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BDS4 EXAM STUDY > Oral Surgery & Histopathology > Flashcards

Oral Surgery & Histopathology Flashcards

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1
Q

What are the red flag signs of oral squamous cell carcinomas??

A
  • Non-healing ulcers
  • Non-homogenous leukoplakia
  • Erythroplakia
  • Induration
  • Tooth mobility [unexplained]
  • Pathological fracture [unexplained]
  • Cervical lymphadenopathy
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2
Q

What are the red flag symptoms of oral squamous cell carcinomas??

A
  • Discomfort and pain
  • Loss of sensation over the distribution of CNV
  • Difficulty eating, swallowing & speaking
  • Loss of apetite, weight loss & fatigue
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3
Q

What do odontogenic cysts and tumours arise from?

A

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

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4
Q

What is the most common odontogenic tumour?

A

Ameloblastoma

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5
Q

What are some epithelial-lined odontogenic cysts?

A
  • radicular cyst
  • residual cyst
  • dentigerous cyst
  • eruption cyst
  • odontogenic keratocyst
  • lateral periodontal cyst
  • gingival cyst
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6
Q

What are some epithelial-lined non-odontogenic cysts?

A
  • nasopalatine duct cyst
  • nasolabial cyst
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7
Q

What are some non- epithelial-lined jaw cysts?

A
  • solitary bone cyst
  • aneurysmal bone cyst
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8
Q

What is the definition of a cyst?

A

a pathological cavity having fluid or semi-fluid contents that has not been created by the accumulation of pus

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9
Q

Discuss the location of a radicular cyst:

A
  • always associated with a non-vital tooth
  • periapical region
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10
Q

Discuss the clinical features of a radicular cyst:

A
  • most common jaw cyst
  • often symptomless
  • incidental finding
  • slowly expanding
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11
Q

Discuss the histopathology of a radicular cyst:

A
  • thick, inflamed fibrous capsule
  • non-keratinising squamous epithelial lining
  • cholesterol nodules
  • Rushton’s bodies
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12
Q

Discuss the location of a residual cyst:

A
  • site of a previously extracted non vital tooth
  • most common in mandibular premolar area
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13
Q

Discuss the clinical features of a residual cyst:

A
  • slowly enlarging swelling
  • symptomless
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14
Q

Discuss the histopathology of a residual cyst:

A
  • thick fibrous capsule
  • non-keratinising squamous epithelial lining
  • chloesterol nodules
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15
Q

Discuss the location of a dentigerous cyst:

A
  • associated with an unerupted tooth
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16
Q

Discuss the clinical features of a dentigerous cyst:

A
  • develop around crowns of unerupted teeth
  • may displace tooth
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17
Q

Discuss the histopathology of a dentigerous cyst:

A
  • capsule resembles dental follicle
  • myxoid areas and odontogenic rests
  • lined by reduced enamel epithlium
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18
Q

Discuss the location of a odontogenic keratocyst:

A

Majority:
- angle of mandible
- posterior maxilla

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19
Q

Discuss the clinical features of a odontogenic keratocyst:

A
  • multilocular radiolucency
  • expands through medullary bone
  • minimal cortical expansion
  • RECURRANCE
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20
Q

Discuss the histopathology of a odontogenic keratocyst:

A
  • thin, fibrous capsule
  • lined by parakeratotic squamous epithelium
  • basal cell palisade
  • satellite cysts
  • occurs commonly in basal cell nevus syndrome
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21
Q

What syndrome are multiple odontogenic keratocysts associated with ?

A

basal cell nevus syndrome (Gorlin-Goltz syndrome)

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22
Q

Discuss the location of a nasopalatine duct cyst:

A

floor of nose to incisive papilla

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23
Q

Discuss the clinical features of a nasopalatine duct cyst:

A
  • swelling
  • displacement of central incisors
  • salty taste
  • radiolucency >6mm
  • vital adjacent teeth
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24
Q

Discuss the histopathology of a nasopalatine duct cyst:

A
  • fibrous capsule
  • lined by respiratory or simple squamous epithelium or both
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25
Q

Where does the epithelial lining of odontogenic cysts originate from?

A
  • Epithelial Rests of Serres
  • Reduced Enamel Epithelium
  • Epithelial rests of Malassez
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26
Q

What are Epithelial rests of Serres & what cysts do they give rise to?

A
  • remnants of dental lamina
  • odontogenic keratocyst
  • lateral periodontal
  • gingival cyst
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27
Q

What is Reduced enamel epithelium & what cysts does it give rise to?

A
  • Derived from enamel organ & covers the fully formed crown of unerupted tooth
  • Dentigerous cysts
  • Paradental cysts
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28
Q

What are Epithelial rests of Malassez & what cysts do they give rise to?

A
  • Form by fragmentation of Hertwig’s epithelial root sheath
  • Radicular cysts
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29
Q

What are the most common type of jaw cyst?

A

Radicular

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30
Q

How does the expansion of a cyst present clinically?

A

Egg shell crackling on palpation due to thinning of bone cortex

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31
Q

How does a radicular cyst present radiographically?

A

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

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32
Q

What is the pathogenesis of radicular cysts?

A

Proliferation of the epithelial rests of Malassez within chronic periapical granulomas due to:
- necrotic pulp

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33
Q

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

A

Watery, straw coloured fluid
OR
Semi-solid brownish material
- breakdown products of degenerating epithelial & inflammatory cells & connective tissue components
- serum proteins
- water & electrolytes
- cholesterol crystals

34
Q

Discuss the radiographic findings of a dentigerous cyst:

A

Well-defined, unilocular radiolucency associated with the crown of an unerupted tooth
- the tooth may be displaced for a considerable distance

35
Q

Describe the histopathological findings of a dentigerous cyst:

A
  • lined by non-keratinised stratified squamous or flattened cuboidal epithelium
  • resembles reduced enamel epithelium
  • fibrous capsule containing loose myxoid areas resembling dental follicle
36
Q

Discuss the findings if you were to aspirate a dentigerous cyst:

A
  • proteinaceous, yellow fluid
  • cholesterol crystals common
37
Q

How common are odontogenic keratocysts?

A

5-10% of jaw cysts

38
Q

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

A

2nd/3rd decade

39
Q

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

A

Mandible (third molar region most common)

40
Q

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

A

These cysts give rise to very few symptoms

41
Q

How do odontogenic keratocysts appear radiographically?

A

Commonly multilocular

42
Q

What syndrome is associated with multiple odontogenic keratocysts? How is this inherited?

A

Basal cell nevus syndrome (Gorlin-Goltz syndrome)
- autosomal dominant trait

43
Q

What is an important clinical feature of odontogenic keratocysts?

A

High recurrence rate

44
Q

Discuss the growth pattern of the odontogenic keratocyst:

A

Destructive pattern of growth
- burrows through cancellous bone in an AP direction

45
Q

What is the aetiology of the nasopalatine duct cyst?

A

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

46
Q

What are the clinical features of a nasopalatine duct cyst?

A

Can present as a slowly enlarging swelling in anterior midline of palate
- discharge may cause salty taste
-

47
Q

Discuss the radiographic findings of a nasopalatine duct cyst:

A

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

48
Q

Discuss the histopathological findings of a nasopalatine duct cyst:

A

Combination of:
- stratified squamous
- pseudostratified ciliated columnar
- cuboidal & columnar epithelium

With connective tissue capsule

49
Q

What provisional diagnoses may you come up with for a nasopalatine duct cyst?

A
  • nasolabial cyst
  • median palatal cyst
50
Q

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:

A

Solitary bone cyst

51
Q

Do solitary bone cysts have an epithelial lining?

A

NO [non-odontogenic cyst]

52
Q

What is a Staphne cavity?

A

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

53
Q

What syndrome is associated with multiple odontomes?

A

Gardner’s syndrome

54
Q

How does a complex odontome appear histologically?

A

Mass of disordered (but well formed) enamel, dentine and cementum

55
Q

What are odontomes?

A

Hamartomatous developmental lesions that can cause delay in eruption of permanent teeth

56
Q

What is the most frequent benign odontogenic tumour?

A

AMELOBLASTOMA
- locally invasive neoplasm
- high recurrence rate

57
Q

What are the histopathological findings of Follicular Ameloblastomas?

A
  • islands of odontogenic eptihelium within fibrous stroma
  • columnar basal cell palisading
  • central cells loosely arranged resembling stellate reticulum
  • reverse polarity of nuclei
58
Q

How are ameloblastomas managed?

A

Excision of area with a margin of uninvolved tissue to reduce chance of recurrence
- long term follow up mandatory

59
Q

What systems are in place for grading epithelial dysplasia?

A

WHO system and Binary system (WHO more common for oral pathology)

60
Q

How can cysts be classified?

A

Based on WHO 2017 Classification

61
Q

How does the 2017 WHO classification divide cysts?

A
  • Odontogenic Cysts of Inflammatory Origin
  • Odontogenic Cysts of Developmental Origin
  • Non-Odontogenic Epithelial Cysts
  • Non-epithelial cysts
62
Q

What cysts come under “Odontogenic Cysts of Inflammatory Origin”?

A
  • Radicular Cysts
  • Inflammatory Collateral Cysts [paradental cysts & mandibular buccal bifurcation cyst]
63
Q

What cysts come under Odontogenic Cysts of Developmental Origin?

A
  • Dentigerous Cyst
  • Odontogenic Keratocyst
  • Lateral Periodontal Cyst
  • Gingival Cysts
  • Calcifying Odontogenic Cyst
64
Q

What cysts fall under “non-odontogenic epithelial cysts”?

A
  • Nasolabial cysts
  • Nasopalatine cyst
65
Q

What cysts fall into the Non-Epithelial Cysts class?

A
  • solitary bone cyst
  • aneurysmal bone cyst
  • stafne idiopathic bone cavity
66
Q

What is the most common jaw cyst?

A

Radicular cyst (60%)

67
Q

What do radicular cysts originate from?

A

Inflammation [arising from necrotic pulp] leading to proliferation of epithelial rests of Malassez
- these originate from Hertwig’s root sheath (dental follicle)

68
Q

How are radicular cysts treated?

A

Enucleation & removal of associated tooth

69
Q

What is the incidence of inflammatory collateral cysts?

A

5% of odontogenic cysts

70
Q

What are Paradental Cysts?

A

Cysts associated with a partially erupted tooth (most frequently third molars)

71
Q

What is the most common developmental odontogenic cyst?

A

Dentigerous cysts (form 20% of all odontogenic cysts)

72
Q

What provisional diagnoses may you come up with for a dentigerous cyst?

A
  • dentigerous cyst
  • adenomatoid odontogenic tumour
  • calcifying epithelial odontogenic tumour
73
Q

How are dentigerous cysts treated?

A

Enucleation with associated tooth
(marsupialisation if large)

74
Q

How do dentigerous cysts present clinically?

A
  • males > females
  • 2nd & 3rd decade
  • asymptomatic, often incidental finding
  • tooth missing from arch
75
Q

What is the radiographic presentation of a dentigerous cyst?

A
  • round/ovoid
  • well-defined unilocular, uniform radiolucency
  • attached to CEJ of unerupted tooth
76
Q

What are the contents of a dentigerous cyst?

A
  • Proteinaceous, yellow fluid
  • Cholesterol crystals common
77
Q

What is basal cell naevus syndrome? How does it occur?

A
  • Autosomal dominant trait

Presentation:
- multiple OKCs
- multiple naevoid BCCs of skin
- skeletal abnormalities

78
Q

What is cyst enucleation?

A

Removal of entire cyst lining & contents
- useful for radicular/residual cysts, dentigerous cysts, keratocysts

79
Q

In what scenario is enucleation unsuitable?

A

Ameloblastoma

80
Q

What complications may arise from enucleation of cysts?

A
  • damage to IAN
  • communication with sinus (OAC)
  • pathological fracture of mandible
  • risk of recurrence

BDS4 EXAM STUDY (39 decks)

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