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
2
Q
What are types of epithelial cells ?
A
1) Odontogenic
2) Non-odontogenic
3
Q
List the types of odontogenic cysts
A
1) inflammatory
2) developmental
4
Q
What are the types of inflammatory odontogenic cysts?
A
1) residual
2) radicular (apical & lateral)
3) paradental
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)
6
Q
List type of non-odontogenic cysts.
A
1) Nasopalatine (incisive canal cyst)
2) nasolabial
3) median palatine
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
8
Q
List the “developmental” non odontogenic cysts.
A
Fissure
a) nasopalatine
b) nasolabial
c) medium palatine
9
Q
List the “ non epithelial” non odontogenic cyst.
A
a) aneurysemal bone cyst
b) simple (solitary, haemorrhahgic, traumatic bone cyst)
10
Q
List examples of odontogenic cysts that are lined with epithelium-derived from rests of Malassez.
A
a) radicular
b) residual
11
Q
List examples of odontogenic cysts that are lined with epithelium derived from reduced enamel epithelium.
A
a) dentigerous
b) eruption
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
13
Q
What is the most frequent type of cyst?
A
Odontogonic cyst - specificially radicular (inflammatory ) with 65% rate of occurance.
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
15
Q
What is the source of epithelium in inflammatory cysts?
A
remnants of hertwigs root sheath
16
Q
What do remnants of hertwig’s root sheat form?
A
epithelial cell rests of malassez
17
Q
Where is the cell rest of malassez located?
A
throughout the periodontal ligament
entrapped within periapical granuloma
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
19
Q
What is the source of odontogenic keratocyst?
A
remnants of the dental lamina
glands of sterres
20
Q
Non odontogenic cysts.
What is the source of epithelium of nasopalatine duct cyst?
A
nasopalatine duct epithelium
21
Q
What is the source of epithelium of nasoloabial duct cyst?
A
epithelium remnants at sites of fissures
22
Q
What is the source of epithelium of mucous retention cyst?
A
salivary duct epithelium
23
Q
What is the source of epithelium of lympoepithelial (branchial) cyst?
A
inclusions of epithelium in lymphoid tissue
24
Q
what is the source thyroglossal cyst?
A
thyroglossal duct epithelium
25
How are epithelial cells stimulated ?
By cytokines that are released by inflammatory cells such as IL1,IL6 and TNF and growth factors.
26
What are the growth factors that causes epethelial cells to proliferate?
a) epidermal growth factors
b) transforming growth factor beta
27
Why are some odontogenic keratocysts linked to gorlins syndrome? (naevoid basal cell carcinoma syndrome)
links to genetic defects in a tumour suppressor gene.
28
What are mechanism of cysts growth?
1) bone resportion
2) internal hydraulic pressure
3) epithelial proliferation
29
Explain the hydrostatic mechanism in inflammatory and dentigerous cysts.
1) protein accumulation around wall "semipermeable"
2) fluid accumulation in cyst
3) + pressure and expansion.
30
How does bone resorption occur?
Caused by the cysts themselves.
they release
1) IL1 by macrophages
2) PGE2 by fibroblasts
3) TNF
that induce bone resorption
31
How do epithelial grow in cysts?
1) EGF (epidermal growth factor)
2) TGF (transforming growth factor)
cause pronounced proliferation of cyst epithelium
32
In which type of cysts pronounced mural growth occur?
odontogenic keratocyst
33
What are some general clinical features of cysts?
1) swelling
2) pain if. infected
3) fluctuant
4) eggshell cracking
5) displacing or loosening of teeth
34
What types of radiological imaging would you do if the cyst is present in the maxilla?
1) PA & oblique occlusal
2) OPG & lateral oblique
3) CBCT
4) True lateral
5) Occipitomental (OM)
35
What type of images would you do if the cyst is present in the mandible?
1) PA & true occlusal
2) OPG & lateral oblique
3) PA
4) CBCT
36
What are some radiological signs of cysts?
a) well-defined, round or oval radiolucency
b) well define margin (corticated= radiopaque)
37
When are cysts not well defined in radiographs?
1) infected
2) solitary bone cyst
3) larger lesions: scalloped margins ex: keratocyst
38
All cysts are round because of hydrostatic mechanism except...
1) odontogenic keratocyst
2) solitary bone cyst
grow through the bone rather than expanding the jaw
39
Where could true multilocular (multiple cavities) be present?
Odontogenic keratocyst
40
What are other reasons for larger cysts appearing multilocular?
because of ridges in the bony wall
41
Where do radicular cysts (non-vital) develop?
within periapical granuloma (>10mm) at apex of non vital tooth.
usually unilocular, well defined and well corticated radiolucency.
42
Where is the most common site of radicular cysts (non-vital) ?
upper maxillary incisors
43
How are radicular cysts (non vital) treated?
endodontic or surgical extraction
44
How do radicular cysts grow?
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.
45
When bacteria reaches pulp, then if no treatment pulp necrosis could happen, however if bacteria further spreadsss what could you get....
acute apical periodontitis
46
What changes to the tooth and its structures that indicates its early acute apical peridontitis..
widening of the PDL.
47
if lamina dura is destroyed what is indicated...
early periapical abscess..
the difference from cysts and this abscess is the difference in inflammation rather the diagnosis..
48
When do u know u have a periapical granuloma or radicular cysts?
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
If it is long standing radicular cysts, what could happen
It may expands and cause destruction of adjacent teeth eventually resorption.
if infected: it will be less defined and not corticated..
50
Residual cysts
are in ....... areas
well defined, round and oval ...........
post .........
edentolous
radiolucency
extraction
51
In residual cysts the epithelial lining is
non keratinised stratified squamous
52
what does non keratinised stratified squamous mean
keratin free
multiple layers in thickness
squamous in shape
53
What does lumen of residual cysts contain?
pale pink serous exudate
macrophages desquamated epithelial cells
inflammatory cells
cholesterol clefts
54
histology,
rete processes
long, prolifereating and merging together. resembles "Active inflammation"
55
in the presence of inflammation, what happens on the other side as a sign of your body's fighting the inflammation.......
fibrous tissue trying to fight inflammation
56
Describe what would you find in a histopathology of a periapical cyst..
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
if there are cholesterol clefts they are usually surrounded by ....
giant cells
58
What are arcading rete processing?
is when during inflammation the rete processing are all joining together
59
What are dentigerious cysts also called?
eruption cyst
60
Where are dentigerous cysts located?
CEJ surrounding crowns of unerupted tooth of 8's and 3's.
Cysts is suspected if follicular space exceeds 3mm.
61
What are characteristics of dentigerous cyst?
1) unilocular well , corticated radiolucenc late buccal expansion
2) classically crown of associated tooth lies centrallt within the cyst
62
How are dentigerous cysts treated?
surgical removal or uncover the tooth doesn't reoccur.
63
Describe histopathology of dentigerous cysts.
Epthehlial lining : non keratinised stratified squamous on a flat basemnet membrane 2-5 cells thick.
mucous metaplasia common
64
What does lumen of dentigerous cysts contain?
cholesterol cleft
and serous exudate
65
what is the common site of odontogenic keratocyst?
angle of mandible and ramus
66
What type of membrane do developmental cysts have ex: dentigerous cysts
flat basal membrane
67
What can some maxilla cysts contain?
respiratory cilia above the basal membrane
68
What types of cells is present in maxilla and mandibular dentigerous cyst?
goblet cells - mucous cells
69
odontofenic keratocysts are multilocular and can be unilocular and associated with ...... teeth.
unerupted
70
How do odontogenic keratocysts grow?
through medullary bone with late buccal expansion
note: can be associated with tooth resorption
71
multiple cysts are associated with what syndrome ................
gorlin goltz syndrome
72
What is gorlin goltz syndrome also known as
nevoid basal cell carcinoma
73
What can pt. with forlin goltz syndrome present with?
bifid ribs, spine and rib abnormalities
palmar and plantar epidermal cysts
odontogenic keratocyst
frontal bossing anf facial milia
74
Gorlin golt syndrome is a rare autosomal dominant disorder characterised by multiple
basal cell carcinoma
75
Describe histology of odontogenic keratocysts
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
where do lateral periodontal cysts occur
from its name "lateral periodontal region
note: is not inflammatory nor odontogenic keratocyst
77
What is lateral periodontal cyst associated with?
lateral rroots of vital teeth
78
Describe characteristics of lateral periodontal cysts.
very small< 1cm
round
well define and corticated & normally unilocular
if very large can cause buccal expansion
79
Describe histology of lateral periodontal cysts
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
What are nasopalatine cysts (incisive canal cyst ) associated with?
vital maxillary incisor
81
What is the size of nasopalatine cyst?
>6mm
82
What are some characteristics of nasopalatine cysts?
round/oval
anterior maxilla
well defined, well corticated monocular radiolucency
83
What is the most common type of non odontogenic cysts?
Nasopaltine cysts , occur in 1% of population
84
What epithelial lining is present in non odontogenic cysts?
1) lining may be non-keratinizing stratified squamous or ciliated respiratory type usually both.
Note: look big nerves and blood vessels in wall
85
What is another type of non odontogenic cyst
solitary bone cyst
86
Describe characteristics of solitary cysts
well corticated, monolocular radiolucency
asymptomatic in the mandible
occur: in children and adolescents under 20 years
87
Describe the cavity and lining of solitary bone cyst
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
What is an aneurysmal bone cysts also classified as
giant cell lesion
89
aneurysmal bone cysts are partially cystic
partially solid
90
Describe characteristics of aneursymal bone cysts
multilocular radiolucency in mandible with cortical expansions
is a soft tissue lesion
91
What is the main cell in aneurysmal bone cyst
giant cells in a very vascularand hypercellular background
92
cysts of soft tissues of mouthh, face and neck
a) cyst of salivary glands
b) lymphoepithelial (branchial clef) cyst
c) dermoid and epidermoid cysts
d) thyroglossal duct
93
Describe cysts of salivary gland (Soft tissue cysts)
mucous extravastion cyst
mucous retention cyst
ranula
94
What is the most commonest site of mucous extravasation cyst?
lower lip usually related to trauma
95
mucous extravasation cysts are surrounded by what type of tissue
granulation tissue
96
retention cysts are related to ....... obstruction
ductal
97
With retention cysts there are dilated salivary duct filled with
mucin
98
Where do lymphoepithelial (branchial cyst) appear?
lateral aspect of the nect
anterior to the sternocleidomastoid muscle
99
How do branchial cysts present as
unilateral
soft-tissue fluctuant swelling
100
with the histological aspect of soft tissue what are the three main aspects yo look for?
1) mucin
2) lymphoid stroma
3) epithelial lining
101
What cysts are lined by epidermis and skin?
dermoid cysts
102
Where are epithelium entrapped in dermoid cysts?
midline floor of mouth above mylohyoid
103
What cysts are developmental remnants of thyroglossal tract decent of the thyroid.
thyroglossal cysts
104
Where do thyroglossal cysts occur ? what type of epithelium is present?
midline
attenuated or respiratory
105
General points of cysts
1) cholesterol cleft
2) mucous metaplasia
3) hyaline bodies
4) flat basement membrane
106
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.
cholesterol clefts
107
can be seen in any cysts but is common in dentigerous cysts and maxillary cysts
mucous metaplasia
108
ound in odontogenic cysts is the only material secreted by odontogenic epithelium and is similar to dental cuticle.
hyaline bodies
109
is normally associated with developmental odontogenic cysts e.g. dentigerous and keratocysts
flat basement membrane
110
What investigation would you carry out on cysts?
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
When would you do aspiration?
looking for pus, serous exudate and look keratocyst low soluble protein less 4g/100ml
ex: aneurysmal bone cyst
112
When would you do an incisional biopsy?
not simple cyst and is extensice
ex: different radiolucencies at angle of mandible
113
When would you do an excisional biopsy?
lesion is small and amenable for excision
