odontogenic cysts Flashcards
What is a cyst?
Pathological cavity filled wholly or partly by epithelium and contains fluid or semi fluid contents
Name 2 types of inflammatory cysts?
Radicular
Residual
Name 4 types of developmental cysts?
Odontogenic keratocyst Dentigerous cysts Eruption cyst Lateral periodontal cyst Gingival cyst Calcifying odontogenic cyst
Name 4 non odontogenic cysts?
Nasopalatine
Nasolabial
Stafne bone cyst
Aneurysmal bone cyst
Radicular cysts:
Explain where they are derived from, clinical and radiology signs and treatment options?
Aetiology:
- derived from cell rests of malassez
- 50% most common cyst
Clinical:
- associated with non vital teeth
- most common in maxilla
Radiology:
- round radiolucency with radiopaque margin extending from lamina dura of non vital teeth
Treatment:
- Endo Tx
- apicetomy +/- cyst enucleation
- retrograde root filling
- XLA +/- cyst enucleation
Residual cysts:
Explain where they are derived from, clinical and radiology signs and treatment options?
Aetiology:
- derived from cell rests of malassez
- peak age >30yrs
Clinical:
- not associated with teeth
Radiology:
- round radiolucency with radiopaque margins not associated with teeth
Treatment:
- enucleation or marsupialisation
Dentigerous cysts:
Explain where they are derived from, clinical and radiology signs and treatment options?
Aetiology:
- derived from reduced enamel epithelium
- 2nd most common cyst
Clinical:
- associated with crown of unerupted tooth
- mandibular 3rd molar and maxillary canines most commonly affected
Radiology:
- circumscribed, unilocular, well defined sclerotic margins associated with crown of an unerupted tooth
Treatment:
- Enucleation +/- XLA
- consider coronectomy if risk of nerve damage
Eruption cysts:
Explain where they are derived from, clinical and radiology signs and treatment options?
Aetiology:
- derived from reduced enamel epithelium
- most common in children
Clinical:
- painless, soft, fluctuant swelling seen in gingivae overlying erupting tooth
- may be blue or purple
- may be common with deciduous and permanent erupting teeth
Radiology:
- radiolucency lesion at alveolar margin and non bony involvement
Treatment:
- asymptomatic - monitor
- symptomatic - surgical excision
Lateral periodontal cyst:
Explain where they are derived from, clinical and radiology signs and treatment options?
Aetiology:
- inconclusive
- peak age 40-70yrs
Clinical:
- may be seen as blue fluctuant swelling associated with gingivae adjacent to vital tooth
- common in mandibular premolars and anterior maxilla regions
Radiology:
- between cervical margin and apex of tooth, round or oval shape, less than 1cm diameter with sclerotic margins
Treatment:
- enucleation or excision
Odontogenic keratocyst:
Explain where they are derived from, clinical and radiology signs and treatment options?
Aetiology:
- inconclusive
- lined with stratified squamous keratinised epithelium
- recurs due to daughter cysts, friable lining and site
- 3rd most common cysts
Clinical:
- may have Associated inferior alveolar nerve paraesthesia
- most common on angle of mandible
Radiology:
- may be unilocular/multilocular, defined sclerotic margins but may be diffuse and have scalloped margins.
Treatment:
- enucleation +/- cryotherapy and carnoys solution due to increased recurrence rate
What is the pattern of inheritance of Gorlin-Goltz syndrome?
Autosomal dominant condition
What is the other name for Gorlin-Goltz syndrome?
Basal cell naevus syndrome
What are the characteristic features of Gorlin-goltz syndrome?
Multiple odontogenic keratocysts in young people Multiple basal cell naevus (BCC) Mid face hypoplasia Frontal bossing - trapezoid skull Prognathism Falx cerebra calcification. Skeletal abnormalities - bifid ribs
What radiology feature is observed with nasopalatine cysts?
Radiographic heart shaped radiolucency
What is the process of enucleation?
- removal of entire cyst lining and repair of the defect
- incision clear of margin lesions and bone overlying lesion may be removed
- aspiration of lesion contents to allow for dissection and avoid rupture followed by debridement of the area
- sutures will lie over healthy bone once removed
- requires 1 visit as whole lining is removed for histology. Less likely to recur but may require GA/sedation
What is the process of marsupialisation?
- involves creation of surgical window in lining of the cyst by removal of overlying mucosa, mucoperiosteal bone to decompress the lumen
- patency of the hole is secured by suture of the cyst lining to mucosa with non resorbable sutures for 10days then removed/replaced
- allows for cyst to decrease due to decreased hydrostatic pressure
- requires multiple visits - minimally invasive, less histology sample and recurrence more common
What is an Ochsenbein-Luebke flap?
Modified 3 sided flap for peri radicular surgery
What is the process of peri radicular surgery?
Remove 3mm of apex and then remove apical 3mm of obturation using ultrasonic
Cut at right angles to root - perpendicular
Retrograde seal:
- RM ZOE; radiopaque, bacteriostatic. Doesn’t prompt cementogenesis and may resorb.
- MTA: (biocompatible, promotes cementogenesis, good seal and moisture resistant).
Close flap with 4 or 5.0 sutures starting with papillae then relieving incisions.
What is the commonest mode of spread of adenoid cystic carcinoma?
Perineural spread
