Pathology Flashcards
what is mostly seen in patients with true generalized microdontia
-a systemic disorder or syndrome, like pitutry dwarfism, oro-faciodigital syndrome or oculo-mandibular -facial syndrome
-or patients who have gone chemotherapy that altered the formation of the developing dentition
microdontia is more common in?
females, with overall incidence of 1.5 to 2%
most affected tooth by hypodontia?
upper lateral -peg shaped
histology of microdontia
teeth are normal, however enamel and dentinal layers are not as robust as normal.
differential diagnosis of microdontia
-pituitary dwarfism
-hypothyroidism
-defects in growth hormones’
treatment of microdontia
restorative options to improve aesthetic
complications associated with microdontia?
function and esthetic challenges
but ususally, the underlying syndrome is the reason for concern
generalized macrodontia is associated with syndromes, name them
1-insulin-resistant diabetes
2-otodental syndrome
3-hypophyseal gigantism
macrodontia is more common in? and at which age?
it has no sex predilection
-age 8 to 13
cause of macrodontia - hostologically>?
over expression of dental developmental structures, resulting in hyperactivity of the tissue produced during tooth development
histophatology of macrodontia?
normal teeth, but with thicker layers of enamel and dentin
generalized cases of macrodontia are associated with?
underlying syndrome, or systemic conditions
what is molarization?
macrodontia in premolar
differential diagnosis of macrodontia
-gemination
-fusion
-facial hemihypertrophy
most affected tooth in macrodontia?
maxillary central incisror
complications or difficulties in macrodontia lies in
1-during extraction
2-moving the teeth in ortho ttt
3-it also may lead to crowding
4-aesthetic concern
Taurodontism is attributed to?
failure of sufficient invagination of the epithelial root sheath during tooth development, which result in misplaced dentin deposition
syndromes associated with taurodontism?
1-amelogenesis imperfecta
2-klinfelter syndrome
3-down sundrome
taurodontism is m ore common in?
male with less that 1%, mostly seen in eskimos and native americans
taurodontism results from one of three suggested pathologic processes?
1- delay of calcification of the pulp chamber
2-deficiency of odontoblasts with a resultant alteration in hertwig’s epithelial root sheath
3-or as a result of disrupted developmental homeostasis
histology of taurdontissm?
normal tooth with abnormally large pulp chamber
taurdontissm is a challenge to every specialty except? and why?
periodontics, because the root furcation is located more apically it reduced the frequency of periodontally driven furcation involvment.
complication of taurdontissm?
extraction due to inability of finding a furcation grip
treatment of fusion?
patients are prone to restorative, periodontal and, endodontic, and surgical complications so patients must be encouraged to keep ideal oral hygine to prevent complications
location of dilaceration depending on the type on tooth
anterior tooth- apical third
first molar- middle third
third molar-coronal third
complication of dilaceration
pulp necrosis and periapical inflammation may be common findings, because the bent portion acts as a cause for bacterial entry
challenges of dilcaeration
for surgery, endo, and ortho
ulceration in the oral cavity are caused by a spectrum of etiologic factors including
-trauma
-infection
-immunte disregulation
-neoplasm
clinical features of traumatic ulcer?
-mostly single
-paingul
-smooth red or whitish yellow surface
-thin erythematous halo
-soft on palpation
-heals spontanously or after remocal of cause within 6-10 days
most affected sites for traumatic ulcer
tongue, lip, buccal mucosa
cause of acute bacterial sialadenitis?
secondary to decreased salivary secretions, various reasons are attributed
there is a higher risk of sialolith in the submandibular duct causing secondary suppurative sialadenitis
clinical features of acute bacterial sialadenitis?
1-sudden onset of pain and swelling, especially around meal time
2-generalized malaise, fever, body ache and sometimes dehydration
3-diffuse inflammatory swelling, induraion, erythema, edema, and extreme tenderness over the affected gland
4-tense, glossy, and erythematous skin
pathologic sign of parotid swelling?
raised ear lobule
systemic sepsis occurs more with which salivary gland?
parotid
why are parotid gland swelling not fluctuant?
due to the fixity of overlying fascia, that’s why with pressure it become very painful because the fascia is nonyielding, and this pressure lead to ischemic nercosis of the gland, and the abscess may burst in the external auditory canal
sialography is contraindicated in cases of?
acute infection and sialoliths
treatment of acute bacterial sialadenitis?
-hydration
-antibiotic
-if swelling doesn’t subside with medications in 2 days or shows an increase then incision and drainage is indicated
chronic bacterial sialadenitis is more common in?
parotid gland
managemnt of chronic bacterial sialadenitis ?
-short term corticosteroid
-followed by the use of sialogougues to increase salivation and flush debris
chronic recurrent parotitis if left untreated may lead to ?
benign lymphoepithelial lesions which can progress to lymphoproliferative disorders like non-Hodgkin’s lymphoma, carcinoma, or psudolymphoma
sialolithiasia or salivary calculi are most commonly seen in?
submandibular gland and duct
which x-ray or film is useful for detecting sublingual and submandibular gland or duct stones in the floor of the mouth?
mandibular occlusal film
which radiograph shows parotid stones?
panormaic
which radiograph shows submandibular stones?
lateral radiograph
sialography if a techinique in which the salivary gland is cannulated with a catheter, and a contrast medium is injected, what are the types of these medium?
both contain high concentration of iodine 25%-40%
1-water-soluble contrast
2-oil-based contrast
repeated inflammatory or infections to irregular narrowing and stricture of the duct caused by reparative fibrosis giving a very characteristic appearance
sausage pattern
most common and rarest location for stones in salivary gland?
most common - submandibular followed with parotid
rarest-sublingual
signs and symptoms of salivary gland stones 9ialolithis)
1-swelling that is exaggerated when eating
2-tenderness
3-repeated inflammatory reaction
4-pus can be observe
5-secondary infection
management of salivary gland stone?
surgical if can’t be removed trans-orally
what is sialolithotomy
surgical incision of a salivary gland for removal of a calculus.
what is sialendoscopy?
is a minimally invasive procedure to diagnose and treat salivary gland disorders including stones, strictures, chronic inflammation and others
complication of sialendoscopy
-salivary duct wall perforation
-nasket entrapment
-post operative infection
-lingual nerve parastesia
-ductal stenosis
most common type of cyst of minor salivary gland?
mucocele
most common location of mucocele?
lower lip
cause of mucocele
trauma
treatment of mucocele?
mucocele should be removed completely with the underlying salivary gland
location of ranula?
floor of the mouth
ranula is also known as?
mucous retention cyst
treatment of ranula?
dissection of the cyst with the sublingual gland, or masrupalization is an alternative
salivary gland neoplasm consist of (% of salivary gland of head and neck?
only 2%
most of salivary gland tumors occur in? in what percent?
parotid = 80%
submandibular and other salivary glands = 20%
80% of parotid gland neoplasm is benign but 50% of submandibular gland neoplasm is malignant
benign salivary gland tumors are?
1-pelomorphic adenoma
2-warthin’s tumor
3-oncosytoma
4-monomorphic adenoma
warthins tumor location is ?
bilateral
malignant salivary gland tumors are?
1-metastitic cutaneous squamous cell carcinoma
2-mucoepidermoid carcinoma
3-adenoid cystic carcinoma
4-adinocarcinoma
5-acinic cell carcinoma
6-lymphoma
preferred radiological modality for tumors?
CT scan, because it provides anatomical details that help determine the exact location and infiltration of the tumor.
reliable method of differentiating between neoplastic and non-neoplastic disorders?
fine needle aspiration
high-grade salivary gland malignancies may also require neck dissection and postoperative radiotherapy to minimize the chance of tumor recurrence
what is a cyst?
petrological cavity lined with epithelium, containing fluid or semi-fluid
cysts of the jaw can be classified into two main groups
1-odontogenic cysts that are lined with epithelium derived from the dental lamina
2-non-odontogenic cysts lined by other types of epitelium
examples of odontogenic cysts
1-dentigerous cyst
2-radicular cyst
3-odontogenic keratocyst
4-lateral periodontal cyst
examples of non-odontogenic cysts
1-nasopalatine cyst
2-nasolabial cyst
3-solitary bone cyst
4-aneurysmal cyst
most common type of odontogenic cyst? and its cause?
radicular cyst, due to pulpal infection leading to non vital tooth
radicaular cyst can be classified dependnig upon their location in relation to the tooth
-apical
-residual
-lateral
dentigerous cyst are considered developmental cyst but certain inflammation can initate them like?
pericoronitis
epithetlium of dentigerous cyst is?
non-keratinized squamous cell epithelium that is continuous with the reduced enamel epithelium of the tooth (because it arises from it)
management of dentigerous cyst?
extraction of the causative tooth and cyst enucleation, but if we need to preserve the tooth we do marsupalization
complication of removal of large cyst in the mandible?
mandibular fracture
odontogenic keratocyst arises from?
the rest of serres
location of OKC?
around the angle of the mandible, like other cysts its often asymptomatic until it get infection
pattern of OKS spreading?
mesiodistal then buccolingual
characteristics of OKC?
-well defined radiolucency
-can be uni or multilocular
-there is often evidence of growth along the medulla of the bone with little cortical expansion
tratment of OKC?
enucleation
problem with OKC after ttt?
high recurrence due to presence of daughter cysts, to overcome this surgeons will use an intra-operative fixative (such as carnoys solution) to degenerate the remaining tissue
characterstis of lateral periodontal cysts
how to distinguish between lateral periodontal cyst and radicular cyst?
in lateral periodontal cyst the tooth is vital
nasopalatine cyst AKA?
incisive canal cyst
characterstics of nasopalatine cyst?
-round, unilocular corticated uniform radiolucensy
-teeth are vital, but there maybe
-pain, discharge, and mobility and displacement
when the nasopalatine duct cysts are small on radiograph it gets difficult of distinguish them from large incisve foramen
why is nasopalatine cyst a heart-shped?
because of the nasal septum or anterior nasal spine
how is nasolabial cyst noticed?
through soft tissue
origin of nasolabial cyst?
epithelial remnants of the nasopalatine duct
solitary bone cyst or traumatic bone cyst characterstis
-well defined, unilocular
-characterized by
-also little cortical expansion scalloping between the roots in common
aneurysmal bone cyst are filled with? and are more common in?
blood
-long bones but can be found in the mandible
characteristics of aneurysmal bone cyst
-multilocular radiolucency with cortical expansion
, sometimes it is difficult to differentia between aneurysmal bone cyst and?
-OKC
-ameloblastoma
first line of treatment of aneurysmal bone cyst
is to distinguish if from other cysts by taking an aspirate.
-this is vital as approaching the cyst surgically without this knowledge lead to catastrophic bleeding
stafne bone cyst is?
entrapment of submandibular salivary gland in the lingual surface of the mandible
recurrence rate of ameloblastoma
it is benign with high recurrence rate
definitive diagnosis of oral lesions is established only after?
incisional, excisional or intraoperative frozen section biopsy
oral cancer screening envolves what steps?
1-anterior gingival and upper lip mucosa
2-lip
3-buccal mucosa
4-lower lip gingiva, mucosa, and vestibule
5-hard palate
6-tonsils and soft palate
7-floor of mouth and ventricle of the tongue
8-lateral border of the tongue
cause of craniofacial anomalies
multifactorial
genes, environment, folic acid deficiency
most common craniofacial congenital anomalies seen at birth?
cleft lip and palate
craniosynostosis?
condition where the suture in the skull of an infant close too early, affecting brain growth and causing intra cranial pressure
hemifacial microsomia?
condition where the tissue on one side of the face are underdeveloped, it mostly affect the ear, mouth, and mandible
hemifacial microsomia AKA?
goldenhar syndrome
problem with vascular malformation?
functional and aesthetic problems
there are several different types of malformations according to which type of blood vessel is most affected.
hemangiomal is a vascular disorder aka
-port wine stain, strawberry hemangioma. salmon patch
most common feature of TMD
1-regional pain in face and preauricular area
2-limitation in jaw movements
3-clicking during movement
there is no single approach for treating TMD
exmples of TMD disorder
1-anterior displacement of the disc (reciprocal clicking of the joint)
2-anterior dislocation of the disk
(locked joint)
treatment approaches for TMD
1-immobilization of the jaw
2-thermotherapy
3-muscle exercise (so not to open beyond necessary)
4-laser
5-occlusal splints
6-occlusal adjustments
7-total joint replacement
what is arthrocentesis?
the first surgical procedure to be done to a patient with displaced disk
(also called joint aspiration) is a procedure where a doctor uses a needle to take fluid out of a joint.
TMJ anatomy - lower and upper joint space responsible for which movement?
lower joint space=rotation
upper joint space=translation (maximum opening
function of ligaments of TMJ?
limit movement of the mandible
what are ligaments of TMJ?
1-capsular ligament (completely cover the tmj joint space, and needs to be punctured to access the joint space
2-disk/ collateral ligament (keeps the disk attached to the condyle during movement)
3-posterior ligament (prevents anterior disk displacement)
4-lateral ligament (prevents anterior disk displacement)
blood supple of the TMJ
MADS
-maxillary
-ascending pharyngeal
-deep auricular
-superficial temporal
Disc displacement or internal derangement
the articular disc is in the wrong place, anteriorly or posteriorly
Disc displacement or internal derangement, types?
1-with reduction= click
disc is anteriorly displaced, and there is a pop sound
2-without reduction=lock
condyle is stuck behind the desk, there is limitation of opening.
if it is in one side in could be ipsilateral mandibular deviation
opening pattern - deflection?
mandible deflects toward the side that is stuck at maximum opening
opening pattern - deviation?
deviation - mandible deviated toward one side but then return back to midline at maximum opening
marsupialization vs enucleation
Enucleation
is defined as a complete removal of the cystic lining with healing by primary intention
marsupialization
is the conversion of a cyst into a pouch, it requires considerable aftercare and patient cooperation in keeping the cavity clean whilst it resolves.
incision vs excision biopsy?
When the entire tumor is removed, the procedure is called an excisional biopsy. If only a portion of the tumor is removed, the procedure is referred to as an incisional biopsy.
