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OSOMOP > Cysts of the Mouth and Jaws > Flashcards

Cysts of the Mouth and Jaws Flashcards

1
Q

What are cysts?

A

Pathological cavity, not formed by the accumulation of pus, which may be lined by epithelium and which usually contains fluid or semi-fluid contents

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2
Q

When is the only time cysts will contain pus?

A

If they become infected

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3
Q

Describe the aetiology and pathogenesis of cysts

A
  • Proliferation of epithelial lining
  • Accumulation of fluid within cyst
  • Keratin formation
  • Resorption of surrounding bone and attempts at repair
  • Slow expansive growth
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4
Q

Name 2 types of non epithelial cysts

A
  1. Solitary bone cyst

2. Aneurysmal bone cyst

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5
Q

Name 2 types of epithelial cysts

A

Developmental (odontogenic and non odontogenic)

Inflammatory

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6
Q

Name 3 inflammatory cysts

A
  1. Dental / radicular cyst (apical or lateral)
  2. Residual cyst
  3. Paradental cyst
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7
Q

Describe the epidemiology of dental cysts

A
  • Most common jaw cyst (70%)
  • More common in males
  • Wide age range (peak 20-25 year old)
  • More common in maxilla than mandible (60:40)
  • More common anterior than posterior (60:40)
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8
Q

Describe the clinical features of dental cysts

A
  • Pain, swelling and mobility of the tooth
  • Associated with non vital tooth
  • Gradual progressive swelling (increase may indicate infection)
  • Egg shell cracking may occur
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9
Q

Describe egg shell cracking as a feature of dental cysts

A
  • Rate of expansion exceeds rate of subperiosteal deposition of bone causing progressive thinning of cortical bone
  • Cracking is cyst wall breaking on palpation
  • Bluish, fluctuant submucosal swelling seen if cortical plate perforated
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10
Q

Describe the radiographic features of dental cysts

A
  • May be large but usually 10-20mm diameter
  • Unilocular radiolucency (round or ovoid)
  • Well defined margins
  • May expand bone
  • 90% related to apex, 10% to lateral aspect
  • Rarely cause resorption
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11
Q

Describe the pathogenesis of dental cysts

A
  • Contents of necrotic pulp seep out of apical foramina
  • Acute inflammatory response evoked
  • Persistent stimulus initiates attempts at healing
  • Central cavity develops and enlarges by fluid accumulation
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12
Q

Describe the contents of dental cysts

A
  1. Cholesterol crystals are common
  2. High levels of soluble proteins
  3. Fluid (including pus if infected)
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13
Q

Describe the pathology of a dental cyst

A
  • Irregular lining of stratified squamous epithelium
  • Abundant granulation tissue
  • Variable inflammatory cell infiltrate
  • Thick wall of dense fibrous tissue
  • Cholesterol crystals may be present
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14
Q

What is the difference between an apical granuloma and a dental cyst?

A

An apical granuloma is a mass of fibrous tissue related to apex of non-vital tooth i.e a dental cyst before central cavitation occurs

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15
Q

Describe the radiological findings, pathogenesis and pathology of apical granuloma

A

Radiology - Similar to dental cyst but smaller (<10mm)
Pathogenesis - Same as dental cyst but less inflammation, epithelial proliferation and no central cavity formation
Pathology - Poorly defined mass of fibrous tissue

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16
Q

What is a residual dental cyst?

A

A dental cyst which fails to resolve after an extraction

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17
Q

Describe a paradental cyst

A
  • Inflammatory odontogenic cyst which develops in relation to crown or root of a partially erupted tooth (usually third molar)
  • No particular clinical significance
  • Well defined radiolucency related to neck of the tooth and coronal third of the root
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18
Q

Name 2 common odontogenic cysts

A
  1. Dentigerous cyst

2. Odontogenic keratocyst

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19
Q

What is a dentigerous cyst?

A
  • A developmental, epithelial lined cyst which surrounds the crown of an unerupted tooth and is attached to the amelocemental junction
  • If associated with a partially erupted tooth, termed an eruption cyst
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20
Q

Describe the epidemiology of dentigerous cysts

A
  • Make up around 15% of all jaw cysts
  • Affect male and female equally
  • Wide age range (peak 15-25 years)
  • Most commonly found on 3, 4, 5 and 8s
  • Other cysts may be present in dentigerous relationship
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21
Q

Describe the clinical features of a dentigerous cyst

A
  • Gradual progressive swelling and facial asymmetry
  • No pain unless infected
  • Infection causes pain and rapid increase in size
  • Unerupted (missing) tooth
  • Blueish swelling if an eruption cyst
22
Q

Describe the radiological features of a dentigerous cyst

A
  • May be large
  • Unilocular radiolucency with well defined margins
  • May expand bone, displace teeth and occasionally resorb teeth
  • Always associated with the crown of an unerupted tooth
23
Q

Describe the pathogenesis of a dentigerous cyst

A
  • Develops within the normal dental follicle of an unerupted tooth
  • Fluid accumulates between enamel and reduced enamel epithelium of the follicle
  • Lesion expands by luminal fluid accumulation
24
Q

Describe the pathology of a dentigerous cyst

A
  • Thin lining of non-keratinising stratified squamous epithelium
  • Thin fibrous wall
  • Very little to no inflammation
25
Q

What is a keratocyst?

A

Developmental odontogenic cyst with a characteristic epithelial lining and a high tendency to recur, usually located at the angle of the mandible but can arise anywhere

26
Q

Describe the epidemiology of keratocysts

A
  • Account for 10% of all jaw cysts
  • Affects 2M:1F
  • Wide age range (peak 20-40 years)
  • Largely found at angle of mandible
  • Small number associated with Gorlin Syndrome
27
Q

Describe the clinical features of a keratocyst

A
  • Gradual progressive swelling and facial asymmetry
  • Unerupted tooth
  • Large number detected as incidental findings
  • May become infected which can lead to pain
28
Q

Describe the radiological features of keratocysts

A
  • May be small or large
  • Well defined radiolucency
  • Often multi locular
  • May expand bone or displace teeth
  • May be associated with unerupted tooth in dentigerous relationship
29
Q

Describe the pathogenesis of keratocysts

A
  • Arises from odontogenic epithelium, either dental lamina or surface epithelium
  • Lesion expands by epithelial proliferation (hydrostatic ofrces)
  • Expand in anteroposterior direction and can reach large sizes without causing bony expansion
30
Q

Describe the pathology of a keratocyst

A
  • Thin layer of highly organised, keratinising, stratified squamous epithelium 5-10 cells thick with a prominent palisaded basal cell layer
  • Often in folds
  • Changes of secondary inflammation can be seen
  • Very little fluid and low levels of soluble protein
31
Q

Describe the follow up for a patient who has suffered from a keratocyst

A
  • Long term follow up mandatory
  • Clinical and radiographical follow up
  • Typically recur between year 2 and year 3
  • Follow up is annual for first 5 years and 3 yearly therafter
32
Q

Describe Gorlin Syndrome

A
  • Autosomal dominant trait
  • Consists of multiple basal cell carcinomas of skin, vertebral and rib anomalies, temperoparietal bossing with broad nasal root and keratocysts
  • Usually present younger than 15 with unusual facial appearance and multiple keratocysts
33
Q

Describe a nasopalatine cyst

A
  • Developmental cyst of the incisive canal in the palate
  • Believed to arise from remnants of nasopalatine ducts
  • Can occur within nasopalatine canal or soft tissues of palate at opening of canal
34
Q

Describe the epidemiology of nasopalatine cysts

A
  • Most common developmental non-odontogenic cyst
  • More common in males
  • Wide age range (peak 40-50 years)
35
Q

Describe clinical features of nasopalatine cysts

A
  • Anterior hard palate or incisive papilla
  • Swelling with or without discharge
  • Discharge tends to occur with infection
  • Blanch on pressure (vascular lesion)
  • Occasionally painful
36
Q

Describe the radiological features of a nasopalatine cyst

A
  • Well defined radiolucency
  • Unilocular or heart shaped
  • Greater than 6mm diameter
  • May displace root or expand bone
37
Q

Describe the pathology of a nasopalatine cyst

A
  • Thin lining of stratified squamous and respiratory type epithelium in varying proportion
  • Fibrous tissue wall
  • Neurovascular bundle present in wall
  • Little inflammation unless infected
38
Q

Describe a dermoid cyst

A
  • Rare developmental non-odontogenic cyst presenting as “doughy” painless swelling in midline floor of the mouth or lateral canthus of the eye
  • Believed to arise from entrapment of embryonic epithelial rests
39
Q

Describe the epidemiology of dermoid cysts

A
  • 2F:1M
  • Wide age range (peak 20-30 years)
  • Slow progressive enlargement
  • Much less common type of cyst
40
Q

Describe the pathology of a dermoid cyst

A
  • Thin lining of stratified squamous epithelium with associated hair follicles and sebaceous glands
  • Thin fibrous wall
41
Q

Describe a nasolabial cyst

A
  • Developmental cyst of the soft tissues of the face found within the nasolabial fold
  • Believed to arise from remnants of nasolacrimal duct
42
Q

Describe the epidemiology of nasolabial cysts

A
  • Very rare (<0.5& of all jaw cysts)
  • 10% are bilateral
  • 4F:1M
  • Wide age range (peak in third decade)
43
Q

Describe the pathology of a nasolabial cyst

A
  • Thin lining of respiratory type epithelium with goblet cells
  • May contain cartilage and mucous glands in the wall
44
Q

Name 5 types of special investigations which can be used for cyst diagnosis

A
  1. Vitality testing
  2. Radiological examination
  3. USS
  4. FNA (Fine Needle Aspiration)
  5. Histopathology
45
Q

Name 3 methods of managing cysts

A
  1. Enucleation
  2. Marsupialisation
  3. Resection
46
Q

Name 4 things the decision on how to manage a cyst rests upon

A
  1. Size, location and nature
  2. Proximity to vital structures
  3. PMH and fitness for surgery
  4. Patient co-operation
47
Q

What is enucleation?

A

Complete removal of the cyst lining which enables histopathological examination and cavity usually heals with minimal aftercare

48
Q

Name 2 types of enucleation

A
  1. Primary closure

2. Secondary intention

49
Q

What is secondary intention enucleation?

A
  • Used in cases where cyst cavity is large
  • Cyst is packed with BIPP pack to allow cavity to heal slowly and stay clean
  • May take several months to heal
50
Q

What is marsupialisation?

A
  • Partial removal of cyst lining
  • Not all cyst lining available for histopathological analysis which may lead to misdiagnosis
  • Less invasive
  • Requires considerable aftercare and cooperation in keeping cavity clean
51
Q

Describe the process of marsupialisation

A
  • Removing a window of lesion and suturing cyst lining to surrounding mucoperiosteum
  • Cavity is filled with ribbon gauze
  • Opening of cyst eliminates osmotic pressure so the cyst will shrink
  • Can be used as single treatment or preliminary treatment for enucleation once lesion decreases in size

OSOMOP (14 decks)

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