Odontogenic cysts Flashcards

1
Q

What is the most common cyst of the jaws?

A

periapical cyst

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2
Q

What are other names for periapical cysts?

A

also known as radicular cysts or apical periodontal cysts

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3
Q

How do periapical cyst originate?

A

due to inflammatory stimulation of the epithelial rests of Malassez

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4
Q

A periapical cyst has a round to ovoid radiolucency at ___ with loss of ___ ___.

A

apex; lamina dura

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5
Q

Periapical cyst is ___ (symptomatic/asymptomatic) and associated with a ___ (vital/nonvital) tooth.

A

asymptomatic; nonvital (pulp test!)

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6
Q

If a periapical cysts develops on the lateral aspect of the root, presumably due to the prescence of a lateral canal in the area, this is called ___ ___ cyst.

A

lateral radicular

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7
Q

Describe a periapical cysts microscopically.

A

inflamed granulation tissue or fibrous connective tissue lined by non-keratinized stratified squamous epithelium

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8
Q

If no cyst lining is seen, it is a “___ ___”.

A

periapical granuloma

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9
Q

How are periapical cysts treated?

A

root canal therapy, apicoectomy, extraction with curettage

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10
Q

The prognosis of a periapical cyst is ___, but if the cyst is not removed, it may persist as a ___ ___.

A

excellent; residual cyst

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11
Q

What is a well-defined radiolucency in the site of a previous extraction?

A

residual cyst

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12
Q

How is a residual cyst treated? What is the prognosis?

A

enucleation with excellent prognosis

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13
Q

A buccal bifurcation cyst usually occurs in ___ in their ___ ___.

A

children; mandibular molars

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14
Q

BBC are thought to be due to proliferation of ___ epithelium associated with ___ extensions in the ___ area.

A

crevicular; enamel; furcation

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15
Q

BBC has localized swelling where and is associated with what?

A

buccal aspect of alveolar process +/- pain, possible foul taste

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16
Q

What is another term for BBC?

A

paradental cyst

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17
Q

T/F. BBCs may be difficult to detect radiographically or may see a well-defined radiolucency in the furcation area superimposed over the roots.

A

True

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18
Q

BBC root apices are typically tipped to ___ cortex - can be seen on ___ radiograph.

A

lingual; occlusal

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19
Q

___ ___ might be seen with BBCs and single or multiple layers of bone formation.

A

Proliferative periostitis

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20
Q

T/F. Microscopically, BBCs look like a periapical cyst

A

True

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21
Q

What is the prognosis of BBC?

A

prognosis is good, but may need recontouring of furcation or perio surgery and involved tooth may be lost due to bone destruction

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22
Q

What is the most common developmental odontogenic cyst?

A

Dentigerous cyst

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23
Q

What is the second most common cyst overall (after periapical)?

A

Dentigerous cyst

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24
Q

Dentigerous cyst develop due to an accumulation of fluid between the ___ of the tooth and the ___ ___ epithelium, which eventually forms the epithelial lining of the cyst.

A

crown; reduced enamel

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25
Q

T/F. By definition, a dentigerous cyst is associated with the crown of an erupted tooth.

A

False, by definition, a dentigerous cyst is associated with the crown of an UNERUPTED tooth.

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26
Q

If the radiolucency around the crown is greater than ___, it is safe to call it a cyst. If it is smaller, it probably represents a hyperplastic dental ___ - the two are histologically indistinguishable.

A

5; follicle

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27
Q

T/F. Any impacted tooth can potentially develop a dentigerous cyst.

A

True.

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28
Q

What is the 1st, 2nd, and 3rd most common site of a dentigerous cyst?

A

1st - mandibular third molar
2nd - maxillary canine
3rd - maxillary third molar

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29
Q

When do dentigerous cysts present? What are the symptoms?

A

2nd and 3rd decades

usually asymptomatic, but can produce swelling or resorption of adjacent tooth roots

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30
Q

Microscopically, an ___ fibrous CT wall is lined by a thin layer of ___ ___ ___ epithelium with a few scattered ___ cells in the lining of a dentigerous cyst.

A

uninflamed; non-keratinized, stratified squamous; mucous

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31
Q

How is a dentigerous cyst treated?

A

removal of the tooth and enucleation of the cyst

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32
Q

T/F. The prognosis of a dentigerous cyst is poor and the tissue should be examined microscopically to rule out OKC, ameloblastoma, or (rarely) squamous cell carcinoma or intraosseous mucoepidermoid carcinoma.

A

False, The prognosis of a dentigerous cyst is EXCELLENT but the tissue should be examined microscopically to rule out OKC, ameloblastoma, or (rarely) squamous cell carcinoma or intraosseous mucoepidermoid carcinoma.

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33
Q

What represents a dentigerous cyst that forms in the soft tissue overlying the crown of an erupting tooth?

A

eruption cyst

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34
Q

An eruption cyst has a ___ swelling and is termed “___ ___”.

A

bluish; eruption hematoma

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35
Q

T/F. Children are usually affected with an eruption cyst.

A

True.

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36
Q

A primoridal cyst is a ___ (common/rare) lesion that is thought to be histogenetically derived from degenerating tooth ___ epithelium.

A

rare; bud

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37
Q

___ cysts develop in place of a tooth, before any ___ material is deposited.

A

Primordial; mineralized

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38
Q

T/F. A history of extraction or surgery in the area is mandatory for a diagnosis of Primordial cyst.

A

False, NO history of extraction or surgery in the area is mandatory for a diagnosis of Primordial cyst.

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39
Q

T/F. Primordial cyst can arise from any tooth in the dentition including (theoretically) supernumeraries.

A

True

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40
Q

Primordial cysts are usually detected as ___ radiolucencies in the area of a ___ tooth.

A

unilocular; missing

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41
Q

Some controversy exists, but the majority of primordial cysts have the microscopic features of ___ ___.

A

odontogenic keratocyst

42
Q

Primordial cysts are treated with ___ and the prognosis is ___, although if the histology is that of an ___, the lesion will have the ___ recurrence rate of that lesion.

A

enucleation; good; OKC; increased

43
Q

Odontogenic Keratocyst is a relatively ___ developmental odontogenic cyst that is ___ but more aggressive than other odontogenic cysts.

A

common; benign

44
Q

What syndrome is OKC associated with?

A

nevoid basal cell carcinoma syndrome

45
Q

With OKC, virtually no cases are seen under ___ yo unless the patient has the syndrome. The peak incidence is usually seen in the ___ decade.

A

10; 3rd

46
Q

OKC prefers the what site?

A

mandible (2:1 ration over the maxilla)

47
Q

With OKC, mandibular lesions usually develop in the ___ quadrants or the ___.

A

posterior; ramus.

48
Q

With OKC, the ___ ___ is favored in patients after 70yo.

A

anterior maxilla

49
Q

T/F. OKCs are typically asymptomatic and resemble primordial cyst, dentigerous cyst, residual cyst or lateral periodontal cyst.

A

True.

50
Q

Up to ___% of OKCs present as ___ radiolucencies with well-demarcated margins and ___ sclerotic borders.

A

80; unilocular; thin

51
Q

T/F. OKCs can hollow out the mandible without expansion.

A

True.

52
Q

What percentage of OKCs exhibit the classic multilocular, expansile radiolucent appearance, which is probably related to the size of the lesion?

A

20%

53
Q

With OKCs, what is noted at time of surgery?

A

cheesy material

54
Q

What three histopathologically criteria are met for OKC?

A
  1. uniformly thin epithelial lining - stratified squamous (8-10 cells thick)
  2. corrugated surface layer of parakeratin
  3. palisaded basal cell layer
55
Q

With OKC, the CT wall is usually ___. If inflammation is present, this will markedly alter the histology of the ___.

A

uninflamed; epithelium

56
Q

___ alters the appearance of the cyst lining with OKC.

A

Inflammation

57
Q

How are OKCs treated?

A

treatment is controversial and depends on size

if small, enucleate in one piece
if larger, marsupialization followed by enucleation

58
Q

The prognosis for OKC is guarded and recurrence rates range from ___-___%, but the average is approximately ___%.

A

3-62%; 30%

59
Q

If they are going to recur, most OKCs do so within ___ years. Patients should be followed ___ for at least __ years post-surgery in order to detect potential recurrent lesions.

A

5; annually; 7

60
Q

What is a complex hamartoneoplastic/malformation syndrome exhibiting over 100 different signs and symptoms related to the skin, CNS, and skeletal system?

A

Nevoid basal cell carcinoma syndrome

61
Q

What condition can be seen if a pt has multiple OKCs arising at an early age?

A

Nevoid basal cell carcinoma syndrome

62
Q

What are alternative names for Nevoid basal cell carcinoma syndrome?

A

Gorlin syndrome and Gorlin-Goltz syndrome (europe)

63
Q

Nevoid basal cell carcinoma syndrome is an autosomal ___ disease of chromosome ___, with ___ ___ and extremely variable ___.

A

dominant; 9; complete penetrance; expressivity

64
Q

In NBCC, ___% of cases are new mutation related to ___ gene.

A

40%; PTCH

65
Q

What are the craniofacial features of NBCC?

A
  1. enlarged occipitofrontal circumference (60cm or more in adults)
  2. heavy brow ridges - frontal bossing
  3. broad nasal root
  4. mild ocular hypertelorism
66
Q

What are the skin findings for NBCC?

A

BCCs

  1. are multiple
  2. occur in unexposed and exposed skin
  3. develop earlier (puberty - 35yo)
  4. show melanin pigmentation
  5. quiescent, with few being aggressive
67
Q

In NBCC, ___% have milia and multiple epidermal cysts and ___% have 1-2mm shallow pits of the palms and/or soles.

A

50%: 65%

68
Q

___% of NBCC shows lamellar calcification of the ___ ___ and ___% have bifid, fused or hypoplastic ___.

A

85%; falx cerebri; 60%; ribs

69
Q

In patients with NBCC, OKCs of the jaws develop in at least ___% of affected patients. This may begin in the 1st decade after age ___.

A

75%; 7

70
Q

T/F. OKCs in NBCC syndrome can be single or multiple but the patient is more likely to have multiple.

A

True.

71
Q

How is NBCC treated?

A
  1. genetic counseling
  2. remove OKCs as needed
  3. remove basal cell Ca’s as needed
  4. use sunscreen and reduce sun exposure to decrease risk of basal cell CA
72
Q

T/F. The prognosis of NBCC is guarded and usually BCCs are relatively small and not very aggressive, but this may be variable.

A

True.

73
Q

When biopsying a newborns ___ ___ in gingival cyst of the newborn, numerous ___ structures appear to represent an enlarged version of the normal structures that arise from ___ ___ ___ (rest of Serres).

A

alveolar ridge; microcystic; dental lamina rests

74
Q

What are other names for gingival cyst of the newborn?

A

dental lamina cyst and alveolar cyst of the newborn

75
Q

Similar to gingival cyst of the newborn, if cysts are found on the ___ ___ it is called Epstein’s pearls) or if they are found laterally along the ___ and ___ ___ they are known as Bohn’s nodules.

What term encompasses all these lesions?

A

palatal raphe; hard and soft palate

palatal cyst of the newborn

76
Q

Gingival cyst of the newborn presents a 1-2mm yellow-white ___ often multiple on the ___ ___ of the ___ in a newborn infant.

A

papules; alveolar ridge; maxilla

77
Q

Gingival cyst of the newborn has a thin, uniform stratified squamous epithelial lining and the cyst lumen is packed with ___ debris.

A

keratin

78
Q

How is gingival cyst of the newborn treated?

A

None, it will either self-marsupialize or involute/degenerate spontaneously.

79
Q

Gingival cyst of the adult is related to ___ ___ cyst and it probably arises from the rests of ___ ___ (___) found in gingival CT.

A

lateral periodontal; dental lamina (Serres)

80
Q

What gives rise to the gingival cyst of the adult?

A

cystic degeneration of the rests

81
Q

T/F. Gingival cyst of the adult is usually found in men over 70 in the posterior segments of the jaw.

A

False, Gingival cyst of the adult has NO SEX predilection, found over 40 in the ANTERIOR segments of the jaw.

82
Q

T/F. Gingival cyst of the adult is only found above the mucoginigival junction on the facial side.

A

False, it can be above or below the mucogingival junction. often on the facial but can be seen on the lingual as well

83
Q

Gingival cyst of the adult presents as a ___-surfaced, ___ shaped elevation affecting the ___ gingiva that is usually ___cm in diameter and tense upon palpation.

A

smooth; dome; attached: 1cm

84
Q

In early lesions, no color change is noted, but larger ones have a ___ or ___ quality.

A

bluish; translucent

85
Q

T/F. In gingival cyst of the adult, the gingival CT contains a cystic cavity lined by thin, uniform layer of cuboidal or attenuated stratified squamous epithelium.

A

True.

86
Q

What is the treatment and prognosis of gingival cyst of the adult?

A

tx: conservative excision
prognosis: excellent

87
Q

What is a non-keratinized developmental cyst occurring adjacent or lateral to the root of a tooth, probably arising from rests of dental lamina (rests of Serres)?

A

lateral periodontal cyst

88
Q

What does the majority of lateral periodontal cysts occur?

A

mandibular premolar area with a few developing in the maxillary lateral incisor region

89
Q

Lateral periodontal cyst peaks in the ___th or ___th decades and presents as an ___ (symptomatic/asymptomatic) unilocular radiolucency on the ___ root surface of the tooth typically less than ___cm in diameter.

A

5; 6; asymptomatic; lateral; 1

90
Q

Lateral periodontal cyst has a thin, uniform stratified squamous epithelium lining uninflamed fibrous CT that is identical microscopically to what condition?

A

gingival cyst of the adult

91
Q

What is the treatment, prognosis and recurrence of lateral periodontal cyst?

A

tx: curettage
prognosis: excellent
recurrence: rare, but follow-up with radiographs

92
Q

What is also known as a “Gorlin Cyst”?

A

Calcifying Odontogenic cyst

93
Q

Calcigying Odontogenic cyst arises from where?

A

rests of dental lamina (rests of Serres)

94
Q

T/F. Calcifying Odontogenic cysts are mostly found in the maxilla in the first decade.

A

False, it is equally found between the maxilla and mandible in the second or third decade (33yrs)

95
Q

___% of calcifying odontogenic cysts are found in the incisor/canine region.

A

65%

96
Q

Calcifying odontogenic cysts are usually ___ but from ___-___% have been reported in the gingival soft tissues and called “___”.

A

intrabony; 13-21%; peripheral

97
Q

With COC, there may be expansion of the ___ bone, a well-defined unilocular radiolucency but ___% may be multilocular and scattered radiopacities is seen in about ___% of cases.

A

alveolar; 10%; 50%

98
Q

What percentage of COCs is associated with an impacted tooth? Odontoma?

A

30%

20%

99
Q

T/F. Resorption and divergence of adjacent roots is often seen with COCs.

A

True.

100
Q

Microscopically, COCs appear similar to odontogenic tumors and ameloblastomas and peripheral ___ cells and ___ ___-like areas are seen.

A

palisading; stellate reticulum

101
Q

In COC, some of the lesional cells undergo a process termed “___ ___” when they change (keratinization?) and may calcify.

Describe these cells.

A

ghost cell

They are pale and eosinophilic with a swollen cytoplasm with loss of the nucleus that exhibits a faint “ghostly” remnant of a nuclear membrane outline.

102
Q

How are COCs treated? What is the recurrence rate?

A

tx: enucleation with curretage
recurrence: not common, but does occur so follow-up recommended.