Cysts of the Oral Region Flashcards
pathologic cavity lined by epithelium
cysts
general features of cysts
- remain small
- rarely loosen teeth
- unless infected, don’t cause pain
- unless infected, do not devitalize nearby teeth
- usually require much information for differentiation (i.e. radiographic/microscopic/clinical features, pt hist., tooth vitality test)
general histologic features of cysts
- epithelium lines central cavity
- connective tissue is the supporting layer
general categories for classification
- odontogenic cysts (OC)
- developmental (fissural) cysts
- pseudocysts
odontogenic cyst that arise from REST OF MALASSE (remnants of Hertzwig’s root sheath)
periapical cysts/radicular cysts
odontogenic cysts that arise from REDUCED ENAMEL EPITHELIUM (covering of crown after enamel formation)
- dentigerous cysts
- eruption cysts
odontogenic cysts that arise from DENTAL LAMINA (rests of serres, originate from oral epithelium and remain after tooth formation)
- odontogenic keratocysts (OKC)/keratocystic odontogenic tumor
- lateral periodontal cysts
- botryoid odontogenic cysts
- gingival cyst of adults
- dental lamina cysts of newborns/Epstein’s pearls
- glandular odontogenic cysts/Sialo-Odontogenic Cyst (intraosseous)
unclassified odontogenic cyst
paradental cyst
MOST COMMON odontogenic cyst
periapical cysts/radicular cysts
2nd MOST COMMON odontogenic cyst
dentigerous cyst
MOST COMMON odontogenic cysts in POSTERIOR MANDIBLE
- odontogenic keratocysts (OKC)/keratocystic odontogenic tumor (can be found anywhere, if in MX usually in canine area, most are intraosseous)
odontogenic cysts that arise from what tissue have a more AGGRESSIVE behavior?
odontogenic cysts that arise from the DENTAL LAMINA
relatively uncommon odontogenic cyst, occur most commonly in ANTERIOR MANDIBLE (premolars)
lateral periodontal cysts
odontogenic cyst of inflammatory origin
periapical/radicular cysts
key features of periapical (radicular) cysts
- MOST COMMON odontogenic cyst
- arise from RESTS OF MALASSEZ
- will test NONVITAL (key for diagnosis)
- well circumscribed apical radiolucency
- may be ASYMPTOMATIC
- histology: proteinaceous debris and necrotic material, may see hyaline (Rushton) bodies
- TX: RCT or extraction
- very little potential for malignant transformation
- incomplete extraction may result in residual cyst
key features of dentigerous (follicular) cysts
- 2nd MOST COMMON odontogenic cyst
- derived from REE
- surrounds the CROWN of UNERUPTED tooth
- in bone (intraosseous) MN 3rd molars > MX canines > MX 3d molars
- histology: cyst wall may have RUSHTON BODIES
- malignant transformation is rare (indication of malignancy = pain, bone destruction, drainage, paresthesia)
- TX: ENUCLEATION and extraction of associated tooth
what odontogenic cyst do some argue is merely an uncommon dentigerous cyst?
paradental cysts
what is enucleation?
removal/shelling-out of a cyst without rupture
what is paresthesia?
altered sensation, non-painful
what is dysesthesia?
altered sensation that the patient finds uncomfortable
what cyst is the soft tissue counterpart of a dentigerous cyst?
eruption cyst
key features of eruption cysts
- arise from REE
- may form an ERUPTION HEMOTOMA
- bone is not affected (extraosseous)
- no malignant potential
- unroof the cyst and allow the tooth to fully erupt, may spontaneously resolve
key features of odontogenic keratocysts (OKCs)
- arise from the dental lamina (rests of serres)
- AGGRESSIVE behavior and distinctive HISTOLOGY
- can occur at any age
- can occur anywhere in the jaw, but most occur in POSTERIOR MN (intraosseous)
- usually unilocular, can be multilocular
- malignant transformation (SCC) is rare but can occur
- can become very large, erode bone and move teeth
what is another name for odontogenic keratocysts (OKCs)?
- keratocystic odontogenic tumor
what is the distinctive histology of OKCs?
Commonly the cysts separate the epithelium from the CT, you usually don’t see anything in the space - lack of inflammatory response in capsule. Capsule wall often contains daughter cysts and cul-de-sacs.
4 main characteristics:
1) THIN, uniform, PARAKERATINIZED squamous epithelium 6-10 LAYERS THICK (required for dx)
2) prominent layer of cuboidal/columnar basal cells (basal cell layer very dark) - lined up like a picket fence (palisade/polarized)
3) rippled/corrugated layer of parakeratin (PRODUCE KERATIN) on luminal surface - parakeratinized, keratin can be seen in the lumen (not required for dx)
4) LACK OF RETE RIDGES, flat epithelial-CT interface
what is marsupialization?
removal of the contents of a cyst with the cyst lining remaining in place
what is eburnation?
smoothing of the bone to an ivory like surface
how do you treat OKCs?
- usual treatment is enucleation w/ eburnation
- marsupialization
- when extensive resection may be necessary
60% recurrence rate
OKCs
is recurrence of OKCs common or uncommon?
COMMON (25-60%), you cannot leave anything behind during removal, recurrence generally occur within 5 years
multiple OKCs are consistent with what syndrome?
nevoid basal cell carcinoma syndrome
what is another name for nevoid basal cell carcinoma syndrome?
Gorlin-Goltz syndrome
if a patient has multiple OKCs why should you refer them to their physician?
to rule out the AUTOSOMAL DOMINANT syndrome, nevoid basal cell carcinoma syndrome
in addition to multiple OKCs, what are the other predominant features of nevoid basal cell carcinoma syndrome?
- bifid ribs
- basal cell carcinoma of the skin
- calcification of the falx cerebri
- palmar pits
- epidermoid cysts
- frontal bossing
what is more aggressive, and orthokeratinized or parakatinized OKC lining?
parakeratinized
are lateral periodontal cysts common or uncommon?
relatively uncommon (only ~1% of OCs)
lateral periodontal cysts are very similar to what other cyst?
gingival cyst of the adult
key features of lateral periodontal cysts
- slow growing, well-circumscribed, nonexpansile (<1cm)
- arise from dental lamina (rest of Serres)
- have a thin lining 1-3 cuboidal cells with distinctive focal thickenings (plaques)
- usually occur in ANTERIOR MN (can occur in the MX), between VITAL teeth
- average age of occurence is 50 y/o
what are the key histological features of lateral periodontal cysts?
- nonkeratinized, stratified squamous epithelium
- thin lining of cuboidal cells, with focal areas of nodular invaginations into cyst lumen
where are lateral periodotnal cysts most commonly found?
- between MN two premolars > anterior MX between the canine and lateral incisor
- can occur between any anterior teeth
how do you treat lateral periodontal cysts and botryoid cysts?
enucleation
recurrence of lateral periodontal cysts is common or rare?
rare
what is the rare, MULTILOCULAR variant of lateral periodontal cyst called?
botryoid odontogenic cyst
which are more aggressive, lateral periodontal cysts or botryoid odontogenic cysts?
botryoid odontogenic cysts
which have a better chance of recurring, lateral periodontal cysts or botryoid cysts?
botryoid cysts (15-20%)
what are some key features of botryoid odontogenic cysts?
- arise from dental lamina (rests of Serres)
- MULTILOCULAR variant of lateral periodontal cysts
- look like a cluster of grapes
- expand bone
- smilar histology to lateral periodontal cysts
- TX w/ enucleation
- similar to to glandular odontogenic cyst but DOSE NOT SECRETE MUCOUS
what odontogenic cyst is thought to be a variant of botryoid cysts?
glandular odontogenic cysts (sialo-odontogenic cyst)
what is the difference between botryoid cysts and glandular odontogenic cysts?
glandular odontogenic cysts SECRETE MUCOUS and have GREATER GROWTH POTENTIAL
what cysts can cross the midline?
glandular odontogenic cysts (this is rare for cysts)
key features of glandular odontogenic cysts
- arise from dental lamina (rests of Serres)
- MUCOUS secreting variant of botryoid cysts
- may be unilocular or multilocular
- primarily occur in the MN
- smilar histology to lateral periodontal cysts
- TX: enucleation and curettage
- may transition to mucoepidermoid carcinoma (a salivary gland tumor)
what does curettage mean?
removal of tissue with a curette from the wall or cavity from another surface
where do glandular odontogenic cysts primarily occur?
the MN
what is the rare, soft tissue variant of lateral periodontal cysts?
gingival cysts of the adult
key features of gingival cysts of the adult
- arise from dental lamina (rests of Serres)
- soft tissue (extraosseous) counterpart of lateral periodontal cysts
- primarily occur in the MN of adults (can occur in MX)
- histologically similar to lateral periodontal cysts, also found in premolar, cuspid, and incisor region
- clinical presentation: small (<1cm), firm but compressible, fulid-filled swelling
- TX: enucleation
what cysts occur in newborns?
dental lamina cysts of newborns
what is another name for dental lamina cysts of newborns?
Epstein Pearls
key features of dental lamina cysts of newborns
- small, sometime multiple, raised cystic nodules found on ALVEOLAR RIDGE
- arise from dental lamina (rests of Serres)
- consist of keratin filled cystic cavity
- very uncommon, scare parents
- often spontaneously develop and disappear
- benign and generally disappear without treatment
key features of paradental cyst
- unclassified odontogenic cyst
- para means that it is found on the side of the crown
- often arise on the distal or buccal aspect of VITAL 3RD MOLARS
- some maintain they are just UNUSUAL DENTIGEROUS CYSTS
- usually contains inflammatory cells in the cyst capsule
what are developmental (fissural) cysts?
cysts that arise from epithelial remnants of ducts and other embryonic epithelial remnants
what are the 5 main categories of developmental cysts?
- cysts of vestigial ducts
- lymphoepithelial cysts
- cysts of vestigial tracts
- cysts of embryonic skin
- cysts of mucosal epithelium
what cysts arise from vestigial ducts?
- cysts of the incisive papilla
- nasopalatine duct cyst (incisive canal cyst)
- nasolabial cyst (nasoalveolar cyst)
key feature of cysts of the incisive papilla
- developmental cysts that arises from vestigial ducts
- occur entirely within the palatal soft tissue (extraosseous)
- not evident radiographically
- TX: enucleation
key features of nasopalatine duct cysts
- developmental cyst that arises from vestigial ducts (remnants of nasoplatine duct)
- occur between VITAL MX central incisors at MIDLINE of palate, ANTERIOR MX (intraosseous)
- HEART SHAPED RADIOLUCENCY
- recurrence is rare
- malignant transformation not reported
what cyst presents with a heart shaped radiolucency?
nasopalatine duct cysts
what cyst presents between the MX central incisors
nasopalatine duct cysts
how do you treat nasopalatine duct cysts?
enucleation
what are histological features of nasopalatine duct cysts?
- lined with squamous or RESPIRATORY epithelium
- CT shows chronic inflammation
key features of nasolabial cysts
- DEVELOPMENTAL cyst of the vestigial ducts (likely from remnants of nasolacrimal duct)
- VERY COMMON IN FEMALES (3x, 40-60 y/o) and blacks
- SOFT TISSUE cyst (extraosseous), does NOT involve bone
- appears in UPPER LIP/side of nose (anterior mucobuccal fold below the ala of the nose)
- most often UNILATERAL (rarely bilateral)
- histology: cystic cavity lined with columnar epithelium with GOBLET CELLS
- TX: excision
- recurrence is rare
what is another name for a nasolabial cyst?
nasoalveolar cyst
what is unique about lymphoepithelial cysts?
they are developmental cysts that have all the usual components of a cyst, PLUS a wall filled with LYMPHOID FOLLICLES
what are the two lymphoepithelial cysts we must know?
- oral lymphoepithelial cysts
- cervical lymphoepithelial cyst
histologically do oral and cervical lymphoepithelial cysts look the same of different?
same
where are oral lymphoepithelial cysts found?
in the FLOOR OF THE MOUTH and POSTERIOR LATERAL BORDERS of TONGUE (can occur other places)
are lymphoepithelial cysts common or uncommon?
uncommon
where are cervical lymphoepithelial cysts found?
in the lateral aspect of the NECK (anterior to the SCM)
how do you treat both types of lymphoepithelial cysts?
excision
what do oral lymphoepithelial cysts look like clinically?
- asymptomatic, painless
- YELLOW or TAN
- superficial, submucosal (extraosseous) mass, <1cm
do cervical lymphepithelial cysts cross the midline?
NO, NEVER!!
what is another name for the cervical lymphoepithelial cyst?
brachial cleft cyst
do cervical lymphoepithelial cysts have malignant potential?
YES, it has been reported (remember these are rare lesions)
where do lymphoepithelial cysts arise from?
lymphoid tissue trapped in the 2nd brachial cleft/pouch
what unique age group do cervical lymphoepithelial cysts affect?
LATE CHILDHOOD or EARLY ADULTHOOD
are cervical lymphoepithelial cysts painful?
no, usually asymptomatic, PAINLESS masses/swelling
what developmental cysts arise from vestigial TRACTS?
thyroglossal duct cysts (remnants of thyroglossal duct)
where do thyroglossal duct cysts occur?
above the THYROID GLAND and below the BASE of the TONGUE
what is histologically significant about thyroglossal duct cysts?
thin cyst lining with THYROID tissue (thyroid follicles) in the wall
what do we know about the recurrence and malignant potential of thyroglossal duct cysts
- recurrence is a distinct possibility
- although rare, these have the ability to malignantly transform to thyroid carcinoma
what developmental cysts arise from embryonic skin?
- dermoid cysts
- embryonic cysts
what developmental, cyst of embryonic skin, is known to affect YOUNG patients (i.e. TEENS)?
dermoid cysts
where do dermoid cysts occur?
- in the MIDLINE of the UPPER NECK or ANTERIOR FLOOR of MOUTH (below the MYLOHYOID muscles)
what is histologically unique about dermoid cysts?
the cyst walls contain one or more skin appendages such as hair, sweat, or sebaceous glands
how do you treat dermoid cysts
excision
how do you treat epidermoid cysts
excision
how do you treat developmental, cysts of embryonic skin
excision
where do epidermoid cysts occur?
primarily on the SKIN
what is unique about histology of epidermoid cysts?
epidermoid cysts have a lumen lined by KERATINIZING stratified squamous epithelium, usually filled with KERATIN
what developmental cysts arise from mucosal epithelium?
surgical ciliated cysts of the maxilla
what cysts are known to be iatrogenic?
surgical ciliated cysts of the maxilla
what procedure is generally results in surgical ciliated cysts of the maxilla?
Caldwell-Luc operation (surgical procedure to clear a BLOCKED MX SINUS by entering through the oral cavity)
how do surgical ciliated cysts of the maxilla form?
epithelium from the MX sinus is surgically implanted in MX bone
how do you treat surgical ciliated cysts of the MX?
excision
