Cysts of the jaws and oral tissues

Question 1

Define a cyst

Answer 1

Pathological epithelial lined cavity in a tissue

Question 2

Types of hard tissue cysts (3)

Answer 2

Odontogenic
Non odontogenic
Non epithelialised (not cysts)

Question 3

Types of soft tissue cysts (2)

Answer 3

Developmental
Non developmental

Question 4

Define odontogenic cyst

Answer 4

Cyst arising from tooth forming tissue

Question 5

Which types of tooth forming tissue can odontogenic cysts arise from?

Answer 5

Enamel organ
Follicle
Epithelial cell rests

Question 6

Types of odontogenic cysts (4)

Answer 6

Radicular / periapical - 70%
Dentigerous - 15%
Keratocyst - 10%
Other - 5%

Question 7

Which odontogenic cysts are inflammatory?

Answer 7

• Radicular / periapical

Question 8

Which odontogenic cysts are non-inflammatory?

Answer 8

• Dentigerous
• Keratocyst

Question 9

How do odontogenic cysts present?

Answer 9

Asymptomatic
Incidental radiographic finding
Tooth migration
Swelling IO
Can be infected / pain

Question 10

How do odontogenic cysts appear radiographically?

Answer 10

Well defined
Corticated
Unilocular or multilocular (single or multiple centres)
Radiolucency

Question 11

Why are cysts a problem?

Answer 11

Grow
Move / damage teeth
Move / damage structures
Infection
Weaken bone - fractures
Makes tx more complex

Question 12

How do periapical / radicular cysts form?

Answer 12

Deeply carious tooth
Leads to PA infection
Bacterial endotoxins: IL-1, 3, 4 and 6, TNF alpha
Pulpally infected non vital tooth
Leads to radicular cyst forming at apex

Question 13

How do periapical cysts appear radiographically?

Answer 13

Centred on apex
Unilocular
Well defined, corticated
Non vital tooth - RCT / caries / trauma

Question 14

How does a residual cyst develop?

Answer 14

Periapical cyst formed
Tooth removed
Residual cyst remains

Question 15

What is the cause of periapical cysts?

Answer 15

Inflammation / chronic infection

Question 16

Where does dentigerous cyst arise from?

Answer 16

Dental follicle
Fluid collects between the follicle and enamel

Question 17

Where can you find dentigerous cysts?

Answer 17

Crown of an unerupted tooth
Amelocemental junction

Question 18

What are effects of dentigerous cyst?

Answer 18

Move teeth
Cause resorption of other teeth

Question 19

Where does odontogenic keratocyst arise from?

Answer 19

Dental lamina

Question 20

How will an odontogenic keratocyst appear radiographically?

Answer 20

Multilocular
Well defined
At angle of mandible
Minimal expansion
Associated with unerupted teeth

Question 21

Which syndrome can be associated with odontogenic keratocysts?

Answer 21

Gorlin-Goltz

Question 22

What are the major criteria for Gorlin-Goltz syndrome AKA Nevoid Basal Cell Carcinoma Syndrome?

Answer 22

• Multiple Basal Cell Carcinomas <20 years
• Odontogenic keratocysts of jaw
• Rib anomalies
• 1st degree relative with Nevoid Basal Cell Carcinoma Syndrome

Question 23

What are eruption cysts?

Answer 23

Overlay erupting tooth in children

Question 24

How to manage eruption cysts?

Answer 24

Rupture spontaneously
May require incision
Self resolve once tooth begins to erupt

Question 25

Where do lateral periodontal cysts come from?

Answer 25

Origin uncertain Dental lamina OR follicle Between amelocemental junction and apex

Question 26

Lateral periodontal cysts in vital or non vital teeth?

Answer 26

Vital

Question 27

How do glandular odontogenic cysts present?

Answer 27

Like other cysts Rare Recurrence likely

Question 28

How do calcifying odontogenic cysts present?

Answer 28

Like other cysts Rare Contain areas of calcification

Question 29

Where do non-odontogenic hard tissue cysts arise from?

Answer 29

Developmental Not from tooth forming tissues Fusion of structures Palatal plates and premaxilla

Question 30

Types of non-epithelialised cysts (2)

Answer 30

Not cysts by definition - Solitary bone cyst - Aneurysmal bone cyst

Question 31

Describe solitary bone cyst

Answer 31

Non odontogenic Not epithelial lined No expansion / movement AKA traumatic bone cyst

Question 32

Describe aneurysmal bone cyst

Answer 32

Not epithelial lined Expansile Faint trabeculation radiographically

Question 33

2 types of soft tissue cysts?

Answer 33

Developmental Non developmental

Question 34

Examples of developmental soft tissue cysts

Answer 34

Dermoid cyst Branchial cleft - cyst may present as neck lump Thyroglossal duct cyst - Adam's apple region

Question 35

What do non developmental cysts affect?

Answer 35

SG tissue

Question 36

How are SGs affected by non developmental cysts?

Answer 36

Mucus retention - saliva blocked in gland / duct Mucus extravasation - escape of saliva from traumatised gland / duct

Question 37

Example of non developmental cyst

Answer 37

Ranula

Question 38

Identifying features of Ranula?

Answer 38

FoM Mucus extravasation Sublingual gland (Frog ballooned up appearance under tongue)

Question 39

How does plunging ranula differ?

Answer 39

In FoM Extends through mylohyoid muscle Neck swelling Needs IO and EO approach

Question 40

Where are lip mucoceles found?

Answer 40

ONLY lower lip Children / young pt

Question 41

Describe lip mucocele

Answer 41

Painless soft fluid filled selling May appear blueish Lower lip only

Question 42

Management of lip mucocele

Answer 42

Cryotherapy Excision

Question 43

Risks of excising lip mucocele?

Answer 43

Recurrence Scarring Swelling Bleeding Bruising