Oral Surgery Flashcards
What is the definition of a cyst?
a pathological cavity with fluid or semi-fluid contents, which has not been created by the accumulation of pus
Name 12 signs and symptoms of cysts
- asymptomatic
- boney expansion
- fluctuant swelling
- missing teeth
- carious, discoloured, fractured teeth
- tilted/displaced teeth
- discharge/sinus
- loose teeth
- mental hypoaethesia
- hollow percussion note
- pain and swelling if secondarily infected
- pathological fracture
what investigations can be used for cysts?
- vitality test
- radiology
- aspiration of cyst contents
- biopsy
what are the management aims for cyts?
eradicate pathology
minimise surgical damage
restore function quickly
what are the treatment options for cysts?
marsupialisation
enucleation
marsupialisation & enucleation
enucleation and curettage/excision
en bloc resection-jaw continuity maintained
partial resection-continuity lost
how do you decide between enucleation and marsupialisation?
depends upon:
type
size
site
medical status
what can be done alongside enucleation if teeth are to be preserved?
peri-radicular surgery
what is enucleation?
complete removal of the cyst lining
when would enucleation be contraindicated?
large cysts
involving a number of vital teeth
in difficult anatomical site
involving potentially useful unerupted tooth
why is elimination of dead space important?
reduce reactionary haemorrhage
reduce post-op infection
how can dead space be eliminated?
drain placement - sucks out stuff
saucerisation? - collapse walls of cavity
pack with pts own bone (autograft) or allograft or xenograft
layered soft tissue close (suture muscle etc into area)
secondary intention (packing with sedative dressing but needs visits to change it - uncomfortable)
what are the advantages of enucleation?
complete removal for histology
cavity heals without complications
what are the disadvantages of enucleation?
infection
incomplete removal of lining
damages to adjacent teeth or antrum
weakening of bone
what is marsupialisation?
creation of a window in the cyst lining, suturing the flap to the remaining lining to allow shrinkage of the lesion which may become self cleansing or by subsequently removed
when would you choose marsupialisation over enucleation?
large cyst involving healthy useful teeth
older frail ppl
when tooth can erupt through - incisors and canines
what kind of healing in marsupialisation?
secondary - granularion tissue `
what are the advantages of marsupialisaton?
avoids pathological fracture
tx for medically compromised pts -avoids GA
avoids damage to adjacent structures
allows potentially useful teeth to erupt
what are the disadvantages of marsupialisation?
orifice closes and cyst reforms
repeat visits
manual dexterity and compliance
complete lining not available for hisotology
what is a radicular cyst
inflammatory in origin associated with a non-vital tooth
what % of dental cysts are radicular
60
what are the 2 collateral cysts
paradental
mandibular buccal bifurcation cyst
what is the incidence of dentigerous cyst
10-15%
what is the incidence of keratocyst
5-10%
what is the incidence of paradental cyst
3-5%
what is the incidence of gingival/lateral periodontal cyst
<1%
what is the incidence of nasopalatine cyst
5-10%
what is the treatment for radicular/lateral/residual cysts
enucleation with either extraction of associated tooth or apicectomy following endodontic treatment
what are the developmental cysts
dentigerous
eruption
odontogenic keratocyst
lateral periodontal
gingival
how do u tell if its lateral periodontal/gingival rather than radicular
theyre associated with vital teeth
what is the tx for dentigrous csyts
enucleation with removal of associated teeth (wisdom teeth)
marsupialisation if unerupted tooth is potetially functional and can be alligned othodonticaly (maxillary canines)
what is keratocyst treatment?
enucleation, paying particular attention to ensure removal of intact lining to reduce recurrence + tooth removal
why is enucleation of keratocysts hard
thin lining and finger like projections
why do keratocysts often recur
daughter cells
what is gorlin syndrome
multiple basal cell carcinomas of the skin
what is commonly found in gorlin sydrome?
odontogenic keratocysts - 75%
what is a staphne’s idiopathic bone cyst
developmental anomaly
ectopic salivary tissue in concavity in the medial aspect of the mandible
what is the tx for staphne’s idioapthic bone cyst
no active tx required
name 2 bone cysts
aneurysmal bone cyst
solitary (haemorrhagic) bone cyst
what is the histopathology of aneurysmal bone cysts
mass of blood-filled spaces with scattered giant cells
how does a solitary bone cyst looks
large radiolucency arching up between roots of teeth
what is the radiographic appearance of ameloblastomas?
uni or multilocular, defined or diffuse edges, usually displaced adjacent structures
what does ameloblastoma arise from
remnants of dental lamina
what are the 3 subtypes of ameloblastoma epithelium
luminal
intraluminal
mural
what types of ameloblastoma can be treated constervatively
luminal and intraluminal
