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Oral Surgery > Cysts of the Jaw > Flashcards

Cysts of the Jaw Flashcards

1
Q

Define a cyst.

A

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

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2
Q

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

A

odontogenic cysts

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3
Q

What are odontogenic cysts lined with?

A

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

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4
Q

What are the 3 most common odontogenic cysts?

A
  • radicular cyst (and residual cyst) 60%
  • dentigerous cyst (and eruption cyst) 18%
  • odontogenic keratocyst 12%
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5
Q

What is a radicular cyst?

A
  • 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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6
Q

In which jaw are radicular cysts more common?

A

maxilla

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7
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 and/or contain dystrophic calcification
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8
Q

What are histological features of a radicular cyst?

A
  • incomplete epithelium
  • connective tissue capsule
  • inflammation in capsule
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9
Q

What is a residual cyst?

A

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

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10
Q

What is lateral radicular cyst?

A
  • radicular cyst associated with an accessory canal
  • located at side of tooth instead of apex
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11
Q

What are inflammatory collateral cysts?

A
  • odontogenic
  • associated with vital tooth
  • collective term for paradental cyst and buccal bifurcation cyst
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12
Q

What is a paradental cyst?

A
  • odontogenic
  • associated with vital tooth
  • typically occurs at distal aspect of partially erupted mandibular third molar
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13
Q

What is a buccal bifurcation cyst?

A
  • odontogenic
  • associated with vital tooth
  • typically occurs at buccal aspect of mandibular first molar
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14
Q

What is a dentigerous cyst?

A
  • also known as follicular cyst
  • developmental odontogenic cyst
  • associated with the crown of an unerupted (and usually impacted) tooth
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15
Q

What are radiographic features of a dentigerous follicular cyst?

A
  • corticated margins attached to CEJ of the tooth
  • may displace the involved tooth
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16
Q

What are histological features of a dentigerous follicular cyst?

A
  • thin non-keratinised stratified squamous epithelium
  • may resemble radicular cyst if inflamed
17
Q

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

A

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

18
Q

What is an eruption cyst?

A
  • variable of dentigerous follicular cyst
  • contained within soft tissue rather than bone
  • associated with an erupting tooth
19
Q

What is an odontogenic keratocyst?

A
  • developmental odontogenic cyst
  • no specific relationship to teeth
  • M > F
  • mandible > maxilla
  • posterior > anterior
20
Q

What are radiographic features of odontogenic keratocyst?

A
  • 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)
21
Q

What is the presentation of Basal Cell Naevus Syndrome?

A
  • 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

22
Q

What is the most common non-odontogenic cyst?

A

nasopalatine duct cyst

23
Q

What is a nasopalatine duct cyst?

A
  • developmental non-odontogenic cyst
  • arises from nasopalatine duct epithelial remnants
  • occurs in anterior maxilla
  • also known as incisive canal cyst
24
Q

What is the presentation of nasopalatine duct cyst?

A
  • asymptomatic
  • “salty” discharge
  • larger cysts may displace teeth or cause swelling in palate
25
Q

What are the histological features of nasopalatine duct cyst?

A

non keratinised stratified squamous and modified respiratory epithelium

26
Q

What are the radiographic features of nasopalatine duct cyst?

A
  • corticated radiolucency between/over roots of central incisors
  • often unilocular
  • may appear “heart-shaped” due to superimposition of anterior nasal spine
27
Q

What is a solitary bone cyst?

A
  • non-odontogenic cyst without an epithelial lining
  • also known as simple/traumatic/haemorrhagic bone cyst
  • asymptomatic
  • incidental finding
28
Q

What are radiographic features of solitary bone cysts?

A
  • 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
29
Q

What is a Stafne cavity?

A
  • 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
30
Q

What further investigations can be done for cysts?

A

Radiology

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

31
Q

What are the treatment options for cysts?

A

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

32
Q

What is the treatment of choice for most cysts?

A

Enucleation

33
Q

What are the advantages of enucleation?

A
  • whole lining cann be examined pathologically
  • primary closure
  • little aftercare needed
34
Q

What are contraindications/disadvantages of enucleation?

A
  • 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
35
Q

What are indications of marsupialisation?

A
  • 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
36
Q

What are advantages of marsupialisation?

A
  • simple to perform
  • may spare vital structures
37
Q

What are contraindications/disadvantages of marsupialisation?

A
  • 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

Oral Surgery (6 decks)

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