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Oral Disease for FINALS > Cysts of the jaws > Flashcards

Cysts of the jaws Flashcards

1
Q

What is a cyst? (2)

A

A pathological cavity with fluid, semi-fluid or gaseous contents and which is not created by the accumulation of pus
It is usually, but not always, lined by epithelium

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2
Q

Parts of a cyst (3)

A

Wall (fibrous connective tissue)
Lumen (space where content of cyst sits)
Lining (usually epithelium)

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3
Q

Odontogenic cysts of inflammatory origin (3)

A

Radicuar cyst
Residual cyst
Collateral/ Paradental cysts

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4
Q

Odontogenic and non-odontogenic developmental cysts (7)

A 
• Follicular cyst
-dentigerous cyst
-eruption cyst
• Odontogenic keratocyst
• Lateral periodontal cyst
• Gingival cyst
• Glandular odontogenic cyst
• Calcifying odontogenic cyst
• Orthokeratinised odontogenic cyst
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5
Q

Sheffield Oral and Maxfax pathology - cysts % of all cases

A

13%

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6
Q

Most common jaw lesions (1)

A

Odontogenic cysts - 55%

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7
Q

Classification of cysts of the jaws (4)

A

Epithelial cysts
-odontogenic: inflammatory or developmental
-non-odontogenic: nasopalatine duct cyst or nasolabial cyst
Cyst-like lesions

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8
Q

Cysts that are seen quickly in babies (1)

A

Alveolar cyst

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9
Q

Gingival cyst (1)

A

Found in adults

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10
Q

Most common jaw cysts (2)

A 
Radicular - 65%
Follicular - 20%
Keratocyst - 5%
Nasopalatine - 5%
Others - <5%
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11
Q

Pathogenesis of jaw cysts: need (3)

A

Source of epithelium
Stimulus for proliferation
Growth and bone resorption

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12
Q

Sources of epithelium (3)

A

Remnants of Hertwigs root sheath –> radicular cysts
Reduced enamel epithelium –> follicular cysts
Remnants of dental lamina –> keratocysts or gingival cysts

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13
Q

Where does the enamel organ develop from? (1)

A

The dental lamina

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14
Q

The PDL contains epithelial remnants of Hertwig’s root heath is called (1)

A

Rest cells of Malassez

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15
Q

Stimuli for proliferation - inflammation (3)

A

Apical granuloma –> radicular cysts
periodontitis –> inferior lateral periodontal cyst
Pericoronitis –> paradental cysts

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16
Q

Stimuli for proliferation - developmental (3)

A 
Factors largely unknown
Dentigerous cyst
-eruptive force and proliferation?
-hydrostatic pressure?
Keratocyst
-epithelial proliferation
-hydrostatic pressure?
-tumour?
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17
Q

Cyst growth and expansion

A
  1. Osmosis and hydrostatic pressure
    - inflammation, cell shedding and cell death results in increased osmotic pressure
    - water drawn in by osmosis, increasing hydrostatic pressure, resulting in unicentric expansion
    - e.g. radicular and dentigerous cysts
  2. Proliferation of the lining e.g. odontogenic keratocyst
  3. Bone resorption
    - IL-1 and IL-6
    - prostaglandins
    - endotoxins
    - stimulation and activation of osteoclasts
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18
Q

Radicular cyst (3)

A

Arise in the periodontal ligament from the
epithelial rests of Malassez as a result of inflammation following death of the pulp.
Always associated with a non-vital tooth.

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19
Q

Apical radicular cysts (1)

A

at the apex of a tooth associated with

the opening of the root canal

20
Q

Lateral radicular cysts (1)

A

at the side of a tooth associated with

a lateral branch of the root canal

21
Q

Residual radicular cyst (1)

A

a radicular cyst which has persisted after extraction of the associated tooth

22
Q

Pathogenesis: radicular cyst (3)

A 
Periapical granuloma (due to caries and non-vital pulp)
Proliferating odontogenic epithelium
Cyst (with non-k SSE lining)
23
Q

Features of radicular cyst pathology (5)

A 
Keratin in 2%
Cilia in 10%
Hyaline bodies in 10%
Mucous cells in 15% 
Cholesterol in 30%
24
Q

Is this a cyst or a granuloma? Cysts ‘tend’ to be (6)

A 
Larger
More radiolucent
Well defined
Corticated outline
Painless
BUT only 50% are correctly diagnosed pre-operatively
25
Q

Size vs pathology (3)

A

90% of lesions >20mm are cysts
65% of lesions 15-19mm are cysts
65% of lesions 5-9mm are granulomas

26
Q

Collateral cyst: paradental cyst (2)

A

A cyst which arises on the lateral aspect of a
tooth as a result of inflammation in a
periodontal pocket. It arises from pocket epithelium.
A particular type of paradental cyst arises at
the buccal aspect of partially erupted molars

27
Q

Histology: collateral/ paradental cyst (1)

A

Similar to radicular cyst

28
Q

What is a follicular cyst? (3)

A

A cyst which surrounds the crown of an
unerupted tooth and arises from the reduced
enamel (follicular) epithelium.
• dentigerous - associated with an impacted
tooth
• eruption - associated with an erupting tooth

29
Q

Pathogenesis of a follicular cyst (3)

A

Impacted tooth
Follicular epithelium proliferates
Cyst forms

30
Q

Where does an eruption cyst lie? (1)

A

Just beneath the oral mucosa

31
Q

Odontogenic keratocyst (3)

A

• A cyst arising in the tooth bearing area and
characterised by a thin lining of parakeratinised epithelium.
• It arises from the dental lamina or its
remnants
• It may replace a tooth

32
Q

Pathogenesis of keratocyst (3)

A

Remnants of dental lamina
Epithelial proliferation
-genetic? trauma?
Cyst develops

33
Q

Lining of odontogenic keratocyst (2)

A

Parakeratinsed SSE

-often little on no bucco-lingual expansion

34
Q

Stats about odontogenic keratocyst (4)

A
  • 62% in males
  • 75% in the mandible
  • 50% in lower third molar area
  • 50% associated with unerupted tooth
35
Q

Recurrence of keratocysts (3)

A

• % recurrence varies
between studies
• Fragility of the lining
• Daughter cysts

36
Q

Odontogenic keratocyst - basal cell naevus syndrome (6)

A

• AKA ‘Gorlin-Goltz syndrome’
• multiple and recurrent odontogenic keratocysts
• basal cell carcinomas of skin
• frontal bossing
• skeletal abnormalities (e.g. bifid ribs)
• cranial abnormalities (e.g. calcification of falx
cerebri)

37
Q

Evidence that an odontogenic keratocyst may be a benign neoplasm (4)

A

High rate of proliferation in the epithelial lining
High rate of recurrence
‘Aggressive’ and infiltrative growth
Association with basal cell carcinoma in BCNS/ Gorlin-Goltz syndrome
• Molecular changes similar to basal cell carcinoma
• PTCH (chromosome 9q) mutation in BCC and Gorlin’s
syndrome

38
Q

Lateral periodontal cyst (3)

A

Occurs on the lateral aspect or between the roots of vital teeth.
It is developmental in origin – rests of Serres.
Occasionally it is multilocular and called botryoid odontogenic cyst

39
Q

Gingival cysts of infants (2)

A

• arises from dental lamina rests in the alveolar
mucosa of infants
• lined by thin parakeratinised epithelium

40
Q

Gingival cysts of adults (2)

A

• arises from dental lamina rests in the attached
gingiva
• lined by thin non-keratinised epithelium

41
Q

Glandular odontogenic cyst (2)

A

A cyst characterised by cuboidal or columnar epithelium with mucous production
Forms duct-like or glandular structures

42
Q

Histology: glandular odontogenic cyst (2)

A

Epithalial thickenings

Mucous cells and ducts

43
Q

Nasopalatine duct cyst (2)

A

Arise in the nasopalatine (incisive) canal from
epithelial residues of the nasopalatine duct
They are lined by respiratory epithelium or stratified squamous epithelium, or often
both

44
Q

Nasolabial cyst (2)

A

Arises in the soft tissue overlying the alveolar
process at the base of the nostril, deep to the
nasolabial fold.
It probably arises from remnants of the nasolacrimal duct and is usually lined by
pseudostratified columnar epithelium

45
Q

Cyst-like lesions (3)

A

Cystic lesions in the jaws, without an epithelial lining:

  • Solitary (simple) bone cyst
  • Stafne’s bone cavity

Oral Disease for FINALS (34 decks)

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