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Oral Disease > Cysts of the Jaw > Flashcards

Cysts of the Jaw Flashcards

Objectives: • Know the classification of cysts of the jaws • Know the basic pathology of cysts • Know the sources of odontogenic epithelium • Know basic mechanisms of cyst formation • Be aware of mechanisms for growth & expansion Know the clinical and pathological aspects of: • Radicular cyst • Paradental cyst • Dentigerous cyst • Odontogenic keratocyst Be aware of the basic facts about remaining cysts

1
Q

What is a cyst? (1)

A

A pathological cavity with fluid, semi-fluid or gaseous contents and which is not created by the accumulation of pus; it is frequently but not always lined by epithelium

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2
Q

What does the enamel organ develop from? (1)

A

The dental lamina

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3
Q

What do radicular cysts form from? Draw a diagram (1+diagram)

A

Hertwigs root sheaf

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4
Q

What do dentigerous cysts form from? (1+diagram)

A

Reduced enamel epithelium

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5
Q

What do keratocysts and gingival cysts form from? (1+diagram)

A

Dental lamina

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6
Q

Where are the epithelial remnants of hertwig’s root sheaf? What are they called?

A
  • Periodontal ligament

- Rest cells of Malassez

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7
Q

List the five odontogenic tissues of the epithelium

A
  • Oral epithelium
  • Dental lamina
  • Enamel organ
  • Reduced enamel epithelium
  • Rests of malassez
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8
Q

List the three odontogenic tissues of the mesenchyme

A
  • Dental papilla
  • Dental follicle
  • Periodontal ligament
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9
Q

Name all the Odontogenic epithelium only lesions (3)

A

a. Ameloblastoma
b. Squamous odontogenic tumour
c. Calcifying epithelial odontogenic tumour

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10
Q

Name all the Odontogenic epithelium PLUS odontogenic mesenchyme lesions (5)

A

a. Ameloblastic fibroma
b. Ameloblastic fibro-odontome
c. Adenomatoid odontogenic tumour
d. Calcifying odontogenic cyst
e. Odontomes - complex and compound

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11
Q

Name all the Odontogenic mesenchyme onle lesions (3)

A

a. Cementoblastoma
b. Fibroma
c. Myxoma

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12
Q

Name all the Odontogenic carcinomas (epithelium) (4)

A

a. Malignant ameloblastoma
b. Primary intraosseous carcinoma
c. Clear cell odontogenic carcinoma
d. Malignant variants of other tumours and cysts

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13
Q

Name all the Odontogenic sarcomas (connective tissue) (3)

A

a. Ameloblastic fibrosarcoma
b. Ameloblastic fibrodentinosarcoma
c. Odontogenic carcinosarcoma

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14
Q

Name all the Osteogenic neoplasms (3)

A

a. Cemento-ossifying fibroma
b. Osteoblastoma
c. Osteosarcoma

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15
Q

Name all the Fibroosseous lesions (4)

A

a. Fibrous dysplasia
b. Periapical cemental dysplasia
c. Florid cemento-osseous dysplasia
d. Focal cemento-osseous dysplasia

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16
Q

Name all the Epithelial cysts (9)

A

a. Radicular cysts
b. Paradental cyst
c. Follicular cysts
d. Dentigerous
e. Eruption
f. Odontogenic keratocyst
g. Lateral periodontal cyst
h. Gingival cysts
i. Glandular odontogenic cyst

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17
Q

Name the Other lesions not mentioned above (5)

A

a. Melanotic neuroectodermal tumour of infancy
b. Cherubism
c. Giant cell granuloma
d. Aneurysmal bone cyst
e. Solitary bone cyst

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18
Q

What is the order of prevalence of non-odontogenic cysts, odontogenic tumours, bone lesions and odontogenic cysts – in most to least common (1)

A

Odontogenic cysts > Odontogenic tumours > Bone lesions > Non-odontogenic cysts

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19
Q

What are the percentage prevalence of odontogenic cysts, odontogenic tumours, fibro-osseous lesions and bone tumours? (4)

A

Odontogenic cysts 70%
Odontogenic tumours 15%
Fibro-osseous lesions 10%
Bone tumours 5%

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20
Q

What two categories can epithelial cysts be divided into? (2)

A
  • Odontogenic

- Non-odontogenic

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21
Q

What classifications of odontogenic cysts are there? (1)

A

Inflammatory or developmental

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22
Q

What inflammatory odontogenic cysts are there? (3)

A
  • Radicular cyst
  • Residual cyst
  • Paradental cysts
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23
Q

What developmental odontogenic cysts are there? (1+2, 6)

A
  • Follicular cysts
    - Dentigerous cyst
    - Eruption cyst
  • Odontogenic keratocyst
  • Gingival cysts
  • Lateral periodontal cyst
  • Botryoid odontogenic cyst
  • Glandular odontogenic cyst
  • Calcifying odontogenic cyst
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24
Q

What non-odontogenic cysts of the jaws are there? (2)

A
  • Nasopalatine duct cyst

- Nasolabial cyst

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25
Q

Draw diagrams of the following cysts: (9)

A
  • Apical radicular
  • Lateral radicular
  • Lateral periodontal
  • Dentigerous
  • Eruption
  • Keratocyst
  • Residual
  • Nasopalatine duct
  • Nasolabial
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26
Q

Draw a diagram of the following cysts and their sites: (5)

A
  • Residual
  • Solitary
  • Keratocyst
  • Gingival cyst (adults)
  • Alveolar Cyst (infants)
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27
Q

Describe the frequency, in percentages, of Radicular, Follicular, Keratocyst, Nasopalatine and Other cysts: (5)

A
  • Radicular 65%
  • Follicular 20%
  • Keratocyst 5%
  • Nasopalatine 5%
  • Others <5%
28
Q

What do jaw cysts need to develop? (3)

A
  • Source of epithelium
  • Stimulus for proliferation
  • Growth and bone resorption
29
Q

What is the inflammatory stimulus for proliferation of a radicular cyst? Diagram (1)

A

Apical granuloma

30
Q

What is the inflammatory stimulus for proliferation of an inflammatory
lateral periodontal cyst? Diagram (1)

A

Periodontitis

31
Q

What is the inflammatory stimulus for proliferation of a paradental cyst? Diagram (1)

A

Pericoronitis

32
Q

What are the stimuli for proliferation of developmental cysts? (1)

A

Largely unknown

33
Q

What could the stimuli for proliferation of a Dentigerous cyst be? (2)

A
  • Eruptive force and proliferation?

- Hydrostatic pressure?

34
Q

What could the stimuli for proliferation of a Keratocyst be? (3)

A
  • Epithelial proliferation
  • Hydrostatic pressure?
  • Tumour?
35
Q

Where/how do radicular cysts arise and what are they always associated with? (2)

A
  • Arise in the periodontal ligament from the epithelial rests of Malassez as a result of inflammation following death of the pulp.
  • Always associated with a non-vital tooth.
36
Q

Describe an apical radicular cyst (1) Diagram

A

At the apex of a tooth associated with the opening of the root

37
Q

Describe a Lateral radicular cyst (1) Diagram

A

At the side of a tooth associated with a lateral branch of the root canal

38
Q

Describe a Residual radicular cyst (1) Diagram

A

A radicular cyst which has persisted after extraction of the associated

39
Q

What are the most common decade of ages to have radicular cysts? (1)

A

30-39yrs > 40-49yrs > 20-29yrs

40
Q

Describe the very basic pathogenesis of a radicular cyst (5)

A
  • Caries of tooth
  • Leads to non-vital pulp
  • Leads to apical granuloma
  • Proliferating odontogenic epithelium of apical granuloma
  • Leads to radicular cyst
41
Q

What is mucous metaplasia? How often is it seen in radicular cysts? (2)

A
  • Mucous cells, change in the type of cells to form abnormal
  • Seen in about 15% of radicular cysts
42
Q

What do cysts ‘tend’ to be in relation to granulomas? (5)

A
  • Larger
  • More radiolucent
  • Well defined
  • Corticated outline
  • Painless
43
Q

What percentage of cysts are correctly diagnosis preoperatively? (1)

A

50%

44
Q

What is a paradental cyst? Describe a particular type (2)

A
  • A cyst which arises on the lateral aspect of a tooth as a result of inflammation in a periodontal pocket. It arises from pocket epithelium.
  • A particular type of paradental cyst arises at the buccal aspect of partially erupted third molars.
45
Q

What is the histology of a paradental cyst similar to? (1)

A
  • Histology is similar to the radicular cyst
46
Q

What is a follicular cyst? (1)

A

A cyst which surrounds the crown of an unerupted tooth and arises from the reduced enamel (follicular) epithelium.

47
Q

What is a dentigerous follicular cyst associated with? (1)

A

Associated with an impacted tooth

48
Q

What is an eruption follicular cyst associated with? (1)

A

Associated with an erupting tooth

49
Q

What is the basic pathogenesis of a follicular cyst? Use diagrams (3)

A
  • Impacted tooth
  • Follicular epithelium proliferates
  • Cyst forms
50
Q

Where does an eruption cyst lie? (1)

A

Just beneath the oral mucosa

51
Q

What is an odontogenic Keratocyst? What does it arise from? (2)

A
  • A cyst arising in the tooth bearing area and characterised by a thin lining of keratinised epithelium.
  • It arises from the dental lamina or its remants and may replace a tooth.
52
Q

What is the basic pathogenesis of a Keratocyst? Use diagrams (3)

A
  • Remnants of dental lamina - Epithelial proliferation, genetic? trauma? - Cyst develops
53
Q

What is jaw cyst/basal cell naevus syndrome? What occurs? (6)

A
  • ‘Gorlin-Goltz syndrome’
  • Multiple and recurrent odontogenic keratocysts
  • Basal cell carcinomas of skin
  • Frontal bossing
  • Skeletel abnormalities (eg. bifid ribs)
  • Cranial abnormalities (eg. calcification of falx cerebri)
54
Q

What can odontogenic keratocysts occasionally be? (1)

A

‘Solid’

55
Q

What evidence is there that an odontogenic Keratocyst may be a benign neoplasm? (6)

A
  • High rate of cell proliferation in the wall
  • High rate of recurrence
  • ‘Aggressive’ and infiltrative growth
  • Association with basal cell carcinoma in ‘Gorlin-Goltz syndrome’
  • Molecular changes similar to basal cell carcinoma
  • PTCH (chromosome 9q) mutation in BCC and Gorlin’s syndrome
56
Q

What did WHO change the odontogenic Keratocyst classification to in 2005? What happened? (2)

A
  • ‘Keratinising cystic odontogenic tumour’

- New terminology not accepted

57
Q

What is a lateral periodontal cyst? What can occur occasionally, what is it then called? (2)

A
  • Occurs on the lateral aspect or between the roots of vital teeth. It is developmental in origin but the source of epithelium is unclear.
  • Occasionally it is multilocular and called botryoid odontogenic cyst
58
Q

What can occur with lateral periodontal cysts? What is common? (2)

A
  • May be multilocular

- Localised thickening of the wall is common

59
Q

What are gingival cysts of infants? (2)

A
  • Arises from dental lamina rests in the alveolar mucosa of infants
  • Lined by thin parakeratinised epithelium
60
Q

What are Gingival cyst of adults? (2)

A
  • Arises from dental lamina rests in the attached gingiva

- Lined by thin non-keratinised epithelium

61
Q

What is a glandular odontogenic cyst? What is it also called? (2)

A
  • Also called sialo-odontogenic cyst
  • A cyst characterised by cuboidal or columnar epithelium with mucous production and forming duct-like or glandular structures
62
Q

What occurs in the histology of a glandular odontogenic cyst? (2)

A
  • Epithelial thickenings

- Mucous cells and ducts

63
Q

What kinds of non-odontogenic cysts are there? (2)

A
  • Nasopalatine duct cyst

- Nasolablial cyst

64
Q

What is a Nasopalatine duct cyst? (2)

A
  • Arise in the nasopalatine (incisive) canal from epithelial residues of the nasopalatine duct
  • They are lined by respiratory epithelium or sratified squamous epithelium, or often both.
65
Q

What is a Nasolabial cyst? Where does it arise? (2)

A
  • Arises in the soft tissue overlying the alveolar process at the base of the nostril, deep to the nasolabial fold.
  • It probably arises from remnants of the nasolacrimal duct and is usually lined by pseudostratified columnar epithelium
66
Q

What are cystic lesions? Give three examples (4)

A
  • Cystic lesions in the jaws, without an epithelial lining
  • Solitary (simple) bone cyst
  • Aneurysmal bone cyst
  • Stafne bone cavity

Oral Disease (9 decks)

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