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BDS 4 - CDS - Radiology > Cysts of the Jaws > Flashcards

Cysts of the Jaws Flashcards

1
Q

what is a cyst?

A

pathological cavity having FLUID, SEMI-FLUID, or GASEOUS CONTENTS

NOT CREATED BY ACCUMULATION OF PUS
pus occurs when cyst gets infected

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2
Q

clinical presentation of cyst?

A
  • Discolouration
  • Swelling
  • result in increased mobility of teeth
  • absence of a tooth (maybe unerupted which causing cyst)
  • May not have clear signs
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3
Q

rate of progression of a cyst

A

slow growing generally (but depends on type of cyst)

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4
Q

what initial radiographic investigations can you carry out for diagnosis of a cyst?

A
  • periapical (if suspected small area)
  • occlusal (if need larger area)
  • OPT
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5
Q

what SUPPLEMENTAL radiographic investigations can you carry out for diagnosis of a cyst?

A
  • Cone beam CT (CBCT)
  • Facial radiographs (PA Mandible, Occipitomental view)
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6
Q

Radiographic features of a cyst?

A
  • SHAPE (spherical/egg-shaped)
  • NUMBER (single, bilateral, multiple)
  • Margins (often well defined, corticated)
  • LOCULARITY (often unilocular)
  • EFFECT ON SURROUNDING ANATOMY (Displacement of teeth, sinuses, inferior alveolar canal)
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7
Q

signs and symptoms of secondary infection from cysts?

A
  • cysts may lose definition & cortication of margins if secondary infected
  • typically associated with clinical signs/symptoms
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8
Q

what are the 3 main classifications of cysts?

A

Structure: Epithelium-lined vs No epithelial lining

Origin: Odontogenic vs non-odontogenic

Pathogenesis: Developmental vs inflammatory

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9
Q

what is an odontogenic cyst?

A
  • occur in tooth-bearing areas
  • most common cause of bony swelling in jaws
  • LINED WITH EPITHELIUM
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10
Q

Odontogenic sources of epithelial cells?

A

RESTS OF MALASSEZ: - Remnants of Hertwig’s epithelial root sheath

RESTS OF SERRES: - remnants of the dental lamina

REDUCED ENAMEL EPITHELIUM: - remnants of enamel organ

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11
Q

names of most common odontogenic cysts?

A
  • radicular cyst
  • dentigerous cyst
  • odontogenic keratocyst
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12
Q

what is a radicular cyst?

A
  • inflammatory odontogenic cyst (non-vital tooth association)
  • usually asymptomatic, if infected results in pain
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13
Q

Radiographic features of a radicular cyst?

A
  • well defined, round radiolucency
  • corticated margin continuous with lamina dura of non-vital tooth
  • large lesions may displace adjacent structures
  • long standing lesions may cause external root resorption
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14
Q

Histology features of radicular cyst?

A
  • epithelial lining (often incomplete)
  • connective tissue capsule
  • inflammation in capsule
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15
Q

how do radicular cysts form from a granuloma?

A
  • epithelial rests of malassez PROLIFERATES in periapical granuloma
  • the epithelium surrounds the fluid area
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16
Q

what are the variants of radicular cysts?

A
  • Residual cyst (persistent cyst after XLA or successful RCT)
  • Lateral radicular cyst (associated with an accessory canal)
17
Q

what is a dentigerous cyst?

A
  • developmental odontogenic cyst (associated with crown of unerupted/impacted teeth)
  • cystic change of dental follicle
18
Q

histology features of dentigerous cyst?

A
  • thin non-keratinised stratified squamous epithelium
19
Q

what is an eruption cyst?

A
  • variant of dentigerous cyst (contained within soft tissue instead of bone)
  • associated with erupting tooth
20
Q

what is an odontogenic keratocyst (OKC)?

A

benign but aggressive cysts within the bone that arise from original tooth term and dental lamina

  • scalloped margins
  • often displace adjacent teeth
  • can have significant mesio-distal expansion without bucco-lingual expansion
21
Q

before an odontogenic keratocyst (OKC) is removed, what type of diagnostic test can be done and what would the findings be to suggest it is an OKC?

A
  • Cyst aspirate

Contains squamous epithelial cells, low protein content

22
Q

What is basal cell naevus syndrome?

A

a rare genetic disorder characterized by multiple basal cell carcinomas, skeletal abnormalities, and other developmental defects.

presents as:
- multiple odontogenic keratocysts
- multiple basal cell carcinomas

23
Q

what are some examples of non-odontogenic cysts?

A
  • nasopalatine duct cyst
  • solitary bone cyst
  • aneurysmal bone cyst
24
Q

what is a nasopalatine duct cyst and its presentation?

A
  • developmental non-odontogenic cyst (nasopalatine duct epithelial remnants, in anterior maxilla)

aka incisive canal cyst

Presentation:
- asymptomatic
- salty discharge
- larger cyst may displace teeth/swelling in palate

25
Q

nasopalatine duct cyst histology features?

A
  • variable epithelial lining
    (non-keratinised stratified squamous & modified respiratory)
26
Q

nasopalatine duct cyst radiology features?

A
27
Q

cyst vs incisive fossa?

A
28
Q

what is a solitary bone cyst & clinical & radiology presentation?

A
  • non-odontogenic cyst without an epithelial lining

Clinical:
- usually asymptomatic -> incidental finding
- rarely pain or swelling

Radiology:
- found in premolar/molar region mandible

29
Q

what are the 3 main ways to obtain material for histology?

A
  • aspiration biopsy - drainage of contents
  • incisional biopsy - partial removal
  • excisional biopsy - complete removal
30
Q

what are the 2 general surgical options for cysts?

A
  1. Enucleation
  2. Marsupialisation
31
Q

What is enucleation?

A
  • all of the cystic lesion is removed
32
Q

what is marsupulisation?

A
  • creation of a surgical window in wall of cyst, remove contents & suturing cyst wall to surrounding epithelium
  • encourages cyst to decrease in size & may be followed with enucleation later on
33
Q

+ve & -ve of enucleation?

A

+VE:
- whole lining can be examined
- primary closure
- little aftercare

-VE:
- risk mandibular fracture
- cavity left may be infected
- damage to adjacent structures
- Incomplete removal may lead to recurrence

34
Q

Indications of marsupialisation?

A
  • if enucleation would damage surrounding tissues
  • difficult access
  • very large cyst with jaw fracture risk
35
Q

+VE & -VE of marsupialisation?

A

+VE:
- Simple to perform
- may spare vital structures

-VE:
- opening may close & cyst may reform
- Complete lining not available for histology
- long time to fill in space

BDS 4 - CDS - Radiology (8 decks)

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