Odontogenic Cysts Flashcards
What are the three discussed Inflammatory Cysts?
Periapical (Radicular) Cyst
Residual Periapical (Radicular) Cyst
Buccal Bifurcation Cyst
What is the most common cyst of the jaws?
Periapical Cyst
The periapical cyst originates from stimulation of ______.
epithelial rests of Malassez (in the PDL)
What shape are periapical cysts?
round to ovoid [at the apex]
True or False: Periapical Cysts are associated with non-vital teeth.
True!
True or False: Periapical Cysts are asymptomatic.
True
What is a Lateral Radicular Cyst?
its a periapical cyst that develops on the lateral aspect of the root, due to presence of a lateral canal in the area
True or False: Periapical Cysts are fibrous connective tissue lined by nonkeratinized stratified squamous epithelium.
True
without the lining epithelium, it is a granuloma NOT a cyst
How is a periapical cyst treated?
root canal therapy
apicoectomy
extraction with curettage
Prognosis of a periapical cyst is excellent, but if the cyst is not removed, it may persist as a ______.
residual cyst
What is a residual cyst? How is it treated?
well-defined radiolucency in the site of a previous extaction which most often represents a periapical cyst which had not been removed
-treated with enucleation
True or False: Buccal Bifurcation Cysts usually occur in children.
True
Buccal for the Babies
Where are buccal bifurcation cysts usually found?
in the mandibular molars
think…bifurcation…mandibular molars have 2 roots
Buccal Bifurcation Cysts are due to proliferation of ______ epithelium association with enamel extensions in the furcation area.
crevicular
True or False: Buccal Bifurcation Cysts may produce swelling and a foul taste.
True
Radiographically, how are buccal bifurcation cysts identified?
- on an occlusal radiograph, the root apices are tipped toward the lingual cortex
- on PA radiographs, radiolucency in the furcation area
What is proliferative periostitis?
single or multiple layers of bone formation that may be seen in association with buccal bifurcation cysts
True or False: The tooth involved with a buccal bifurcation cyst may be lost due to bone destruction.
True
What is the most common DEVELOPMENTAL odontogenic cyst?
Dentigerous Cyst
What is the most common odontogenic cyst overall? Second most common overall?
Periapical= most common cyst Dentigerous= 2nd most common cyst, 1st most common developmental cyst
What is a Dentigerous Cyst?
accumulation of fluid between the crown of an unerupted tooth and the reduced enamel epithelium (the REE becomes the epithelial lining of the cyst)
If the radiolucency around a crown is greater than _____, it is probably safe to call it a dentigerous cyst. If it is smaller, it probably represents a ______.
5mm
hyperplastic dental follicle (histologically indistinguishable)
SIZE MATTERS :)
True or False: Any impacted tooth can potentially develop a dentigerous cyst.
True
What are the most common sites for a dentigerous cyst?
1st: Mandibular thirds
2nd: Maxillary canines
3rd: Maxillary thirds
Most dentigerous cysts present in the ____ or ____ decade.
2nd or 3rd
Radiographically, how are dentigerous cysts most easily identified?
the radiolucency surrounds the crown and CONNECTS AT THE “NECK OF THE TOOTH” (aka CEJ)
Dentigerous cysts have an uninflammed connective tissue wall lined by a thin layer of NKSS epithelium and a few scattered ____ cells in the lining.
mucous
How is a dentigerous cyst treated?
removal of the tooth and enucleation of the cyst
The tissue removed from a dentigerous cyst should be evaluated to rule out _____, ________, _____, or _____.
OKC
ameloblastoma
squamous cell carcinoma
intraosseous mucoepidermoid carcinoma
What is an eruption cyst?
a bluish swelling that forms in the soft tissue overlying the erupting crown (dentigerous is impacted)
Who is generally affected by eruption cysts?
children
-no treatment needed unless the child is biting on the cyst
A Primordial Cyst is a rare lesion that is thought to be histogenetically derived from the ________ epithelium.
degenerating tooth bud epithelium
(develops in place of a tooth before any mineralized material is deposited- it LOOKS like a residual cyst but there was never a tooth to begin with)
True or False: A primordial cyst may arise from any tooth in the dentition, even a supernumerary.
True
Primordial cysts have the microscopic features of ______.
OKC (odontogenic keratocyst)
Enucleation of a primordial cyst gives it a good prognosis. However, it the histology is that of OKC, why is the recurrence rate higher?
friable cyst lining
True or False: The odontogenic keratocyst is a common developmental odontogenic cyst.
True
Odontogenic Keratocysts are benign and ______.
aggressive
Which syndrome are OKCs associated with?
Nevoid Basal Cell Carcinoma Syndrome
Unless the patient has Nevoid Basal Cell Carcinoma Syndrome, OKC lesions are uncommon under the age of _____. Which decade shows peak incidence of OKC?
10 years old 3rd decade (20s)
True or False: OKC is more common in the maxilla.
False, mandible (2:1)
True or False: OKC is more common in the anterior region.
False, posterior
Patients over 70 years old, frequently have OKC lesions in the _____.
anterior maxilla
True or False: OKC lesions may occur anywhere in the maxilla or mandible.
True
Order of most common occurrence for OKC:
Posterior Mandible 49%
Posterior Maxilla 20%
Anterior Maxilla 13% (due to prevalence in elderly)
Anterior Mandible 9%
Up to 80% of OKC presents as a unilocular radiolucency with a ______ border.
thin, sclerotic
What type of material is usually noted inside the cyst during removal?
“cheesy” keratin material
What are the 3 histopathologic criteria for OKC?
- Uniform, thin, SS epithelial lining (8-10 cells thick)
- Surface layer of parakeratin
- Palisaded basal cell layer
The recurrence rate of OKC is increased if the cyst wall contains “______” lesions or “_____” cysts. What is the range of recurrence rates?
satellite lesions
daughter cysts
3-62% (average 30% recur)
Treatment for small OKC lesions is ______. Treatment for large OKC lesions is _______.
small: enucleation
large: marsupialization–> enucleation
True or False: If OKC is going to recur, it will do so within a year.
False, within 5 years
follow pts for 7 years to prevent recurrence
______ : A complex hamartoneoplastic malformation syndrome exhibiting over 100 different signs and symptoms related to the skin, CNS, and skeletal system.
Nevoid Basal Cell Carcinoma Syndrome
red flag: multiple OKC at an age less then 10
Nevoid Basal Cell Carcinoma Syndrome is also known as ______.
Gorlin-Goltz Syndrome
Gorlin Syndrome is an AD inherited disease associated with chromosome ___ and showing variable expressivity.
9
40% of cases are new mutations related to PTCH gene
Patients with Gorlin Syndrome (NBCCS) have what craniofacial attributes?
enlarged orbitofrontal circumference >60cm
heavy brow ridges
broad nasal roots
increased space between eyes (hypertelorism)
How does Gorlin Syndrome affect the rate of BCC?
Patients have: multiple BCC BCC in nonexposed areas BCC with melanin pigmentation BCC at an early age
What are two common skin ailments associated with Nevoid Basal Cell Carcinoma Syndrom?
Milia and Multiple Epidermal Cysts (50%)
1-2mm Shallow pits of palms and soles (65%)
What are the musculoskeletal and radiographic findings of Nevoid Basal Cell Carcinoma Syndrome?
Lamellar Calcification of the Falx Cerebri (85%)
Bifid/Fused/Hypoplastic Ribs (60%)
How often do Gorlin Syndrom patients have OKC of the jaws?
75% of patients
Gingival cysts of the newborn are microcystic structures that arise from ________.
dental lamina rests (rests of Serres)
aka dental lamina cysts
“Palatal Cyst of the Newborn” is a term used to describe three gingival cysts in infants. They are:
alveolar ridge =
palatal raphe =
jxn. hard/soft palate =
dental lamina cyst
Epstein’s Pearls
Bohn’s Nodules
Gingival Cyst of the newborn are ____ mm yellow-white papules, that often occur in multiples on the _______ of the newborn. The papules contain _____debris.
1-2 mm
alveolar ridge
keratin
True or False: The Gingival Cyst of the Adult arises from the rests of dental lamina just like those of the newborn.
True (rests of serres)
True or False: Gingival Cysts of the adult are more common in males.
False, no sex predilection
Gingival cysts of the adult occur in the ____ segments of the jaws and usually appear in patients over the age of ____.
anterior
40
How does a gingival cyst appear clinically?
- could be above or below MGJ
- often on facial
- less than 1 cm
- tense on palpation
- smooth surface, dome-shaped elevation
- no color change until larger (become bluish)
Gingival cyst cavities are lined by a thin layer of _____ stratified squamous epithelium.
cuboidal
Other than gingival cysts, which adult cysts develop from rests of serres?
Lateral Periodontal Cysts
Calcifying Odontogenic Cysts
same histology
The majority of Lateral Periodontal Cysts occur in the ______ _______ area with a few developing in the _______ _____ region.
most: mandibular premolar
some: maxillary lateral incisor
The peak incidence for lateral periodontal cysts is in the _____ and ____ decades.
5th and 6th
True or False: Lateral Periodontal Cysts are unilocular radiolucencies that are less than 1 cm in diameter.
True
Treatment of lateral periodontal cysts is ____.
curettage
Calcifying Odontogenic Cysts are also known as ______.
Gorlin Cysts
True or False: Gorlin Cysts are more common in the mandible.
False! Equal distribution
What percentage of Gorlin Cysts are found in the incisor/canine region?
65%
Calcifying Odontogenic Cysts are usually intrabony but 13-21% have been found in the ______.
gingival soft tissues (peripheral)
How do Calcifying Odontogenic Cysts usually affect adjacent roots?
resorption and divergence of the roots
____% of COCs are associated with an impacted tooth. _____% of COCs are associated with an odontoma.
30%
20%
The mean age for Calcifying Odontogenic Cysts is around _____ years.
33 years old
Calcifying Odontogenic Cysts have lesional cells that undergo a process termed _______ change and peripheral cells that ______.
Ghost Cell
palisate (line up)
Ghost Cells are pale and _____ with a swollen cytoplasm and lost nucleus.
eosinophilic
True or False: After enucleation and curretage, recurrence of COCs is not common.
True
