Oral Surgery - Cysts and Tumours Flashcards
what is the definition of a cyst
pathological cavity filled with fluid or air - that is not filled with the accumulation of pus
what are the broad classifications of odontogenic cysts
inflammatory - radicular, paradental, mandibular buccal bifurcation
developmental - dentigerous cyst, OKC, lateral periodontal, gingival, calcifying odontogenic cyst
what are the three types of non-odontogenic cysts
nasopalatine duct cyst
staphne’s bone cavity
aneurysmal bone cyst
what are radicular cysts
associated with non vital tooth
due to proliferation of epithelial rests of malassez (HERS)
what are residual cysts
radicular cysts that remain in the jaws after an extraction of the affected tooth
name histopathological aspects of radicular/ residual cysts
regular lining of non-keratinised squamous cell epithelium
deposits of cholesterol
vascular capsule
inflammatory infiltrate
rushton bodies
what is the radiographic appearance of radicular/ residual cyst
round or oval
unilocular and well defined
uniform radiolucency
what are paradental cysts
associated with PE 3rd molars where the inflammatory stimulus is periocoronitis
what are mandibular buccal bifurcation cysts
occur in children and associated with buccal aspect of erupting FPM
what is a dentigerous cyst
they embrace the whole crown of an unerupted tooth and attach at CEJ
lined with epithelium derived from reduced enamel epithelium (REE)
associated with impacted mandibular 8s
what is an eruption cyst
overlies an erupting tooth
most frequently seen in deciduous incisors of FPMs
what is the histopathology of dentigerous/ eruption cysts
thin regular layer of non-keratinising stratified squamous epithelium
capsule resembles dental follicle
myxoid areas
lined with reduced enamel epithelium
how do dentigerous cysts present radiologically
round or oval
well defined unilocular
uniform radiolucency
attached to crown of unerupted tooth
what is an OKC
arises from cell rests of serres (dental lamina)
has an unusual growth pattern with high risk of recurrence
grows mesio-distally before any bony expansion bucco-lingually
what is the histopathology of OKCs
thin connective tissue wall
uninflamed
lined with parakeratinised stratified squamous epithelium
can lead to daughter cells
how do OKCs present radiographically
oval
well-defined
uni or multilocular
what syndrome is associated with OKCs
basal cell naevus (Gorlin Goltz)
multiple naevoid basal cell carcinomas of the skin
what is orthokeratinised odontogenic cyst
uncommon developmental cyst
similar presentation to OKC
unilocular without epithelial proliferations or satellite cells
what is the histopathology of orthokeratinised odontogenic cyst
prominent orthokeratinisation
flattened basal cell layer
no association with naevoid basal cell carcinoma syndrome
what is a lateral periodontal cyst
associated with lateral surface of root (canine/ premolar region)
what is the histopathology of lateral periodontal cysts
thin lining stratified squamous epithelium
similar to gingival cysts
what are gingival cysts
appear on attached gingivae as less than 1cm pink/blue swellings
derived from rests of serres (dental lamina) in gingival or alveolar soft tissues
what are gingival cysts that appear on the palate of infants termed
epsteins pearls
what are glandular odontogenic cysts
mulitlocular
mainly in anterior mandible
high recurrence
what is the histopathology of glandular odontogenic cysts
uninflamed fibrous wall lined by glandular cuboidal epithelium
what is calcifying odontogenic cysts
benign lesion that are about 1-3cm diameter
adjacent teeth displaced
bony expansion occurs
what is a nasopalatine duct cyst
non-odontogenic
comes from epithelial remnants pf naso-palatine duct
heart shaped on true maxillary occlusal radiograph
what is the histopathology of naso-palatine duct cyst
stratified squamous epithelium lining
also has respiratory cuboidal lining
neurovascular bundles found in capsule
what are three examples of non-epithelial cysts found in the jaws
solitary bone cyst
staphne’s cavity
aneurysmal bone cyst
what is solitary bone cyst
unknown aetiology
varied size and radiolucency with irregular outline
scalloping prominent
what is stafne’s idiopathic bone cavity
round or oval radiolucency lies below level of IAN
how are cysts managed
referral
initial consultation
special radiographs - including plain film radiograph, CBCT or CT
biopsy
diagnosis
treatment plan and discussion
what are the treatment options for cysts
enucleation
marsupialisation
surgical resection
what is cyst enucleation
removal of entire cyst lining and contents
used for radicular, residual or keratocysts
what are potential complications of cyst enucleation
damage to IAN
communication with maxillary sinus
pathological fracture of mandible
risk of recurrence
what is marsupialisation
removing part of the cyst and leaving the top uncovered
useful for large simple cysts, keratocyst or dentigerous cysts
what are complications of marsupialisation
needs further surgery to remove cyst
long treatment time before completion
chance of infection
uncomfortable
what is segmental resection
removal of cyst with margin of normal bone
used for ameloblastoma and sarcoma
what are the three types of origin of odontogenic tumours
epithelial
mesenchyme
mixed
what are three examples of epithelial odontogenic tumours
ameloblastoma
calcifying epithelial odontogenic
adenomatoid odontogenic tumour
what is an ameloblastoma
benign but locally destructive
posterior mandible
knife edged external replacement resorption of neighbouring teeth
what are the two types of ameloblastoma
follicular
plexiform
what is follicular ameloblastoma
islands present in fibrous tissue
stellate reticulum tissue
no connective tissue capsule
what is plexiform ameloblastoma
cells arranged in strands rather than islands
stellate reticulum tissue
no connective tissue capsule
what is the management of an ameloblastoma
surgical resection with margin of 1mm sound bone
what is an adenomatoid odontogenic tumour
benign
unilocular radiolucency with internal calcifications surround crown of unerupted maxillary canine
attaches APICAL to CEJ (not like dentigerous)
what is the histopathology of adenomatoid odontogenic tumour
epithelial cells arranged in duct like structures
rosette appearance
patchy calcification and fibrous tissue capsule
what is the management for an adenomatoid odontogenic tumour
surgical removal
what is calcifying epithelial odontogenic tumour
benign
radiolucency has internal radiopacities
variable appearance
pleomorphic epithelial cells with dark nuclei
pink staining amyloid
what is an example of an odontogenic mesenchymal tumour
odontogenic myxoma
what is an odontogenic myxoma
benign
occurs more in mandible
well- defined radiolucency with thin corticated margin
soap bubble appearance
what is the histopathology of odontogenic myxoma
loose myxoid tissue with stellate cells
islands of inactive odontogenic epithelium
no capsule - locally invasive
what is the management of an odontogenic myxoma
curettage or resection due to high recurrence rate
what is the only mixed odontogenic tumour
odontoma
what is an odontoma
benign tumour
odontome supernumerary
malformation of dental tissues (enamel = epithelial and dentine = mesenchyme)
what are the two types of odontoma
compound = ordered structures appear as mini teeth (anterior maxilla)
complex - disordered mass of dental tissues (posterior mandible)
what is the aetiology of radicular/ residual/ lateral cysts
rests of malassez from HERS
what is the aetiology of dentigerous cyst
reduced enamel epithelium
what is the aetiology of OKC
rests of serres
what is the aetiology of ameloblastoma
rests of serres
rests of malassez
reduced enamel epithelium
