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BDS 2: Pathology and Microbiology > L12 Introduction to Cysts of the Jaw > Flashcards

L12 Introduction to Cysts of the Jaw Flashcards

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1
Q

What is a cyst?

A

A pathological cavity having fluid, semi-fluid or gaseous contents, not formed by the accumulation of pus.
May or may not have an epithelial lining.

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2
Q

Describe the strutcure of a cyst.

A
  • Cyst capsule: usually made of fibrous CT/granulation tissue, BVs
  • Cyst lining: epithelial lining, not present in all cysts, usually non-keratinised stratified squamous
  • Lumen: contains fluid/semi-fluid/solid/gaseous components
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3
Q

What does the cyst wall refer to?

A

The cyst capsule and cyst lining

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4
Q

What are the 2 categories cysts are divided into?

A
  • Odontogenic: epithelial lining is derived from epithelial tissues associated with tooth development
  • Non-odontogenic: epithelial lining is derived from sources other than the tooth forming organ
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5
Q

What are the 2 categories odontogenic cysts are divided into?

A
  • Inflammatory: stimulus for cyst development is inflammation, most commonly periapical inflammation
  • Developmental: stimulus for cyst development is uncertain
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6
Q

Name 3 odontogenic inflammatory cysts.

A
  • Radicular
  • Residual
  • Paradental
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7
Q

What is the alternative name for a radicular cyst?

A

Apical periodontal cyst

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8
Q

Name 7 developmental inflammatory cysts.

A
  • Follicular cysts
  • Odontogenic keratocyst
  • Gingival cyst
  • Lateral periodontal cyst
  • Botryoid odontogenic cyst
  • Glandular odontogenic cyst
  • Calcifying odontogenic cyst
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9
Q

What are the 2 types of developmental inflammatory follicular cysts?

A
  • Dentigerous cyst (encloses tooth crown)

- Eruption cyst

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10
Q

What are the 3 categories of non-odontogenic cysts?

A
  • Inclusion cysts
  • Congenital cysts
  • Cysts without epithelial lining
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11
Q

Give examples of inclusion cysts.

A
  • Nasopalatine
  • Nasoalveolar
  • Median palatal
  • Globulomaxillary
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12
Q

Give examples of congenital cysts.

A
  • Thyroglossal duct
  • Lymphoepithelial
  • Dermoid cyst
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13
Q

Give examples of cysts without an epithelial lining.

A
  • Bone
  • Salivary gland
  • Stromal cysts in neoplasms
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14
Q

Where are radicular cysts found?

A 
At the apex of a non vital tooth.
Can be:
- Apical radicular
- Lateral redicular
- Residual radicular cyst: associated with extracted tooth
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15
Q

Where are odontogenic keratocysts most commonly found?

A

At the angle of the mandible.

Not directly associated with a tooth.

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16
Q

What are the 3 requirements for a cyst?

A
  • Source of epithelium
  • Stimulus for proliferation of epithelium
  • Bone resorption for cavity of cysts to enalrge and grow
17
Q

Give examples of the origins of epithelial linings of odontogenic cysts.

A
  • Hertwigs epithelial root sheath/Rests of Malassez = radicular cysts
  • Reduced enamel epithelium = dentigerous cysts
  • Dental lamina/Glands of Serres = odontogenic keratocysts, gingival cysts
18
Q

Describe a dentigerous cyst.

A

Odontogenic cyst formed from the reduced enamel epithelium, associated with the crown of an unerupted tooth, non-keratinised epithelium.

19
Q

Describe an odontogenic keratocyst.

A

Odontogenic cyst from the dental lamina/Glands of Serres, found in the angle of the mandible, multi-lobular, keratinised epithelium.

20
Q

Describe a radicular cyst.

A

Odontogenic inflammatory cyst from the epithelial rests of Malassez in the PDL as a consequence of inflammation, generally following death of the pulp.
Often develops from periapical granuloma.
Also known as apical periodontal cyst.

21
Q

Describe the incidence of radicular cysts.

A
  • Peak age 4-5th decades
  • Uncommon in deciduous teeth
  • 63% men affected, 37% women
22
Q

Where are radicular cysts most likely to form?

A
  • More likely in maxilla (60), mandible 40%

- Maxillary anterior tooth commonly affected (37%), due to being more likely to be traumatised

23
Q

Describe the symptoms of a radicular cyst.

A
  • Many are symptomless
  • Larger cysts will present as slowly enlarging swellings
  • May present with signs of acute inflammation due to secondary infection
  • May be more than 1 cysts, suggestion of cyst prone individuals
24
Q

Describe the signs of a radicular cyst.

A
  • Labial or buccal swelling associated with a non-vital tooth
  • May be palatal swelling (e.g. with upper incisors), but rarely lingual swelling
  • Small cysts may produce bony hard swellings
  • Larger cysts may be spring with eggshell crackling
  • Large cysts may erode bone
25
Q

Describe the radiological presentation of an apical periodontal cyst.

A
  • Uniformally radiolucent round or oval lesion at root apex
  • Well demarcated periphery
  • Surrounded by a narrow radiopaque margin extending from the lamina dura of the affected tooth
26
Q

How can you differentiate between a radicular cyst and periapical granuloma radiographically?

A

Cysts tend to be:

  • Larger
  • More radiolucent
  • Well defined
  • Corticated outline
  • Painless

Cysts tend to be larger than granulomas

27
Q

Describe the composition of a radicular cyst.

A
  • Spherical or ovoid
  • Cyst wall of variable thickness (can be very thin or up to 5mm thick)
  • May be yellow nodules of cholesterol
  • Brown fluid contents with shimmering cholesterol crystals
28
Q

Describe the histological features of the epithelium of an apical periodontal (radicular) cyst.

A
  • Non-keratinised stratified squamous epithelium
  • Epithelium often discontinuous, between 1-50 cells thick
  • Epithelial lining may be proliferating and show arcading, or be quiescent
  • Mucous cells present in 40% of cysts
  • Some cysts have pseudo-stratified ciliated epithelium, more common in maxillary cysts
  • Rarely have keratinised epithelium
29
Q

Describe the histological features of the capsule of an apical periodontal cyst.

A
  • Condensed fibrous CT
  • Variable inflammatory cell infiltrate
  • Cholesterol clefts with associated foreign body giant cell reaction and haemosiderin deposits
30
Q

Describe the cysts contents of a radicular cyst.

A
  • May be straw coloured, but often stained brown by heamorrhage
  • Usually contains cholesterol crystals giving a shimerring appearance
31
Q

What are the 3 stages of apical periodontal cyst pathogenesis?

A

1) Initiation
2) Cyst formation
3) Cyst enlargement

32
Q

Describe radicular cyst initiation.

A

1) Epithelial proliferation of rests of Malassez in a periapical granuloma following pulp necrosis
2) Proliferation possibly caused by products of pulp necrosis or by local changes in the supporting CT e.g. reduction in pH, increased CO2 tension
3) The proliferating epithelium has a characteristic
histological appearance with arcades and rings of
epithelium encircling cores of vascular connective tissue

33
Q

Describe radicular cyst formaiton.

A

3 possible mechanisms:

  • Cavity forms within a proliferating mass of epithelium due to epithelial degeneration and necrosis
  • Epithelium proliferates to line a cavity formed as a result of CT breakdown due to proteolytic activity
  • Epithelium proliferates to line the CT surface of an abscess cavity
34
Q

Describe radicular cyst enlargement.

A
  • Appear to expand equally in all directions
  • Suggest increased pressure in cyst lumen causing expansion
  • Alveolar bone must resorb to allow expansion
35
Q

Describe the increased pressure in the radicular cyst lumen and its effects on bone.

A
  • Pressure in the cyst lumen is higher than the capillary pressure
  • High pressure caused by lysis of epithelial and inflammatory cells, and inflammatory exudate
  • Fluid also flows into lumen via semi-permeable membrane also increasing pressure
  • Pressure against surrounding alveolar bone causes bone resorption
36
Q

What is the management of a radicular cyst?

A
  • Many resolve following extraction or endodontic treatment of extracted tooth
  • Surgical intervention: enucleation (removal of cyst capsule)
  • Marsupialisation: used for larger cysts, decompression by cutting open cyst and draining into oral cavity

BDS 2: Pathology and Microbiology (14 decks)

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