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BDS4 Radiology > Cysts of the Jaws 1 > Flashcards

Cysts of the Jaws 1 Flashcards

1
Q

What is a cyst

A

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

-> almost all are benign

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2
Q

What is a cyst called if it contains pus?

A

Infected cyst- pus is not part of pathology

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3
Q

What makes cysts a diverse group of lesions?

A

Can be:

symptomatic or asymptomatic

Slow or Fast growing

Indolent or destructive

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4
Q

What are the signs and symptoms of cysts?

A
  • Swelling
  • Pain & Tenderness
  • Gradual tooth movements/spacing
  • Mobility
  • Prevented tooth eruption
  • Discolouration of the tooth
  • Egg shell cracking noise on palpation
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5
Q

How do you know if the cyst is coming from odontogenic or from the periodontium?

A

Assess the vitality
-> If vital = coming from the periodontium

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6
Q

How do you decide which radiographs to take for a cyst?

A

Patient history

Clinical examination

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7
Q

Which initial radiographs are taken to investigate cysts?

A

Periapical radiograph

Occlusal radiograph (if larger)

Panoramic radiograph (if very large)
- Only use large if necessary (higher radiation dose)
- Don’t use for (esp upper) anterior cysts
- Lots of limitations as there is anatomical features superimposed

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8
Q

Which supplemental radiographs can be used to investigate cysts?

A
  • Cone beam CT (CBCT)
  • Facial radiographs
  • PA mandible view
  • Occipitomental view

-> important as these show proximity to surrounding anatomy

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9
Q

Which radiographic features of cysts should be assessed?

A
  1. Location
  2. Shape
  3. Margins
  4. Locularity- how many chambers (uni/multi/pseudo)
  5. Multiplicity- how many of them there are (single is most common)
  6. Inclusion of erupted teeth
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10
Q

What shape do cysts tend to be on radiographs?

A

Spherical or egg shaped
-> can stretch as it reaches cortical bone as there is less resistance (some may destroy cortex)

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11
Q

How do margins of cysts appear radiographically?

A

Usually well defined and corticated
-> unless infection

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12
Q

What is meant by pseudolocular?

A

Appears like this as it pushes up against other structures

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13
Q

What does multiple cysts suggest?

A

That they are occurring as a result of a syndrome

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14
Q

How is aggression of cyst predicted?

A

By looking at effect on surrounding anatomy
-> Displacement of cortical plates, adjacent teeth, maxillary sinus, IAC

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15
Q

What may occur to tooth roots due to chronic cysts?

A

Root resorption

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16
Q

How are cysts classified?

A

Structure- epithelium lined OR non-epithelium lined

Origin- odontogenic OR non-odontogenic

Pathogenesis- developmental OR inflammatory

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17
Q

Where are odontogenic cysts never found?

A

Above maxillary sinus

Below IDN

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18
Q

What are the developmental types of odontogenic cyst?

A

Dentingerous (eruption) cyst

Odontogenic keratocyst

Lateral periodontal cyst

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19
Q

What are the inflammatory types of odontogenic cyst?

A

Radiciular cyst (and residual)

Inflammatory collateral cyst
-> Paradental
-> Buccal bifurcation cyst

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20
Q

What are the developmental types of non-O cysts?

A

Nasopalatine duct cyst

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21
Q

What are the other types of non-odontogenic cyst?

A

Solitary bone cyst

Aneurysmal bone cyst

-> no-epithelial lining

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22
Q

What are the general features of odontogenic cysts?

A

Occur in tooth bearing areas
-> arise from tooth material (can be a follicle)

Most common bony swelling of jaws
-> 90% of all cysts in oral/maxillofacial region

All lined with epithelium

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23
Q

What are the epithelial remnants can lead to odontogenic cyst formation?

A

Rests of Malassez (radicular)
-> Remnants of Hertwig’s epithelial root sheath

Rests of Serres (OK)
-> Remnants of the dental lamina

Reduced enamel epithelium (Dentigerous)
-> Remnants of the enamel organ

24
Q

What are the most common odontogenic cysts?

A

Radicular cyst

Dentigerous cyst

Odontogenic Keratocyst

25
Q

What causes radicular cysts?

A

Associated with a non-vital tooth
-> Initiated by chronic inflammation at apex of tooth due to pulp necrosis

26
Q

What are the epidemiological features of radicular cysts?

A

Usually occurs in 40-50s

M=F

60% in maxilla, 40% in mandible

27
Q

How do radicular cysts present?

A

Often asymptomatic

Pain if they become infected

Usually slow growing with limited expansion

28
Q

How are periapical granulomas and radicular cysts differentiated?

A

If diameter of radiolucency is >15mm
-> 2/3 of these are radicular cysts

*PA granulomas will respond to RCT

29
Q

What are the radiographic features of radicular cysts?

A

Round/oval

Well-defined

Coricated- margin continuous with lamina dura of non-vital tooth

Larger lesions may displace adjacent structures

Long standing lesions
-> External root resorption
-> dystrophic calcification

30
Q

How do radicular cysts appear histologically

A
  • Epithelial lining (often incomplete)- NK stratified squamous
  • Connective tissue capsule
  • Inflammation in capsule
  • Cholesterol clefts
  • Mucous metaplasia
  • Hyaline/rushton bodies (unique to odontogenic epithelium)- no clinical significance
31
Q

What can cause rests of mallasez to start dividing in radicular cysts?

A

Endotoxins from bacteria

32
Q

What is meant by unicentric and multicentric?

A

Unicentric- all parts expand at same rate

Multicentric- parts of epithelium are more active
-> finger like processes form and grow in AP direction (with less clinical swelling)

33
Q

How do radicular cysts form?

A

Proliferating epithelium with central necrosis

Epithelium surround fluid area

34
Q

How does continued growth of radicular cysts occur?

A

Osmotic effect with semi-permeable wall

Cytokine mediated growth

35
Q

What is a residual cyst? (variant of radicular)

A

When radicular cyst around apex of NV toothl persists after loss of tooth/successful RCT
-> as an encapsulated collection of fluid

36
Q

What is a lateral radicular cyst?

A

Radicular cyst associated with a lateral/accessory canal (not apex)
-> located at side

37
Q

What is an inflammatory collateral cyst?

A

Inflammatory odontogenic cyst assicuated with vital tooth

-> encompasses paradental and buccal bifurcation (depends on location)

38
Q

Where does a paradental cyst occur?

A

Typically occurs at distal aspect of partially-erupted mandibular third molar

39
Q

Where does a buccal bifurcation cyst occur?

A

Typically occurs at buccal (buccal bifurcation) aspect of mandibular first molar

40
Q

What is a dentigerous cyst?

A

Developmental odontogenic cyst associated with crown of unerupted (& usually impacted) tooth e.g. mandibular third molars, maxillary canines
-> Cystic change of dental follicle

41
Q

What are the epidemiological features of dentigerous cysts?

A

Most common in 2nd-4th decades

Male > female

Mandible > maxilla

Most commonly assoc. with 8s as these are often unerupted/impacted

42
Q

What are the radiographic features of a dentigerous cyst?

A

Corticated margins attached to ACJ

Larger cysts may begin to envelope root of tooth

Initially symmetrical- may expand unilaterally as it gets larger

May be evidence of displacement of teeth and cortical bone

43
Q

What do patients complain of when they have dentigerous cysts?

A

Lip is numb- cyst pushes on IDN

Mobility of adjacent teeth

44
Q

What are the histological features of dentigerous cysts?

A

Thin NK Stratified squamous epithelium lining
-> attached to ACJ of unerupted tooth

May look like radicular cyst if inflamed

45
Q

What is the histological indicators of enlarged follicle?

A

Cuboidal epithelium

Walls have islands of lamina

46
Q

How are dentigerous cysts distinguished from enlarged follicle?

A

Consider cyst if follicular space >4mm/ radiolucency is asymmetrical
-> Measure from surface of crown to edge of follicle
-> Assume cyst if >10mm

47
Q

What is an eruption cyst?

A

Variant of dentigerous cyst (almost exclusive to children)
-> Contained within soft tissue rather than bone

Associated with an erupting tooth
-> More commonly incisors

48
Q

What is an odontogenic keratocyst?

A

Developmental odontogenic cyst with no specific relationship to teeth (may be near or touching and does arise from tooth tissue)

49
Q

What are the epidemiological features of OK?

A
  • Most common in 2nd & 3rd decades
  • Male > female
  • Mandible > maxilla (3:1)
  • Posterior > anterior
  • Worse recurrence rate
50
Q

What are the radiographic features of OK?

A

Scalloped margins

Often multilocular

Often cause displacement of adjacent teeth

Root resorption is uncommon

51
Q

How do OK characteristically expand?

A

Enlarges markedly in medullary bone space before displacing cortical bone
-> significant mesio-distal expansion without bucco-lingual expansion

52
Q

What are the pre-operative diagnostic tests for OK?

A

Cyst aspirate
-> should contain- squames and low protein content (<4g/dl)

53
Q

What are the histological features of an OK?

A

Wall
-> daughter/sateillite cysts can be found (if these are left they will form a new cyst)

Epithelial lining- may be parakeratinised
-> No rete pegs in epithelium
-> Basal palisading- basal cells at same height
-> evidence of multicentric growth with finger like projections

Cavity- wavey appearance

54
Q

How are OKs treated?

A

Marsupialisation
1. Cut a hole and allow it to drain slightly = reduces in size and moves away from the canal and reduces risk of mandibular fracture and can be removed easier.
2. Remove tooth too to prevent recurrence
3. Close monitoring for years post surgery

55
Q

How does basal cell naevus syndrome present? (aka Gorlin-Goiltz/Bifid rib syndrome)

A

Multiple odontogenic keratocysts

Multiple basal cell carcinomas

Palmar & plantar pitting

Calcification of intracranial dura mater

56
Q

How does basal cell naevus syndrome differ from OK?

A

Histological identical to non-syndromic OK but occur at younger age around 15 years

BDS4 Radiology (8 decks)

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