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OS bds4 > Cysts of the Jaw and Oral Regions I & II > Flashcards

Cysts of the Jaw and Oral Regions I & II Flashcards

1
Q

How are Cysts classified?

A

1) location:
a) jaw
b) maxillary antrum
c) soft tissue of face and neck

2) Cell type
a) epithelial
b) non epithelial

3) Pathogenesis
a) developmental
b) inflammatory

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2
Q

What are types of epithelial cells ?

A

1) Odontogenic
2) Non-odontogenic

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3
Q

List the types of odontogenic cysts

A

1) inflammatory
2) developmental

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4
Q

What are the types of inflammatory odontogenic cysts?

A

1) residual
2) radicular (apical & lateral)
3) paradental

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5
Q

What are the types of developmental odontongenic cysts?

A

1) ODONTOGENIC KERATOCYSTS odontogenic keratocysts
2) DENTIGEROUS CYSTS (follicular & eruption cysts)
3) lateral periodontal cyst
4) gingival cyst of the adults
5) glandular odontogenic cysts (sialo-odontogenic)

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6
Q

List type of non-odontogenic cysts.

A

1) Nasopalatine (incisive canal cyst)
2) nasolabial
3) median palatine

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7
Q

What are other types of non-odontogenic cysts ? hint “non ….. cysts..

A

Non epithelial cysts

a) solitary bone cyst
b) aneurysmal bone cyst

Unique : Stafne bone vyst

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8
Q

List the “developmental” non odontogenic cysts.

A

Fissure

a) nasopalatine
b) nasolabial
c) medium palatine

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9
Q

List the “ non epithelial” non odontogenic cyst.

A

a) aneurysemal bone cyst
b) simple (solitary, haemorrhahgic, traumatic bone cyst)

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10
Q

List examples of odontogenic cysts that are lined with epithelium-derived from rests of Malassez.

A

a) radicular
b) residual

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11
Q

List examples of odontogenic cysts that are lined with epithelium derived from reduced enamel epithelium.

A

a) dentigerous
b) eruption

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12
Q

List examples of odontogenic cysts that are lined with epithelium derived from remnants of dental lamina

A

a) odontogenic keratocyst
b) lateral periodontal cyst
c) gingival cyst of adults
d) glandular odontogenic cyst

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13
Q

What is the most frequent type of cyst?

A

Odontogonic cyst - specificially radicular (inflammatory ) with 65% rate of occurance.

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14
Q

Describe the pathogenesis of cysts in general.

A

1) source of epitheial
2) stimulus for cavitation and epithelial cell proliferation
3) mechanism for continuous growth and bone resorption

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15
Q

What is the source of epithelium in inflammatory cysts?

A

remnants of hertwigs root sheath

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16
Q

What do remnants of hertwig’s root sheat form?

A

epithelial cell rests of malassez

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17
Q

Where is the cell rest of malassez located?

A

throughout the periodontal ligament
entrapped within periapical granuloma

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18
Q

Where do dentigerous cysts occur?

A

When reduced enamel epithelium on top of enamel seperates from enamel
the split between reduced enamel epithelium and enamel is where the cyst forms

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19
Q

What is the source of odontogenic keratocyst?

A

remnants of the dental lamina

glands of sterres

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20
Q

Non odontogenic cysts.

What is the source of epithelium of nasopalatine duct cyst?

A

nasopalatine duct epithelium

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21
Q

What is the source of epithelium of nasoloabial duct cyst?

A

epithelium remnants at sites of fissures

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22
Q

What is the source of epithelium of mucous retention cyst?

A

salivary duct epithelium

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23
Q

What is the source of epithelium of lympoepithelial (branchial) cyst?

A

inclusions of epithelium in lymphoid tissue

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24
Q

what is the source thyroglossal cyst?

A

thyroglossal duct epithelium

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25
Q

How are epithelial cells stimulated ?

A

By cytokines that are released by inflammatory cells such as IL1,IL6 and TNF and growth factors.

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26
Q

What are the growth factors that causes epethelial cells to proliferate?

A

a) epidermal growth factors
b) transforming growth factor beta

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27
Q

Why are some odontogenic keratocysts linked to gorlins syndrome? (naevoid basal cell carcinoma syndrome)

A

links to genetic defects in a tumour suppressor gene.

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28
Q

What are mechanism of cysts growth?

A

1) bone resportion
2) internal hydraulic pressure
3) epithelial proliferation

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29
Q

Explain the hydrostatic mechanism in inflammatory and dentigerous cysts.

A

1) protein accumulation around wall “semipermeable”
2) fluid accumulation in cyst
3) + pressure and expansion.

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30
Q

How does bone resorption occur?

A

Caused by the cysts themselves.

they release
1) IL1 by macrophages
2) PGE2 by fibroblasts
3) TNF

that induce bone resorption

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31
Q

How do epithelial grow in cysts?

A

1) EGF (epidermal growth factor)
2) TGF (transforming growth factor)

cause pronounced proliferation of cyst epithelium

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32
Q

In which type of cysts pronounced mural growth occur?

A

odontogenic keratocyst

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33
Q

What are some general clinical features of cysts?

A

1) swelling
2) pain if. infected
3) fluctuant
4) eggshell cracking
5) displacing or loosening of teeth

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34
Q

What types of radiological imaging would you do if the cyst is present in the maxilla?

A

1) PA & oblique occlusal
2) OPG & lateral oblique
3) CBCT
4) True lateral
5) Occipitomental (OM)

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35
Q

What type of images would you do if the cyst is present in the mandible?

A

1) PA & true occlusal
2) OPG & lateral oblique
3) PA
4) CBCT

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36
Q

What are some radiological signs of cysts?

A

a) well-defined, round or oval radiolucency
b) well define margin (corticated= radiopaque)

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37
Q

When are cysts not well defined in radiographs?

A

1) infected
2) solitary bone cyst
3) larger lesions: scalloped margins ex: keratocyst

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38
Q

All cysts are round because of hydrostatic mechanism except…

A

1) odontogenic keratocyst
2) solitary bone cyst

grow through the bone rather than expanding the jaw

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39
Q

Where could true multilocular (multiple cavities) be present?

A

Odontogenic keratocyst

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40
Q

What are other reasons for larger cysts appearing multilocular?

A

because of ridges in the bony wall

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41
Q

Where do radicular cysts (non-vital) develop?

A

within periapical granuloma (>10mm) at apex of non vital tooth.

usually unilocular, well defined and well corticated radiolucency.

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42
Q

Where is the most common site of radicular cysts (non-vital) ?

A

upper maxillary incisors

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43
Q

How are radicular cysts (non vital) treated?

A

endodontic or surgical extraction

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44
Q

How do radicular cysts grow?

A

limited to buccal expansion
continuous with the lamina dura of root of affected tooth.

note: can cause root resportion and displacement however does not usually cause resorption.

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45
Q

When bacteria reaches pulp, then if no treatment pulp necrosis could happen, however if bacteria further spreadsss what could you get….

A

acute apical periodontitis

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46
Q

What changes to the tooth and its structures that indicates its early acute apical peridontitis..

A

widening of the PDL.

47
Q

if lamina dura is destroyed what is indicated…

A

early periapical abscess..

the difference from cysts and this abscess is the difference in inflammation rather the diagnosis..

48
Q

When do u know u have a periapical granuloma or radicular cysts?

A

1) u see well defined area of radiolucency , round and dense
2) surround by sceloritic bone
3) >10mm

if it is more than 1.5cm in diameter it is a CYST if not it is a granuloma.

49
Q

If it is long standing radicular cysts, what could happen

A

It may expands and cause destruction of adjacent teeth eventually resorption.

if infected: it will be less defined and not corticated..

50
Q

Residual cysts
are in ……. areas
well defined, round and oval ………..
post ………

A

edentolous
radiolucency
extraction

51
Q

In residual cysts the epithelial lining is

A

non keratinised stratified squamous

52
Q

what does non keratinised stratified squamous mean

A

keratin free
multiple layers in thickness
squamous in shape

53
Q

What does lumen of residual cysts contain?

A

pale pink serous exudate
macrophages desquamated epithelial cells
inflammatory cells
cholesterol clefts

54
Q

histology,

rete processes

A

long, prolifereating and merging together. resembles “Active inflammation”

55
Q

in the presence of inflammation, what happens on the other side as a sign of your body’s fighting the inflammation…….

A

fibrous tissue trying to fight inflammation

56
Q

Describe what would you find in a histopathology of a periapical cyst..

A

1) cystic lumen
2) epithelial lining
a) inflammatory cells
b) hyaline bodies
3) fibrous capsule
a) fibroblasts
b) collagen fibres and blood vessels
c) chronic inflammatory cells
d) chholesterol clefts

57
Q

if there are cholesterol clefts they are usually surrounded by ….

A

giant cells

58
Q

What are arcading rete processing?

A

is when during inflammation the rete processing are all joining together

59
Q

What are dentigerious cysts also called?

A

eruption cyst

60
Q

Where are dentigerous cysts located?

A

CEJ surrounding crowns of unerupted tooth of 8’s and 3’s.

Cysts is suspected if follicular space exceeds 3mm.

61
Q

What are characteristics of dentigerous cyst?

A

1) unilocular well , corticated radiolucenc late buccal expansion
2) classically crown of associated tooth lies centrallt within the cyst

62
Q

How are dentigerous cysts treated?

A

surgical removal or uncover the tooth doesn’t reoccur.

63
Q

Describe histopathology of dentigerous cysts.

A

Epthehlial lining : non keratinised stratified squamous on a flat basemnet membrane 2-5 cells thick.
mucous metaplasia common

64
Q

What does lumen of dentigerous cysts contain?

A

cholesterol cleft
and serous exudate

65
Q

what is the common site of odontogenic keratocyst?

A

angle of mandible and ramus

66
Q

What type of membrane do developmental cysts have ex: dentigerous cysts

A

flat basal membrane

67
Q

What can some maxilla cysts contain?

A

respiratory cilia above the basal membrane

68
Q

What types of cells is present in maxilla and mandibular dentigerous cyst?

A

goblet cells - mucous cells

69
Q

odontofenic keratocysts are multilocular and can be unilocular and associated with …… teeth.

A

unerupted

70
Q

How do odontogenic keratocysts grow?

A

through medullary bone with late buccal expansion

note: can be associated with tooth resorption

71
Q

multiple cysts are associated with what syndrome …………….

A

gorlin goltz syndrome

72
Q

What is gorlin goltz syndrome also known as

A

nevoid basal cell carcinoma

73
Q

What can pt. with forlin goltz syndrome present with?

A

bifid ribs, spine and rib abnormalities
palmar and plantar epidermal cysts
odontogenic keratocyst
frontal bossing anf facial milia

74
Q

Gorlin golt syndrome is a rare autosomal dominant disorder characterised by multiple

A

basal cell carcinoma

75
Q

Describe histology of odontogenic keratocysts

A

1) thin fibrous cyst wall
2) uninflamed
3) flat basement membrane but keratinized epithelial lining,
4) lumen filled with keratin
5) basel cells prominent
6) free keratin flowing if cyst intact

76
Q

where do lateral periodontal cysts occur

A

from its name “lateral periodontal region

note: is not inflammatory nor odontogenic keratocyst

77
Q

What is lateral periodontal cyst associated with?

A

lateral rroots of vital teeth

78
Q

Describe characteristics of lateral periodontal cysts.

A

very small< 1cm
round
well define and corticated & normally unilocular

if very large can cause buccal expansion

79
Q

Describe histology of lateral periodontal cysts

A

1) flat basement membrane
2) epithelial layer 2-5cells thick
3) may be multicystic
4) fibrous cyst wall is thin and uninformed
5) scattered glycogen-rich clear cells

80
Q

What are nasopalatine cysts (incisive canal cyst ) associated with?

A

vital maxillary incisor

81
Q

What is the size of nasopalatine cyst?

A

> 6mm

82
Q

What are some characteristics of nasopalatine cysts?

A

round/oval
anterior maxilla
well defined, well corticated monocular radiolucency

83
Q

What is the most common type of non odontogenic cysts?

A

Nasopaltine cysts , occur in 1% of population

84
Q

What epithelial lining is present in non odontogenic cysts?

A

1) lining may be non-keratinizing stratified squamous or ciliated respiratory type usually both.

Note: look big nerves and blood vessels in wall

85
Q

What is another type of non odontogenic cyst

A

solitary bone cyst

86
Q

Describe characteristics of solitary cysts

A

well corticated, monolocular radiolucency
asymptomatic in the mandible
occur: in children and adolescents under 20 years

87
Q

Describe the cavity and lining of solitary bone cyst

A

cavity empty
no epithelial lining and no wall or thin fibrous wall

Note: irregular outline (upper border arches up between the roots of the teeth)

88
Q

What is an aneurysmal bone cysts also classified as

A

giant cell lesion

89
Q

aneurysmal bone cysts are partially cystic

A

partially solid

90
Q

Describe characteristics of aneursymal bone cysts

A

multilocular radiolucency in mandible with cortical expansions

is a soft tissue lesion

91
Q

What is the main cell in aneurysmal bone cyst

A

giant cells in a very vascularand hypercellular background

92
Q

cysts of soft tissues of mouthh, face and neck

A

a) cyst of salivary glands
b) lymphoepithelial (branchial clef) cyst
c) dermoid and epidermoid cysts
d) thyroglossal duct

93
Q

Describe cysts of salivary gland (Soft tissue cysts)

A

mucous extravastion cyst
mucous retention cyst
ranula

94
Q

What is the most commonest site of mucous extravasation cyst?

A

lower lip usually related to trauma

95
Q

mucous extravasation cysts are surrounded by what type of tissue

A

granulation tissue

96
Q

retention cysts are related to ……. obstruction

A

ductal

97
Q

With retention cysts there are dilated salivary duct filled with

A

mucin

98
Q

Where do lymphoepithelial (branchial cyst) appear?

A

lateral aspect of the nect
anterior to the sternocleidomastoid muscle

99
Q

How do branchial cysts present as

A

unilateral
soft-tissue fluctuant swelling

100
Q

with the histological aspect of soft tissue what are the three main aspects yo look for?

A

1) mucin
2) lymphoid stroma
3) epithelial lining

101
Q

What cysts are lined by epidermis and skin?

A

dermoid cysts

102
Q

Where are epithelium entrapped in dermoid cysts?

A

midline floor of mouth above mylohyoid

103
Q

What cysts are developmental remnants of thyroglossal tract decent of the thyroid.

A

thyroglossal cysts

104
Q

Where do thyroglossal cysts occur ? what type of epithelium is present?

A

midline
attenuated or respiratory

105
Q

General points of cysts

A

1) cholesterol cleft
2) mucous metaplasia
3) hyaline bodies
4) flat basement membrane

106
Q

are spaces left by cholesterol crystals during tissue processing. Cholesterol is derived from the breakdown of red blood cells. Clefts are a feature of inflamed cysts and are non specific.

A

cholesterol clefts

107
Q

can be seen in any cysts but is common in dentigerous cysts and maxillary cysts

A

mucous metaplasia

108
Q

ound in odontogenic cysts is the only material secreted by odontogenic epithelium and is similar to dental cuticle.

A

hyaline bodies

109
Q

is normally associated with developmental odontogenic cysts e.g. dentigerous and keratocysts

A

flat basement membrane

110
Q

What investigation would you carry out on cysts?

A

1) clinical
a) site
b) unerupted teeth
c) swelling
4) eggshell cracking
5) displacement or loosening of teeth
2) radiological
3) biopsy
a) excisional
b) incisonal

111
Q

When would you do aspiration?

A

looking for pus, serous exudate and look keratocyst low soluble protein less 4g/100ml

ex: aneurysmal bone cyst

112
Q

When would you do an incisional biopsy?

A

not simple cyst and is extensice

ex: different radiolucencies at angle of mandible

113
Q

When would you do an excisional biopsy?

A

lesion is small and amenable for excision

OS bds4 (3 decks)

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