Odontogenic Cysts Flashcards
3 Inflammatory Cysts
- Periapical (Radicular) Cyst
- Residual Periapical (Radicular) Cyst
- Buccal Bifurcation Cyst
8 Developmental Cysts
- Dentigerous Cyst
- Eruption Cyst
- Primordial Cyst
- Odontogenic Keratocyst (OKC)
- Gingival (alveolar) Cyst of the Newborn
- Gingival Cyst of the adult
- Lateral Periodontal Cyst
- Calcifying Odontogenic Cyst
Most common cyst of the jaws
Periapical cyst
How does a periapical cyst usually originate?
Due to inflammatory stimulation of the epithelial rests of Malassez
Teeth associated with a periapical cyst usually test _____ (vital/non-vital)
Non-vital
Why might a patient with a periapical cyst be experiencing pain?
If there is a secondary infection or if the cyst is large
A periapical cyst may also present as a ___ ___ cyst
Lateral radicular cyst
A periapical cyst shows inflamed granulation tissue or fibrous connective tissue lined by _______ (keratinized/non-keratinized) _____ ______ epithelium
Non-keratinized stratified squamous
If there is NO cyst lining, then a periapical cyst is referred to as a ____ _____
Periapical granuloma
Treatment for a periapical cyst
- Endo
- Apicoectomy
- Extraction
If a periapical cyst is not removed or resolved, then it may persist as a _____ _____
Residual cyst
Where will you see a residual cyst?
In the site of a previous extraction or endo treated tooth
Treatment for residual cyst
Enucleation
A cyst in the mandibular molars (mostly) that usually affects children
Buccal bifurcation cyst
You may see ____ ____ in a patient with a buccal bifurcation cyst
Proliferative periostitis
The histology of a buccal bifurcation cyst is similar to what other cyst?
Periapical
Treatment for a buccal birfurcation cyst?
Enucleation
Most common developmental odontogenic cyst
Dentigerous cyst
Most common cyst overall? 2nd most common?
Most - periapical
2nd - dentigerous
Why does a dentigerous cyst develop?
Due to accumulation of fluid between the crown and the reduced enamel epithelium, which eventually forms the epithelial lining of the cyst
What part of the tooth is a dentigerous cyst associated with?
The crown of an unerupted tooth
How can you distinguish between a dentigerous cyst and a hyperplastic dental follicle?
> 5 mm = cyst
< 5 mm = follicle
Most common tooth to have a dentigerous cyst? 2nd most? 3rd most?
Most - mandibular 3rds
2nd - maxillary canine
3rd - maxillary 3rds
Is a dentigerous cyst inflamed or uninflamed?
Uninflamed
Treatment for a dentigerous cyst
Remove tooth and cyst
If there are mucous cells in the lining of a dentigerous cyst, then they may explain:
Central (intraosseous) mucoepidermoid carcinoma
Dentigerous cyst that forms in the soft tissue overlying the crown of an erupting tooth (seen in children)
Eruption cyst
Eruption cysts can also be called ___ ___ due to their coloring
Eruption hematoma
Rare lesion that is thought to be histogenetically derived from degenerating tooth bud epithelium
Primordial cyst
A primordial cyst develops in place of:
A tooth, before any mineralized material is deposited
What is mandatory when diagnosing a primordial cyst?
No history of extraction or surgery in the area
The Europeans insist that primordial cysts are the same as ____
OKCs
What type of epithelium is seen in primordial cysts?
Parakeratotic stratified squamous epithelium
What type of basal cells are seen in primordial cysts
Hyperchromatic palisaded basal cells
True/False: If the histology of a primordial cyst is that of an OKC, then the lesion will have the increased recurrence rate of OKC?
True
OKCs can occur singly or can be associated with _____
Nevoid Basal Cell Carcinoma Syndrome (NBCCS)
OKCs may resemble:
Primordial cysts, dentigerous cysts, residual cysts, or lateral periodontal cysts
What area of the mouth do OKCs favor after the age of 70?
Anterior maxilla
When might a patient have an OKC under the age of 10?
If they have a syndrome
What area of the mouth is the most common for OKCs?
Posterior mandible
3 criteria for OKCs
- Uniformly thin epithelial lining of stratified squamous epithelium 8-10 cells thick
- Corrugated paraketatin surface
- Palisaded basal cell layer
Treatment of OKC if smaller? If larger?
Smaller - enucleate in one piece
Larger - marsupialization followed by enucleation
Prognosis for OKC
Guarded
The syndrome when multiple OKCs arise at an early age
Nevoid Basal Cell Carcinoma Syndrome
Another name for NBCCS
Gorlin Syndrome
NBCCS is autosomal ____
Dominant
Clinical features of NBCCS
Enlarged occipitofrontal circumfrence, heavy brow ridges, broad nasal root, mild ocular hypertelorism
Skin features of NBCCS
Milia and multiple epidermal cysts
1-2 mm shallow pits on palms/soles
NBCCS have 5 features
- Are multiple
- Occur in unexposed and exposed skin
- Develop at an earlier age
- Often show melanin pigmentation
- Usually quiescent, a few are aggressive
2 radiographic features that most patients with NBCCS show?
- Lamellar calcification of the falx cerebri
2. Bifid, fused or hypoplastic ribs
Treatment for NBCCS
Remove OKCs and BCCs as needed
Prognosis for NBCCS
Guarded
“Dental lamina cyst”
Gingival cyst of the newborn
What do gingival cysts of the newborn represent?
An enlarged version of the normal microcystic structures that arise from dental lamina rests (rests of Serres)
What are the gingival cysts of the newborn called if they’re on the palatal raphe? If they’re laterally along the hard/soft palate?
Palatal raphe - Epstein’s pearls
Lateral of hard/soft palate - Bohn’s nodules
What term encompasses Epstein’s pearls and Bohn’s nodules?
Palatal cyst of the newborn
Clinical features of gingival cysts of the newborn? Usually which arch?
1-2mm yellow-white papules on the alveolar ridge of the newborn (usually maxillary)
What type of debris will you find in the lining of a gingival cyst of the newborn
Keratin
Why do gingival cysts of the newborn not require any treatment?
They self-marsupialize or involute/degenerate spontaneously
Where are gingival cysts of the adult typically found?
Anterior segments of the jaws above or below the MGJ (usually facial)
What radiographic changes are seen in gingival cysts of the adult?
Minimal, if any
Treatment for gingival cysts of the adult
Conservative excision
A non-keratinized developmental cyst occuring adjacent or lateral to the root of a tooth, probably arising from rests of dental lamina (rests of Serres)
Lateral periodontal cyst
Most common area to see a lateral periodontal cyst
Mandibular premolar-canine-lateral incisor region
What cyst does the lateral periodontal cyst look identical to in the histology?
Gingival cyst of the adult
Treatment for a lateral periodontal cyst
Curettage
Most Calcifying Odontogenic Cysts (Gorlin cysts) are seen in what region?
Anterior (incisor-canine region)
Calcifying Odontogenic Cysts are usually _____
Intrabony
Calcifying Odontogenic Cysts have 3 important radiographic features
- Scattered radiopacities
- Associated with impacted teeth
- Associated with odontoma
The teeth in a Gorlin Cyst test ____
Vital
A Gorlin cyst is histologically similar to a ____ ____ ____
Odontogenic Tumor Ameloblastoma
Some lesional Gorlin cyst cells undergo ___ ___ change
“Ghost cell” (loss of nucleus exhibits ghostly remnant of nuclear outline)
Treatment for Gorlin cyst
Enucleation and curettage
