial May have pain or be tender on palpation Mand > max Posterior > anterior
70
Radiographic presentation of aneurysmal bone cysts
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
Histopathologic findings of aneurysmal bone cysts
RBC filled space of varying sizes Lacks epithelial lining Surrounded by fibrous CT and reactive bone
72
Management of aneurysmal bone cysts
Surgical curettage (20-50% recurrence) Partial resection (10% recurrence) Clinical and radiographic follow-up for recurrence

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