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Oral Surgery > Cysts of the jaws > Flashcards

Cysts of the jaws Flashcards

1
Q

What is the pathogenesis of jaw cysts?

A
  • source of epithelium
  • stimulus for proliferation
  • growth via osmotic factors and hydrostatic forces with unicentric expansion, eg. radicular cyst
  • intrinsic properties of epithelial linings with multicentric expansion
  • bone resorption via osteoclasts
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2
Q

What is the definition of a cyst?

A

Pathological fluid filled cavity lined by epithelium

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3
Q

Give some examples of odontogenic systs?

A
  • radicular/residual (inflammatory)
  • odontogenic keratocyst
  • dentigerous cyst
  • lateral periodontal cyst
  • orthokeratinised keratocyst
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4
Q

What are some examples of non-odontogenic cysts?

A
  • nasopalatine duct cyst
  • nasolabial cyst
  • branchial cyst
  • dermoid cyst
  • thryoglossal duct cyst
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5
Q

What are the symptoms of a cyst?

A
  • swelling
  • paraesthesia
  • mobile teeth
  • pain if infected
  • bony expansion
  • crepitus
  • fluctuant swelling
  • non-vital teeth
    -displaced teeth
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6
Q

What radiographs can you take for cysts?

A
  • plain films
  • CBC gives an idea of the margin of the cavity
  • CBCT gives an idea of contents of the cavity
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7
Q

What should the diagnosis of cysts be on?

A

Diagnosis must be on histological grounds.

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8
Q

Where do odontogenic cysts arise from and where do they affect?

A

they arise from tooth bearing epithelium
- rests of serres, REE, rests of malassez
- therefore only affect tooth bearing areas

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9
Q

What is a radicular cyst? Type?

A

An odontogenic cyst of inflammatory origin associated with a non-vital tooth.
- most common cysts of the jaws (55% of odontogenic cysts)
- peaks in 40-50 yrs

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10
Q

What is the pathogenesis of a radicular cyst?

A

Stimulation of the cell rests of malassez from apical inflammation secondary to pulpal necrosis

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11
Q

What is the histology of radicular cyst?

A
  • lumen- layer of non-keratinised simple squamous epithelium
  • surrounded by inflamed fibrous or granulation tissue
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12
Q

What is a residual cyst?

A

Remains after extraction of offending tooth
- predilection site- mandibular premolar area

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13
Q

What is a dentigerous cyst?

A

An odontogenic cyst that is attached to the cervical region of an unerupted tooth that envelopes the crown.

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14
Q

What is the pathogenesis of a dentigerous cyst?

A

Fluid accumulation between the reduced enamel epithelium and the crown of a tooth.

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15
Q

Which teeth are dentigerous cysts most commonly associated with?

A

Lower third molar

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16
Q

What is the presentation of a dentigerous cyst?

A
  • symptomless, incidental finding
  • painful if infected
  • always attached to CEJ
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17
Q

What is the histology of a dentigerous cyst?

A
  • lining- thin layer- 2 to 4 cells of regular epithelium
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18
Q

What is the lining of an odontogenic keratocyst?

A
  • thin regular lining of parakeratinised stratified squamous epithelium
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19
Q

What cells are in the odontogenic keratocyst?

A
  • palisading hyperchromatic basal cells
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20
Q

What does an odontogenic keratocyst come from?

A
  • remnants of dental lamina
  • cell rests of serres
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21
Q

Where are most odontogenic keratocysts found?

A
  • 50% found in posterior body and ramus
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22
Q

What is the presentation of an odontogenic keratocyst?

A
  • symptom free
  • cause no expansion so often large at presentation
  • can cause root displacement, but possibly resorption
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23
Q

What is the radiographic appearance of odontogenic keratocyst?

A
  • multilocular, but unilocular is more common
  • well defined
  • usually corticated
24
Q

What is the histology of an odontogenic keratocyst?

A
  • thin regular parakeratinised epithelium which is thin, friabe and difficult to remove intact
  • 5-8 cell layers thick
  • without rete ridges
  • parakeratin is usually corrugated- so keratin flakes can break off and fill cyst
  • basal cell layer well defined, palisaded with hyperchromatic nuclei
  • daughter cysts cause recurrence
25
Q

What are the symptoms of Gorlin Goltz syndrome?

A
  • multiple odontogenic keratocysts (mostly posterior maxilla)
  • epidermoid carcinomas
  • calcification of falx cerebri
  • medduloblastoma
  • frontal bossing
  • bifid ribs
  • nevoid basal cell carcinomas
26
Q

What is a lateral periodontal cyst lined by?

A

Non-keratinised epithelium

27
Q

Where does a lateral periodontal cyst occur?

A
  • on the lateral aspect of tooth or between the roots of erupted teeth
  • more in the mandible
28
Q

What is the presentation of the lateral periodontal cyst?

A
  • usually incidental finding
  • tooth is vital
29
Q

What is the radiographic finding of a lateral periodontal cyst?

A
  • well defined
  • corticated
  • unilocular
  • if multilocular- botryoid cyst
30
Q

What does the nasopalatine duct cyst arise from?

A
  • epithelial remnants in the incisive canal
31
Q

What is the nasopalatine duct cyst lined with?

A
  • respiratory type epithelium
32
Q

What is the presentation of the nasopalatine duct cyst?

A

sessile swelling palatal to the maxillary incisors
- normal incisive canal is 6mm

33
Q

What is the radiographic finding of nasopalatine duct cyst?

A
  • well defined corticated lying between maxillary incisors and potentially displacing
  • classically a heart shaped radiolucency
34
Q

What is a solitary bone cyst?

A

An intraosseous cavity which is not lined by epitheliium and is either empty or filled with serous or sanguineous fluid.
- not a true cyst

35
Q

Where is the solitary bone cyst mostly found?

A
  • tooth bearing area
  • usually body of mandible
36
Q

What is the presentation of a solitary bone cyst?

A
  • incidental finding
  • radiograph shows scalloped and often extending between roots of teeth
  • on opening up cavity it is usually empty, has no lining
  • investigation is curative
37
Q

What is the stafne defect due to?

A

Thought to be due to the submandibular gland pressing against lingual cortex.

38
Q

What does the radiograph of stafne defect show?

A

Well defined, unilocular radiolucency in posterior mandible
- always below ID canal

39
Q

What is an aneurysmal bone cyst?

A

Cystic or multi-cystic expansile osteolytic neoplasm composed of blood filled spaces separated by fibrous septa containing osteoclast like cells.

40
Q

Which people does aneurysmal bone cyst occur in most?

A
  • younger patients
  • 10-20 years
41
Q

What is the presentation of an aneurysmal bone cyst?

A
  • painful bony swelling
  • rapidly expanding
  • unilocular or multilocular radiolucencies
42
Q

How to decide what treatment to do for a jaw cyst?

A
  • definitive histopathological diagnosis- sample
  • biological behaviour of the lesion- nasty or nice
  • location and dimension of the lesion- iatrogenic/pathological fracture
  • proximity to important anatomical structures- neuropraxia
  • patient compliance- enucleation vs marsupalisation- what will they manage what will they cope with
  • other local factors like access
43
Q

What is enucleation?

A

Complete removal of the whole cyst lining

44
Q

What are indications for enucleation?

A
  • accessible cysts not involving soft tissues
  • small to moderately sized cysts not extensively involving vital teeth or important anatomical structures
45
Q

What is the advantages of enucleation?

A
  • complete removal of entire pathological tissue
  • rapid healing
  • decreased need for post operative care
46
Q

Disadvantages of enucleation?

A
  • large cysts are difficult to remove
  • risk of damage
  • risk of mandibular fracture
  • risk of OAC or involvement of the nasal floor
  • if the cyst extends to soft tissues, complete removal may not be possible and greater possibility of recurrence
47
Q

How do you carry out enucleation?

A

curette is used to enucleate with the concave side towards the bone
- at the greatest diameter of the cyst, the curette is reversed facing the cyst lining

48
Q

What is marsupialisation?

A

Cyst uncovered or de-roofed, maintained open so contents can drain out and the lining epithelium is exposed to the mouth.

49
Q

What are the indications for marsupilisation?

A
  • large cysts that are weakening the jaw
  • cysts involving vital teeth
  • cysts involving maxillary sinus or inferior alveolar canal
  • dentigerous or eruption cysts to allow teeth to erupt
  • in elderly patients
50
Q

Disadvantages of marsupialisation?

A
  • pathological tissue left
  • get slow healing
  • can get premature closure leading to further surgery
51
Q

What are the advantages of marsupialisation?

A
  • preservation of vital structures from surgical damage
  • minimises bone removal
  • bare bone not exposed to infection
  • less traumatic than enucleation
  • lining appears to become thicker and easier to enucleate histologically resembling oral mucosa
52
Q

What surgery can you use adjunctively?

A
  • peripheral ostectomy- remove peripheral bone
  • en-bloc resection- including surrounding bone
53
Q

What is cryotherapy?

A

Following enucleation, the bony cavity is frozen with cryoprobe (liquid nitrogen -70 degrees) for 1 minute, twice. If soft tissue involved, they are frozen for 30 seconds, twice.

54
Q

How is Carnoy’s solution used?

A

As a fixative in conjunction with enucleation within the cystic cavity or bony cavity
- neurotoxic and carcinogenic

55
Q
A

Oral Surgery (3 decks)

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