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Module 7 > ORAL PATH odontogenic cysts > Flashcards

ORAL PATH odontogenic cysts Flashcards

1
Q

What is a cyst?

A

a pathological cavity having fluid or semi-fluid content

lined wholly or in part by epithelium

NOT due to accumulation of pus

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2
Q

what is an accumulation of pus called?

A

an abscess

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3
Q

what are the 2 main classifications of cysts of the jaws?

A

odontogenic
non-odontogenic

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4
Q

where are odontogenic cysts derived from?

A

epithelial residues of tooth-forming organ

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5
Q

what are the 2 categories of odontogenic cysts?

A

inflammatory
developmental

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6
Q

what do teeth develop from?

A

odontogenic epithelium and neural crest derived ectomesenchyme

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7
Q

what becomes the enamel organ?

A

dental lamina budding down from the ectoderm

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8
Q

what are the 4 layers of the enamel organ?

A

inner enamel epithelium
outer enamel epithelium
stellate reticulum
stratum intermedium

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9
Q

what layer of the enamel organ forms ameloblasts?

A

inner enamel epithelium

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10
Q

what cells develop into the pulp?

A

ectomesenchyme

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11
Q

how is dentine laid down?

A

by odontoblasts which are differentiating pulpal cells

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12
Q

at what point is the enamel matrix laid down?

A

after dentine is laid down

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13
Q

how is root formation mapped out?

A

after crown formation, the enamel organ reduces to form the root sheath of hertwig

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14
Q

what are remnants of the dental lamina known as?

A

glands of serres

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15
Q

what are remnants of the root sheath of hertwig known as?

A

cell rests of malassez

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16
Q

what are the types of inflammatory odontogenic cysts?

A

radicular cysts (apical, lateral, residual)
inflammatory collateral cysts (paradental, mandibular buccal bifurcation)

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17
Q

what is the most common type of jaw cyst?

A

radicular cyst (55%)

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18
Q

where do radicular cysts arise from?

A

epithelial proliferation
or
cyst formation within some periapical granulomas

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19
Q

where is the most frequent location of radicular cysts?

A

anterior maxilla

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20
Q

do radicular cysts come with symptoms?

A

often none
slow growing swelling

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21
Q

what is the one diagnostic criteria for a radicular cyst?

A

must be associated with a non-vital tooth

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22
Q

radiographic features of radicular cyst?

A

usually at the apex (unless associated with a lateral canal)
well-circumscribed unilocular radiolucent lesion

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23
Q

what is the pathogenesis of a radicular cyst?

A

proliferation of epithelium in response to inflammation
cysts enlarges due to osmotic pressure
local bone resorption

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24
Q

what are the key histopathological features of radicular cysts?

A

cholesterol clefts
haemosiderin

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25
Q

treatment for radicular cyst?

A

small cysts may resolve after RCT/XLA/periradicular surgery

enucleation

marsupialisation for very large lesions

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26
Q

what is enucleation?

A

entire lesion removed

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27
Q

what is marsupialisation?

A

converting cyst into a pouch to let it drain prior to enucleation

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28
Q

what is a lateral radicular cyst?

A

radicular cyst arising from a lateral root canal branch of a non-vital tooth

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29
Q

what is a residual cyst?

A

radicular cyst that persists after xla of the associated non-vital tooth

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30
Q

what are the 2 variants of inflammatory collateral cysts and where do you find them?

A

paradental cyst - lower 3rd molars
mandibular buccal bifurcation cyst - lower 1st or 2nd molars

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31
Q

aetiology of inflammatory collateral cysts?

A

inflammation associated with pericoronitis
or
enamel spur on buccal aspect of involved tooth

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32
Q

what exacerbates inflammatory collateral cysts?

A

food impaction

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33
Q

what type of collateral cyst is more common?

A

paradental

34
Q

what are the clinical features of an inflammatory paradental cyst?

A

chronic pericoronitis association
associated with vital tooth
well-demarcated radiolucency

35
Q

what are clinical features of mandibular buccal bifurcation inflammatory cysts?

A

painless swelling
associated with tooth tilted buccally with deep perio pocket
well demarcated buccal radiolucency

36
Q

treatment of mandibular buccal bifurcation cysts?

A

enucleation
removal of 8s and paradental cyst

37
Q

list the types of developmental odontogenic cysts?

A

odontogenic keratocyte
dentigerous cyst/ eruption cyst
lateral periodontal cyst and botryoid odontogenic cyst
glandular odontogenic cyst
gingival cysts
calcifying odontogenic cyst
orthokeratinised odontogenic cyst

38
Q

where do you find most odontogenic keratocysts?

A

posterior mandible

39
Q

are odontogenic keratocysts symptomatic?

A

only if they are infection or when cortical bony expansion

40
Q

radiographic features of odontogenic keratocysts?

A

well-defined radiolucency
uni or multi locular lesion

41
Q

aetiology of odontogenic keratocysts?

A

remnants of the dental lamina (glands of serres)
mutation/ inactivation of PTCH1 gene, chromosome 9
activation of SHH signaling pathway = aberrant cell proliferation of epithelium

42
Q

what was the classification for odontogenic keratocysts in 2005?

A

keratocystic odontogenic tumour

43
Q

why did are odontogenic keratocysts no longer called keratocystic odontogenic tumours?

A

there isnt enough evidence to support a neoplastic origin

44
Q

what is gorlin syndrome?

A

naevoid basal cell carcinoma syndrome

45
Q

what syndrome do keratocysts present in?

A

Gorlin syndrome

46
Q

what is the histopathology of odontogenic keratocysts?

A

cystic lesion
keratinised stratified squamous epithelial lining
corrugated parakeratin layer
no inflammation (unless secondary infection)

47
Q

what type of cyst is an odontogenic keratocyst?

A

benign developmental cyst

48
Q

treatment options for odontogenic keratocysts?

A

marsupialisation
enucleation
marsupialisation + enucleation
enucleation + carnoys solution
enucleation + cryotherapy
resection

48
Q

what is carnoys solution?

A

eliminates any cyst/ daughter cysts leftover

49
Q

what is the best tx option for odontogenic keratocysts?

A

no evidence

some evidence to support lower recurrence rate with enucleation + carnoys solution and for resection

50
Q

what is a dentigerous cyst?

A

developmental cyst
encloses all or part of a crown of unerupted tooth
attached to the ACJ
affects impacted teeth or teeth late to erupt

51
Q

are dentigerous cysts symptomatic?

A

symptom free until significant swelling or if infected
potential ballooning expansion

52
Q

radiographic features of dentigerous cysts?

A

well-circumscribed unilocular radiolucency associated with crown of unerupted tooth

53
Q

histopathology of dentigerous cyst?

A

non-keratinised stratified squamous epithelial lining
fibrous capsule
no inflammation unless secondary infection

54
Q

treatment for dentigerous cysts?

A

enucleation
exposure/ transplantation/ xla of associated tooth

55
Q

what must you include on the pathology request form if suspect a dentigerous cyst?

A

clinical attachment of lesion to ACJ of unerupted tooth

56
Q

what is an eruption cyst?

A

dentigerous cyst arising in the extra-alveolar location

57
Q

clinical features of eruption cysts?

A

typically seen in children
deciduous and permanent molars
present as bluish swelling

58
Q

treatment options for eruption cysts?

A

none
exposure of erupting tooth

59
Q

clinical features of lateral periodontal cyst?

A

uncommon
arise in adjacent to vital tooth
canine and premolar region of mandible
usually symptom free, incidental finding
well-circumscribed radiolucency in PDL

60
Q

what do lateral periodontal cysts arise from?

A

cell rests of malassez

61
Q

treatment for lateral periodontal cysts?

A

enucleation
recurrence is rare

62
Q

what is a botryoid odontogenic cyst?

A

very rare multicystic variant of lateral periodontal cyst

botryoid = ‘bunch of grapes’ - polycystic appearance

63
Q

how do botryoid odontogenic cysts present radiographically?

A

multilocular radiolucency

64
Q

where do you find botryoid odontogenic cysts?

A

mandibular premolar, canine region

65
Q

clinical features of glandular odontogenic cysts?

A

very rare
anterior mandible
multilocular

66
Q

what malignant condition must glandular odontogenic cysts be differentiated from?

A

central mucoepidermoid carcinoma

67
Q

treatment for glandular odontogenic cysts?

A

enucleation but high recurrence rate

68
Q

what are gingival cysts?

A

developmental cysts which occur in infants
superficial keratin-filled cysts in the gingivae of newborns

69
Q

what causes gingival cysts in infants?

A

proliferation of dental lamina remnants (glands of serres)

70
Q

what do gingival cysts in infants present as?

A

white nodules

71
Q

treatment for gingival cysts?

A

none
usually disappear in a few weeks

72
Q

do you get gingival cysts in adults?

A

very rarely

73
Q

treatment for gingival cysts in adults?

A

simple excision

74
Q

what is a calcifying odontogenic cyst?

A

painless swelling of the jaw which can present with tooth displacement and resorption

75
Q

aetiology of calcifying odontogenic cysts?

A

arises from dental lamina

76
Q

what was the 2005 classification for calcifying odontogenic cysts?

A

neoplasm

77
Q

treatment for calcifying odontogenic cyst?

A

enucleation
recurrence is rare

78
Q

clinical features of orthokeratinised odontogenic cysts?

A

in the mandible
painless swelling of the jaw
well-defined unilocular radiolucency

79
Q

aetiology of orthokeratinised odontogenic cysts?

A

pathogenesis uncertain but likely derives from dental lamina

80
Q

treatment for orthokeratinised odontogenic cysts?

A

enucleation
recurrence is rare

Module 7 (62 decks)

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