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Cysts of the Jaw & Oral Regions Flashcards

1
Q

What is a cyst?

A

Pathological cavity containing fluid, semi-fluid or gas

Often lined by epithelium

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2
Q

What can the classification of a cyst be based on?

A

Location (jaw/soft tissues/maxillary antrum)

Cell type (epithelial/non-epithelial)

Pathogenesis (Developmental/inflammatory)

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3
Q

What are the 2 main categories of cysts based on WHO (1992)?

A

Epithelial

Non-epithelial

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4
Q

What are the 2 types of epithelial cysts?

A

Odontogenic & non-odontogenic

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5
Q

What are the 2 types of odontogenic systs?

A

Inflammatory odontogenic systs

Developmental odontogenic cysts

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6
Q

What are the 3 types of inflammatory odontogenic cysts?

A

Radicular cyst (apical & lateral)

Paradental cyst

Residual cyst

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7
Q

What are the 5 types of developmental odontogenic cysts?

A

Odontogenic keratocyst

Dentigerous cyst (Follicular/eruption cyst)

Lateral periodontal cyst

Glandular odontogenic cyst (sialo-odontogenic)

Gingival cyst of adults

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8
Q

Where are epithelial, non-odontogenic cysts found?

A

Fissures

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9
Q

Name 3 types of epithelial, non-odontogenic cysts

A

Median palatine cyst

Nasiolabial cyst

Nasopalatine cyst (incisive canal cyst)

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10
Q

Are non-epithelial cysts odontogenic or non-odontogenic?

A

Non-odontogenic

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11
Q

Name 2 types of non-epithelial cysts

A

Solitary bone cyst

Aneurysmal bone cyst

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12
Q

Where are the 3 sources from which the lining of epithelium is derived from?

A

Rests of Malassez

Reduced enamel epithelium

Remnants of the dental lamina

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13
Q

Which cysts have epithelium derived from the Rests of Malassez?

A

Radicular cyst

Residual cyst

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14
Q

Which cysts have epithelium derived from reduced enamel epithelium?

A

Dentigerous cyst

Eruption cyst

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15
Q

Which cysts have epithelium derived from remnants of the dental lamina?

A

Odontogenic keratocyst

Lateral periodontal cyst

Gingival cyst of adult

Glandular odontogenic cyst

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16
Q

What are the 3 things needed for a cyst to form? (Pathogenesis)

A
  1. Source of epithelium
  2. Stimulus for cavitation + epithelial cell proliferation
  3. Mechanism(s) for continued cyst growth + accompanying bone resorption (cyst will only grow if bone is resorbed)
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17
Q

What are the sources of epithelium of inflammatory cysts and how do they proliferate?

A

Epithelial cell rests of Malassez derived from remnants of Hertwig’s root sheath

Cell rests dotted throughout PDL, when trapped within periapical granuloma, with correct stimulus it proliferates

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18
Q

What is the source of epithelium of dentigerous cysts and how does it proliferate?

A

Reduced enamel epithelium (REE)

Space between REE + enamel leads to cyst formation

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19
Q

What is the source of epithelium of an odontogenic keratocyst>

A

Remnants of dental lamina (initial buds before tooth germ, aka Glands of Serres)

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20
Q

What is the source of epithelium of a nasopalatine duct cyst?

A

Nasopalatine duct epithelium - between 2 palatine processes

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21
Q

What is the source of epithelium of a nasolabial cyst?

A

Epithelial remnants at site of fissures (between processes)

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22
Q

What is the source of epithelium of a mucous retention cyst?

A

Salivary duct epithelium

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23
Q

What is the source of epithelium of a lympoepithelial/branchial cyst?

A

Inclusions of epithelium in lymphoid tissue

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24
Q

What is the source of epithelium of a thyroglossal cyst?

A

Thyroglossal duct epithelium

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25
What are the stimuli for epithelial proliferation + cavitation?
Inflammation/inflammatory stimulus Inflammatory cells secrete cytokines Possible links to genetic defects in a tumour suppressor gene in a subset of odontogenic keratocysts Genetic stimulus
26
Give examples where inflammation/inflammatory would be a stimulus for epithelial proliferation + cavitation
Site-specific: e.g. necrotic pulp -> PA granuloma -> inflammatory cyst Periodontal pocket - lateral periodontal inflammatory dental cyst (if lots of inflammation)
27
Which cytokines would be released by inflammatory cells for epithelial proliferation + cavitation?
IL-1, IL-6 + TNF + growth factors Epidermal growth factor (EGF) + transforming growth factor (TGF) beta
28
What are the 3 mechanisms of cyst growth?
1. Internal hydraulic pressure 2. Bone resorption 3. Epithelial growth
29
Describe the internal hydraulic pressure mechanism of cystic growth and which cysts it occurs in
Expansion of inflammatory + dentigerous cysts Protein accumulation within cyst walls as semipermeable membrane due to osmotic pressure Fluid accumulates within cyst lumen creating positive pressure in the cysts -> encouraging bone resorption
30
Describe the bone resorption method of cystic growth
Pro-inflammatory cytokines IL-1 (released by macrophages), TNF + PGER (released by fibroblasts) induce bone resorption Produced by inflammatory cells in cysts, stimulating bone resorption
31
Describe the epithelial growth method of cystic growth and where do we see it in particular
Growth factors such as EGF + TGF beta may cause pronounced proliferation of cyst epithelium Particularly important in odontogenic keratocysts which show pronounced mural growth even in absence of marked inflammation
32
What are the general clinical features of cysts?
Swelling Displacement/loosening of teeth Pain (if infected) Eggshell cracking Sign of fluctuance - movable/compressible; the larger the cycts, the more fluctuance
33
What type of radiograph would you take for small cystic lesions?
I/O PA
34
How many rads are usually taken for cysts? How are they taken and why?
2 images taken at right angles to each other So can locate where the cyst is
35
Which radiographs are taken of the maxilla?
PA + oblique occlusal OPG + lateral oblique Occipitomental (OM) True lateral CBCT
36
Which radiographs are taken of the mandible?
PA + true occlusal OPG + lateral oblique PA (Ap) of mandible CBCT
37
What are the radiological signs to look for?
Location Size Shape Margin Effect on adjacent structures
38
How do cysts appear clinically?
Well-defined, round or oval radiolucency Well-defined margin
39
What type of teeth are radicular cysts related to?
Related to non-vital tooth
40
Where do radicular cysts develop within?
Periapical granuloma
41
Describe how a radicular cyst would look on a radiograph
Unilocular, well defined, well corticated radiolucency at apex of non-vital tooth
42
Where is the commonest site of radicular cysts?
Upper incisors
43
What are the peak ages for a radicular cyst?
4-5th decade
44
Describe the nature of radicular cysts' growth
Regular growth limited buccal expansion Usually continuous with the lamina dura of root of affected tooth
45
Do radicular cysts cause resorption?
Do not usually cause resorption If long-standing can cause resorption + displacement of adjacent teeth
46
How are radicular cysts treated?
Endo surgical extraction
47
What can form if a radicular cyst is retained following an extraction?
Residual radicular cyst
48
Describe what a residual radicular cyst looks like on a radiograph
Well-defined, round/oval radiolucency
49
Where are residual radicular cysts always found?
Edentulous area After extraction of affected tooth
50
What is the key histology of a radicular cyst?
Thick wall of fibrous granulation tissue Inflamed - chronic + acute inflammatory cells (neutrophils) Cholestrol clefts + foreign body giant cells in wall/lumen Mucous cells particularly in maxillary cysts, due to location - hyaline bodies may be seen
51
Describe the epithelial lining of a radicular cyst
Non-keratinised stratified squamous Variable thickness most common but can be thin/attenuated in long-standing cysts
52
What is inside the lumen of a radicular cyst?
Pale pink serous exudate, macrophages, desquamated epithelial cells, inflammatory cells + cholestrol clefts
53
What are dentigerous cysts also known as?
Eruption cysts
54
What are dentigerous cysts attached to?
Attached at CEJ surrounding crown of unerupted 8s + 3s (typically enveloping crown)
55
What is the peak age for a dentigerous cyst?
3-4th decade
56
When is a cyst expected in regard to the follicular space?
If it exceeds 3mm
57
Describe the radiological appearance of a dentigerous cyst
Unilocular, well-corticated radiolucency, late buccal expansion Classically crown of associated tooth lies centrally within cyst
58
What is the treatment of a dentigerous cyst?
Surgical removal/uncover tooth
59
Do dentigerous cysts recur?
No recurrence
60
Describe the key histology of dentigerous cysts
Cyst wall variably thick often with a bluish myxoid appearance like dental follicle Pink exudate sometimes in cavity Mucous metaplasia common
61
Describe the epithelial lining of dentigerous cysts
Non-keratinised stratified squamous epithelium on a flat basement membrane 2-5 cells thick If inflamed lining looks like inflammatory cysts
62
What is found in the lumen of dentigerous cysts?
Pink serous exudate, cholestrol clefts
63
What is the commonest site of a odontogenic keratocyst?
Angle of mandible + ramus
64
Locularity of an odontogenic keratocyst?
Usually multilocular, but can be unilocular + associated with an unerupted tooth, very little expansion
65
What is the peak age of odontogenic keratocysts?
2nd + 3rd decades
66
How does an odontogenic keratocyst grow?
Through medullary bone with late buccal expansion May be associated with tooth root resorption
67
What is the treatment for odontogenic keratocysts?
Surgical removal
68
Does recurrence occur with odontogenic keratocysts + why?
Recurrence is common Due to difficulty in removal + daughter cysts
69
Multiple odontogenic keratocysts are associated with which syndrome?
Gorlin Goltz
70
What is another name for Gorlin Goltz syndrome?
Nevoid basal cell Carcinoma
71
What type of disease is Gorlin Goltz syndrome?
Rare autosomal disorder characterised by multiple basal cell carcinoma
72
List the clinical features of Gorlin Goltz syndrome
Developmental defects such as bifid ribs, spine + rib abnormalities Palmar + plantar epidermal pits Calcification of the falx cerebri Relative macrocephaly, facial milia, frontal bossing
73
Key histology of odontogenic keratocysts in someone with Gorlin Goltz syndrome
Thin fibrous cyst wall Normally uninflamed Small daughter cysts may be in the wall Epithelial lining is keratinised - normally parakeratinised with a corrugated surface - flat basement membrane Basal cells darkly stained with reversal of nuclear polarity - like ameloblasts Lumen filled with keratin
74
What is a lateral periodontal cyst?
Any cyst in the lateral periodontal region that is not an inflammatory cyst or an atypical odontogenic keratocyst
75
What are lateral periodontal cysts associated with?
Lateral roots of vital teeth
76
Describe the radiographic appearance of a lateral periodontal cyst
Usually very small, <1cm in diameter Round, well-defined, corticated + normally unilocular Can cause buccal expansion if very large
77
What is the key histology of a lateral periodontal cyst?
It is a developmental cyst so largely flat basement membrane Epithelial layer is 2-5 cells thick Thickened in areas to form swirled plaques Scattered glycogen rich clear cells May be multicystic Fibrous cyst wall is thin + uniformed
78
Where are nasopalatine cysts found?
Midline, anterior maxilla, just posterior to upper central incisors Associated with a vital maxillary incisor
79
At what age do nasopalatine cysts commonly form?
5-6th decade
80
Describe the radiological appearance of nasopalatine cysts
Well-defined, well-corticated monolocular radiolucency Round/oval
81
How big are nasopalatine cysts?
>6mm
82
What is the most common non-odontogenic cyst?
Nasopalatine cyst
83
Describe the key histology of nasopalatine cysts
Lining may be nonkeratinising stratified squamous or ciliated respiratory type epithelium, usually both Look for big nerves + blood vessels in wall
84
When are solitary bone cysts likely to form?
Children + adolescents under 20 years
85
Where are solitary bone cysts found?
Body of mandible
86
Describe the radiographic appearance of a solitary bone cyst
Well corticated, monolocular radiolucency Irregular outline
87
Describe the cavity of a solitary bone cyst
No wall/thin fibrous wall no epithelial lining Cyst lumen often empty
88
Describe the key histology of a solitary bone cyst
Fibrovascular tissue only No epithelial cyst lining Occasional giant cells + haemosidenin pigment may be seen
89
What is an aneurysmal bone cyst often classified as?
Giant cell lesion
90
At what age are aneurysmal bone cysts found?
Children + young adults
91
Describe the radiographic appearance of an aneurysmal bone cyst
Multilocular radiolucency in the mandible with cortical expansion
92
Describe what the aneurysmal cyst is like
Partially cystic partially solid Contains blood filled cystic spaces
93
Describe the key histology of the aneurysmal bone cyst
Localised proliferative lesion of vascular tissue, containing giant cells + granulation tissue therefore it is a soft tissue lesion
94
What are the 4 types of cysts in the soft tissues of the mouth, face + neck
Cysts of the salivary glands Lymphoepithelial (Branchial cleft) cyst Thyroglossal duct cysts Dermoid + Epidermoid cysts
95
Name 3 types of cysts of the salivary glands
Mucous extravasation cyst Mucous retention cyst Ranula
96
Where is the most common site of a mucous extravasation cyst?
Lower lip is quite common
97
Causes of mucous extravasation cysts
Related to trauma - e.g. pt biting on lip
98
What is the key histology of a mucous extravasation cyst?
Surrounded by granulation tissue
99
When are mucous retention cysts likely to happen?
In older age
100
Why do mucous retention cysts occur?
Dilated salivary duct filled mucin Related to ductal obstruction
101
When do lymphoepithelial (branchial) cleft cysts appear?
Late in childhood or in early adulthood
102
Describe the clinical appearance and location of a lympoepithelial (branchial cleft) cyst?
Presents as unilateral Soft tissue fluctuant swelling Typically appears in lateral aspect of neck, anterior to sternocleidomastoid muscle
103
What is the key histology of soft tissue cysts?
Look for an epithelial lining Look for mucin Look for a lymphoid stroma From epithelial remnants within lymphoid tissue Attenuated (reduced) epithelium surrounded by reactive lymphoid stroma
104
What are dermoid cysts?
Developmental anomalies occasionally in soft tissues of head + neck
105
Where are dermoid cysts found?
Entrapped epithelium normally in midline, floor of mouth above mylohyoid
106
What is the key histology of dermoid cysts?
Cyst lined by epidermis + skin
107
At what age are dermoid cysts found?
May be found at birth/in older patients Majority are 15 + 35 y/o F=M
108
How do thyroglossal cysts occur?
Developmental remnants of thyroglossal tract during descent of thyroid
109
Where do thyroglossal cysts occur?
In midline
110
What is the key histology of a thyroglossal cyst?
Cyst lined by attenuated/respiratory epithelium Often some thyroid follicles in the cyst wall
111
What are cholesterol clefts?
Spaces left by cholesterol crystals during tissue processing Cholesterol is derived from the breakdown of RBCs Clefts are a feature of inflamed cysts + are non-specific
112
Where do we see mucous metaplasia?
Can be seen in any cysts but common in dentigerous cysts + maxillary cysts
113
Where are hyaline bodies found + what are they?
Found in odontogenic cysts Only material secreted by odontogenic epithelium + similar to dental cuticle
114
Where do we see a flat basement membrane?
Normally associated with developmental odontogenic cysts -e.g. dentigerous + keratocysts
115
What are the 3 ways to investigate a cyst?
1. Clinically 2. Biopsy 3. Radiologically
116
What is assessed clinically when investigating a cyst?
Site + vital/non-vital Absent/unerupted tooth Swelling Eggshell cracking, fluctuation Displacement/loosening of teeth
117
What are the 3 types of biopsies?
Aspiration Excisional biopsy Incisional biopsy
118
When would you carry out aspiration?
Aneurysmal bone cyst - looking for a blood-hemangioma Pus Serous exudate Keratin either by smear onto cytology slide or estimation of soluble protein
119
When would you carry out an incisional biopsy?
When lesion extensive/reason to believe it is not a simple cyst e.g. dif radiolucencies at angle of mandible
120
When would you carry out an excisional biopsy?
When lesion is small + amenable for excision

Cysts (2 decks)

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