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Oral Surgery > Cysts > Flashcards

Cysts Flashcards

1
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
Not an inflammatory, cancerous, infectious growth or inflammatory condition

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2
Q

How are cysts classified?

A

Structure
–epithelial-lined vs no epithelial lining
Origin
–odontogenic (based on dental tissues) vs. non-odontogenic
Pathogenesis
–developmental vs inflammatory

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3
Q

What are odontogenic cysts?

A

Come from dental tissues
Occur in tooth-bearing areas
Most common cause of bony swelling in the jaws
All lined with epithelium

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4
Q

What are the rests of malassez?

A

Remnants of Hertwigs root sheath

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5
Q

What are the rests of serres?

A

Remnants of the dental lamina

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6
Q

What is the reduced enamel epithelium?

A

Remnants of the enamel organ

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7
Q

How can the rests of malassez form cysts?

A

Other enamel epithelium and inner enamel epithelium, this forms the roots- then this epithelium disappears once the hard tissue is formed
Sometimes the clusters of this odontogenic epithelium make clusters in the PDL, if these are activated (infection, cytokines) and these can form odontogenic cysts and odontogenic tumours (cells do not divide initially)

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8
Q

If a cyst is above the IAN, what is it likely to be in origin?
If a cyst is below the IAN, what is it likely to be in origin?

A

Above IAN= odontogenic
Below IAN= non-odontogenic

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9
Q

How does the reduced enamel epithelium form cysts?

A

Inner and outer enamel become close together once the tooth is about to erupt into the oral cavity= reduced enamel epithelium (covers the developed crown)
This disintegrates once the tooth becomes closer to oral epithelium allowing for eruption
Forms eruption cysts when this does not disintegrate

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10
Q

What is a radicular cyst?

A

Inflammatory odontogenic cyst
Always associated with a non-vital tooth
Initiated by chronic inflammation at the apex of the tooth due to pulp necrosis

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11
Q

What is the incidence of a radicular cyst?

A

Male=Female
60% maxilla:40% mandible
Can involve any non vital tooth
Most common in 4th and 5th decades

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12
Q

What are the radiographic features of a radicular cyst?

A

Well-defined, round/oval radiolucency
Corticated margin continuous with lamina dura of non-vital tooth
Larger lesions may displace adjacent structures
Long-standing lesions may cause external root resorption &/or calcification
Always unilocular

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13
Q

What is the histology of a radicular cyst?

A

Regular lining of non-keratinised squamous epithelium
Deposits of cholesterol
Vascular capsule
Inflammatory infiltrate

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14
Q

What is a periapical granuloma?

A

Mass of granulation tissue that attaches to non-vital tooth apex

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15
Q

How is a periapical granuloma formed?

A

State of constant inflammation
Create a mass of epithelial tissue (rests of malassez) as cytokines trigger these to divide becomes further and further away from surrounding blood supply
Necrosis occurs at the centre
Leaves a gap, difference in pressure causes build up in fluid and expansion of the cyst, activates interleukins (osteoclasts) and causes bone resorption

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16
Q

How can radicular cysts form?

A

Proliferating epithelium with central necrosis
Epithelium surrounds fluid area

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17
Q

What are Rushton Bodies (histology)?

A

Cells present in odontogenic epithelium
No significance or prognostic factors
Lining of odontogenic cysts

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18
Q

What happens in mucous metaplasia (histology)?

A

Epithelial cells become mucous secreting cells

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19
Q

What are cholesterol clefts?

A

Spaces in epithelium where cholesterol used to be stored
Biopsy removes the lipid tissue and creates spaces where the cholesterol used to be stored- cholesterol clefts

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20
Q

What is a residual cyst?

A

When a radicular cyst persists after the loss of tooth (or after tooth is successfully root canal treated)
Knowledge of clinical/treatment history is important to avoid misdiagnosis
Well defined radiolucency

21
Q

What is a lateral radicular cyst?

A

Radicular cyst associated with an accessory canal
Located at side of tooth instead of apex

22
Q

What is an inflammatory collateral cyst?

A

Inflammatory odontogenic cysts
Associated with a vital tooth
Collective term for:
–paradental cyst (occurs at the distal of partially-erupted mandibular third molars)
–buccal bifurcation cyst (occurs at buccal aspect of mandibular first molar)

23
Q

What is a Dentigerous Cyst?

A

Developmental odontogenic cyst
Reduced enamel epithelium has not completely resorbed
Associated with crown of unerupted (usually impacted) tooth
Cystic change of dental follicle
Tooth can be displaced

24
Q

What is the histology of a dentigerous cyst?

A

Thin non-keratinised stratified squamous epithelium
Arises from reduced enamel epithelium

25
Q

When would you consider a radiolucency to be a dentigerous cyst vs an enlarged follicle?

A

Consider cyst if follicular space is 5mm or more
–measure from surface of crown to edge of follicle
–normal follicle space typically 2-3mm
–assume cyst if >10mm
Consider cyst if radiolucency is asymmetrical

26
Q

What is an eruption cyst?

A

Variant of dentigerous cyst
–contained within soft tissue rather than bone

27
Q

What is an odontogenic keratocyst (OKC)?
Name some features.

A

Developmental odontogenic cyst
–no specific relationship to teeth
Very thin lining, multilocular, can be associated with unerupted tooth or not
Very high recurrence rates
Often have scalloped margins
Often cause displacement of adjacent teeth

28
Q

What is the characteristic expansion of an odontogenic keratocyst?

A

Can enlarge markedly in the medullary bone space before displacing cortical bone
i.e. can have significant mesio-distal expansion without buccal-lingual expansion
INFILTRATIVE GROWTH PATTERN

29
Q

What is the histopathology of an odontogenic keratocyst?

A

Epithelial lining with keratin formation (parakeratosis)
Epithelial basal cells- palisading same size and shape and nuclei at the same level (uniform)
Epithelium has no rete pegs - thin attachment to underlying connective tissue
Also daughter cysts present in the wall

30
Q

What contributes to odontogenic keratocysts having high levels of recurrence?

A

Thin friable lining -> difficulty to remove in surgery
Infiltrative growth means it is more likely for some of the cyst to be left behind

31
Q

What is Basal Cell Naevus Syndrome?

A

Person has multiple odontogenic keratocysts, multiple basal cell carcinomas (of the skin), calcification of intracranial dura matter, palmar and plantar piting
AKA Gorlin-Goltz syndrome

32
Q

What is a nasopalatine duct cyst?

A

Developmental non-odontogenic cyst
–arises from nasopalatine duct epithelial remnants
–occurs in anterior maxilla

33
Q

What is the presentation of a nasopalatine cyst?

A

Often asymptomatic
Patient may note salty taste
Larger cysts may displace teeth or cause swelling in the palate
Always involve the midline but not always symmetrical

34
Q

What is the histology of a nasopalatine duct cyst?

A

Variable epithelial lining
–non-keratinised stratified squamous & modified respiratory

35
Q

What do the radiographical images appear like for a nasopalatine duct cyst?

A

Periapical &/or standard maxillary occlusal radiograph
Has a corticated radiolucency between/over roots of central incisors
Often unilocular
May appear heart shaped- superimposition of anterior nasal spine

36
Q

When determining if it is a nasopalatine cyst or the incisive fossa, what transverse diameter would you assume incisive fossa, consider monitoring and suspect it is a cyst?

A

<6mm, assume incisive fossa
6-10mm, consider monitoring
>10mm, suspect cyst

37
Q

What is a solitary bone cyst?

A

Non-odontogenic cyst without an epithelial lining

38
Q

What is the presentation of a solitary bone cyst?

A

Usually asymptomatic - incidental finding
Rarely any pain or swelling

39
Q

What is a Stafne Cavity?

A

Not a cyst but commonly mistaken as one
–only occurs in the mandible
–contains salivary or fatty tissue
–a depression in the bone (cortical bone is preserved)

40
Q

What are the 3 methods to obtain material for histopathological analysis?

A

Aspiration biopsy- drainage of contents
Incisional biopsy- partial removal
Excisional biopsy- complete removal

41
Q

What are the 2 treatment options for a cyst?

A

Enucleation
Marsupialisation

42
Q

What is Enucleation of a cyst?

A

All of the cystic lesion is removed

43
Q

What is Marsupialisation of a cyst?

A

Creation of a surgical window in the wall of the cyst, removing the contents of the cyst & suturing the cyst wall to the surrounding epithelium (decompression of the cyst, allows the cyst to shrink)
Used where cysts are too large to remove at once
Can be followed by enucleation once cyst has shrunk

44
Q

What are the advantages of enucleation?

A

Whole lining can be examined pathologically
Primary closure
Little aftercare needed

45
Q

What are the contraindications/disadvantages of enucleation?

A

Risk of mandibular fracture with large cysts
Old age/ill health
Clot-filled cavity may become infection
Incomplete removal of lining may lead to recurrence
Damage of adjacent structures

46
Q

What are the indications for performing marsupialisation?

A

If enucleation would damage surrounding structures
Difficult access to the area
May allow eruption of teeth affected by a dentigerous cyst
Elderly or medically compromised
Very large cysts

47
Q

What are the advantages of marsupialisation?

A

Simple to perform
May spare vital structures

48
Q

What are the contra-indications/disadvantages of marsupialisation?

A

Opening may close & cyst may reform
Complete lining not available for histology
Difficult to keep clean and lots of aftercare needed
Long time to fill in
Might need an obturator to keep marsupialisation window open

49
Q

What is an orthokeratinised odontogenic cyst?

A

Uncommon Developmental Cust
Similar presentation to OKC but histologically distinct with orthokeratinisation and flattened basal cell layer
Unilocular without epithelial proliferations or satellite cysts

Oral Surgery (19 decks)

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