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DENT 322 - Image Interpretation > Cysts > Flashcards

Cysts Flashcards

1
Q

Define a cyst (4)

A
  • A pathologic cavity filled with fluid
  • Lined by epithelium
  • Surrounded by a connective tissue wall
  • Fluid is secreted by cells lining the cavity
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2
Q

Define a cystlike lesion

A

A pathologic cavity filled with fluid but lacking an epithelium

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3
Q

3 classes of cysts

A
  • Odontogenic cysts
  • Nonodontogenic cysts (developmental cysts)
  • Cystlike lesions
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4
Q

2 classes of odontogenic cysts

A
  • Inflammatory cysts
  • Developmental cysts
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5
Q

Describe the mechanism of cyst enlargement

A
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6
Q

4 clinical symptoms of cysts

A
  • Swelling
  • Lack of pain
  • Frequent association with teeth
  • Sometimes cyst becomes infected –> painful
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7
Q

Where are cysts located (5)

A
  • Within bone
  • Any location in the maxilla or mandible
  • Odontogenic cysts most often in tooth-bearing region
  • In mandibule –> above mandibular canal
  • In maxilla –> may grow into the maxillary sinus
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8
Q

Describe the periphery and shape of cysts (3)

A
  • Well-defined periphery with a thin, radiopaque line
  • Sometimes, secondary infection can change this aspect into more sclerotic (thicker) boundary)
  • Usually round or oval shape
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9
Q

Describe the internal structure of cysts (3)

A
  • Radiolucent
  • Long-standing cysts have calcifications
  • Some cysts have septa which produce multiple loculations
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10
Q

5 effects of cysts on surrounding structures

A
  • Tooth displacement
  • Tooth resorption
  • Bone expansion
  • Displacement of the mandibular canal
  • Cyst may invaginate into the maxillary sinus
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11
Q

Define a radicular cyst

A

A cyst that most likely results when rests of epithelial cells in the periodontal ligament are stimulated to proliferate and undergo cystic degeneration by inflammatory products from a nonvital tooth

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12
Q

2 types of inflammatory cysts

A
  • Radicular cysts
  • Residual cysts
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13
Q

5 clinical features of radicular cysts

A
  • Most frequent cysts of the jaws
  • Arise from nonvital teeth
  • Asymptomatic unless secondary infection occurs
  • Swelling (large cysts)
  • Incidence of radicular cysts is greater between 30 - 60 years
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14
Q

4 radiographic features of radicular cysts

A
  • Located at the apex of a nonvital tooth
  • Well-defined cortical border
  • Round shape
  • Radiolucent
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15
Q

4 effects of radicular cysts on surrounding structures

A
  • Displacement and root resorption of the adjacent teeth
  • Cortical expansion
  • Invagination into the maxillary sinus
  • Displacement of the mandibular canal
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16
Q

4 differential diagnoses of radicular cyst

A
  • Apical granuloma
  • Early stage of periapical cemental dysplasia
  • Central giant cell granuloma
  • Malignant tumor (metastasis)
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17
Q

How to differentiate a radicular cyst from an apical granuloma

A
  • A small radicular cyst may be impossible to differentiate from an apical granuloma
  • Well-defined cortical border, size greater than 1 cm are more characteristic of a cyst
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18
Q

How to differentiate early stage of periapical cemental dysplasia from radicular cysts

A
  • Around vital teeth
  • Anterior teeth of the mandible
  • Black women more prevalent
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19
Q

Define lateral radicular cyst

A

A radicular cyst originating from an accessory root canal (existence of a lateral root canal)

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20
Q

Differential diagnosis for lateral radicular cyst

A

Lateral periodontal cyst

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21
Q

Define residual cyst

A

A cyst that remains after incomplete removal of the original cyst. A radicular cyst or granuloma left after extraction of a tooth.

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22
Q

4 clniical features of residual cysts

A
  • Asymptomatic
  • Often discovered on radiographic examination of edentulous area
  • Bone expansion
  • Pain in the case of secondary infection
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23
Q

6 radiographic features of residual cysts

A
  • Oval or circular shape
  • Well-defined border
  • Cortical or sclerotic border (if it become secondarily infected)
  • Radiolucent
  • Cortical expansion
  • Tooth displacement or resorption
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24
Q

2 differential diagnoses for residual cysts

A
  • Other solitary cysts (odontogenic keratocyst; slight cortical expansion)
  • Stafne bone defect (below the mandibular canal)
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25
Q

5 types of developmental odontogenic cysts

A
  • Dentigerous cyst
  • Odontogenic keratocyst
  • Lateral periodontal cyst
  • Calcifying odontogenic cyst (Gorlin cyst)
  • Glandular odontogenic cyst
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26
Q

Define dentigerous cyst

A

A cyst that forms around an unerupted crown, which begins when fluid accumulates between the epithelium and the crown of an unerupted tooth. Attached at the cementoenamel junction.

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27
Q

Most common cyst of development

A

Dentigerous cyst

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28
Q

Age group most commonly affected by dentigerous cyst

A

20 - 30 years

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29
Q

Most frequent locations of dentigerous cysts (4)

A
  • Mandibular third molar
  • Upper canine
  • Maxillary third molar
  • Lower premolar
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30
Q

5 clinical symptoms/findings of dentigerous cysts

A
  • Missing tooth
  • Hard swelling
  • Facial asymmetry
  • No pain
  • Sometimes developping around supernumary tooth (mesiodens)
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31
Q

Radiographic location of dentigerous cysts

A
  • Epicenter is found just above the crown
  • Cyst attaches at the CEJ
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32
Q

Internal aspect of dentigerous cyst

A

Radiolucent

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33
Q

Periphery and shape of dentigerous cyst

A

Well-defined border

Curved outline

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34
Q

4 effects on surrounding structures by dentigerous cysts

A
  • Tooth displacement (apical direction)
  • Tooth resorption
  • Expansion of the outer cortical boundary
  • Displacement of the mandibular canal in an inferior direction
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35
Q

5 differential diagnoses for dentigerous cysts

A
  • Hyperplastic follicle (vs. small dentigerous cyst)
  • Odontogenic keratocyst
  • Cystic ameloblastoma
  • Ameloblastic fibroma
  • Adenomatoid odontogenic tumor
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36
Q

How to differentiate between small dentigeorus cyst and hyperplastic follicle

A
  • Size of normal follicular space = 2 - 3 mm
  • When follicular space exceeds 5 mm –> dentigerous cyst
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37
Q

3 ways to differentiate odontogenic keratocyst from dentigerous cyst

A
  • OK does not expand bone to the same degree
  • OK is less likely to resorb teeth
  • OK is not attached to the CEJ
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38
Q

3 ways to differentiate cystic ameloblastoma from dentigerous cyst

A
  • CA presents curved bony septa creating internal compartments
  • CA is less homogenous
  • CA is not attached to the cementoenamel junction
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39
Q

How to differentiate ameloblastic fibroma from dentigerous cyst

A

No attachment at the CEJ

40
Q

How to differentiate between adenomatoid odontogenic tumor and dentigerous cyst

A

Internal calcifications

41
Q

Composition of odontogenic keratocyst

A

Rests of dental lamina

42
Q

3 tumorlike characteristics of odontogenic keratocyst (keratocystic odontogenic tumor)

A
  • Innate growth potential consistent with a benign tumor
  • Growth does not result from osmotic pressure
  • Distinctive histologic appearance (epithelial lining is keratinized and thin)
43
Q

Significance of finding several odontogenic keratocysts

A

These cysts may constitute part of a basal cell nevus syndrome (Gorlin syndrome)

44
Q

Frequency of odontogenic keratocysts

A

3 - 11% of all cystic lesions of the jaws

45
Q

Age group of odontogenic keratocysts

A

20 - 40 yrs

46
Q

Most frequent location of odontogenic keratocysts

A

Posterior body of the mandible

47
Q

4 clinical symptoms/findings of odontogenic keratocysts

A
  • No symptoms
  • Sometimes mild swelling
  • Inside of cyst contains a viscous or cheesy material (characteristic)
  • High risk of recorruence (due to small satellite cysts)
48
Q

Location of epicenter of odontogenic keratocyst

A

Above the manibular canal

49
Q

Periphery and shape of odontogenic keratocyst

A

Curved outline

Evidence of a cortical border

Scalloped outline (contiguous arcs)

50
Q

Internal structure of odontogenic keratocysts

A
  • Radiolucent
  • Occasionally, septa may be present –> multilocular appearance
51
Q

3 effects of odontogenic keratocysts on surrounding structures

A
  • Teeth displacement
  • Flight expansion of the outer cortical boundary –> propensity to grow along the internal aspect of the jaws
  • Displacement of the mandibular canal in an inferior direction
52
Q

5 differential diagnoses for odontogenic keratocysts

A
  • Dentigerous cyst
  • Cystic ameloblastoma
  • Odontogenic myxoma
  • Traumatic cysts
  • Central giant-cell granuloma
53
Q

How to differentiate dentigerous cyst from odontogenic keratocyst

A
  • DC is connected to the CEJ
  • DC has a greater propensity to expand the cortical plates
  • DC does not present scalloped margin
54
Q

How to differentiate odontogenic myxoma from odontogenic keratocyst

A

Trabecular pattern –> fine septa

55
Q

How to differentiate traumatic cysts from odontogenic keratocysts

A

Mild cortical plate expansion

56
Q

How to differentiate central giant cell granuloma from odontogenic keratocyst

A

Located in the anterior part of the mandible

57
Q

3 abnormalities associated with basal cell nevus syndrome

A
  • Multiple nevoid basal cell carcinomas of the skin
  • Skeletal abnormalities
  • Multiple odontogenic keratocysts
58
Q

Inheritance pattern of Gorlin syndrome

A

Autosomal dominant inheritance

59
Q

8 skeletal anomalies of Gorlin syndrome

A
  • Bifid rib
  • Vertebral fusion
  • Polydactyly
  • Temporoparietal bossing
  • Mild prognathism
  • Flat face
  • Multiple OK (high recurrence rate)
  • Calcification of the flax cerebri
60
Q

2 skin lesions assocaited with Gorlin syndrome

A
  • Brown papules
  • Basal cell carcinomas (appear later than OK)
61
Q

Define lateral periodontal cyst

A
  • Cysts which arise from epithelial rests in periodontium lateral to the dental root.
  • Developmental odontogenic cyst occuring to the lateral root surface of a vital tooth.
  • Usually unicystic but may appear as cluster of small cysts –> boryoid odontogenic cysts
  • Do not confuse with lateral radicular cyst (inflammatory origin)
62
Q

4 clniical features of lateral periodontal cysts

A
  • Asymptomatic
  • Less than 1 cm in diameter
  • 20 - 60 years
  • Male predominance
63
Q

Location of lateral periodontal cysts

A
  • 50 - 70% observed in mandible
  • Mostly in a region extending from the lateral incisor to the second premolar
64
Q

Periphery and shape of lateral periodontal cysts

A
  • Well-defined lesion
  • Round or oval shape
65
Q

Internal structure of lateral periodontal cyst

A
  • Radiolucent
  • Boytroid cyst –> mulitlocular appearance
66
Q

3 effects on surrounding areas by lateral periodontal cysts

A
  • May efface the LD of the adjacent root
  • Tooth displacement
  • Bone expansion
67
Q

4 differential diagnoses fro lateral periodontal cysts

A
  • Small odontogenic keratocyst
  • Mental foramen
  • Lateral radicular cyst
  • Odontogenic tumor (ameloblastoma)
68
Q

What are calcifying cystic odontogenic tumors (CCOT) associated with 20% of the time

A

Odontoma

69
Q

3 clniical features of CCOT

A
  • Age distribution = 20 - 40 yrs
  • Slow-growing, painless swelling
  • No sex predominance
70
Q

Location of calcifying odontogenic cysts

A

Equal distribution between jaws

75% occur anterior to the first molar

71
Q

Periphery and shape of calcifying odontogenic cysts

A
  • Well-defined lesion
  • Curved cystlike shape
  • Sometimes ill-defined and irregular
72
Q

Internal structure of calcifying odontogenic cysts

A
  • Radiolucent
  • Calcified material
73
Q

3 effects on surrounding areas by calcifying odontogenic cysts

A
  • Teeth displacement
  • Root resorption
  • 20 - 50 % associated with a tooth
74
Q

3 differential diagnoses for calcifying odontogenic cysts

A

Lesions having internal calcifications

  • Adenomatoid odontogenic tumor
  • Ameloblastic fibro-odontoma
  • Calcifying epithelial odontogenic tumor
75
Q

Define glandular odontogenic cyst

A
  • Rare cyst derived from odontogenic epithelium with a spectrum of characteristics including salivary gland features.
  • Slight female predominance with a mean age of 46 - 50 yrs
  • Aggressive
  • High recurrence rate (25 - 30%)
76
Q

Location of glandular odontogenic cysts

A

Mostly in anterior madible

77
Q

Periphery and shape of glandular odontogenic cysts

A

Curved outline with a cortical boundary

78
Q

Internal structure of glandular odontogenic cysts

A

Radiolucent

79
Q

2 effects of glandular odontogenic cysts on surrounding structures

A
  • Expansion of the cortical plate
  • Teeth displacement
80
Q

Most common of non-odontogenic cysts

A

Nasopalatine canal cyst (10% of jaw cysts)

81
Q

Define nasopalatine canal cyst

A

Cyst resulting from embryonic epithelial rests of nasopalatine duct, which undergo proliferation and cyst degeneration

82
Q

4 symptoms and findings of nasopalatine canal cysts

A
  • Most often asymptomatic
  • Small, well-defined swelling just posterior to the central incisors, salty taste
  • Lesion may expand into nasal cavity
  • Pressure from the cyst on nasopalatine nerves causes numbness over the palatal mucosa
83
Q

Location of nasopalatine canal cysts

A

Nasopalatine canal or foramen, may involve hard palate

84
Q

Periphery and shape of nasopalatine canal cysts

A
  • Well-defined
  • Circular or oval, somtimes heart shaped
86
Q

Internal structure of nasopalatine canal cysts

A

Radiolucent

87
Q

4 effects of nasopalatine canal cysts on surrounding structures

A
  • Divergence of the roots of the central incisors
  • Root resorption
  • Displacement of the nasal floor in a superior direction
  • Expansion of the labial and palatal cortex
88
Q

2 differential diagnoses of nasopalatine canal cysts

A
  • Large incisive foramen (>6 mm)
  • Radicular cyst or granuloma associated with a central incisor
89
Q

How to differentiate between radicular cyst or granuloma associated with a central incisor versus a nasopalatine canal cyst

A

Enlargement of the periodontal ligament space and vitality test (should be on non-vital tooth)

90
Q

4 characteristics of traumatic bone cyst (simple bone cyst)

A
  • Empty cavity within bone
  • Lined with connective tissue (not a true cyst)
  • Unknown etiology
  • May be localized aberration in normal bone remodeling or metabolism
91
Q

7 clinical features of traumatic bone cysts

A
  • Mostly 10 - 20 yrs
  • Male predominance (2:1)
  • Multiple may occur with cemento-osseous dysplasia
  • Most often asymptomatic
  • Occasional pain or tenderness
  • Bone expansion or tooth displacement
  • Most discovered by chance
92
Q

Most common location of traumatic bone cyst

A

Almost all found in mandible (mostly posterior)

93
Q

Periphery and shape of traumatic bone cysts

A

Most often well-defined

Curved outline

Occasionally scalloped border

94
Q

Internal structure of traumatic bone cysts

A

Totally radiolucent

May appear multilocular (prnounced scalloping –> appearance of septa)

95
Q

2 effects of traumatic bone cysts on surrounding structures

A

Often lesion involves all the bone around the roots of teeth but leaves the lamina dura intact

Bone expansion

96
Q

2 differential diagnoses for traumatic bone cysts

A
  • Odontogenic keratocyst
  • Malignant lesion
97
Q

3 ways to differentiate odontogenic keratocyst from traumatic bone cyst

A
  • OK causes resorption and tooth movement
  • MRI shows empty bone cavity for traumatic bone cyst versus cavity filled with fluid in OK
  • OK occurs in older age group
98
Q

2 ways to differentiate malignant lesion from traumatic bone cyst

A
  • No maintenance of lamina dura
  • Ill defined and bone destruction

DENT 322 - Image Interpretation (12 decks)

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