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Radio II: Exam 2 > E2: Cysts of the Jaws > Flashcards

E2: Cysts of the Jaws Flashcards

1
Q

What are the four essential features that make a “cyst”?

A

1. Pathological cavity (not natural)

#2. Filled with fluid
#3. Lined by epithelium
#4. Connective tissue wall

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2
Q

Which of the 4 characteristics of a cyst qualifier would be seen on a radiograph?

A

pathological cavity

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3
Q

Where is a typical location of a cyst?

A
  1. Usually inside bone, may be in soft tissues
  2. Rarely in condyle or coronoid process
  3. Odontogenic cysts in tooth bearing areas
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4
Q

The borders of a cysts are described as

A
  • Well‐defined, smooth
  • Corticated (any white line)
  • Irregular or sclerotic if infected (crisp white line called sclerosis)
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5
Q

The shape of the cysts are described as

A
  1. Spherical (on cross‐sections)
  2. Circular (on 2‐D images)
  3. Oval, when contacts a hard surface, e.g., cortical bone or roots
  4. Scalloped border (seashell)
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6
Q

What are the effects of cysts?

A
  1. Slow growing
  2. Displaces roots, may resorb
  3. Displaces IAC (mandible) or sinus floor (maxillary)
  4. Sharp and smooth border
  5. Expands or perforates cortical plates
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7
Q

The radiographic appearance of cysts is described as

A
  1. Radiolucent: Loss of bone
  2. Distinct border: Slow growing, Fluid filled balloon or Soft tissue mass
  3. Fluid: hydraulic pressure (pushes in all directions)
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8
Q

At what size can you see the corticated borders of a cyst?

A

5mm or more

A small cyst that’s 2mm is not going to show a corticated border

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9
Q

What are the 3 different classification of cysts?

A

inflammatory, developmental and “other”

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10
Q

What are the two types of inflammatory cysts?

A

radicular and inflammatory collateral cysts

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11
Q

What are the different types of developmental cysts?

A
  • Dentigerous
  • Odontogenic keratocyst
  • Lateralperiodontal
  • Glandular odontogenic
  • Nasopalatine

DO-NGL

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12
Q

What are the different types of radicular cysts?

A

apical and lateral

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13
Q

The lateral radicular cyst usually results from what part of the tooth?

A

accessory canals

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14
Q

The apical radicular cyst usually results from what part of the tooth?

A

main pulp canal

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15
Q

What are the different types of inflammatory collateral cysts?

A

buccal bifurcation and paradental

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16
Q

What type of cyst?

A

radicular

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17
Q

What type of cyst?

A

residual

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18
Q

What type of cyst?

A

dentigerous

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19
Q

What type of cyst?

A

lateral periodontal (between two roots)

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20
Q

What type of cyst?

A

glandular (a group of cysts between two roots)

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21
Q

What type of cyst?

A

OKC (oral keratinized cyst, elongated)

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22
Q

What type of cyst?

A

nasopalatine (only between incisors, only from nasopalatine canal)

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23
Q

What type of cyst?

A

simple bone cyst (not a true cyst because it’s not fluid filled)

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24
Q

What type of cyst?

A

mucous retention cyst (not a true cyst because it’s mucus, not fluid)

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25
Q

What are the different names for a radicular cyst?

A
  • Radicular cyst
  • Periapical cyst
  • Apical periodontal cyst
  • Dental cyst
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26
Q

Generally, when would you see a radicular cyst?

A

carious lesion, fractured crown or trauma

from lecture

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27
Q

What is the disease mechanism for a radicular cyst?

A
  1. Inflammatory products of nonvital tooth (MUST be nonvital - this is CRITICAL)
  2. Epithelial cells of Malassez proliferate and undergo cystic transformation
  3. Hydraulic/osmotic pressure (to become larger and pushes upon nearby structures)
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28
Q

What are the clinical features of a radicular cyst?

A
  1. Any age, but more common in the third to sixth decade
  2. Nonvital tooth: caries, trauma, large restoration
  3. No symptoms unless infected (most radicular cysts are found by chance)
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29
Q

What are the imaging features of a radicular cyst?

Location, border, shape, size, internal content and effects

A
  1. Location: Epicenter related to apex, Lateral when related to an accessory canal, About 60% in maxilla (but can be on any tooth)
  2. Border: Well defined, corticated, Loss of cortication when infected, Thin cortex of small cysts (can’t see margin)
  3. Shape: outline is circular, larger lesions are oval
  4. Size: small lesions difficult (similar to granuloma or abscess), larger lesions, greater than 2cm in diameter are more likely to be a cyst
  5. Internal content: no radiopacity, long-standing cyst may have discrete calcifications
  6. Effects: displace and resorption of roots, displaces cortex, sinus floor and inferior alveolar canal
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30
Q

What is the differential diagnosis for radicular cysts?

A
  1. granuloma or abscess
  2. lateral periodontal cyst - VITAL tooth
  3. odontogenic keratocyst - VITAL tooth

radicular cysts are non-vital

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31
Q

What is the management for radicular cyst?

A
  1. Endodontic therapy (root canal)
  2. Apicoectomy
  3. Extraction
  4. Recurrence is uncommon (but if you don’t remove it, it becomes a residual cyst)
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32
Q

Describe the cyst seen in this radiograph

A

Large carious lesion indicates tooth is non-vital. It has a well corticated oval lesion that is pushing on the nearby structures (the roots of the first and second molar), and the inferior alveolar canal.

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33
Q

Describe the cyst seen in this radiograph

A

radicular cyst: Non-vital tooth (Endo treated tooth), oval small cyst, touching nasopalatine canal, radiolucent

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34
Q

Describe the cyst seen in this radiograph

A

radicular cyst: circular, has not pushed on any adjacent structures

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35
Q

Describe the cyst seen in this radiograph

A

radicular cyst: oval

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36
Q

What is the disease mechanism for a residual cyst?

A
  1. A remaining cyst after removal of the original cyst
  2. Usually a remaining radicular cyst
  3. History of extraction
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37
Q

What are the clinical features of a residual cyst?

A
  1. Mostly asymptomatic
  2. Incidental finding on a radiograph
  3. Occasional pain if infected
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38
Q

What are the imaging features of a residual cyst?

A
  1. Location: edentulous area, at the level of apices of neighboring teeth
  2. Border, size, shape, internal content and effects: same as radicular cyst - only difference is there is no tooth.
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39
Q

What is the differential diagnosis of a residual cyst?

A
  1. odontogenic keratocyst
  2. salivary gland depression (inferior to the canal) - (Stagne’s cyst –> defect, not a true cyst) and is only in the mandible
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40
Q

What is the treatment/management of residual cysts?

A
  1. surgical removal
  2. marsupialization if lesion is large (make a pocket in the bone, but you don’t remove the whole cyst)
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41
Q

Describe the cyst in this radiograph

A

residual cyst: circular cyst in an edentulous area with missing molars

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42
Q

This is a radiograph of the mandible. What “cyst” would occur here?

A

Stagne’s cyst (not a true cyst)

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43
Q

A biopsy is not recommended for what kind of cyst?

A

buccal bifurcation

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44
Q

What does a sclerotic border of a cyst signify?

A

infection

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45
Q

What are the requirements for buccal bifurcation cyst?

A

Must be on the buccal and in a bifurcation

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46
Q

What is the disease mechanism for a buccal bifurcation cyst?

A

unknown etiology, epithelial cells rests in PDL

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47
Q

What are the different names for buccal bifurcation cyst?

A
  • BBC
  • mandibular infected buccal cyst
  • paradental cyst

Paradental cyst is sometimes regarded as not an accurate name.

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48
Q

What are the clinical features of buccal bifurcation cysts?

A
  • children: 5-13 years
  • delayed eruption of the 1st or 2nd mandibular molar
  • lingual cusps higher than buccal
  • vital teeth
  • buccal swelling
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49
Q

What are the location of buccal bifurcation cysts?

A
  • Buccal to the mandibular first molar
  • Less commonly with the second molar
  • Little distal to the furcation
  • Bilateral: BBBC
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50
Q

What is the border of buccal bifurcation cysts?

A

Well defined, corticated,
Often infected, sclerosis of the wall

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51
Q

What is the effect of buccal bifurcation cysts?

A
  • Tipping of the crown
  • Lingual cusps higher than the buccal
  • Roots closer to the lingual cortex
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52
Q

What are the differential diagnosis for buccal bifurcation cyst?

A
  • Radicular cyst (in the same area but is non-vital)
  • Paradental cyst: third decade of life
  • Dentigerous cyst

Remember that BBC occur in vital teeth & in children

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53
Q

What is the management of buccal bifurcation cyst?

A
  • Microscopic features are nonspecific, histopath (biopsy) not recommended
  • Conservative curettage
  • Spontaneous resolution
  • No extraction

No root canal bc tooth is vital, may heal on its own.

54
Q

What are the different names for a dentigerous cyst?

A
  • eruption cyst (in soft tissues)
  • follicular cyst
55
Q

What is the disease mechanism for a dentigerous cyst?

A
  1. Developmental, can be inflammatory
  2. Fluid between the crown and the epithelium or fluid in the
    layers of the epithelium
56
Q

What are the clinical features for a dentigerous cyst?

A
  • Most common developmental cyst
  • Associated with crown of an impacted or unerupted tooth
  • Mostly in permanent dentition. Rarely in deciduous dentition
  • Occurs with supernumerary tooth too
57
Q

What are the imaging features of a dentigerous cyst?

Location, border, shape, size, internal content and effects

A
  • Location: around the crown of a tooth, Mn 3rd molar and Mx canine, at CEJ (central, lateral or circumferential)
  • Border: well defined, corticated (loss of cortication when infected), thin cortex of small cysts
  • Shape: circular outline, large lesions are oval
  • Size: follicular space >3mm on PA, can be very large
  • Content: radiolucent (except for crown of impacted tooth)
  • Effects: considerable tooth displacement, resorption of roots of adj teeth when it becomes big, displaces sinus floor and inferior alveolar canal, moderate expansion of cortex
58
Q

What type of shape is this?

A

central

tooth at center

59
Q

What type of shape is this?

A

lateral

60
Q

What type of shape is this?

A

circumferential

big cyst, but still starts at CEJ

Biopsy can help us if the cyst look like it does not start at the CEJ

61
Q

What is the differential diagnosis for the dentigerous cyst?

A
  1. Hyperplastic follicle
  2. Odontogenic keratocyst
  3. Unicystic ameloblastoma

FOR EXAM: 2 conditions that may look similar: odontokeratic cyst (mild), ameloblastoma (HUGE expansion)

62
Q

What is the treatment/management of the dentigerous cyst?

A
  1. Surgical removal, with or without the tooth
  2. Histopath (biopsy) because it may be a tumor (ameloblastoma)
  3. Mural ameloblastoma (arises from the walls of the dentigerous cyst)
  4. Squamous cell carcinoma
  5. Mucoepidermoid carcinoma
63
Q

What type of cyst is this?

A

dentigerous cyst

64
Q

What type of cyst is this?

A

dentigerous cyst

65
Q

What type of cyst is this?

A

dentigerous cyst

66
Q

What type of cyst is this?

A

dentigerous cyst

67
Q

What type of cyst is this?

A

dentigerous cyst

68
Q

What is the disease mechanism for lateral periodontal cyst?

A
  1. Rare
  2. Epithelial rests on the lateral aspects of a tooth
  3. Usually a single lesion (98% of the cases), may be a cluster—botryoid
69
Q

What are some similar conditions of lateral periodontal cyst?

A
  • Gingival cyst of the adult
  • Botryoid odontogenic cyst
    OKC
    Lateral radicular cyst
70
Q

What are the clinical features for lateral periodontal cyst?

A
  1. Tooth is vital
  2. Asymptomatic (88% cases)
  3. Mean age is ~50 years, seen in second decade of life or later
  4. No gender predilection
71
Q

What are the imaging features of a lateral periodontal cyst?

Location, border, shape, size, internal content and effects

A
  • Location: 70% in mandible, lateral incisor to PM area, lateral aspect of root (between 2 roots)
  • Size: usually ~1cm, some up to 3 cm (rare)
  • Shape: oval (large) or circular (small)
  • Border: corticated
  • Effects: loss of lamina dura, displacement of tooth (not always), expansion of cortex (50% of cases)
72
Q

What are the differential diagnosis of a lateral periodontal cyst?

A
  1. Radicular cyst from an accessory canal (non-vital) on the side of a tooth
  2. Odontogenic keratocyst (has a hot dog shape)
73
Q

What is the management for lateral periodontal cyst?

A
  1. Start with a vitality test
  2. Simple enucleation
  3. Recurrence is low (if it’s OKC, it’d have a high recurrence)
  4. Botryoid variety has more aggressive behavior

Biopsy recommended to differentiate from OKC

74
Q

What type of cyst?

A

lateral periodontal cyst

75
Q

What type of cyst?

A

lateral periodontal cyst

76
Q

What type of cyst?

A

lateral periodontal cyst

77
Q

What type of cyst?

A

lateral radicular cyst

78
Q

What is the disease mechanism of glandular odontogenic cyst?

A

rare, originated from odontogenic epithelium with salivary gland
features (related to mucoepidermoid carcinoma?)

79
Q

What is another name for glandular odontogenic cyst?

A

sialo-odontogenic cyst

“Sialo” because of salivary origin

80
Q

What are the clinical features of a glandular odontogenic cyst?

A
  1. 4th to 5th decade of life, mean age is about 48 yrs.
  2. Aggressive behavior
  3. M>F
81
Q

What are the imaging features of a glandular odontogenic cyst?

Location, border, shape, size, internal content and effects

A
  • Location: Mandibular anterior region, Less commonly - maxillary anterior region, Mandible: Maxilla = 3:1
  • Border: Well defined, corticated, Scalloped, Multilocular, may be unilocular (Lit. search: ~60% unilocular!)
  • Effects: Displacement of the roots, Cortical expansion (73% cases) and perforation if severe (26% cases), Root resorption (14% cases)
82
Q

What is the differential diagnosis for glandular odontogenic cyst?

A
  1. Ameloblastoma (multiocular/multicystic) - but causes high displacement
  2. Odontogenic keratocyst (due to scalloped appearance)
  3. Central mucoepidermoid carcinoma
  4. Solitary lesion: lateral periodontal cyst (if in the cervical)
83
Q

What is the management for glandular odontogenic cyst?

A
  • High recurrence
  • Aggressive treatment
  • Enucleation or resection
  • Follow‐up imaging (because of high recurrence)
84
Q

What type of cyst?

A

glandular odontogenic cyst

85
Q

What type of cyst?

A

glandular odontogenic cyst

86
Q

Odontogenic keratocyst affect which demographic?

A
  • About 10% of all odontogenic cysts
  • Slightly more in male
  • Any age, infancy to old age
  • Frequent age range of 10‐40 years
87
Q

What is the typical location of an odontogenic keratocyst?

A
  • 60‐80% of OKC in mandible
  • Posterior body of the mandible (90% distal to canines)
  • Superior to alveolar canal
  • Sometimes with an unerupted tooth, similar to a dentigerous cyst
88
Q

What is the border of an odontogenic keratocyst?

A
  • Well‐defined smooth corticated border
  • Large lesions may have multilocular appearance (cyst compartments)
89
Q

What is the shape and size of an odontogenic keratocyst?

A
  • Tends to grow along the length of the bone (so if in mandible, will follow mandible)
  • Forms tunnel or sausage shape
  • Can become large (asymptomatic and no cortical expansion)
90
Q

What is the internal content of an odontogenic keratocyst?

A
  • Radiolucent
  • Presence of keratin does not make the lesion radiopaque (no calcification)
  • Some septa (some vertical lines)
91
Q

What are the effects of odontogenic keratocyst?

A
  • Minimal cortical expansion in the body
  • High recurrence
  • Some cortical expansion in ramus
  • Displaces or resorbs teeth, but less than dentigerous cyst
92
Q

What type of cyst is this?

A

odontogenic keratocyst

93
Q

What type of cyst is this?

A

odontogenic keratocyst

94
Q

What type of cyst is this?

A

odontogenic keratocyst

95
Q

What type of cyst is this?

A

odontogenic keratocyst

96
Q

What type of cyst is this?

A

odontogenic keratocyst

97
Q

What are the different names for Gorlin-Goltz syndrome (multiple OKC)?

A
  • Gorlin syndrome
  • Basal cell nevus syndrome
  • Nevoid basal cell carcinoma syndrome
98
Q

What are the clinical features of Gorlin-Goltz syndrome?

A
  1. Starts early in life, after 5 years
  2. Multiple OKCs
  3. Recurrence rate of OKCs in Gorlin‐Goltz is higher than non‐
    syndromic OKCs
  4. Skin cancer
  5. Bifid rib and other abnormalities
99
Q

What are the imaging features of Gorlin-Goltz syndrome?

A
  • Multiple OKCs
  • Radiographic features same as solitary OKC
  • Size: a few mm to several cm
  • Calcification of falx cerebri
100
Q

What is the differential diagnosis for Gorlin-Goltz syndrome?

A

Multiple dentigerous cysts

101
Q

Other conditions with multiple radioluciencies include

A
  • Cherubism
  • Multiple myeloma

However, the clinical symptoms are VERY different.

102
Q

What type of cyst is this?

A

Gorlin-Goltz syndrome

103
Q

What is the management for Gorlin-Goltz syndrome?

A
  1. Thorough image analysis, using CT or CBCT
  2. Aggressive surgery, as recurrence is high
  3. Follow‐up imaging
  4. Genetic analysis
104
Q

What is the disease mechanism for nasopalatine duct cyst?

A

Arises from epithelial remnants of the nasopalatine duct

105
Q

What are the different names for nasopalatine duct cyst?

A

Incisive canal cyst
Median palatine cyst

106
Q

What are the clinical features for nasopalatine duct cyst?

A
  • Most common between 40 and 60 years.
  • About 10% of the jaw cysts
  • More in male
107
Q

What is the location for the nasopalatine duct cyst?

A
  • Midline of maxilla between centrals
  • Extends to hard palate (median palatine cyst)
  • May not be symmetric
108
Q

What is the border and shape for nasopalatine duct cysts?

A
  1. Circular or oval, well defined
  2. Sagittal view: curvature of the anterior wall of the canal
  3. Heart shape, when ANS is superimposed on occlusal or
    periapical view
109
Q

Which anatomic variation of the canal is it?

A

cylindrical

110
Q

Which anatomic variation of the canal is it?

A

hourglass

111
Q

Which anatomic variation of the canal is it?

A

funnel

112
Q

Which anatomic variation of the canal is it?

A

spindle

113
Q

What is the size for a nasopalatine duct cyst?

A
  1. Large foramen, wider than 6 mm may appear as a cyst
  2. Some canals are uniformly wide (5‐6 mm), less likely to be a
    cyst (Clue: Curvature of the anterior wall of the canal on a cross
    sectional image)
114
Q

What are the effects of a nasopalatine duct cyst?

A
  • May cause expansion of maxilla, discomfort or pain
  • May flare the roots of the central incisors
115
Q

What is the differential diagnosis for nasopalatine duct cyst?

A
  • Large nasopalatine canal
  • Radicular cyst
116
Q

What is the management of nasopalatine duct cyst?

A
  • Enucleation
  • Marsupialization if the lesion is large
117
Q

What type of cyst?

A

nasopalatine duct cyst

118
Q

What is the disease mechanism for simple bone cyst?

A
  • Etiology unknown
  • No epithelial lining, not a true cyst
  • Localized aberration of bone remodeling
  • Cavity in bone lined with connective tissue
119
Q

What are the different names for simple bone cyst?

A
  • Traumatic bone cyst (wrong - not trauma)
  • Hemorrhagic cyst (wrong - no bleeding)
  • Solitary bone cyst (SBC)
  • Idiopathic bone cavity (IBC - best name)

SBC or TBC are better names

120
Q

What are the clinical features for simple bone cyst?

A
  • Incidental finding
  • Mean age: 17 years
  • Male/female: 2:1

No relationship with trauma, common in 17 yr old males (but not 19 or 20) probably due to spontaneous healing

121
Q

What is the location for simple bone cyst?

A
  • Mandible
  • Ramus and posterior mandible
122
Q

The border of a simple bone cyst is described as

A
  • Well‐defined or ill‐defined
  • Scallops between roots of teeth
123
Q

What is the shape of simple bone cyst?

A
  • Outline is smooth
  • Large lesions are oval
  • Tends to grow along the length of the bone
124
Q

What is the internal content of simple bone cyst?

A
  • Radiolucent
  • May be empty, or contain fluid
125
Q

What is the effect of simple bone cyst?

A
  • Vital teeth
  • Usually no displacement of teeth (because cavity is empty)
  • May expand the cortex
126
Q

What is the differential diagnosis for simple bone cyst?

A

Odontogenic keratocyst
OKC may displace teeth, or resorb the roots

127
Q

What is the management for simple bone cyst?

A
  • Conservative opening and curettage (see if it’s cavity or if there is fluid)
  • Spontaneous resolution

If there is “cheesy” filling = OKC

128
Q

What type of cyst?

A

simple bone cyst

129
Q

What type of cyst?

A

simple bone cyst

130
Q

What type of cyst?

A

simple bone cyst

Radio II: Exam 2 (8 decks)

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