odontogenic cysts Flashcards
Periapical Cyst
most common cysts of jaw, inflammatory origin
Periapical Cyst caused by what
inflammatory stimulation of the epithelial rests of Malassez
Periapical Cyst clinically
asymmptomatic,
non vital tooth
Periapical Cyst radiographically
roud ovid radiolucency at apex
Periapical Cyst microscopically
inflamed granulation tissue or fibrous connective tissue lined by non- keratinized stratified squamous epithelium
Periapical Cyst, inflammation through lateral canals can lead to what
lateral radicular cyst
Periapical Cyst trt
endodontic therapy +/- apicoectomy, or extraction with curettage
Periapical Cyst prognosis
excellent
Periapical Cyst, if tooth is removed lesion may occasionally persist…called what
residual periapical cyst
Dentigerous Cyst is what kind of cyst
Most common developmental odontogenic cyst, second overall only to periapical (inflammatory)
Dentigerous Cyst, whats happening
Fluid accumulates between the crown of the tooth and the reduced enamel epithelium (increased osmotic pressure), leading to gradual enlargement of the cyst
leads to Subsequent infection/inflammation may occur
Dentigerous Cyst characteristic
When lucent space around the crown is > 3-4 mm, considered consistent with dentigerous cyst
Dentigerous Cyst radiographically
are mimicked by many odontogenic cysts and tumors
Dentigerous Cyst most common site
mandibular 3rd molar region, maxillary canines, maxillary 3rds
Dentigerous Cyst present when
2nd 3rd decade of life.
Dentigerous Cyst clinically
usually asymptomatic. unless infection is present, may resorb adjacent roots or produce swelling
Dentigerous Cyst microscopically
uninflamed fibrous connective tissue lined by a thin non-keratinized stratified squamous epithelium
can have scattered mucus cells in lining
Dentigerous Cyst trt
Removal of the tooth and enucleation of the cyst, decompression of large cysts
Dentigerous Cyst prognosis
excellent
Dentigerous Cyst what do you do after enucleation of the cyst
Microscopic exam of lesional tissue to rule out OKC, ameloblastoma, other odontogenic cysts/tumors, or (rarely) central mucoepidermoid carcinoma
Eruption Cyst
Adentigerous cyst that forms in the soft tissue overlying the crown of an erupting tooth
Eruption Cyst what does it look like
Bluish swelling common (bleeding), thus the term “eruption hematoma”
Eruption Cyst affects who
mostly children
Primordial Cyst common or rare?
rare
Primordial Cyst derived from what
from degenerating tooth bud epithelium
Primordial Cyst develops when
in place of a tooth, before any mineralized material is deposited
Primordial Cyst clinical/radiographically diagnosis
based on no history of extraction or surgery in the area
Primordial Cyst which tooth?
any tooth
Primordial Cyst radiographically
as a unilocular radiolucency in the area of a missing tooth, usually a 3rd molar
Primordial Cyst microscopically look like what
odontogenic keratocyst (OKC)
Primordial Cyst trt
Enucleation
Primordial Cyst prognosis
Good. With histologic diagnosis of OKC, periodic radiographic follow-up for local recurrence is warranted.
Odontogenic Keratocyst, common or rare? aggressiveness?
Relatively common, but locally aggressive cyst (keratocystic odontogenic tumor)
Odontogenic Keratocyst associated with what syndrome
Associated with nevoid basal cell carcinoma syndrome (suspected in pts.
Odontogenic Keratocyst who and where
peak at 3rd decade
mandible- posterior ramus
Odontogenic Keratocyst, after 60 years old where is the most common site
anterior maxilla
Odontogenic Keratocyst clinically
asymptomatic, can cause some swelling/discomfort with enlargement.
Odontogenic Keratocyst radiographically
Majority (up to 80%) present as unilocular radiolucencies with well-demarcated margins and a thin sclerotic border
Only 20% exhibit the classic multilocular, expansile radiolucent appearance, which is probably related to the size of the lesion
Odontogenic Keratocyst 3 criteria histologically
- uniformly thin epithelial lining - stratified squamous – 6-8 cells thick
- corrugated surface layer of parakeratin
- palisaded, dark basal cell layer
Odontogenic Keratocyst CT cell wall
can be inflammed or uninflammed. will look different histologically
Odontogenic Keratocyst trt
is controversial and depends on size of lesion
With smaller lesion, careful enucleation as a single piece is ideal
With larger lesion, decompression followed by enucleation
Odontogenic Keratocyst prognosis
guarded
Odontogenic Keratocyst recurrence
3-62%
5-year minimum follow- up indicated a 40-50% recurrence rate
Odontogenic Keratocyst should be monitored for how long
7 years after surgery
Nevoid Basal Cell Carcinoma Syndrome
A complex syndrome of malformations and neoplasms exhibiting over 100 different features related to skin, CNS, and skeleton
Nevoid Basal Cell Carcinoma Syndrome which gene and chromosome
PTCH gene,
chromosome 9
Nevoid Basal Cell Carcinoma Syndrome genetic characteristic
Autosomal dominant, extremely variable expressivity, 40% are new mutations
Nevoid Basal Cell Carcinoma Syndrome Craniofacial features:
– Enlarged occipitofrontal cranial circumference (60 cm or more in adults)
– Heavy brow ridges
– Broad nasal root
– Mild ocular hypertelorism
Nevoid Basal Cell Carcinoma Syndrome skin features:
- are multiple
- occur in unexposed, as well as exposed, skin
- develop at an earlier age (puberty-35 years)
- often show melanin pigmentation
- are usually quiescent, with a few being aggressive
also
1-2 mm shallow pits of the palms and/or soles (65%)
Milia and multiple epidermoid cysts (50%)
Nevoid Basal Cell Carcinoma Syndrome radiographic findings
Lamellar calcification of the falx cerebri (85%)
Bifid, fused or hypoplastic ribs (60%)
Nevoid Basal Cell Carcinoma Syndrome dental concerns
Odontogenic keratocysts of the jaws (85%) may develop during 1st decade, but after age 7 years
patient is more likely to have syndrome if ______
multiple
Nevoid Basal Cell Carcinoma Syndrome trt
- genetic counseling
- remove OKCs as needed 3. remove BCCs as needed
- patient should use sunscreen and reduce sun exposure to decrease risk of basal cell Ca
Nevoid Basal Cell Carcinoma Syndrome prognosis
guarded, radiographically follow ups
Gingival Cyst of the Newborn also called what
dental lamina cyst
Gingival Cyst of the Newborn, where do they come from
enlarged structures probably from dental lamina
Gingival Cyst of the Newborn what are they
Present as 1-2 mm yellow-white papules, often multiple on alveolar ridge of newborn infant
Gingival Cyst of the Newborn where are they found
maxilla usually
Gingival Cyst of the Newborn histo
Thin, uniform stratified squamous epithelial lining
Cyst lumen is packed with keratin debris

Gingival Cyst of the Newborn trt
None, self marsupialize.
Gingival Cyst of the Adult forms from
Related to the lateral periodontal cyst
Arises from dental lamina rests in the gingival connective tissue (rests of Serres)
Gingival Cyst of the Adult who and where
adults, 40 years and older, anterior segments
Gingival Cyst of the Adult clinical appearance
Smooth-surfaced, dome-shaped elevation of the attached gingiva
Usually less than 1 cm in diameter Tense on palpation
Otherwise asymptomatic
Translucent or bluish appearance is often noted
Gingival Cyst of the Adult may look like a resemble
May mimic mucocele, but on attached gingiva
Minimal, if any, findings on radiograph
Gingival Cyst of the Adult histo
a cystic cavity lined by a thin, uniform layer of cuboidal or attenuated non-keratinized stratified squamous epithelium
Gingival Cyst of the Adult trt
conservative excision
Gingival Cyst of the Adult prognosis
excellent
Lateral Periodontal Cyst
Defined as a developmental cyst occurring adjacent or lateral to the root of a tooth,
Lateral Periodontal Cyst arises from what
intrabony rests of dental lamina
Lateral Periodontal Cyst where
Mandibular premolar area, maxillary lateral incisor region
Lateral Periodontal Cyst who and when
5th and 6th decade
Lateral Periodontal Cyst clinical
Asymptomatic unilocular radiolucency, lateral root surface of vital tooth
Typically less than 1 cm in diameter
Lateral Periodontal Cyst histo
thin non-keratinized stratified squamous epithelium lining, uninflamed fibrous connective tissue
Lateral Periodontal Cyst trt
curettage
Lateral Periodontal Cyst prognosis
excellent
Calcifying Odontogenic Cyst also known as
Gorlin cyst
Calcifying Odontogenic Cyst found where
Equal distribution between maxilla and mandible; anterior > posterior jaws
Calcifying Odontogenic Cyst, when
May occur at any age, with peak occurrence in second and third decade (mean age - 33 years)

Calcifying Odontogenic Cyst radiographically
Usually a well-defined, unilocular radiolucency
Scattered radiopacities in about 50% of cases
Calcifying Odontogenic Cyst, MOST 85% are ____
cystic
some solid variants though
30% of COC’s are associated with an ______, 20% with ______, (~ 80% of cases __________)
impacted tooth, odontoma, resorption of adjacent tooth roots common
Calcifying Odontogenic Cyst histo
with proliferation of odontogenic epithelial cells which at their periphery show a cuboidal or columnar appearance of the basal cells, similar to ameloblastoma
Calcifying Odontogenic Cyst, as cells approach the lumen what happens
“ghost cell change”
Cells are pale and eosinophilic, with swollen cytoplasm and loss of the nucleus that exhibits a faint nuclear membrane outline
maybe a form of coagulative necrosis
Calcifying Odontogenic Cyst trt
enucleation with curettage
Calcifying Odontogenic Cyst reoccurrence?
possible, follow up periodically
