Cysts of the Jaw Flashcards by Amirah H

Define a cyst.

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

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What is the most common cause of bony swellings in the jaws?

odontogenic cysts

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What are odontogenic cysts lined with?

Epithelium.
* rests of Malassez
* rests of Serres
* reduced enamel epithelium

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What are the 3 most common odontogenic cysts?

radicular cyst (and residual cyst) 60%
dentigerous cyst (and eruption cyst) 18%
odontogenic keratocyst 12%

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What is a radicular cyst?

inflammatory odontogenic cyst
assciated with a non-vital tooth
initiated by chronic inflammation at tooth apex due to pulp necrosis
often asymptomatic unless infected

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In which jaw are radicular cysts more common?

maxilla

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What are the radiographic features of a radicular cyst?

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 and/or contain dystrophic calcification

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What are histological features of a radicular cyst?

incomplete epithelium
connective tissue capsule
inflammation in capsule

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What is a residual cyst?

when radicular cyst persists after loss of tooth (or after tooth is successfully RCTed)

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What is lateral radicular cyst?

radicular cyst associated with an accessory canal
located at side of tooth instead of apex

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What are inflammatory collateral cysts?

odontogenic
associated with vital tooth
collective term for paradental cyst and buccal bifurcation cyst

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What is a paradental cyst?

odontogenic
associated with vital tooth
typically occurs at distal aspect of partially erupted mandibular third molar

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What is a buccal bifurcation cyst?

odontogenic
associated with vital tooth
typically occurs at buccal aspect of mandibular first molar

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What is a dentigerous cyst?

also known as follicular cyst
developmental odontogenic cyst
associated with the crown of an unerupted (and usually impacted) tooth

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What are radiographic features of a dentigerous follicular cyst?

corticated margins attached to CEJ of the tooth
may displace the involved tooth

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What are histological features of a dentigerous follicular cyst?

thin non-keratinised stratified squamous epithelium
may resemble radicular cyst if inflamed

What is the difference between a dentigerous follicular cyst and an enlarged follicle?

consider cyst if follicular space > 4mm
* measure from crown surface to edge of follicle
* assume cyst if > 10mm

What is an eruption cyst?

variable of dentigerous follicular cyst
contained within soft tissue rather than bone
associated with an erupting tooth

What is an odontogenic keratocyst?

developmental odontogenic cyst
no specific relationship to teeth
M > F
mandible > maxilla
posterior > anterior

What are radiographic features of odontogenic keratocyst?

scalloped margins
25% are multilocular
often cause displacement of adjacent teeth
characteristic expansion: significant mesio-distal expansion without bucco-lingual expansion (significant enlargement in medullary bone space before displacing cortical bone)

What is the presentation of Basal Cell Naevus Syndrome?

multiple odontogenic keratocysts
multiple basal cell carcinomas
palmar and planter pitting
calcification of intracranial dura mater

Also known as:
* Gorlin-Goltz syndrome
* bifid rib syndrome

What is the most common non-odontogenic cyst?

nasopalatine duct cyst

What is a nasopalatine duct cyst?

developmental non-odontogenic cyst
arises from nasopalatine duct epithelial remnants
occurs in anterior maxilla
also known as incisive canal cyst

What is the presentation of nasopalatine duct cyst?

asymptomatic
“salty” discharge
larger cysts may displace teeth or cause swelling in palate

What are the histological features of nasopalatine duct cyst?

non keratinised stratified squamous and modified respiratory epithelium

What are the radiographic features of nasopalatine duct cyst?

* **corticated radiolucency between/over roots of central incisors** * often **unilocular** * may appear "heart-shaped" due to superimposition of anterior nasal spine

What is a solitary bone cyst?

* non-odontogenic cyst without an epithelial lining * also known as simple/traumatic/haemorrhagic bone cyst * asymptomatic * incidental finding

What are radiographic features of solitary bone cysts?

* majority in premolar/molar region of mandible * can also occur in non-tooth bearing areas * may have scalloped margins (pseudolocular appearance) * may project up between roots of adjacent teeth

What is a Stafne cavity?

* not a cyst * depressionn in the bone * only in mandible * lingual (inferior to inferior alveolar canal) * contains salivary or fatty tissue * asymptomatic * well-defined, often corticated radiolucency

What further investigations can be done for cysts?

**Radiology** **Histological analysis** (required to confirm diagnosis): * aspiration biopsy (drainage of contents) * incisional biopsy (partial removal) * excisional biopsy (complete removal)

What are the treatment options for cysts?

**Enucleation** All of the cystic lesion is removed. **Marsupialisation** * create a surgical window in the wall of the cyst * remove the contents * suture cyst wall to the surrounnding epithelium * this encourages the cyst to decrease in size * may be followed by enucleation later

What is the treatment of choice for most cysts?

Enucleation

What are the advantages of enucleation?

* whole lining cann be examined pathologically * primary closure * little aftercare needed

What are contraindications/disadvantages of enucleation?

* risk of mandibular fracture with very large cysts * old age; ill-health * clot-filled cavity may become infected * wish to preserve tooth (dentigerous follicular cyst) * incomplete removal of lining may lead to recurrence * damage to adjacent structures

What are indications of marsupialisation?

* if enucleation would damage surrounding structures e.g. ID canal * difficult access to the area * may allow eruption of teeth affected by a dentigerous follicular cyst * elderly or medically compromised patients unable to withstand extensive surgery * very large cysts which would risk aw fracture if enucleation was performed * can combine with enucleation as a later procedure

What are advantages of marsupialisation?

* simple to perform * may spare vital structures

What are contraindications/disadvantages of marsupialisation?

* opening may close and cyst may reform * complete lining not available for histology * difficult to keep clean and lots of aftercare needed * long time to fill in