Oral surgery and histopathology Flashcards
What are the signss in head and neck cancer that require referral?
- persistent lumps - more than 3 weeks
- unexplained ulceration and swelling for more than 3 weeks
- unexplained persistent hoarsness for more than 3 weeks
- Pain in throat or swallowing for more than 3 weeks
- difficulty chewing, speaking , tasting
What are the red flags of squamous cell carcinoma?§
- non healing ulcers
- non homogenous leukoplakia
- erythroplakis
- induration
- tooth mobility (unexplained)
- pathological fracture (unexplained)
- Pathological fracture (unexplained)
- Cervical lymphadenopathy
What are the symptoms of oral squamous cell carcinoma?
- discomfort and pain
- loss of sensation over the distribution of CNV
- Difficulty eating, swallowing and speaking
- loss of apetite, weight loss and fatigue
What do odontogenic cysts and tumours arise from?
tooth-forming epithelium and mesenchyme in the jaw bones during development
Most common odontogenic tumour?
Ameloblastoma
Epithlial lined odontogenic cysts?
radicular cyst
residual cyst
dentigerous cyst
eruption cyst
odontogenic keratocyst
lateral periodontal cyst
gingival cysts
Non odontogenic epithelial lined cysts
- nasopalatine duct cyst
- nasolabial cyst
What are some non epithelial lined jaw cysts?
- solitary bone cyst
- aneurysmal bone cyst
Cyst definition
A pathological cavity which can be filled with fluid, semi-fluid or gaseous contents that has not been created by the accumulation of pus
Location of a radicular cyst
- associated with a non-vital tooth
- peri-apical region
Clinical features of a radicular cyst?
- most common jaw cyst
- often symptomless
-incidental finding - slowly expanding
Histopathology of radicular cyst
- thick inflamed fibrous capsule
- non keratinised squamous epithelial lining
- cholestrol nodules present
- rushton’s bodies
Location of a residual cyst
At site of previously extracted mandibular tooth (most common in mandibular premolar area)
Clinical features of a residual cyst
- slowly enlarging swelling
- symptomless
Histopathology of a residual cyst
- Thick fibrous capsule
non keratinised squamous epithelial lining - Cholestrol nodules
Discuss the location of a dentigerous cyst
Associated with a non erupted tooth
Discuss the clinical features of a dentigerous cyst
- develop around crowns of unerupted teeth
- may displace tooth
Histopathology of a dentigerous cyst
- Capsule resembles dental follicle
- myxoid (mucous substance) areas and odontogenic rests
- lined by reduced enamel epithelium
Discuss the location of a odontogenic keratocyst
- angle of mandible
- posterior maxilla
Clinical features of a odontogenic keratocyst
- multilocular radiolucency
- expands through medullary bone
- minimal cortical expansion
- can recurr
Histopathology of a odotogenic keratocyst
- Thin fibrous capsule
lined by parakeratotic squamous epithelium - basal cell palisade
- satellite cysts
- occurs commonly in basal cell nevus syndrome
What syndrome are multiple odontogenic keratocysts associated with?
basal cell nevus syndrome (gorlin-goltz syndrome)
Discuss the location of a nasopalatine duct cyst
Floor of nose to incisive papilla
Discuss the clinical features of a nasopalatine duct cyst
- swelling
- displacement of central incisors
- salty taste
- radiolucency>6mm
- vital adjacent teeth
Discuss the histopathology of a nasopalatine duct cyst
- Fibrous capsule
- lined by respiratory or simple squamous cell
Where does the epithelial lining of odontogenic cysts originate from?
- epithelial rests of serres
- reduced enamel epithelium
- epithelial rests of malassez
What are epithelial rests of serres and what cysts do they give rise to?
- remnants of dental lamina
- odontogenic keratocyst
- lateral periodontal cyst
- gingival cyst
What is reduced enamel epithelium and what cysts does it give rise to?
- derived from enamel organ and covers the fully formed crown of unerupted tooth
- dentigerous cysts
- paradental cysts
What are epithelial rests of malassez and what cysts do they give rise to?
- from fragmentation of herwig’s epithelial root sheath
- Radicular cyst
Most common type of jaw cyst
Radicular
How does the expansion of a cyst present clinically?
Egg shell cracking on palpation due to thinning of bone cortex
How does a radicular cyst present radiographically
Round or ovoid radiolucency at the root apex - corticated margins continuous with lamina dura of tooth
What is the pathogenesis of radicular cysts?
Proliferation of the epithelial rests of malassez within chronic periapical granulomas due to necrotic pulp
Discuss the contents of a radicular cyst if it were to be aspirated
- Watery straw coloured fluid
OR - semi solid brownish material
This may contain: - breakdown products of degenerating epithelial and inflammatory cells and connective tissue components
- Serum proteins
- water and electrolytes
- cholestrol crystals
Radiographic findings of a dentigerous cyst
well defined , unilocular radiolucency associated with the crown of an unerupted tooth
- the tooth may be displaced
Describe the histopathological findings of a dentigerous cyst?
- lined by non-keratinised stratified squamous or cuboidal epithelium
- resembles reduced enamel epithelium
- fibrous capsule containing loose myxoid areas resembling dental follicle
Findings of dentigerous cyst if you will aspirate it?
- proteinaceous, yellow fluid
- chlestrol crystals are common
How common are odontogenic keratocysts?
5-10% of jaw cysts
When is the peak age/incidence of development of an odontogenic keratocyst?
2nd to 3rd decade
Where is the most common site for development of an odontogenic keratocyst
mandible in the third molar region
Why do patients with odontogenic keratocyst tend to present so late?
Because the symptoms associated with these cysts are very few
How do odontogenic keratocysts appear radiographically?
They are commonly multilocular
How is gorlin-goltz syndrome inherited?
autosomal dominant trait
What is the important feature of odontogenic keratocyst?
it has high recurrance rate
Discuss the growth pattern of the odontogenic keratocyst
destructive pattern of growth ( moves through cancellous bone in an AP direction)
What is the aetiology of the nasopalatine duct cyst?
Arises from epithelial remnants of the nasopalatine duct that connects the oral and nasal cavities
What are the clinical features of a nasopalatine duct cyst?
Present as a slowly enlarging swelling in anterior midline of palate (discharge may cause salty taste)
Discuss the radiographic findings of a nasopalatine duct cyst
Well defined round/ovoid/heart shaped radiolucencies with corticated margins
Discuss the histopathological findings of a nasopalatine duct cyst
It is a combination of
- stratified squamous
- pseudostratified ciliated columnar
- cuboidal and columnar epithelium
with connective tissue capsule
What provisional diagnoses might be associated with nasopalatine duct cyst?
- nasolabial cyst
- median palatal cyst
What type of cyst presents on a radiograph as “scalloping around & between the roots of standing teeth, most frequently in the premolar/molar regions” and it has clear/blood stained fluid on aspiration:
solitary bone cyst
Do solitary bone cysts have an epithelial lining?
No (non-odontogenic cyst)
What is staphne cavity?
Idiopathic developmental bone cavity located on mandible
- round, well demacated radiolucency between premolar region and angle of jaw
- usually below IAN canal
