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BDS 3: Oral Diseases > L11 Cysts of the jaws > Flashcards

L11 Cysts of the jaws Flashcards

1
Q

What is the definition of a cyst?

A

A pathological cavity having fluid, semi-fluid or gaseous contents which is not created by the accumulation of pus; it is frequently, but not always, lined by epithelium.

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2
Q

Do odontogenic cysts contain epithelium?

A

Yes, always.

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3
Q

Describe the 3 components of a cyst.

A
  • Capsule: connective tissue and/or granulation tissue, BVs, +/-inflammation, +/- cholesterol, +/- heamosiderin
  • Lining: epithelial or not
  • Lumen: fluid, semi-fluid or gaseous. Contains serum proteins, tissue products, lining cells +/- inflammatory cells, +/- cholesterol

Cyst lining + capsule = cyst wall

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4
Q

What is the difference between odontogenic and non-odontogenic cysts?

A

Odontogenic: epithelial lining derived from epithelial residues of the tooth forming organ

Non-odontogenic: epithelial lining, if present, is derived from other sources than the tooth forming organ

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5
Q

What 2 categories are odontogenic cysts divided into?

A
  • Inflammatory
  • Developmental
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6
Q

What are the 3 types of inflammatory odontogenic cysts?

A
  • Radicular cysts
  • Residual cysts
  • Inflammatory collateral cysts (paradental or buccal bifrucation cyst)
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7
Q

Describe radicular cysts.

A

Most common inflammatory odontogenic cyst, arise from a non-vital tooth usually as a result of caries.
Arises from the epithelial rests of Malassez in the PDL as a consequence of inflammation, usually following pulp necrosis.

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8
Q

Describe residual cysts.

A

Same as radicular, except the tooth has been extracted and the cyst has remained.

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9
Q

Describe paradental cysts.

A

Most common inflammatory collateral cyst, usually affects the lower 3rd molars.

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10
Q

Describe buccal bifurcation cysts.

A

An inflammatory collateral cyst seen in children.

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11
Q

Name the developmental odontogenic cysts.

A
  • Follicular (dentigerous and eruption cysts)
  • Odontogenic keratocyst
  • Gingival cyst
  • Lateral periodontal cyst
  • Botryoid odontogenic cyst
  • Orthokeratinised odontogenic cyst
  • Glandular odontogenic cyst
  • Calcifying odontogenic cyst
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12
Q

Which 2 types of developmental odontogenic cysts are most common?

A
  • Odontogenic keratocysts
  • Follicular cysts (dentigerous, eruption)
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13
Q

The pathogenesis of jaw cysts require which 3 components?

A
  • A source of epithelium
  • Stimulus for proliferation
  • Growth and bone resorption
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14
Q

What are the 3 sources of odontogenic epithelium in cyst formation?

A
  • Hertwig’s epithelial root sheath (epithelial rests of Malassez)
  • Reduced enamel epithelium
  • Dental lamina
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15
Q

Which cysts’ epithelia develop from the epithelial rests of Malassez?

A
  • Radicular cysts
  • Residual cysts
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16
Q

Which cysts’ epithelia develop from the reduced enamel epithelium?

A
  • Dentigerous cysts
  • Eruption cysts
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17
Q

Which cysts’ epithelia develop from the dental lamina?

A
  • Odontogenic keratocysts
  • Gingival cysts
  • Lateral periodontal cysts
  • Odontogenic tumours
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18
Q

What type of tooth is a radicular cyst always associated with?

A

A non-vital tooth

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19
Q

What are the 3 main locations of radicular cysts?

A
  • Apical: at the apex of the tooth, associated with the opening of the root canal
  • Lateral: at the side of the tooth, associated with a lateral branch of the root canal
  • Residual: a radicular cyst which has persisted after extraction of the associated tooth
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20
Q

What age group are radicular cysts most commonly seen in?

A

Age 31-40

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21
Q

Which teeth are radicular cysts most commonly seen in?

A

Most common in the maxillary anterior region, particularly the lateral and central incisors.

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22
Q

What are the symptoms of a radicular cyst?

A
  • Many are symptomless and discovered incidentally on radiographs
  • Larger cysts present as slowly enlarging swellings
  • May present with signs of acute inflammation due to re-infection of cyst
  • Non-vital tooth
  • Suggestion that some individuals are susceptible to cysts and present with more than 1 cyst
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23
Q

What are the signs of a radicular cyst?

A
  • Usually not many signs
  • Larger cysts may present with buccal swellings
  • May be palatal swelling, but rarely lingual
  • Small cysts can produce bony hard swellings
  • Large cysts may be springy with egg shell crackling sound when compressed
  • Large cysts may erode the bone and be fluctuant (compressible)
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24
Q

What cyst is shown in these radiographs?

A

Radicular.
Radicular cysts have corticated borders.

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25
Q

For a radicular cyst, the cyst cavity is continuous with what?

A

The cyst cavity is continuous with the lamina dura, means the cyst has arisen from the PDL.
Glistening appearance due to cholesterol deposits.

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26
Q

Describe the epithelial lining of radicular cysts.

A
  • Stratified squamous epithelium
  • Non-keratanised (somes keratnised if cyst is open to the mouth)
  • Varying thickness
  • Arcaded appearance due to thin strands of odontogenic epithelium extending into CT
  • Mucus cell metaplasia is common, see grey coloured Goblet cells microscopically
  • Ciliated epithelium may be seen
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27
Q

Describe the capsule of radicular cysts.

A
  • Highly variable
  • Condensed densely fibrous connective tissue
  • Variable inflammatory cell infiltrate: macrophages, lymhpocytes and plasma cells (blue cells)
  • Cholesterol clefts with associated foreign body giant cell reaction and haemosiderin deposits
28
Q

Describe the cyst contents for radicular cysts.

A
  • May be straw coloured
  • Usually contains cholesterol crystals, creates a shimmering appearance
  • Often stained brown due to haemorrhage
29
Q

How can you differentiate between a periapical granuloma vs a radicular cyst?

A

Cysts tend to be:
- Larger
- More radiolucent
- Oval shape
- Well demarcated
- Corticated outline
- Usually painless
Size.
Smaller = periapical granuloma
Bigger = apical periodontal cyst

30
Q

Briefly describe paradental cysts.

A
  • Inflammatory odontogenic cyst
  • Occurs near to the cervical margin of the lateral aspect of a root as a consequence of an inflammatory process in a periodontal pocket
  • Commonly affects mandibular 3rd molars
  • Typically due to pericoronitis associated with PE teeth
  • Poor OHI and food impaction
  • Well defined radiolucency
  • Corticated border
  • Always has a history of pericoronitis
31
Q

Describe the pathogenesis of paradental cysts.

A
  • Unclear mechanism
  • Inflammatory origin
  • Some teeth have an enamel spur extending from the buccal cervical margin to the root furcation, it is believed that inflammation due to pericoronitis in these cases leads to cyst expansion of the reduced enamel epithelium lining the enamel spur
  • Some research suggests that cyst expansion occurs secondary to destruction of alveolar bone as a result of inflammation in pericoronitis

Histologically identical to radicular cysts

32
Q

What is the management of a paradental cyst?

A

Extraction of impacted tooth and removal of cyst.

33
Q

Briefly describe dentigerous cysts.

A

An odontogenic developmental cyst arising from the REE.
Crown of tooth in the cyst lumen.
The dental follicle is attached to the amelocemental junction and surrounds the crown of an unerupted tooth.

34
Q

What demographic of patients usually present with dentigerous cysts?

A
  • Wide range of ages
  • Twice as common in men than women
35
Q

Where are dentigerous cysts more commonly found?

A
  • Twice as common in the mandible than the maxilla
  • Any teeth can be affected, order of frequency:
  • Mandibular 3rd molars
  • Maxillary canines
  • Maxillary 3rd molars
  • Mandibular premolars

Occassionally associated with supernumerary teeth and odontomes.

36
Q

Describe the radiographic features of a dentigerous cyst.

A
  • Thin, radiolucent rim attached to the amelocemental junction
  • Corticated border
  • Unilocular
37
Q

What are the histological features of dentigerous cysts?

A
  • Thin epithelium, 2-5 cells thick
  • Non-keratinised stratified squamous epithelium (occasionally flattened low cuboidal epithelium)
  • Mucous metaplasia is common, increases with age of cyst
  • Fibrous capsule is free from inflammation unless there has been secondary inflammation
38
Q

Describe the pathogenesis and expansion of dentigerous cysts.

A
  • Mechanism of cyst formation unclear stimulus unknown
  • Associated with unerupted teeth but estimated that only approx. 1% of unerupted teeth develop dentigerous cysts- therefore other unknown factors must be involved in the pathogenesis
  • Fluid accumulates either between the REE and enamel, or within intercellular spaces of REE leading to cyst formation
  • Also believed that compression of the follicle in potentially erupting but impacted teeth obstructs venous outflow, raises venous pressure, increases transudation across capillary wall, the increased hydrostatic pressure separates the follicle from the crown and cyst formation

SUMMARY: Expansion is due to raised hydrostatic pressure, may enlarge rapidly in children, much slower in adults.

39
Q

Describe eruption cysts.

A
  • An odontogenic developmental follicular cyst
  • Can involve deciduous or permanent teeth
  • Extra-alveolar location
  • Present as fluctuant swellings on the alveolar mucosa
  • Usually blueish colour
  • Don’t require treatment and usually resolve by themself
40
Q

What is the management of a dentigerous cyst?

A
  • Enucleation of cyst with extraction of the associated tooth
  • Marsupialisation of cyst in select cases
41
Q

Describe odontogenic keratocysts.

A
  • Developmental odontogenic cyst arising from the dental lamina or its remnants within the tooth bearing areas
  • Characterised by a thin lining of keratinised epithelium
  • Relatively uncommon, account for approx. 10% of odontogenic cysts
  • Tendency to recur
42
Q

What type of patients are odontogenic keratocysts most commonly seen in?

A
  • Wide age range
  • Peak in second, third and sixth decades of life
  • More common in men than women
43
Q

Where in the jaws are odontogenic keratocysts more common?

A
  • 70-80% present in the manidble (50% of these involve the 3rd molar and ascending ramus)
  • Majority of cases are posterior to the first premolar in both the maxilla and mandible
44
Q

How do patients with odonotgenic keratocysts normally present?

A
  • Remarkably few symptoms unless secondarily infected
  • In young children, they often present as part of a wider syndrome
  • Often discovered on routine radiographs
  • Most are solitary
  • Tend to enlarge in an antero-posterior direction
45
Q

Multiple odontogenic keratocysts are associated with what syndrome?

A

Gorlin-Goltz syndrome
Aka. basal cell naevus syndrome

46
Q

What cyst do these radiographs show?

A

Odontogenic keratocyst
- Well defined
- Corticated
- Not associated with an impacted or carious tooth

47
Q

Explain the histopathology of odontogenic keratocyts.

A
  • Thin, folded epithelium (5-10 cells thick)
  • Corrugated surface layer and thinly parakeratinised
  • Palisaded basal layer cells
  • High mitotic rate
  • Thin fibrous capsule, usually no inflammation unless secondarily infected
48
Q

Why do odontogenic keratocysts have a high risk or recurrence?

A
  • Epithelial buds which create microcysts called satellite cysts
  • If the cyst isn’t completely removed and anything is left behind, the satellite cysts redevelop and cause recurrence of the odontogenic keratocyst
49
Q

Describe the cyst fluid of an odontogenic keratocyst.

A
  • Contains desquamated epithelial cells and keratin (rarely seen in any other jaw cyst type)
  • Low soluble protein concentration compared to other odontogenic cysts, less than 4g per litre
50
Q

Describe the management of an odontogenic keratocyst.

A
  • MUST have histological confirmation before deciding on definitve treatment
  • Complete enucleation: can be challenging to remove all of the delicate, thin lining
  • Marsupialisation: for very large cysts
  • Resection if very large (rare)
51
Q

What is the recurrence rate for odontogenic keratocysts?

A

10-60%
Decreasing due to early recognition and improved management.

52
Q

What are the clinical manifestations of naevus basal cell carcinoma syndrome (Gorlin-Goltz)?

A
  • Numerous basal cell carcinomas on the skin
  • Skeletal abnormalities: cervical rib and vertebral deformities
  • Frontal and temporoparietal bossing
  • Hypertelorism (distance between eyes)
  • Mild mandibular prognathism
  • Multiple odontogenic keratocysts
53
Q

Briefly describe lateral periodontal cysts.

A
  • A developmental odontogenic cyst occuring on the lateral aspect or between the roots of vital teeth
  • Arise from the dental lamina
  • Usually affect upper premolars
  • Associated with non-carious teeth
  • Well-defined unilocular radiolucent area, corticated border
  • Involves the bone
54
Q

What is the name of the rare multilocular form of a lateral periodontal cyst?

A

Botryoid odontogenic cyst

55
Q

What is the management of a lateral periodontal cyst?

A

Excision

56
Q

Describe the histology of a lateral periodontal cyst.

A
  • Thin odontogenic epithelium
  • Plaque like thickenings
57
Q

Describe gingival cysts.

A
  • In infants: arise from dental lamina rests in the alveolar mucosa, don’t require treatment
  • In adults: arise from dental lamina rests in the attached gingiva, similair histology to lateral perio cysts except there is no bone involvement in gingival cysts
58
Q

Name the types of non-odontogenic cysts that exist.

A
  • Congenital cysts present in soft tissue
  • Cyst like lesions e.g. idiopathic bone cavity presenting in the mandible
  • Aneurysmal bone cysts can also present in non-head and neck sites
59
Q

Which stucture typically indicates whether a cyst is odontogenic or non-odontogenic in origin?

A

The ID canal:
- Above the canal = odontogenic
- Below the canal = non-odontogenic

60
Q

Describe the nasopalatine cyst.

A
  • Aka the incisive canal cyst
  • One of the most common non-odontogenic cysts
  • Non-carious teeth
  • Arises from epithelial residues in the nasopalatine canal
  • Most common in 4th and 6th decades of life
  • 40% are asymptomatic, the remainder present when infected
61
Q

Describe the radiology of nasopalatine cysts.

A
  • Ovoid/heart shaped radiolucency in the midline of the maxilla
  • Bilaterally symmetrical behind the central incisors, may displace the teeth
62
Q

Describe the histology of nasopalatine cysts.

A
  • Epithelial lining is stratified squamous epithelium and/or pseudostratified ciliated epithelium
  • Fibrous tissue capsule frequently contains nerves and medium sized blood vessels
63
Q

Describe the pathology of nasopalatine cysts.

A
  • Thought to be due to entrapment of epithelium during formation of the palate
64
Q

Describe the management of nasopalatine cysts.

A

Enucleation

65
Q

Summarise which epithlium source each odontogenic cyst type arises from.

A

BDS 3: Oral Diseases (13 decks)

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