Oral surgery and histopathology

Question 1

What are the signss in head and neck cancer that require referral?

Answer 1

• 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

Question 2

What are the red flags of squamous cell carcinoma?§

Answer 2

• non healing ulcers
• non homogenous leukoplakia
• erythroplakis
• induration
• tooth mobility (unexplained)
• pathological fracture (unexplained)
• Pathological fracture (unexplained)
• Cervical lymphadenopathy

Question 3

What are the symptoms of oral squamous cell carcinoma?

Answer 3

• discomfort and pain
• loss of sensation over the distribution of CNV
• Difficulty eating, swallowing and speaking
• loss of apetite, weight loss and fatigue

Question 4

What do odontogenic cysts and tumours arise from?

Answer 4

tooth-forming epithelium and mesenchyme in the jaw bones during development

Question 5

Most common odontogenic tumour?

Answer 5

Ameloblastoma

Question 6

Epithlial lined odontogenic cysts?

Answer 6

radicular cyst
residual cyst
dentigerous cyst
eruption cyst
odontogenic keratocyst
lateral periodontal cyst
gingival cysts

Question 7

Non odontogenic epithelial lined cysts

Answer 7

• nasopalatine duct cyst
• nasolabial cyst

Question 8

What are some non epithelial lined jaw cysts?

Answer 8

• solitary bone cyst
• aneurysmal bone cyst

Question 9

Cyst definition

Answer 9

A pathological cavity which can be filled with fluid, semi-fluid or gaseous contents that has not been created by the accumulation of pus

Question 10

Location of a radicular cyst

Answer 10

• associated with a non-vital tooth
• peri-apical region

Question 11

Clinical features of a radicular cyst?

Answer 11

• most common jaw cyst
• often symptomless
  -incidental finding
• slowly expanding

Question 12

Histopathology of radicular cyst

Answer 12

• thick inflamed fibrous capsule
• non keratinised squamous epithelial lining
• cholestrol nodules present
• rushton’s bodies

Question 13

Location of a residual cyst

Answer 13

At site of previously extracted mandibular tooth (most common in mandibular premolar area)

Question 14

Clinical features of a residual cyst

Answer 14

• slowly enlarging swelling
• symptomless

Question 15

Histopathology of a residual cyst

Answer 15

• Thick fibrous capsule
  non keratinised squamous epithelial lining
• Cholestrol nodules

Question 16

Discuss the location of a dentigerous cyst

Answer 16

Associated with a non erupted tooth

Question 17

Discuss the clinical features of a dentigerous cyst

Answer 17

• develop around crowns of unerupted teeth
• may displace tooth

Question 18

Histopathology of a dentigerous cyst

Answer 18

• Capsule resembles dental follicle
• myxoid (mucous substance) areas and odontogenic rests
• lined by reduced enamel epithelium

Question 19

Discuss the location of a odontogenic keratocyst

Answer 19

• angle of mandible
• posterior maxilla

Question 20

Clinical features of a odontogenic keratocyst

Answer 20

• multilocular radiolucency
• expands through medullary bone
• minimal cortical expansion
• can recurr

Question 21

Histopathology of a odotogenic keratocyst

Answer 21

• Thin fibrous capsule
  lined by parakeratotic squamous epithelium
• basal cell palisade
• satellite cysts
• occurs commonly in basal cell nevus syndrome

Question 22

What syndrome are multiple odontogenic keratocysts associated with?

Answer 22

basal cell nevus syndrome (gorlin-goltz syndrome)

Question 23

Discuss the location of a nasopalatine duct cyst

Answer 23

Floor of nose to incisive papilla

Question 24

Discuss the clinical features of a nasopalatine duct cyst

Answer 24

• swelling
• displacement of central incisors
• salty taste
• radiolucency>6mm
• vital adjacent teeth

Question 25

Discuss the histopathology of a nasopalatine duct cyst

Answer 25

- Fibrous capsule - lined by respiratory or simple squamous cell

Question 26

Where does the epithelial lining of odontogenic cysts originate from?

Answer 26

- epithelial rests of serres - reduced enamel epithelium - epithelial rests of malassez

Question 27

What are epithelial rests of serres and what cysts do they give rise to?

Answer 27

- remnants of dental lamina - odontogenic keratocyst - lateral periodontal cyst - gingival cyst

Question 28

What is reduced enamel epithelium and what cysts does it give rise to?

Answer 28

- derived from enamel organ and covers the fully formed crown of unerupted tooth - dentigerous cysts - paradental cysts

Question 29

What are epithelial rests of malassez and what cysts do they give rise to?

Answer 29

- from fragmentation of herwig's epithelial root sheath - Radicular cyst

Question 30

Most common type of jaw cyst

Answer 30

Radicular

Question 31

How does the expansion of a cyst present clinically?

Answer 31

Egg shell cracking on palpation due to thinning of bone cortex

Question 32

How does a radicular cyst present radiographically

Answer 32

Round or ovoid radiolucency at the root apex - corticated margins continuous with lamina dura of tooth

Question 33

What is the pathogenesis of radicular cysts?

Answer 33

Proliferation of the epithelial rests of malassez within chronic periapical granulomas due to necrotic pulp

Question 34

Discuss the contents of a radicular cyst if it were to be aspirated

Answer 34

- 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

Question 35

Radiographic findings of a dentigerous cyst

Answer 35

well defined , unilocular radiolucency associated with the crown of an unerupted tooth - the tooth may be displaced

Question 36

Describe the histopathological findings of a dentigerous cyst?

Answer 36

- lined by non-keratinised stratified squamous or cuboidal epithelium - resembles reduced enamel epithelium - fibrous capsule containing loose myxoid areas resembling dental follicle

Question 37

Findings of dentigerous cyst if you will aspirate it?

Answer 37

- proteinaceous, yellow fluid - chlestrol crystals are common

Question 38

How common are odontogenic keratocysts?

Answer 38

5-10% of jaw cysts

Question 39

When is the peak age/incidence of development of an odontogenic keratocyst?

Answer 39

2nd to 3rd decade

Question 40

Where is the most common site for development of an odontogenic keratocyst

Answer 40

mandible in the third molar region

Question 41

Why do patients with odontogenic keratocyst tend to present so late?

Answer 41

Because the symptoms associated with these cysts are very few

Question 42

How do odontogenic keratocysts appear radiographically?

Answer 42

They are commonly multilocular

Question 43

How is gorlin-goltz syndrome inherited?

Answer 43

autosomal dominant trait

Question 44

What is the important feature of odontogenic keratocyst?

Answer 44

it has high recurrance rate

Question 45

Discuss the growth pattern of the odontogenic keratocyst

Answer 45

destructive pattern of growth ( moves through cancellous bone in an AP direction)

Question 46

What is the aetiology of the nasopalatine duct cyst?

Answer 46

Arises from epithelial remnants of the nasopalatine duct that connects the oral and nasal cavities

Question 47

What are the clinical features of a nasopalatine duct cyst?

Answer 47

Present as a slowly enlarging swelling in anterior midline of palate (discharge may cause salty taste)

Question 48

Discuss the radiographic findings of a nasopalatine duct cyst

Answer 48

Well defined round/ovoid/heart shaped radiolucencies with corticated margins

Question 49

Discuss the histopathological findings of a nasopalatine duct cyst

Answer 49

It is a combination of - stratified squamous - pseudostratified ciliated columnar - cuboidal and columnar epithelium with connective tissue capsule

Question 50

What provisional diagnoses might be associated with nasopalatine duct cyst?

Answer 50

- nasolabial cyst - median palatal cyst

Question 51

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:

Answer 51

solitary bone cyst

Question 52

Do solitary bone cysts have an epithelial lining?

Answer 52

No (non-odontogenic cyst)

Question 53

What is staphne cavity?

Answer 53

Idiopathic developmental bone cavity located on mandible - round, well demacated radiolucency between premolar region and angle of jaw - usually below IAN canal