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FINALS - Oral Surgery > Cysts > Flashcards

Cysts Flashcards

1
Q

How can you categorise cysts?

A

Asymptomatic/symptomatic
Slow growing/fast growing
Indolent/destructive

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2
Q

In general are cysts benign?

A

Yes

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3
Q

What is a cyst?

A

A pathological cavity having fluid, semi-fluid, or gaseous contents which is not created by the accumulation of pus.

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4
Q

How can cysts present?

A

Often asymptomatic
Found as incidental finding
Blue/red swelling
Pain and profusion if infected
Tooth mobility

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5
Q

What radiographs should be taken when investigating a cyst?

A

First line:
- PA
- Occlusal
- Panoramic

Can consider:
- CBCT
- Facial
- PA mandible
- Occipitomental view

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6
Q

What features of a cyst should be noted on a radiograph?

A

Location
Shape (egg shaped)
Margins (well defined, corticated)
Locularity (Uniocular, multi-ocular)
Multiplicity
Effect on surrounding anatomy
Inclusion of unerupted teeth

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7
Q

By what mechanism do cysts grow?

A

Hydrostatic pressure

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8
Q

What types of developmental odontogenic cyst are there?

A

Dentigerous cyst (eruption cyst)
Odontogenic keratocyst
Lateral periodontal cyst

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9
Q

What types of inflammatory odontogenic cyst are there?

A

Radicular cyst (residual)
Paradental cyst
Buccal bifurcation cyst

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10
Q

What types of non-odontogenic cyst are there?

A

Nasopalatine duct cyst
Nasiolabal cyst
Globulomaxillary cyst
Median cyst

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11
Q

What types of non-epithelial cyst are there?

A

Solitary bone cyst
Aneurysmal cyst

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12
Q

What are odontogenic cysts?

A

Occur in tooth-bearing areas
Most common cause of bony swelling
Lined with epithelium

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13
Q

What are the sources of odontogenic cysts?

A

Rests of Malassez
Rests of Serres
Remnants of reduced enamel epithelium

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14
Q

What is a radicular cyst?

A

An inflammatory odontogenic cyst
Always associated with a non-vital tooth
Chronic inflammation from apex of tooth

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15
Q

What are the radiographic features of a radicular cyst?

A

Well defined
Corticated margin continuous with lamina dura of non-vital tooth
Displacement of adjacent structures

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16
Q

Describe the histology of a radicular cyst?

A

Often incomplete epithelial lining
Connective tissue capsule
Inflammation within capsule

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17
Q

Describe the way in which a radicular cyst can form from a granuloma?

A

Rests of Malassez proliferate into PA granuloma

Proliferating epithelium has central necrosis OR

Epithelium surrounds fluid area

Continued growth occurs due to semi-permiable wall and cytokine mediated growth

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18
Q

What is a residual cyst?

A

A cyst persisting after the loss of a tooth. Appears as longitudinal bony defect.

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19
Q

What is a lateral radicular cyst

A

A radicular cyst associated with an accessory canal.

Located at the side of the tooth rather than the apex.

20
Q

What are inflammatory collateral cysts?

A

Inflammatory odontogenic cysts, associated with a vital tooth.

Further differentiation into paradental cyst, and buccal bifurcation cyst.

21
Q

What is a dentigerous cyst?

A

Developmental odontogenic cyst, associated with crown of unerupted tooth.

22
Q

Give four histological signs of a radicular cyst?

A

Variable inflammation
Cholesterol clefts
Mucous metaplasia
Hyaline/rushton bodies

23
Q

How would you differentiate between an enlarged follicle an a dentigerous cyst?

A

Consider cyst if follicular space 5mm or more.

Normal follicular space is 2-3mm, and if this exceeds 10mm then assume its a cyst.

24
Q

What is an eruption cyst?

A

A variant of dentigerous cyst, contained within the soft tissue.

Associated with an erupting tooth, and found more commonly in the incisors.

25
Q

What is an odontogenic keratocyst?

A

Developmental odontogenic cyst, with no specific relationship to teeth.

26
Q

What is basal cell naevus syndrome?

A

Multiple odontogenic keratocysts
Multiple basal cell carcinomas
Calcification of inter cranial dura mater

27
Q

What is a mucous retention cyst?

A

Benign self-limiting lesions, that originate from the accumulation of fluids inside the sinus membrane

28
Q

Give three examples of non-odontogenic cyst?

A

Nasopalatine duct cyst
Solitary bone cyst
Aneurysmal bone cyst

29
Q

If a cyst presents below the IAN canal of the mandible, what is the cyst more likely to be?

A

A non-odontogenic cyst

30
Q

How does a nasopalatine duct cyst present?

A

Circuluar radiolucency in the duct
Arrises from the nasopalatine duct, and occurs in the anterior maxilla.

31
Q

What radiographic views may be useful when investigating a nasopalatine duct cyst?

A

PA
Standard maxillary occlusal
CBCT if planning surgery

32
Q

What are the radiographic findings of a nasopalatine duct cyst?

A

Corticated radiolusency between/over roots of central incisors

Often uniocular

May appear heart shaped due to superimposition of nasal spine

33
Q

What anatomical feature may be confused with a nasopalatine duct cyst?

A

The incisive fossa
Sizes 6-10mm in diameter monitor
10mm+ suspect cyst

34
Q

What is a solitary bone cyst?

A

Non-odontogenic cyst without an epithelial lining

Can be simple, tarumatic, or haemorrhagic

Can occur in association with other bone pathology

35
Q

How do solitary bone cysts present?

A

Usually asymptomatic

Rarely pain and swelling

Radiographically:
- Majority in premolar/molar region of mandible
- Variable definition and cortication
- May have scalloped margins
- May project up between roots of adjacent teeth

36
Q

What is a Stafne cavity?

A

Depression in the bone, containing salivary of fatty tissue.

Most common on angle or posterior body of mandible. Typically well defined, corticated, and asymptomatic.

37
Q

What methods are there for obtaining a sample for histopath?

A

Aspiration biopsy (drain contents)
Incisional biopsy (partial removal)
Excisional biopsy (complete removal)

38
Q

What are the two main treatment options for cysts?

A

Enucleation (All of cyst is removed)

Marsupialisation (Create window, remove contents, and suture cyst wall to epithelium)

39
Q

What are the advantages of enucleation?

A

Whole lining can be pathologically examined
Primary closure
Little aftercare is needed

40
Q

What are the contraindications of enucleation?

A

Risk of mandibular fracture with large cysts
May wish to preserve tooth
Old age/ill health

41
Q

What are the potential risks of enucleation?

A

Cavity may become infection
Incomplete removal, leading to recurrance
Damage to adjacent structures inc. teeth

42
Q

What are the indications for marsupialisation?

A

If enucleation would damage structures
Difficult access to area
May allow eruption of teeth
Lower risk of jaw fracture

43
Q

What are the advantages of marsupialisation?

A

Simple to perform
May spare vital structures

44
Q

What are the contraindications for marsupialisation?

A

Opening may close and cyst may reform
Complete lining not available for histopath
Difficult to keep clean
Requires obturator to keep open
Long time for bony infil

45
Q

What are the differential diagnosis for non-cystic radiolucencies?

A

Odotogenic tumours
Giant cell lesions
FCO lesions
Radiolucent non-odontogenic tumours

46
Q

What is the management of a suspected cyst in general practice?

A

Referral
Initial consultation
Special investigation
Biopsy
Diagnosis

Tx:
- Enucleation
- Marsupialisation
- Surgical resection

FINALS - Oral Surgery (14 decks)

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