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Oral Surgery 2 > Management of Benign Odontogenic Cysts and Tumors > Flashcards

Management of Benign Odontogenic Cysts and Tumors Flashcards

1
Q

basic surgical goals

A
  1. eradication of pathological conditions

2. functional rehabilitation of patient

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2
Q

eradication of pathological conditions

A

remove lesion in entirety without leaving cells behind

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3
Q

what is imperative prior to definitive treatment?

A

histological dx

i.e. periapical cyst vs ameloblastoma

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4
Q

T/F: techniques to remove a cyst is more aggressive than a tumor

A

false, techniques to removing tumor are more aggressive

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5
Q

T/F: there is a wide array of tissue deficits that are possible after eradication of a lesion

A

true

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6
Q

functional rehabilitation of the patient is best accomplished if what?

A

reconstruction is planned while planning the excisional surgery

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7
Q

a true cyst contains what?

A

an epithelial lining

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8
Q

inflammatory cyst

A
  1. periapical cyst

2. residual cysts

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9
Q

developmental cyst

A
  1. dentigerous cyst
  2. odontogenic keratocyst
  3. lateral periodontal cyst
  4. glandular odontogenic cyst
  5. calcifying odontogenic cysts (Gorlin’s cyst)
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10
Q

management of cysts

A
  1. enucleation
  2. enucleation and curettage (E&C)
  3. marsupialization
  4. staged marsupialization and enucleation (decompression technique)
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11
Q

what is the treatment choice for cystic lesion?

A

enucleation

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12
Q

enucleation

A

removal of entire cystic lesion without rupture

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13
Q

fibrous connective tissue wall allows for what during enucleation?

A

allows a cleavage plane between lesion and bony cavity

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14
Q

indications for enucleation

A

any cyst that can be removed in entirety and safely without harming adjacent structures

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15
Q

common examples of when enucleation is indicated

A
  1. dentigerous cyst

2. periapical cyst

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16
Q

advantages of enucleation

A

histopathologic examination of the entire cystic wall

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17
Q

T/F: initial biopsy/treatment via enucleation is curative in certain situations

A

true

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18
Q

disadvantages of enucleation

A
  1. possible pathological fracture
  2. devitalization of teeth
  3. injury to nerve
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19
Q

technique for enucleation

A
  1. gain access to cyst
  2. aspirate
  3. use largest curette that defect will allow
  4. visualize bony cavity for soft tissue remnants
  5. smooth bony margins and obtain water tight primary closure
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20
Q

T/F: when performing enucleation, you should cleavage plane and use the concave surface towards the bone

A

true

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21
Q

post-op instructions for enucleation

A
  1. diet/activity modification
  2. meticulous oral hygiene
  3. may require close follow-up with periodic panoramic radiograph
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22
Q

how often should you follow up with a panoramic on patient who underwent enucleation?

A

every 6 months

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23
Q

how long should it take for bone to fill into space that you enucleated?

A

6-12 months

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24
Q

what will happen to the expanded bone after enucleation?

A

it will recontour over time

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25
what is done first to the cyst first in enucleation and curettage (E&C)?
enucleation
26
how do you perform enucleation and curettage (E&C)?
mechanical (burs) curettage is performed to remove 1-2 mm of bone at the entire periphery of bony cavity
27
T/F: you can curette aggressively in order to perform enucleation and curettage (E&C) but the outcome is better with mechanical
true
28
indications for enucleation and curettage (E&C)
1. when removing a known aggressive cyst such as OKC (high occurance) 2. second surgery after recurrence when 1st surgery (enucleation) was deemed curative
29
advantage of enucleation and curettage (E&C)
destroys any suspected epithelial remnants
30
by destroying any suspected epithelial remnants with enucleation and curettage (E&C), what do you decrease the chances of?
decrease chance of recurrence
31
disadvantage of enucleation and curettage (E&C)
1. damage to neurovascular bundle | 2. dental pulps stripped
32
marsupialization
open a cystic lesion and maintain patency to an adjacent cavity
33
marsupialization decreases what?
intracystic pressure so causes cyst shrinkage and bony fill
34
T/F: marsupialization is rarely the sole treatment
true
35
marsupialization is usually a preliminary step before what?
definitive enucleation of the smaller cyst
36
indications for marsupialization
1. adjacent vital structures at risk with enucleation 2. difficult surgical access to all portions of cyst 3. medical compromise
37
T/F: if not all portions of the cyst is removed then recurrence rate increases
true
38
advantages of marsupialization
1. simple to perform 2. can spare vital structures 3. either completely resolves lesion or makes it much smaller and easier to tx and reconstruct
39
disadvantages of marsupialization
1. cannot histologically examine the entire cystic wall 2. patient inconvenience with home care 3. occasional secondary infections
40
T/F: areas left behind during marsupialization may be more aggressive than the piece removed
true
41
technique of marsupialization
1. aspirate 2. create 1 cm or large elliptical incision in soft tissue 3. create bony window 4. piece of cystic lining removed and sumbitted for histopathologic exam 5. cystic contents evacuated 6. keep window into cyst patient
42
what should you do if patient has a thick cystic lining when performing marsupialization?
suture to oral mucosa
43
what should you do if patient has thin/friable cystic lining when performing marsupialization?
pack cavity for 10-14 days to prevent oral mucosa from healing over window
44
post-op instructions for marsupialization
1. pt is responsible for irrigating the cystic cavity | 2. routine follow-up with radiographic evaluation to assess progress
45
T/F: cavity that is left to patent after marsupialization was performed may become secondarily infected
true
46
how long do you leave the cavity after marsupialization open for?
until goals for choosing marsupialization have been met
47
staged marsupialization and enucleation is also known as what?
"decompression" technique
48
staged marsupialization and enucleation
opening cyst to oral cavity (marsupialization) and surgical plan is to make the cyst smaller (decompression) for final enucleation and curettage at a later date
49
T/F: marsupialization alone is more commonly performed than staged marsupialization and enucleation
false, staged marsupialization and enucleation is more commonly performed vs marsupialization alone
50
staged marsupialization and enucleation allows what?
1. bone cover of vital structures | 2. increased strengthening of jaw
51
T/F: routine follow-up with radiographic assessment is done until bone fills stalls and/or goals are met with staged marsupialization and enucleation
true
52
how do you enucleate remaining cyst in staged marsupialization and enucleation?
1. elliptical incision around opening of cyst | 2. remove all cystic lining
53
indications for staged marsupialization and enucleation
1. concerns for injury to adjacent anatomical structures 2. size of lesion 3. marsupialization alone does not resolve lesion 4. need to examine entire lesion histopathologically
54
advantages of staged marsupialization and enucleation
1. develops a thickened cystic lining 2. reduces morbidity and accelerates complete healing 3. simple to perform 4. can save vital structures 5. completely resolves lesion or makes it smaller and easier to tx and reconstruct
55
disadvantages of staged marsupialization and enucleation
1. patient inconvenience 2. occasional secondary infection 3. cannot histologically examine the entire cystic wall
56
if you cann't histologically examine the entire cystic wall of a lesion during staged marsupialization and enucleation, what is a remedy for this concern?
secondary enucleation
57
T/F: advantages and disadvantages of enucleation vs staged marsupialization and enucleation is the same
true
58
tx of periapical cyst
1. remove underlying process with either RCT or extraction 2. enucleate +/- curettage 3. abx if necessary
59
tx of residual cyst
enucleation and curettage
60
tx of dentigerous cyst
extraction of affected tooth and enucleation and curettage
61
what should you consider doing if dentigerous cyst is larger?
consider staged marsupialization and enucleation and curettage
62
tx of odontogenic keratocyst (OKC)
enucleation and curettage with potential extraction
63
what should you consider doing if odontogenic keratocyst (OKC) is larger?
consider staged marsupialization and enucleation and curettage
64
tx of lateral periodontal cyst
enucleation with perservation of tooth
65
tx of glandular odontogenic cyst
1. enucleation and curettage | 2. some advocate more aggressive treatment (resection)
66
tx of calcifying odontogenic cyst (Gorlin's)
enucleation and curettage
67
epithelial jaw tumors
1. ameloblastoma 2. adenomatoid odontogenic tumor 3. calcifying epithelial odontogenic tumor (Pindborg) 4. squamous odontogenic tumor
68
mixed epithelial and ectomesenchymal jaw tumors
1. ameloblastic fibroma 2. ameloblastic fibro-odontoma 3. odontoma
69
ectomesenchymal jaw tumors
1. odontogenic fibroma 2. odontogenic myxoma 3. cementoblastoma
70
management of jaw tumors are based on what?
1. lesion behavior 2. anatomic location 3. desired reconstruction results
71
what drives tx choice of jaw tumors?
histological diagnosis
72
T/F: jaw tumors in the mandible have a poorer prognosis
false, poorer prognosis in maxilla
73
why is a jaw tumor in maxilla have a poorer prognosis?
due to undetected growth
74
why is anatomic location important in tx'ing jaw tumors?
1. proximity to adjacent vital structures 2. size of tumor 3. intraosseous vs extraosseous
75
why is management of jaw tumors partly based on desired reconstruction results?
the structure you want to recreate after the tumor is eradicated may influence how the surgery is performed
76
indications for enucleation and curettage of jaw tumors
1. slow-growing, non-aggressive tumors 2. most odontogenic tumors 3. medically compromised
77
tumor types that is indicated for enucleation and curettage
1. odontoma 2. ameloblastic fibroma 3. ameloblastic fibro-odontoma 4. AOT 5. cementoblastoma 6. odontogenic fibroma
78
indications for resection of jaw tumors
1. aggressive lesions either by histopath or clinical behavior 2. tumors that would be difficult to remove in entirety by enucleation/curettage alone
79
in order for jaw tumors to decrease chance of recurrence, what is needed?
tumors need a margin of uninvolved tissue (hard or soft)
80
tumor types that is indicated for resection of jaw
1. ameloblastoma 2. myxoma 3. CEOT 4. squamous odontogenic tumor
81
enucleation and curettage surgical technique
local removal of the tumor by instrumentation or direct contact with the lesion
82
T/F: enucleation and curettage surgical technique is the same for cysts
true but may have to section lesional tissue
83
resection
1. lesion is removed with a 1 cm margin of uninvolved tissue
84
what are the 3 different types of resection technique?
1. marginal 2. segmental 3. total
85
marginal resection
maintains continuity at inferior border
86
segmental resection
full-thickness portion removed
87
total resection
remove entire jaw

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