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SCR > Cysts Of The Jaws COPY > Flashcards

Cysts Of The Jaws COPY Flashcards

1
Q

What is a cyst?

A

A pathological cavity having fluid, semi-fluid or gaseous contents, and which is not created by accumulation of pus

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2
Q

What are cystic lesions like?

A

Diverse!

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3
Q

Describe the typical radiographic presentation of a cyst

A

Shape
- spherical or egg

Margins
- often well defined
- often corticated

Locularity
- often unilocular
- can be multi or pseudolocular

Multiplicity
- single, bilateral, multiple
- multiple often indicates a syndrome

Effect on surrounding anatomy
- displacement of cortical plates, adjacent teeth, maxillary sinus, IAN canal
- root resorption can occur in chronic cysts

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4
Q

Why may a cyst lose its defined corticated margins?

A

Secondary infection

  • typically accompanied by clinical symptoms
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5
Q

How are cysts classified?

A

Structure - epithelium lined vs not

Origin - odontogenic or non-odontogenic

Pathogenesis - developmental vs inflammatory

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6
Q

Give all odontogenic developmental cysts

A

Dentigerous cyst
- eruption cyst

Odontogenic keratocyst

Lateral periodontal cyst

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7
Q

Give all odontogenic inflammatory cysts

A

Radicular cyst
- and residual cyst

Inflammatory collateral cysts
- paradental cyst
- buccal bifurcation cyst

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8
Q

Give non-odontogenic, developmental cyst

A

Nasopalatine duct cyst

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9
Q

Give non-odontogenic, other, non-epithelial lined cysts

A

Solitary bone cyst

Aneurysmal bone cyst

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10
Q

What is an odontogenic cyst

A

Cyst that occurs in tooth-bearing areas
- all lined with epithelium

  • most common cause of bony swelling in jaws
  • > 90% of all cysts in oral and maxillofacial region
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11
Q

What are the most common odontogenic cysts and their incidences?

A

Radicular cyst and residual cyst - 60% of odontogenic cysts

Dentigerous cyst and eruption cyst - 18%

Odontogenic keratocyst - 12% of cysts in maxfax region

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12
Q

What is a radicular cyst? Its incidence?

A

Inflammatory odontogenic cyst
- always associated with non-vital tooth
- initiated by chronic inflammation at apex of tooth due to pulpal necrosis

60% maxilla
40% mandible
40s and 50s age

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13
Q

Sources of epithelium in cysts?

A

Hertwigs root sheath

Rests of serres
- remnants of dental lamina

Reduced enamel epithelium
- remnants of enamel organ

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14
Q

Radicular cyst vs periapical granuloma?

A

Radiolucency >15mm
- 2/3 of cases with be cyst

Periapical granuloma develops into radicular cyst

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15
Q

Presentation of radicular cyst?

A

Often asymptomatic
- may become infected and become symptomatic

Slow-growing with limited expansion

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16
Q

Radiographic presentation of radicular cyst?

A

Well-defined, corticated margin, round/oval
- continuous with Lamina dura of non-vital tooth

Long standing lesions may:
- displace surrounding anatomy
- cause external root resorption =

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17
Q

Histology of a radicular cyst

A

Epithelial lining that is often incomplete
- connective tissue capsule
- inflammation inside the capsule

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18
Q

How does periapical granuloma form a radicular cyst?

A

Epithelial rests of malassez (hertwigs root sheath remnants) proliferates in the granuloma

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19
Q

What is a residual cyst?

A

Variant of radicular cyst
- radicular cyst persists after removal of tooth, or after successful RCT

20
Q

What is a lateral radicular cyst?

A

Radicular cyst associated with accessory canal
- located at side of tooth and not apex

21
Q

What is an inflammatory collateral cyst?

A

Inflammatory odontogenic cyst
- associated with vital tooth
- pouch lined with non-keratinised epithelium

Collective term used for

Paradental cyst - distal aspect of partially erupted mandibular third molar

Buccal bifurcation cyst - buccal aspect of mandibular first molar

22
Q

What is a Dentigerous cyst?

A

Developmental odontogenic cyst
- associated with crown of unerupted and usually impacted tooth
- cystic change of dental follicle

23
Q

Radiographic presentation of Dentigerous cyst?

A

Corticated margins attached to CEJ of tooth
- larger ones may begin to envelope root of tooth

  • may displace involved tooth
  • initially symmetrical
  • variable displacement of cortical bone
24
Q

Histology of Dentigerous cyst?

A

Thin, non-keratinised stratified squamous epithelium
- may resemble radicular cyst if inflamed

25
Q

When may an enlarged follicle be a Dentigerous cyst?

A

Follicle space 5mm or more
- crown surface to edge of follicle

Should normally be 2-3mm

Assume cyst if >10mm

26
Q

What is an eruption cyst?

A

Variant of Dentigerous cyst
- contained within soft tissue rather than bone
- associated with an erupting tooth
- more commonly incisors and almost exclusive to children

27
Q

What is an odontogenic keratocyst? Its incidence?

A

Developmental odontogenic cyst with no specific relationship to teeth

20s-30s
Mandible 3:1 maxilla
Posterior > anterior

28
Q

Radiographic appearance of odontogenic keratocyst ?

A

Scalloped margins

25% multilocuar

Often cause displacement of adjacent teeth

Often significant mesial-distal expansion with little bucolic-lingual expansion

29
Q

Pre-operative diagnostic tests for odontogenic keratocyst

A

Cyst aspirate

30
Q

Histology of OKC?

A

Parakeratosis

Loss of keratin if inflamed

Thin friable lining

Daughter cysts

31
Q

What is basal cell naevus syndrome

A

Multiple odontogenic keratocyst
Multiple basal cell carcinomas
Calcification of intracranial dura mater

Cysts histologically identical to non-syndromes form except these occur younger at around 15

32
Q

What is a nasopalatine duct cyst? Incidence?

A

Developmental, non-odontogenic cyst
- arising from epithelial remnants in nasopalatine duct

40s-60s
M>F

33
Q

What is a nasopalatine duct cyst?

A

Developmental, non-odontogenic cyst arising from epithelium of nasopalatine duct

40s-60s
M>F

34
Q

Clinical presentation of nasopaltine cyst?

A

Often asymptomatic

Pt may report salty discharge

Larger cysts may displace teeth or cause palatal swelling

Always involve mid line but not always symmetrical

35
Q

Radiographic presentation of nasopalatine cyst?

A

Corticated radiolucency between / over roots of central incisors

Often unilocular

36
Q

How monitor incisive fossa vs nasopalatine cyst?

A

<6mm assume incisive fossa

6-10mm consider monitoring

> 10mm assume cyst

37
Q

What is a solitary bone cyst? Incidence?

A

Non-odontogenic cyst without an epithelial lining

20s
M>F
Mandible&raquo_space; maxilla

38
Q

Clinical presentations of solitary bone cyst?

A

Usually asymptomatic
- rarely pain or swelling

39
Q

Radiographic presentation of solitary bone cyst?

A

Premolar / molar region of mandible

Variable definition and cortication

Scalloped / psuedolocular appearance

May project up between roots of adjacent teeth

40
Q

What is a stafne cavity?

A

Not a cyst, but a depression in bone that is filled with salivary or fatty tissue

  • always in mandible
  • posterior body or angle
  • often inferior to IAN
  • well defined and corticated
41
Q

Why take incisional biopsy of cyst?

A

Obtain sample for histological analysis
- be combined with marsuipialisation sometimes

42
Q

Options for tx of cyst?

A

Enucleation
- all of cystic lesion removed

Marsupialisation
- creation of surgical window in wall of cyst so contents can be removed
- encourages cyst to decrease in size

43
Q

Advantages enucleation?

A
  • Whole lining can be pathologically examined
  • primary closure
  • little aftercare
  • less % recurrence
44
Q

Contraindications / disadvantages enucleaiton

A

Risk of mandibular fracture

Would rather Preserve tooth if dentigerous

Old age / ill health

Recurrence higher %

Damage to adjacent structures

45
Q

Indications for marsupialisation?

A

If enucleation would damage surrounding tissues such as IAN

When access is difficult

Dentigerous cyst may erupt after

Elderly / immunocompromised

Very large cysts which may cause mandibular fracture

46
Q

Contraindications / disadvantages to marsupialisation?

A

Cyst reformation

Complete lining not available for histology

Difficult to clean with lots of aftercare

Long time to fill in

47
Q

How may a marsupialised cyst be kept open?

A

Obturator made from thermoplastic retainer

SCR (25 decks)

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