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BDS4 Radiology > Cysts of the Jaws 2 > Flashcards

Cysts of the Jaws 2 Flashcards

1
Q

What is a nasal palatine duct cyst? (aka incisive canal cyst)

A

A developmental non-odontogenic cyst that arises from nasopalatine duct epithelial remnants
- Occurs in anterior maxilla

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2
Q

What are the epidemiological characteristics of NPD cysts?

A

Occurs in 40-60s

M>F

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3
Q

How do NPD cysts present?

A
  • Often asymptomatic
  • Patient may note “salty” discharge (similar to infection)
  • Larger cysts may displace teeth or cause swelling in palate
  • Always involve midline but not always symmetrical (Grow off to one side)
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4
Q

How does the epithelial lining of NPD cyst vary?

A

Some areas are NK stratified squamous and some modified respiratory

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5
Q

Which radiographs are used to diagnose an NPD cyst?

A

PA

Standard maxillary occlusal

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6
Q

What are the radiographic features of an NPD cyst?

A
  • Corticated radiolucency between/over roots of central incisors
  • Often unilocular
  • May appear “heart shaped” due to superimposition of anterior nasal spine
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7
Q

What are the radiographic features of the incisive fossa?

A
  • May or may not be visible on radiographs
  • Midline, oval-shaped radiolucency
  • Typically not visibly corticated
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8
Q

How is incisive fossa distinguished from NPD cyst? (in absence of clinical issues)

A

If transverse diameter:

<6mm: assume incisive fossa

6-10mm: consider monitoring and take another x-ray in 6 months time

> 10mm: suspect cyst

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9
Q

What is a solitary bone cyst?

A

A Non-odontogenic cyst without an epithelial lining

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10
Q

What are the other names for solitary bone cyst?

A

simple/traumatic/haemorrhagic bone cyst

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11
Q

What are the epidemiological features of solitary bone cysts?

A
  • Most common in 2nd decade
  • Male > female
  • Mandible > maxilla
  • Can occur in association with other bone pathology e.g. fibro-osseous lesions
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12
Q

How are keratocysts distinguished from solitary bone cysts? Why is this important?

A

Bone cysts seen on younger patients with larger finger like projections in between

Important- keratocysts need to be managed

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13
Q

How do solitary bone cysts tend to present clinically?

A

Usually asymptomatic
-> incidental finding

Rarely- pain or swelling

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14
Q

What are the radiological features of a solitary bone cyst?

A

Majority in premolar/molar region of mandible
-> Can also occur in non-tooth-bearing areas

Variable definition & cortication

May have scalloped margins giving a pseudolocular appearance

May project up between the roots of adjacent teeth

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15
Q

What is a stafne cavity?

A

Not a cyst but commonly mistaken as one- Actually a depression in the bone (concavity)
-> Cortical bone preserved
-> Only occur in mandible, almost exclusively lingual
-> Contains salivary or fatty tissue
-> asymptomatic

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16
Q

When do stafne cavities tend to present?

A

50-60s

17
Q

What are the radiographic features of a stafne cavity?

A

Location- angle or posterior body of mandible
-> often inferior to IDC

Well defined

Often corticated

Rarely displaces adjacent structures

18
Q

What are the means of obtaining material from a cyst for histology?

A
  1. Aspiration biopsy – drainage of contents
    - Can do in GDP
    - Can tell you if it’s a cavity or mass
  2. Incisional biopsy – partial removal
    - Can help differential diagnosis of ameloblastoma
  3. Excisional biopsy – complete removal
19
Q

What is used for an aspiration biopsy?

A

Wide bore needle with 5-10ml syringe

20
Q

What material may we get from an aspiration biopsy?

A

Air

Blood

Pus- infection

Cyst fluid
-> Clear straw coloured fluid in inflammatory or developmental cysts
-> White or cream semi-solid may indicate keratocyst

21
Q

What can cause resistance in an aspiration biopsy?

A

Soft tissue blocking

22
Q

What is the purpose of an incisional biopsy?

A

To obtain a sample of the lining for histological analysis

23
Q

How is an incisional biopsy carried out?

A

Give LA

Select place where lesion appears superficial

Raise mucoperiosteal flap

Remove bone as required – using mongeurs or a round bur

Incise & remove a section of lining

24
Q

What may an incisional biopsy be combined with?

A

Marsupialisation

25
Q

What is the limitation of radiology in diagnosis of cysts?

A

Must follow up with histology for final diagnosis

26
Q

What are the surgical treatment options for cysts?

A

Enucleation- treatment of choice most commonly

Marsupialisation

27
Q

What is enucleation?

A

All of the cystic lesion is removed (entire cyst lining removed with the associated tooth/root if present)

28
Q

What are the advantages of enucleation?

A

Whole lining can be examined pathologically

Primary closure

Little aftercare needed

29
Q

What are the disadvantages of enucleation

A
  • Risk of mandibular fracture with very large cysts
  • (Dentigerous cyst) wish to preserve tooth
  • Old age/ill health- can’t be put under GA
  • Clot-filled cavity may become infected
  • Incomplete removal of lining may lead to recurrence
  • Damage to adjacent structures
  • Daughter cysts in the keratocyst lining – to remove all of these would cause damage to adjacent structures/anatomy (have to use marsupialisation)
30
Q

What is marsupilisation?

A

Creation of a surgical window in the wall of the cyst, removing the contents of the cyst & suturing the cyst wall to the surrounding epithelium
-> Encourages the cyst to decrease in size & may be followed by enucleation at a later date

Done under LA

31
Q

How is window kept open?

A

Obturator- prevents tissues growing back over it

32
Q

What are the indications for marsupialisation?

A
  • If enucleation would damage surrounding structures (e.g. ID canal)
  • Difficult access to the area
  • May allow eruption of teeth affected by a dentigerous cyst
  • Elderly or medically compromised patients unable to withstand extensive surgery
  • Very large cysts which would risk jaw fracture if enucleation was performed
  • Can combine with enucleation as a later procedure
33
Q

What are the advantages of marsupialistion?

A

Simple to perform

Spares vital structures

34
Q

What are the disadvantages of marsupialisation?

A
  • Opening may close & cyst may reform
  • Complete lining not available for histology
  • Difficult to keep clean & lots of aftercare needed
  • Long time to fill in

BDS4 Radiology (8 decks)

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