cysts of face and jaws Flashcards
list inflammatory odontogenic cysts (3)
radicular cyst
residual radicular cyst
inflammatory collateral cyst
radiographic appearance of cysts
variable site/size
uni/multilocular
well-defined, often corticated
radiolucent +/- opacities
can cause jaw expansion, displacement, resorption
list developmental odontogenic cysts (7)
odontogenic keratocyst
dentigerous cyst
lateral periodontal cyst
botryoid cyst
glandular odontogenic cyst
calcifying odontogenic cyst/tumour
orthokeratinised odontogenic cyst
list developmental non-odontogenic cysts (2)
nasopalatine duct cyst
nasolabial cyst
what categories are cysts split into?
inflammatory or developmental
odontogenic or non-odontogenic
which cysts arise from rests of Serres? (3)
odontogenic keratocyst
lateral periodontal and botryoid cyst
orthokeratinised odontogenic cyst
which rests arise from rests of Malassez? (3)
radicular and residual cyst
inflammatory collateral cyst
glandular odontogenic cyst
what does structure does a dentigerous cyst arise from?
follicle (reduced enamel epithelium)
give features of radicular cyst (source, demographic, radiograph, histology)
- inflammatory odontogenic
- cell rests of Malassez, hydrostatic growth
- middle age male
S - apex of non-vital tooth (often upper 2)
S - >1.5cm
S - circular/oval, unilocular
O - well-defined, corticated
R - radiolucent
E - tooth/structure displacement, bony expansion/thinning/perforation, rarely RR
Histology - hyperplastic odontogenic epithelium, Rushton bodies, cholesterol crystals
radicular cyst management (2)
XLA/RCT +/- enucleation
monitor, radiograph 3/12
differentials for radicular cyst (3)
- ameloblastoma
- other odontogenic tumours
- giant cell granuloma
how may residual radicular cyst differ from radicular cyst (2)
- may have dystrophic mineralisation, better organised histology
- no characteristic non-vital tooth
give features of inflammatory collateral cyst (type, source, age, radiograph, histology)
- inflammatory odontogenic
- cell rests of Malassez, hydrostatic growth
- children 15-30yo
S - furcation of VITAL lower molars
S -
S - round, unilocular
O - well-defined, corticated
R - RL
E - tooth displacement, expansion
Same histology as radicular
treatment of inflammatory collateral cyst (2)
- enucleation
- extraction if associated with 8
histology of radicular cyst (3)
- hyperplastic odontogenic epithelium
- Rushton bodies
- cholesterol crystals
histology of inflammatory collateral cyst (3)
- hyperplastic odontogenic epithelium
- Rushton bodies
- cholesterol crystals
give features of odontogenic keratocyst (type, source, demographic, radiograph, histology)
- developmental odontogenic
- rests of Serres (keratinising), burrowing growth
- 10-30yo or BCNS
S - angle of mandible, UE 8 associated, next commonest U3
S
S - round-elongated, usually multilocular
O - well-defined, corticated, scalloped
R - RL, internal septa = soap bubble
E - displacement and jaw expansion in late stage
Histology: - regular stratified squamous epithelium, palisaded basal layer, ortho/parakeratinised
- satellite cysts
- Rushton bodies
treatment of odontogenic keratocyst (2)
- enucleation, marsupialisation, en bloc resection +/- peripheral ostectomy/Carnoy’s/cryotherapy
- follow up for 7 years
what syndrome may OKCs be associated with?
basal cell naevus syndrome
describe basal cell naevus syndrome (AKA, mutation, age, s/s)
AKA jaw cyst, bifid rib syndrome
- AD patched gene mutation (hedgehog pathway)
- 0-30yo
- multiple OKCs
- multiple BCCs on non-sun exposed areas
- bifid fused supernumerary ribs
- falx cerebri calcification, frontal bossing, broad nasal root/hypertelorism, mild skeletal III
- skin pitting (palmar/plantar)
- 5% medulloblastoma
give features of dentigerous cyst (type, source, age, radiograph, histology)
- developmental odontogenic, reduced enamel epithelium, hydrostatic growth
- 10-30yo
S - around crown of UE tooth attaching at CEJ, L8 > U3 > U8
S - >5mm (normal follicle <3mm)
S - round-elongated, unilocular
O - well-defined, corticated
R - RL
E - tooth/structure displacement, bone expansion, root resorption 50%
Histology: - reduced enamel epithelium or thickened stratified non-keratinised
treatment of dentigerous cyst
XLA with enucleation or marsupialisation and allow eruption
give features of lateral periodontal cyst (type, source, age, radiograph, histology)
- developmental odontogenic, rests of Serres
- middle aged adult (40-70yo)
S - VITAL lower canine/premolar, between roots of two teeth
S
S - round-oval
O - well-defined, corticated
R - RL
E - lamina dura resorption, tooth displacement
Characteristic histology - thin epithelium with plaque-like thickenings
treatment of lateral periodontal cyst
enucleation + curettage
how does botryoid cyst differ to lateral periodontal cyst? (3)
- multilocular
- more growth potential
- requires conservative surgical excision and curettage
give features of glandular odontogenic cyst (type, source, age, radiograph)
- developmental odontogenic, rests of Malassez
- wide age range
S - mandible
S
S - usually multilocular
O - well-defined, scalloped, corticated
R - RL
E - tooth displacement, expansion and perforation
treatment of glandular odontogenic cyst (small vs large)
small = enucleated
large = excised with margin
give features of nasopalatine duct cyst (type, age, radiograph, histology)
- developmental non-odontogenic
- 30-60yo
S - vital teeth, maxillary midline overlying incisive foramen
S - >10mm (normal <6mm, enlarges with age)
S - round/oval, heart-shaped (anterior nasal spine)
O - well-defined, corticated
R - RL
E - root displacement, rarely RR
Histology - ciliated respiratory (columnar pseudostratified) or orthokeratinised, relatively unspecific
treatment of nasopalatine duct cyst
enucleation
give features of nasolabial cyst (type, demographic, site, effects, histology)
- developmental non-odontogenic
- middle aged female
S - nasolabial fold, upper buccal sulcus/lip, 10% bilateral
E - swelling, nasal obstruction, resorb nasal aperture bone
Histology - respiratory epithelium (nasolacrimal duct)
what structure do nasolabial cysts likely arise from?
nasolacrimal duct
treatment of nasolabial cyst
enucleation (as not firmly attached to bone) and excision (as superficially adherent to soft tissue)
histology of lateral periodontal cyst
thin epithelium with plaque-like thickenings
describe Bohn’s nodules/Epstein’s pearls
- developmental abnormalities
- keratin-filled, small translucent swellings
- alveolar ridge and palate of newborn
treatment of gingival cyst in adult
conservative excision
describe solitary bone cyst (cause, age, radiograph, histology, bloods)
- possibly caused by trauma
- childhood or early adulthood
- radiographically = well-defined, not corticated RL lesion which arcs up between tooth roots
- no epithelial lining, lack of tissue generally
- elevated bilirubin levels
solitary bone cyst management (2)
- no treatment needed (reaches burnout stage, bone deposition)
- but curettage/surgery may help trigger healing
solitary bone cyst age group
childhood or early adulthood
solitary bone cyst radiographic appearance
well-defined, not corticated RL lesion which arcs up between tooth roots
