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module 8 > oral surgery > Flashcards

oral surgery Flashcards

1
Q

what does an abscess ALWAYS have?

A

pus

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2
Q

what might be inside of a cyst

A

fluid or pus

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3
Q

what is a cyst?

A

pathological cavity having fluid or semi-fluid contents

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4
Q

is a cyst created by the accumulation of pus?

A

no

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5
Q

where do cysts most commonly appear in the body

A

jaw bones

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6
Q

what is a fluid filled cavity created by the accumulation of pus?

A

abscess

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7
Q

what is a cyst often lined with

A

epithelium

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8
Q

why do cysts commonly form in the jaws?

A

because of the epithelial remnants left over from the development of teeth eg dental lamina

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9
Q

what do we have remnants of epithelium in the jaws from?

A
  • development of teeth
  • fusion of pharyngeal arches
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10
Q

why are cysts of the jaws often epithelial lined?

A

because of the epithelial remnants of teeth and pharyngeal arches

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11
Q

are cysts always epithelial lined?

A

no

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12
Q

what are radicular inflammatory cysts derived from?

A

root sheath of hertwig

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13
Q

what classification is used for cysts of the head and neck?

A

WHO 2022 cyst classification

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14
Q

what is the most common cyst in the head and neck?

A

radicular cyst

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15
Q

what is a radicular cyst associated with

A

non-vital tooth

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16
Q

where are radicular cysts seen

A

anterior maxilla

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17
Q

how do cysts in the jaws form

A
  • remnants lie in a little ball of dormant cells in the alveolar bone
  • something triggers the ball of cells to start proliferation
  • they get to a size where the growth exceeds the amount of nutrition available so the central cells die
  • the peripheral cells continue to proliferate while the cells in the middle undergo apoptosis
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18
Q

what is usually the trigger for epithelial remnants that form cysts to being proliferation

A

bacterial infection

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19
Q

what does the pressure of the expanding cyst cause on the neighbouring bone?

A

osteoclastic stimulation –> resorption

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20
Q

what type of pressure allows a cyst to expand?

A

hydrostatic pressure

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21
Q

what can happen if an expanding cyst is close to the buccal plate or palatal shelf?

A

erosion of overlying cortex

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22
Q

what happens if a cyst erodes through the overlying cortex

A

can perforate through the mucosa

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23
Q

what drives the expansion of a cyst

A

hydrostatic fluid

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24
Q

what can a cyst present in the mouth as if eroded through the overlying cortex

A
  • expansion of mucosa
  • soft to touch - fluctuant swelling
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25
Q

intraorally, on palpation how would you recognise a cyst?

A

soft swelling of mucosa

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26
Q

what happens if a cyst expands at a fast rate?

A

can erode through the mucosa - causing an opening like a sinus

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27
Q

what can happen if a cyst causes an opening like a sinus through the mucosa?

A

bacteria can get into the cyst cavity and cause infection

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28
Q

what will happen if a cyst becomes infected?

A

becomes symptomatic

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29
Q

when are cysts symptomatic

A

when they become infected - generally not until then

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30
Q

what sign can bony expansion of a cyst cause intraorally?

A

egg-shell crackling - bone breaks to the touch

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31
Q

how are asymptomatic cysts often found

A

chance finding on a radiograph

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32
Q

what intraoral sign of a cyst will there be if there is only mucosa overlying it and no bone?

A

fluctuant swelling - soft to the touch

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33
Q

what may be a dental sign of cysts

A
  • missing teeth
  • carious teeth
  • fractured teeth
  • discoloured teeth
  • loose teeth
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34
Q

why might teeth tilt because of a cyst

A

the pressure of the underlying cyst pushes the tooth out of the way

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35
Q

why might a cyst cause teeth to be loose?

A

underlying cyst may cause bone loss around the adjacent teeth

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36
Q

what is the name for swelling putting pressure on the alveolar nerve?

A

mental hypoaethesia

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37
Q

what percussion sound will a tooth associated with a cyst make

A

hollow sound

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38
Q

when would pain occur with a cyst?

A

infection

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39
Q

what might be a sign of a very large cyst taking over a large portion of the mandibular bone

A

pathological fracture

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40
Q

how would you know if a cyst is slow growing?

A

the body will form extra layers of bone over the top of the cyst to try and wall off the hydrostatic pressure

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41
Q

what 4 investigations would be made for a cyst

A
  • vitality testing of teeth
  • radiographs
  • aspiration of contents
  • biopsy
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42
Q

what radiographs would be taken for a cyst of the jaws

A
  • DPT in first instance
  • supplement with CBCT
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43
Q

what syringe and needle should be used to aspirate the contents of a cyst

A

10-20ml, wide bore needle

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44
Q

should LA be given before aspirating a cyst?

A

yes

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45
Q

what would cyst contents being clear with crystallisation that sparkles indicate?

A

inflammatory radicular cyst

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46
Q

what would cyst contents being clear with crystallisation that sparkles indicate?

A

inflammatory radicular cyst

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47
Q

what could blood in the contents of cyst indicate?

A

intra-alveolar vascular lesion

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48
Q

why would a biopsy of a cyst be taken

A
  • establish which type
  • rule out tumours
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49
Q

why is a cyst called “cyst-like radiolucency” clinically?

A

cannot call it a cyst before a biopsy confirms it

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50
Q

what are the management aims of a cyst?

A
  • eradicate pathology entirely
  • minimise surgical damage
  • restore function as quickly as possible
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51
Q

what is the treatment of choice for a cyst

A

enucleation

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52
Q

what are the Tx options for a cyst

A
  • marsupialisation
  • enucleation
  • both
  • en bloc resection
  • partial resection
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53
Q

how does a clinician decide between enucleation or marsupialisation

A
  • type
  • size
  • site
  • general medical status (for GA)
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54
Q

what can marsupialisation be in combination with if we want to preserve teeth involved with a cyst

A

peri-radicular surgery

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55
Q

what is enucleation

A

complete removal of cyst and lining

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56
Q

how does the body heal after enucleation

A
  • large bony cavity fills with blood clot
  • blood clot liquifies
  • is replaced by granulation tissue
  • replaced by bone
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57
Q

how long does healing after enucleation take

A

several months

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58
Q

following enucleation, how can closure be achieved?

A
  • primary closure
  • secondary closure
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59
Q

how is primary closure of a cyst done after enucleation

A

suturing the cavity over

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60
Q

how is secondary closure of a cyst done after enucleation

A

packing the defect, then replacing subsequent packs until the granulation tissue fills the base of the defect to the top

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61
Q

how is primary or secondary closure chosen after enucleation?

A

size of the cyst
adjacent vitality of teeth
any useful teeth in area

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62
Q

how would you plan the flap when undertaking enucleation

A

so it doesnt directly overly the osteotomy site - raise flap away from the cyst

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63
Q

how is a cyst accessed if there is still overlying bone

A

raise flap
osteotomise the site

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64
Q

how is the cyst/cyst lining removed from the defect

A

curettage

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65
Q

how should the sutures be places after enucleation of a cyst

A

so they are far away from the osteotomy site

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66
Q

why do we try and eliminate dead space when treating a cyst

A
  • reduce reactionary haemorrhage
  • reduce post-op infection
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67
Q

how does post-op infection happen if dead space is left when treating a cyst

A

the initial blood clot liquifies creating a very nutrient rich source for bacteria

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68
Q

how does a drain placement help with dead space after enucleation of a cyst

A

the vacuum sucks down the overlying mucosa to minimise the amount of dead space

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69
Q

other than dead space, what else does placing a drain after enucleation help with

A

reactionary haemorrhage as reduces the volume of blood clot that fills the space

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70
Q

why would a clinician choose to collapse the walls of the cavity after enucleation

A

converts the cavity shape into a larger shape that mucosa can fall over more easily, minimising the dead space

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71
Q

how can a clinician eliminate dead space after enucleation of a cyst

A
  • biological materials
  • layered soft tissue closure
  • drain placement
  • collapse cavity walls
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72
Q

what can a clinician use to fill the space after enucleation of a cyst

A
  • pts own bone
  • bone graft
  • pts own muscles
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73
Q

what is the layered soft tissue closure post-enucleation of a cyst

A

suturing muscle into the area

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74
Q

is layered soft tissue closure post-enucleation of a cyst commonly done

A

no

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75
Q

what are the advantages of enucleation of a cyst

A
  • complete removal for histology
  • once primary closure, heals well without complication
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76
Q

what are the disadvantages of enucleation of a cyst

A
  • large dead space - infection
  • recurrence if incomplete removal of lining
  • damage to adjacent structures
  • weakening of the bone
77
Q

what may be damaged during enucleation of a cyst

A
  • teeth
  • antrum
  • nerves eg IAN
78
Q

what may happen if a very large cyst is enucleated

A

pathological fracture risk

79
Q

what is marsupialisation

A

create a window into the cyst lining to allow shrinkage of the lesion

80
Q

how is a cyst marsupialised

A

the raised flap is sutured to the remaining lining

81
Q

when is marsupialisation the treatment of choice for a cyst

A

when there is a very large cyst with multiple health teeth

82
Q

what type of pt might marsupialisation be chosen for regardless of the cyst

A

older/ frail pt

83
Q

what is a ‘useful’ tooth that may cause the clinician to choose marsupialisation over enucleation?

A

tooth that can erupt through the space where the cyst is eg canine, incisor

84
Q

in marsupialisation where should the flap be planned for

A

directly over the area of bone we want to remove

85
Q

what might be used in marsupialisation to help reduce infection

A

acrylic bung

86
Q

what might be used in marsupialisation to help reduce infection

A

acrylic bung

87
Q

how does an acrylic bung help reduce infection after marsupialisation

A

blocks orifice to prevent food entering and encourage secondary closure

88
Q

what type of closure is there in marsupialisation

A

secondary

89
Q

what are the advantages of marsupialisation

A
  • avoids path fracture
  • good for MH compromised pts that cant have GA
  • avoids damage to adjacent structures
  • allows useful teeth to erupt
90
Q

what are the disadvantages of marsupialisation

A
  • can close early causing recurrence
  • repeat visits over long period
  • manual dexterity and compliance needed from pt
  • cannot get definite diagnosis
91
Q

why might a cyst close prematurely when using marsupialisation

A

pt non-compliant with bung

92
Q

why cant we get the full diagnosis when using marsupialisation

A

lining isnt entirely removed for pathology

93
Q

what origin are radicular cyst

A

inflammatory

94
Q

what % of dental cysts do radicular cysts make up

A

60

95
Q

what % of dental cysts do radicular cysts make up

A

60

96
Q

where on a non-vital tooth does a radicular cyst affect

A

apex

97
Q

what % of radicular cyst can turn out to be a residual cyst

A

20

98
Q

name 2 collateral cyst

A

paradental cyst
mandibular buccal bifurcation cyst

99
Q

what is the incidence of radicular cysts

A

60-75%

100
Q

what is the incidence of dentigerous cysts

A

10-15%

101
Q

what is the incidence of a keratocyst

A

5-10%

102
Q

what is the incidence of paradental cysts

A

3-5%

103
Q

what is the incidence of gingival/lateral periodontal cysts

A

<1%

104
Q

what is the incidence of a nasopalatine cyst

A

5-10%

105
Q

what is a residual cyst

A

area of a cyst where the associated tooth has been extracted

106
Q

what is the Tx for radicular cyst

A

enucleation with either XLA of tooth or apicectomy following RCT

107
Q

how are lateral cysts and residual cysts treated

A

enucleation with either XLA of tooth or apicectomy following RCT

108
Q

what is the Tx if a radicular cyst is really big and compromised adjacent teeth

A

marsupialisation +/- enucleation

109
Q

how is a paradental cyst treated

A

enucleation + XLA of 8 if impacted

110
Q

name 5 developmental cysts

A
  • dentigerous
  • eruption
  • keratocyst
  • lateral periodontal
  • gingival
111
Q

where does a dentigerous cyst form

A

around the crown of unerupted teeth

112
Q

what does a dentigerous cyst form from

A

remnants of the reduced enamel epithelium

113
Q

where is a dentigerous cyst always attached to

A

ACJ

114
Q

how is a dentigerous cyst treated for an 8

A

enucleation and removal of associated tooth

115
Q

how is a dentigerous tooth treated for any other tooth than an 8

A

marsupialisation and align tooth with ortho

116
Q

what is a sign of a CHRONIC cyst

A

well defined corticated margins

117
Q

what does no lamina dura indicate with a cyst

A

acute problem

118
Q

what should the pt be told about long term outcome if marsupialisation is carried out

A

defect is often left in the bone

119
Q

what is the Tx for a keratocyst

A

enucleation and XLA of tooth

120
Q

what should the clinician pay attention to when removing a keratocyst

A

remove all the lining –> high recurrence as daughter cysts in the lining

121
Q

where do keratocysts commonly form

A

angle of the mandible

122
Q

what does a keratocyst form from

A

dental lamina

123
Q

what is the problem with enucleation and removing the lining of a keratocyst

A

lining is very fragile and forms in antero-posterior “finger-like” projections through the trabeculae bone

124
Q

what is carnoys solution

A

fixative lining that floods the cavity to fix any of the lining thats left behind

125
Q

is carnoys solution advocated? why?

A

no, can fix delicate structures eg IAN

126
Q

what is cryotherapy in cyst removal?

A

where the cavity is flooded with sterile saline and the cryotherapy probe is inserted until it freezes

127
Q

is cryotherapy advocated in cyst removal, why?

A

debatable - no evidence base

128
Q

what should always follow removal of keratocysts? and why

A
  • radiographic long term follow up
  • high recurrence rate
129
Q

how were keratocysts previously treated when regarded as odontogenic tumours?

A

en bloc resection

130
Q

what does root resorption often indicate in terms of type of pathology

A

less likely it is a cyst and more likely to be a tumour

131
Q

what should you do before managing a pathology where there is root resorption

A

biopsy to determine diagnosis - more likely to be a tumour

132
Q

what is the other name for gorlin goltz syndrome

A

nevoid basal cell carcinoma

133
Q

what does gorlin goltz syndrome cause?

A

development of multiple keratocytes

134
Q

what inheritance pattern does gorlin goltz syndrome follow

A

autosomal dominant

135
Q

what genetic mutation cause gorlin goltz syndrome

A

PTCH gene found on chromosome 9

136
Q

what % of gorlin goltz pts have an odontogenic keratocyst

A

75%

137
Q

what is the average age that a pt with gorlin goltz syndrome will develop keratocysts in their mandibel

A

19

138
Q

what other bony anomalies does a pt with gorlin goltz have

A

rib and vertebrae

139
Q

what other feature of dental significance do pts with gorlin goltz syndrome have

A

prognathic mandible

140
Q

what does a lateral periodontal cyst develop associated to

A

vital tooth

141
Q

how can you determine the difference between developmental and inflammatory cysts prior to surgery

A

vitality testing of teeth

142
Q

what is the Tx of a gingival cyst

A

enucleation/ excision

143
Q

what is the most common epithelial non-odontogenic (fissure) cyst

A

nasopalatine duct cyst

144
Q

where does a nasopalatine duct cyst develop

A

incisive canal

145
Q

what does a nasopalatine duct cyst for from

A

remnants of the fusion of the pharyngeal arches - sensory organ of jacobson

146
Q

what symptom is characteristic of a nasopalatine duct cyst

A

salty taste

147
Q

what type of radiolucency is often seen with a nasopalatine duct cyst

A

heart shaped

148
Q

what is the Tx of a nasopalatine duct cyst

A

enucleation after establishing vitality of adjacent teeth

149
Q

how would a nasopalatine duct cyst be accessed

A

full-thickness palatal envelope flap

150
Q

where do nasolabial cysts form

A

in the nasolabial fold between the upper lip and cheek

151
Q

what is the Tx of nasolabial cysts

A

marsupialisation

152
Q

name a non-epithelialise primary bone cyst

A

staphnes idiopathic bone cyst

153
Q

what is staphnes idiopathic bone cyst

A

developmental abnormality

154
Q

what causes the formation of staphnes defect

A

ectopic salivary tissues in the concavity of the mandible

155
Q

which salivary gland causes staphnes defect

A

sublingual

156
Q

what is the Tx for staphnes idiopathic bone cyst

A

none needed

157
Q

name 2 bone cysts

A
  • aneurysmal bone cyst
  • solitary (haemorrhagic) bone cyst
158
Q

what is the aetiology of aneurysmal bone cyst

A

unknown

159
Q

what age group does aneurysmal bone cyst affect

A

10-20 years

160
Q

where deos aneurysmal bone cyst appear

A

mandible

161
Q

what can be seen histologically in an aneurysmal bone cyst

A
  • mass of blood filled spaces with scattered giant cells
162
Q

what does currettage of an aneurysmal bone cyst often cause

A

triggers healing

163
Q

how is diagnosis of aneurysmal bone cyst determined

A

biopsy

164
Q

how is a biopsy of an aneurysmal bone cyst taken

A
  • raise flap
  • make osteotomy
  • currette out contents
165
Q

who is a solitary bone cyst often seen in

A

teenagers

166
Q

what gender are solitary bone cysts more common in

A

female

167
Q

where are solitary bone cysts commonly found

A

mandible

168
Q

what will be seen radiographically for solitary bone cysts

A

large radiolucency arching up between roots of teeth

169
Q

what is the Tx of a solitary bone cyst

A

resolve spontaneously

170
Q

what are solitary bone cysts thought to be caused by

A

bleed in the bone

171
Q

what is an ameloblastoma

A

odontogenic tumour

172
Q

what are ameloblastomas derived from

A

dental lamina

173
Q

is ameloblastoma benign or malignant

A

benign

174
Q

what age group are ameloblastomas most commonly seen in

A

40-50

175
Q

what % of ameloblastomas are found in the mandible

A

80

176
Q

what characteristics do ameloblastoma have

A

aggressive and invasive

177
Q

what will be seen radiographically for an ameloblastoma

A

uni/multi-ocular, defined or diffuse edged, usually displaces adjacent structures

178
Q

how are ameloblastomas diagnosed

A

biopsy under LA

179
Q

what do we need from the biopsy to be able to diagnose ameloblastoma histologically

A

part of the lining

180
Q

what are the three subtypes of ameloblastoma

A
  • luminal
  • intraluminal
  • mural
181
Q

how are the different subtypes of ameloblastoma differentiated from each other

A

according to the distribution of the proliferation of the epithelium

182
Q

how are luminal and intraluminal ameloblastomas treated

A

conservatively

183
Q

what mutation causes ameloblastoma

A

BRAF p. V600E mutations

184
Q

what is the newest odontogenic lesion that is an epithelial odotogenic neoplasm called?

A

adenoid ameloblastoma

185
Q

what is adenoid ameloblastoma composed of

A

cribriform architecture and duct-like structures frequently including dentinoid

186
Q

what is dentinoid

A

dysplastic form of dentine

187
Q

how many cases of adenoid ameloblastoma have been documented

A

40

188
Q

what is the Tx for ameloblastoma (mural)

A

en bloc resection

module 8 (9 decks)

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