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cysts, tumours, bone pathology > cysts of the jaws > Flashcards

cysts of the jaws Flashcards

1
Q

definition

A

a pathological cavity containing fluid, semi-fluid or gaseous contents and which is not created by the accumulation of pus
sterile fluid - not abscess
can get pus in cysts if infected but not initial cause

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2
Q

how are cysts diverse?

A

asymptomatic/symptomatic - often asymptomatic unless infected
slow/fast growing
indolent/destructive

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3
Q

are most cysts benign or malignant?

A

benign

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4
Q

describe usual cyst shape and the reason why

A

often spherical or egg-shaped

most grow by hydrostatic pressure - accumulation of fluid causes cyst to grow in a certain direction

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5
Q

usual cyst margins

A

well-defined and corticated

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6
Q

locularity of cysts

A

often unilocular

can be multilocular (or pseudolocular)

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7
Q

what might multiple cysts indicate?

A

a syndrome

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8
Q

describe effects cysts can have on surrounding anatomy

A

displacement of cortical plates, adjacent teeth, MS, IAC
variable degree and pattern of growth - along bone through trabecular bone - get more MD expansion in mandible than BL as dense cortical bone
RR may occur with chronic cysts

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9
Q

what can be included in cysts?

A

UE teeth

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10
Q

secondary infection

A

cysts may lose definition and cortication of margins if secondarily infected
typically associated with clinical S+S

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11
Q

classification

A

structure - epithelial lined vs no epithelial lining
origin - Odontogenic vs non-odontogenic
pathogenesis - developmental vs inflammatory

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12
Q

Odontogenic developmental cysts

A 
dentigerous cyst (+eruption cyst)
Odontogenic keratocyst
lateral periodontal cyst
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13
Q

Odontogenic inflammatory cysts

A

radicular (+residual) cyst
inflammatory collateral cysts
- paradental cyst
- buccal bifurcation cyst

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14
Q

non-odontogenic developmental cyst

A

nasopalatine duct cyst

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15
Q

non-odontogenic other cysts

A

solitary bone cyst
aneurysmal bone cyst
no epithelial lining

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16
Q

where do Odontogenic cysts occur?

A

in tooth bearing areas

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17
Q

what is the most common cause of bony swelling in the jaws?

A

Odontogenic cysts
>90% of all cysts in the oral and MF region
2nd most common group of oral and MF lesions in adults (14-15%)

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18
Q

what are all Odontogenic cysts lined with?

A

epithelium

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19
Q

Odontogenic sources of epithelium

A

Rests of Malassez
Rests of Serres
reduced emamel epithelium

epithelial rests get switched on (often by inflammation)

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20
Q

Rests of Malassez

A

remnants of Hertwig’s epithelial root sheath

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21
Q

Rests of Serres

A

remnants of the dental lamina

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22
Q

reduced enamel epithelium

A

remnants of the enamel organ

covers crown of UE tooth then breaks down as tooth erupts

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23
Q

most common Odontogenic cysts

A

radicular (+residual) - 60%
dentigerous (+ eruption) - 18%
Odontogenic keratocyst - 12%

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24
Q

what type of cyst is a radicular cyst?

A

inflammatory Odontogenic cyst

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25
Q

what is a radicular cyst always associated with?

A

a non-vital tooth

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26
Q

cause of a radicular cyst

A

non-vital tooth

initiated by chronic inflammation at apex of tooth due to pulp necrosis

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27
Q

incidence of radicular cyst

A

most common in 4th and 5th decade
M=F
60% maxilla, 40% mandible
can involve any tooth

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28
Q

presentation of radicular cyst

A

often asymptomatic - may become infected - pain
typically slow growing with limited expansion
can produce alveolar bone expansion +/- discharge

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29
Q

what is the only way to confirm if a lesion has progressed to a radicular cyst?

A

surgically excise

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30
Q

stages of radicular cyst formation

A

pulpal necrosis
periapical periodontitis
periapical granuloma
radicular cyst

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31
Q

radicular cyst vs periapical granulomas

A

difficult to differentiate radiographically
- radicular cysts typically larger
if radiolucency diameter >15mm - 2/3 of cases will be radicular cysts

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32
Q

radiographic features of a radicular cyst

A

well-defined, round/oval radiolucency
corticated margin continuous with lamina dura of non-vital tooth
larger lesions may displace adjacent structures
long-standing lesions may cause external root resorption and/or contain dystrophic calcification
unilocular
uniform radiolucency

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33
Q

histology of radicular cysts

A

epithelial lining (often incomplete)
- can get ulceration/hyperplasia
- usually non-keratinised SSE 2-10 layers thick
fibrous CT vascular capsule
inflammation in capsule - inflammatory infiltrate
can get cholesterol clefts

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34
Q

growth of a radicular cyst

A

radicular cyst from granuloma
- Epithelial rests of malassez in PDL become active, divide and proliferate

radicular cysts may form by:

  • proliferating epithelium with central necrosis - centre of granuloma cut off from blood supply
  • OR epithelium surrounds fluid area

continued growth

  • osmotic effect with semi-permeable wall
  • cytokine mediated growth - also ILs - activation of osteoclasts

variable inflammation
cholesterol clefts
mucous metaplasia
hyaline/rushton bodies (only in Odontogenic epithelium)

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35
Q

cholesterol clefts

A

cholesterol in fluid due to rbcs breaking down

may get calcification within cholesterol

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36
Q

variants of a radicular cyst

A

residual cyst

lateral radicular cyst

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37
Q

residual cyst

A

when radicular cyst persists after loss of tooth (or after tooth is successfully RCT)
clinical history is important to avoid misdiagnosis

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38
Q

lateral radicular cyst

A

radicular cyst associated with an accessory canal

located at side of tooth instead of apex

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39
Q

cyst S+S

A

“egg shell” crackling on palpation - cyst thins cortical bone so when you press it cracks slightly

tingling/altered sensation - presses on nerve

  • nasopalatine n (anterior palate)
  • IO nerve (side nose, cheek, U lip)

movement/displacement of adjacent teeth

mobility

change in occlusion

sinus involvement - muffling sound, postural changes discomfort

diplopia - v large cyst in maxilla can push up orbital floor

painless swelling of buccal cortex

can get fluctuant swelling if bone completely resorbed

hollow percussion note

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40
Q

what type of cyst is an inflammatory collateral cyst?

A

inflammatory Odontogenic cyst

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41
Q

what are inflammatory collateral cysts associated with?

A

a vital tooth

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42
Q

incidence of inflammatory collateral cysts

A

2-7% of Odontogenic cysts

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43
Q

what is the pouch lined with in inflammatory collateral cysts?

A

non-keratinised epithelium

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44
Q

what is included in inflammatory collateral cysts?

A

paradental cyst

buccal bifurcation cyst

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45
Q

where does a paradental cyst typically occur?

A

distal aspect of PE L8

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46
Q

where does a buccal bifurcation cyst typically occur?

A

the buccal aspect of L6

roots go lingually, crowns go buccally - affects occlusion

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47
Q

what type of cyst is a dentigerous cyst?

A

developmental Odontogenic cyst

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48
Q

what are dentigerous cysts associated with?

A

crown of UE (+ usually impacted) tooth
e.g. L8s, U3s
cystic change of dental follicle

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49
Q

what is a dentigerous cyst the result of?

A

cystic change of the dental follicle

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50
Q

incidence of dentigerous cysts

A

most common in 2nd-4th decades
M>F
mandible>maxilla

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51
Q

features of a dentigerous cyst

A

corticated margins attached to CEJ of tooth (where dental follicle usually attaches)

  • larger cysts may begin to envelope root of tooth
  • be careful not to misinterpret

may displace involved tooth

tends to be symmetrical initially
- larger cysts may begin to expand unilaterally

variable displacement of cortical bone (i.e. bony expansion)

tooth missing from arch

round/ovoid well-defined unilocular, uniform radiolucency

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52
Q

histology of dentigerous cysts

A

thin non-keratinised SSE

- may resemble radicular cyst if inflamed

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53
Q

dentigerous cyst vs enlarged follicle

A

consider cyst if follicular space >4mm
- measure from surface of crown to edge of follicle
- assume cyst if >10mm
consider cyst if radiolucency is asymmetrical

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54
Q

what is an eruption cyst?

A

variant of dentigerous cyst
contained within ST rather than bone
Rests of Serres

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55
Q

presentation of an eruption cyst

A

associated with an erupting tooth
more commonly incisors/FPMs
almost exclusive to children
bluish over an erupting tooth
may/may not need intervention - tx conservatively and tooth often erupts
surgical excision of cyst sometimes required
ST

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56
Q

what type of cyst is an Odontogenic keratocyst?

A

development Odontogenic cyst

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57
Q

does an OK have a relationship to teeth?

A

no specific one

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58
Q

incidence of OK

A

most common in 2nd and 3rd decades
M>F
mandible>maxilla (3:1) 70-80% mandible, esp 3rd molar region
posterior>anterior

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59
Q

what was OK previously called?

A

keratocystic Odontogenic tumour

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60
Q

describe OK margins

A

often scalloped

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61
Q

what % of OKs are multilocular?

A

25%

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62
Q

what do OKs often cause of adjacent teeth?

A

displacement

root resorption uncommon

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63
Q

characteristic expansion of OKs

A

can enlarge markedly in medullary bone space before displacing cortical bone
i.e. can have significant MD expansion without BL expansion

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64
Q

pre-op diagnostic test - cyst aspirate for OK

A

contains squames

low soluble protein content: 40g/l (other cysts >50)

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65
Q

histology of OK

A 
corrugated wavy epithelium
parakeratosis
loss of keratin if inflamed
no rete pegs - can detach quite easily
basal palisading - nuclei same level
epithelium tends to grow in clusters
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66
Q

recurrence of OKs

A

high recurrence rate (aggressive) - need close monitoring

thin friable lining - difficulty of surgery

daughter/satellite cysts

  • small cysts in lining of main cyst
  • don’t leave in lining of bone as will grow - recurrence

cell nests (esp retromolar)

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67
Q

presentation of Basal cell naevus syndrome

A 
multiple OKs
multiple basal cell carcinomas
palmar and plantar pitting
calcification of intracranial dura mater
skeletal abnormalities - ribs and vertebrae bifid ribs
characteristic facial features - frontal and temporal parietal bossing, hypertelorism, mild mandibular prognathism 
abnormalities of Ca and PO4 metabolism
etc

aka Gorlin-Goltz syndrome, bifid rib syndrome

cysts histologically identical to non-syndromic form but often occur at younger age e.g. 15yrs

autosomal dominant trait

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68
Q

non-odontogenic cysts

A

nasopalatine duct cyst
solitary bone cyst
aneurysmal bone cyst

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69
Q

what is the most common non-odontogenic cyst?

A

nasopalatine duct cyst

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70
Q

what type of cyst is a nasopalatine duct cyst?

A

developmental non-odontogenic cyst

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71
Q

what does a nasopalatine duct cyst originate from?

A

nasopalatine duct epithelial remnants

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72
Q

where does a nasopalatine duct cyst occur?

A

anterior maxilla

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73
Q

incidence of nasopalatine duct cyst

A

most common in 4th-6th decades

M>F

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74
Q

presentation of nasopalatine duct cyst

A

often asymptomatic
pt may note “salty” discharge
larger cysts may displace teeth or cause swelling in palate
always involve midline but not always symmetrical

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75
Q

histology of nasopalatine duct cyst

A

variable epithelial lining: non-keratinised stratified squamous and modified respiratory

76
Q

radiography for a nasopalatine duct cyst

A

PA and/or standard maxillary occlusal

  • corticated radiolucency between/over roots of central incisors
  • often unilocular
  • may appear “heart shaped” due to superimposition of ant nasal spine

CBCT
- indicated if better visualisation of cyst needed for surgical planning

77
Q

cyst vs incisive fossa

A

incisive fossa

  • may/may not be visible on radiographs
  • midline/oval shaped radiolucency
  • typically not visibly corticated

in absence of clinical issues, consider transverse diameter

  • <6mm assume incisive fossa
  • 6-10mm consider monitoring
  • > 10mm suspect cyst
78
Q

solitary bone cyst

A

non-odontogenic cyst without an epithelial lining

aka simple/traumatic/haemorrhagic bone cyst

79
Q

incidence of a solitary bone cyst

A

most common in 2nd decade
M>F
mandible>maxilla
can occur in association with other bone pathology e.g. fibro-osseous lesions

80
Q

clinical presentation of solitary bone cyst

A

usually asymptomatic - incidental finding

rarely pain or swelling

81
Q

radiographic presentation of solitary bone cyst

A

majority in premolar/molar region of mandible
- can also occur in non-tooth bearing areas

variable definition and cortication

may have scalloped margins giving a pseudolocular appearance

may project up between the roots of adjacent teeth

82
Q

Stafne cavity

A

not a cyst but commonly mistaken as one

actually a depression in the bone - cortical bone preserved

83
Q

where does a Stafne cavity occur?

A

only in mandible, almost exclusively lingual

84
Q

what does a Stafne cavity contain?

A

salivary or fatty tissue

85
Q

Stafne cavity presentation

A 
most common in 5th and 6th decades
often in angle or posterior body
often inferior to IAC
asymptomatic
well-defined, often corticated radiolucency
rarely displaces adjacent structures
86
Q

obtaining material for histology

A

aspiration biopsy - drainage of contents
incisional biopsy - partial removal
excision biopsy - complete removal

87
Q

aspiration biopsy equipment

A

wide bore needle

5-10ml syringe

88
Q

aspiration biopsy - what you can get

A

air
blood
pus
cyst fluid
- clear straw coloured fluid in inflammatory or developmental cysts
- white or cream semi-solid may indicate keratocyst

may be unable to withdraw plunger

89
Q

purpose of incisional biopsy

A

to obtain a sample of the lining for histological analysis

90
Q

incisional biopsy method

A

usually under LA
select place where lesion appears superficial
raise mucoperiosteal flap
remove bone as required - using rongeurs or a round bur
incise and remove a section of lining

procedure may be combined with marsupialisation (a tx option)

91
Q

limitations of radiology

A

can only do provisional diagnosis

histology to confirm

92
Q

tx - surgical options

A

enucleation

marsupialisation

93
Q

what is enucleation?

A

all of the cystic lesion is removed - lining and contents

94
Q

what is marsupialisation?

A

creation of a surgical window in the wall of the cyst, removing the contents of the cyst and suturing the cyst wall to the surrounding epithelium
encourages cyst to decrease in size and may be followed by enucleation at a later date

95
Q

what is the tx of choice for most cysts?

A

enucleation

96
Q

advantages of enucleation

A

whole lining can be examined pathologically
primary closure
little aftercare needed

97
Q

disadvantages of enucleation

A

risk of mandibular fracture with v large cysts
dentigerous cyst? wish to preserve tooth
old age, ill health
clot filled cavity may become infected
incomplete removal of lining may lead to recurrence
damage to adjacent structures

98
Q

healing following enucleation

A

around 36m - need long-term follow up

clot gradually replaced with bone

99
Q

indications for marsupialisation

A

if enucleation would damage surrounding structures e.g. IDC
difficult access to area
may allow eruption of teeth affected by dentigerous cyst
elderly/medically compromised pts unable to withstand extensive surgery
v large cysts which would risk jaw fracture if enucleation was performed
can combine with enucleation as a later procedure

100
Q

advantages of marsupialisation

A

simple to perform

may spare vital structures

101
Q

contraindications/disadvantages of marsupialisation

A

opening may close and cyst may reform
complete lining not available for histology
difficult to keep clean and lots of aftercare needed
long time to fill in

102
Q

obturator

A

plastic tray used to keep marsupialisation window open

103
Q

non-epithelial cysts

A

solitary bone cyst
aneurysmal bone cyst
Stafne idiopathic bone cavity

104
Q

epithelial non-odontogenic cysts

A

nasolabial cyst
nasopalatine cyst
globulomaxillary cyst
median cyst

105
Q

epithelial Odontogenic developmental cysts

A 
dentigerous cyst 
 - eruption cyst
OK
lateral periodontal cyst
 - Botryoid Odontogenic cyst
gingival cysts
 - adults
 - infants (alveolar cyst)
glandular Odontogenic cyst
calcifying Odontogenic cyst
orthokeratinised Odontogenic cyst
106
Q

epithelial Odontogenic inflammatory cysts

A 
radicular cyst
 - residual
inflammatory collateral cysts
 - paradental
 - mandibular buccal bifurcation
107
Q

3 ways in which cysts grow

A

epithelium differentiates and grows
inflammatory process
osmotic pressure

108
Q

Odontogenic cysts of inflammatory origin

A 
radicular cyst
 - residual
inflammatory collateral cysts
 - paradental
 - mandibular buccal bifurcation
109
Q

Odontogenic cysts of developmental origin

A 
dentigerous cyst
 - eruption cyst
OK
lateral periodontal cyst
 - subtype: Botyroid Odontogenic cyst
gingival cysts
 - of adults
 - of infants (alveolar cyst)
glandular Odontogenic cyst
calcifying Odontogenic cyst
orthokeratinised Odontogenic cyst
110
Q

what is a Botryoid Odontogenic cyst a subtype of?

A

lateral periodontal cyst

111
Q

non-odontogenic epithelial cysts

A

nasolabial cyst
nasopalatine cyst
globulomaxillary cyst
median cyst

112
Q

nasolabial cyst

A

ST cyst
invasive
can distort nose

113
Q

non-epithelial cysts

A

solitary bone cyst
aneurysmal bone cyst
Stafne’s idiopathic bone cavity

114
Q

what is the most common broad category of cysts?

A

Odontogenic cysts of inflammatory origin

115
Q

what does a radicular cyst form from the proliferation of?

A

epithelium (rests of malassez)

originate from Hertwigs root sheath (dental follicle)

116
Q

usual treatment of a radicular cyst

A

generally simple enucleation and removal of associated tooth

  • can do endo and intracanal medicament while waiting for referral appt
  • as a min need RCT but warn that if they keep tooth cyst may recur
117
Q

radicular cyst content

A

varies from watery, straw-coloured fluid through to semi-solid brownish material

118
Q

where do inflammatory collateral cysts usually occur?

A

lateral (usually buccal) aspect of PE, vital tooth - originate from pericoronal tissue so to side of crown

119
Q

what % of Odontogenic cysts are inflammatory collateral?

A

5%

120
Q

what % of inflammatory collateral cysts are paradental?

A

60%

121
Q

what is the usual inflammatory stimulus for paradental cysts?

A

pericoronitis

122
Q

how does a paradental cyst relate to the tooth?

A

well-defined radiolucency is related to the neck of tooth and coronal 1/3 of root

123
Q

what does the pathology of a paradental cyst resemble?

A

inflammatory radicular cyst

124
Q

what % of inflammatory collateral cysts are mandibular buccal bifurcation cysts?

A

> 35%

125
Q

mandibular buccal bifurcation cysts in children

A

usually buccal aspect of erupting first molar

can cause delayed eruption of 6s

126
Q

what is the most common developmental Odontogenic cyst?

A

dentigerous cyst

127
Q

what % of odontogenic cysts are dentigerous?

A

20%

128
Q

what are dentigerous cysts lined with?

A

epithelium derived from reduced enamel epithelium (from enamel organ)

129
Q

what is the usual tx for a dentigerous cyst?

A

often cyst enucleation with associated tooth or marsupialisation if large

130
Q

contents of a dentigerous cyst

A

proteinaceous yellowish fluid

cholesterol crystals common

131
Q

histopathology of an eruption cyst

A

synonymous to a dentigerous cyst

132
Q

what % of all MF cysts are OKs?

A

12%

133
Q

what does an OK arise from?

A

cell rests of Serres (originates from remnants of dental lamina)

134
Q

unusual growth pattern of OKs

A

enlarges in AP direction

can reach large size without causing gross bony expansion

135
Q

reviewing a pt after an OK

A

keep reviewing pt for 5 years

radiographic review annually as such high risk of recurrence due to satellite cysts

136
Q

do OKs usually cause symptoms?

A

no

137
Q

radiographic presentation of an OK

A

oval
well-defined, uniform radiolucency
uni or multilocular

138
Q

OK contents

A

thick grey/white cheesy material with keratinous debris

139
Q

basal cell naevus syndrome management

A

MDT - dentists, OMFS, neurologists, dermatologists
adequate tx of cysts
removal of tumours and regular screening
suggestion of annual OPGs
dermatological examination 3-6m, avoidance of UV light
neurological review if child

140
Q

orthokeratinised odontogenic cyst

A

uncommon developmental cyst, used to be considered a variant of OKC
similar presentation to OKC but histologically distinct with prominent orthokeratinisation and flattened basal cell layer
unilocular without epithelial proliferations or satellite cysts
no recorded case of occurrence with naevoid basal cell carcinoma syndrome
rarely recur following simple enucleation
now a distinct entity to OKC in WHO 2017 classification

141
Q

lateral periodontal cyst incidence

A

rare - 0.4% of odontogenic cysts

142
Q

how are lateral periodontal cysts related to teeth?

A

associated with lateral surface of tooth root

  • canine and premolar region in mandible, followed by anterior maxilla
  • vital tooth, usually asymptomatic and incidental findings
143
Q

what age group usually have lateral periodontal cysts?

A

middle aged

144
Q

what do pts with lateral periodontal cysts usually present with?

A

may present with expansion

well-demarcated radiolucent area

145
Q

histopathology of a lateral periodontal cyst

A

thin lining SSE

similar to gingival cysts

146
Q

how are lateral periodontal cysts often treated?

A

simple enucleation

147
Q

Botryoid odontogenic cyst

A

multilocular variant of LPC
often larger
more likely to recur than LPC

148
Q

what are gingival cysts derived from?

A

remnants of the dental lamina (rests of Serres) in gingival or alveolar soft tissues

149
Q

gingival cysts in adults

A

mandibular attached gingiva as <1cm pink/bluish sessile swellings

150
Q

histology of gingival cysts in adults

A

thin lining of SSE

151
Q

gingival cysts in infants

A

Bohn’s nodules
common - up to 90% of neonates
small yellow/cream nodules on edentulous alveolar mucosa
similar cysts present on palate - Epstein’s pearls, but aren’t odontogenic
naturally degenerate, no tx required

152
Q

incidence of glandular odontogenic cyst

A

rare - 0.2% of odontogenic cysts

153
Q

glandular odontogenic cyst presentation

A

mainly anterior mandible
slow growing, painless
unilocular/multilocular radiolucency
may reach large size with erosions of cortical plate

154
Q

glandular odontogenic cyst histology

A

uninflamed fibrous wall lined by glandular cuboidal epithelium

155
Q

problems with glandular odontogenic cyst

A

potentially aggressive, locally invasive nature

high recurrence rate

156
Q

calcifying odontogenic cyst family

A

member of ghost cell family of odontogenic lesions (‘ghost’ epithelial cells in histopathology)
- originally considered variant of calcifying cystic odontogenic tumour but now regarded as developmental cyst

157
Q

clinical presentation of calcifying odontogenic cyst

A

wide age range but usually <40years old
75% are intraosseous and either jaw may be involved
majority arise anterior to FPM
usually small about 1-3cm in diameter
shape is variable but usually monocular
adjacent teeth usually displaced +/or resorbed. bony expansion

158
Q

radiographic presentation of calcifying Odontogenic cyst

A

initially radiolucent, unilocular or multilocular

in more advanced stage contains a variable amount of calcified radiopaque material

159
Q

recurrence of calcifying odontogenic cyst

A

rarely recur, mainly benign course

160
Q

what is the most common non-odontogenic cyst?

A

nasopalatine duct (incisive canal) cyst 5-10%

161
Q

origin of nasopalatine duct cyst

A

epithelial remnants of nasopalatine duct

162
Q

clinical presentation nasopalatine duct cyst

A

M>F, 5th-6th decades
salty discharge/taste
slowly enlarging swelling anterior palate midline
heart shaped
may be asymptomatic and found during routine Rx investigation

163
Q

radiographic presentation of nasopalatine duct cyst

A

well-defined round, ovoid or heart shaped radiolucency

sclerotic margin

164
Q

histopathology of nasopalatine duct cyst

A

lined by stratified squamous and respiratory/cuboidal epithelium
NV bundles found in capsule - from incisive nerves

165
Q

non-epithelial jaw cysts

A

occur most often in long bones
occasionally found in jaws (almost exclusively in mandible)
e.g. solitary bone cyst, aneurysmal bone cyst, Stafne’s idiopathic bone cavity

166
Q

solitary bone cyst

A

simple/haemorrhagic/traumatic bone cyst

aetiology unknown

167
Q

solitary bone cyst clinical presentation

A

children and adults, no sex predilection
premolar/molar region of mandible
asymptomatic, chance radiographic finding
bony expansion in around 25% cases

168
Q

solitary bone cyst radiographic presentation

A

radiolucency of variable size, irregular outline, moderately well-defined
scalloping prominent feature

169
Q

surgical exploration of solitary bone cyst

A

rough bony-walled cavity devoid of any detectable lining
rapid healing follows
although will resolve spontaneously without

170
Q

Stafne’s idiopathic bone cavity

A

developmental anomaly of mandible

asymptomatic, chance finding

171
Q

Stafne’s idiopathic bone cavity - radiographic presentation

A

round or oval, well-demarcated radiolucency
between premolar region and angle of jaw
usually located below IDC (occasionally bilateral)

172
Q

Stafne’s idiopathic bone cavity - surgical exploration

A

saucer-shaped depression of concavity lingual aspect of mandible
varying depth
majority of cases, contains ectopic salivary tissue in continuity with SMG

173
Q

non-cystic radiolucent lesions for differential diagnoses

A

odontogenic tumours
giant cell lesions
fibrocementoosseous lesions
radiolucent non-odontogenic tumours

174
Q

management of cysts

A 
referral
initial consultation
special investigation? - plain film radiograph/CBCT/CT?
biopsy - LA or GA?
diagnosis
tx plan and discussion
tx options
 - enucleation - ideal
 - marsupialisation/decompression
 - surgical resection
175
Q

what does cyst enucleation depend on?

A

size of cyst and type

176
Q

what type of cysts is enucleation useful for?

A

radicular/residual cysts, dentigerous cysts, keratocysts

177
Q

what is enucleation not suitable for?

A

ameloblastoma

178
Q

complications of enucleation

A

mainly related to size, position and type of cyst

  • damage to IAN
  • communication with MS (OAC)
  • pathological fracture of mandible
  • risk of recurrence
179
Q

marsupialisation

A

‘fenestration’ +/- tube/grommit insertion

180
Q

what can sometimes occur after a biopsy?

A

marsupialisation

181
Q

what is marsupialisation useful for?

A

useful for large simple cysts, keratocyst, dentigerous cysts

- if v concerned about jaw fracture

182
Q

complications of marsupialisation

A 
needs further surgery for cyst removal
long tx before completion
chance of reinfection
uncomfortable
need to clean cyst themselves out regularly
183
Q

segmental resection

A

removal of cyst with margin of ‘normal’ bone

184
Q

what is segmental resection mainly used for?

A

ameloblastoma

sarcoma

185
Q

what secondary procedure does segmental resection normally require?

A

reconstruction of defect

186
Q

Carnoy’s solution

A

acetic acid, chloroform, ethanol

kills epithelial cells and satellite cells

187
Q

usually why wouldn’t you need a biopsy?

A

if associated tooth needs extraction

cysts, tumours, bone pathology (4 decks)

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