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Oral Path 2 > Radiolucent Odontogenic Lesions > Flashcards

Radiolucent Odontogenic Lesions Flashcards

1
Q

Cysts

A
  • Pathologic sack or cavity w/ a central lumen lined by epithelium
    • We make dx based on epithelial lining
  • Slowly growing & asymptomatic (unless inflamed)
  • Persistent & progressive and can become large and destructive if not tx’d
    • They’ll keep growing until you remove them
  • Rad: Well-defined RL lesion, often corticated borders
  • Do not infiltrate surrounding bone
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2
Q

Components of cysts

A
  • Lumen
  • Epithelial lining
  • CT wall
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3
Q

Cyst Tx

A

Varies from enucleation to aggressive curettage

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4
Q

Where do the epithelial components of cysts come from inside the bone?

A
  • Dental lamina
  • Reduced enamel epithelium
  • Epithelial Rests (of Malassez) from HERS
    • Remnants of odontogenesis
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5
Q

Odontogenic cysts of the jaw: Origin of epithelial rests

A
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6
Q

T/F: Cysts & benign tumors have similar appearance. Inflammatory & malignancy have similar appearance.

A

True, true.

  • Cysts and benign tumors slowly push and displace anatomical structures
    • Can’t move tooth anymore, creates smooth resorption that looks like it follows hydraulic apperarance in directional resorption
  • Inflammatory lesions and malignancies are quick - grow around teeth quickly, area that is growing starts to get pushed out and expand = non-directional resorption
    • PDL space gone
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7
Q

Radicular (Periapical) Cyst

A
  • Assoc w/ necrotic debris & bacteria of non-vital pulp
  • Origin of epithelium is Epithelial Rests of Malassez
  • Pulp necrosis → Inflammation → Radicular granuloma → Keratinocyte GF → Proliferation of epithelial rests
  • Most grow slowly
  • Asymptomatic unless acutely inflamed
  • Rad: PA, well circumscribed, RL; loss of lamina dura; cannot be differentiated from PA granuloma & abscess
  • Healing Radicular Cyst
    • Original outline still seen
    • Bone grows inward
    • “Rolled border” appearance
      • After endo tx, bone starts filling back in from the outside to create rolled border
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8
Q

What is the most common developmental odontogenic cyst?

A

Dentigerous (Follicular) Cyst

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9
Q

Dentigerous (Follicular) Cyst

A
  • Most common developmental odontogenic cyst
    • ​2nd most common cyst
  • ​Pathogenesis: Proliferation of reduced enamel epithelium
  • Rad: Well-defined, unilocular RL around/associated w/crown of unerupted tooth, often corticated border
  • Attached to the CEJ of unerupted tooth or odontoma
  • Most common w/ M3s & MX K9s
  • Generally asymptomatic and discovered on routine radiographic exam
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10
Q

Dentigerous (Follicular) Cyst: Clinical features

A
  • Small cysts are asymptomatic
  • Can grow to large sizes and cause bony expansion
  • Pain and swelling if infected
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11
Q

Dentigerous (Follicular) Cyst: Radiographic features

A
  • Well-defined and often corticated border
  • May be extensive and destructive
  • Unilocular and multilocular
    • Usually unilocular but anything can become multilocular as it gets bigger
  • Can displace affected tooth
  • Can result in root resorption of adjacent teeth
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12
Q

Dentigerous (Follicular) Cyst: Tx

A
  • Enucleation and removal of affected tooth
  • Marsupialization followed by excision for larger lesions (not commonly done)
  • Little tendency to recur when completely removed
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13
Q

Eruption Cyst

A
  • ST analogue of dentigerous cyst
    • Only in ST around alveolar crest
  • Consists of cystic fluid and/or blood accumulated b/w erupting tooth and dental follicle
  • Appears as soft translucent swelling in gingival mucosa overlying crown of erupting tooth; traumatized, can lead to eruption hematoma
  • Purple if blood present
  • Most common in children <10yo
  • Dentigerous cyst that forms after it has broken through alveolar crest; cyst not in bone
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14
Q

Eruption Cyst Tx

A
  • Not usually tx’d bc tooth will erupt
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15
Q

What is the second most common cyst?

A

Dentigerous (Follicular) Cyst

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16
Q

What is the 3rd most common cyst?

A

Keratocystic Odontogenic Tumor (Odontogenic Keratocyst)

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17
Q

Other name for Keratocystic Odontogenic Tumor

A

Odontogenic Keratocyst

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18
Q

Keratocystic Odontogenic Tumor

A
  • AKA Odontogenic Keratocyst
  • 3rd most common cyst
  • Odontogenic cyst w/ specific microscopic features and clinical features
  • Arises from dental lamina
  • Relatively aggressive behavior & tx
  • High recurrence rate
  • Associated w/ nevoid basal cell carcinoma syndrome
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19
Q

Keratocystic Odontogenic Tumor: Clinical features

A
  • Can occur in any odontogenic location
  • Most common in MN body & ramus
  • Tends to grow in anterior-posterior direction in MN
    • Does not cause expansion in MN body typically
  • More growth potential than other odontogenic cysts
  • Higher rate of recurrence
  • Large OKCs may be associated w/ pain, drainage, paresthesia
  • Large OKCs do not tend to expand jaws
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20
Q

Keratogenic Odontogenic Tumor: Rad

A
  • Assoc w/ unerupted tooth in 25-40% of cases
  • Well-defined RL area
  • Smooth corticated margin
  • Unilocular or multilocular
    • ​Smaller lesions = unilocular
    • Larger lesions = multilocular
  • Usually displaces teeth
  • Little to no expansion, despite large size; but CAN cause expansion, esp in ramus
  • Frequently mimics other lesions
  • Daughter cysts: Mini cysts around main cysts that get left behind when we enucleate the cyst
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21
Q

Why do OKCs occur often and have tumoral characteristics?

A

Daughter cysts: Mini cysts around main cysts that get left behind when we enucleate the cyst

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22
Q

OKC Tx

A
  • Surgical excision w/ peripheral ostectomy, Carnoy solution
  • Avg recurrence rate of 30%
  • Most recur in 5yr, but may not until >10yr → long term clinical & radiographic f/u
  • Occasionally, local resection and bone grafting are necessary
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23
Q

What would you include in differential dx along w/ OKC?

A
  • Dentigerous (Follicular) Cyst
  • Lateral Periodontal Cyst
  • Nasopalatine Cyst
  • Radicular Cyst
  • Residual Cyst
  • Primordial Cyst
  • “Globulomaxillary” Cyst
  • Idiopathic Bone Cavity
  • Ameloblastoma & other benign odontogenic tumors
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24
Q

What is the only cyst that can be MIXED, while all others are ALWAYS RADIOLUCENT?

A

Calcifying odontogenic cyst

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25
Q

Lateral Periodontal Cyst

A
  • Arise from dental lamina along lateral surface of the root
    • From previous epithelium and normal around PMs
    • Does not mess w/ PDL/lamina dura
  • <2% of all jaw cysts
  • Asymptomatic
  • 75-80% in PM-K9-LI area
  • MN > MX
  • Assoc w/ vital or non-vital teeth
26
Q

Lateral Periodontal Cyst: Rad

A
  • Well-defined RL lesion
  • Relatively small, usually <1cm
  • Rad features are not dx’c
27
Q

Lateral Periodontal Cyst: Tx

A
  • Enucleation
28
Q

Other names for Gorlin Syndrome

A

Nevoid Basal Cell Carcinoma Syndrome

Gorlin-Goltz Syndrome

29
Q

Gorlin Syndrome

A
  • AKA Nevoid BCC Syndrome, Gorlin-Goltz Syndrome
  • ​Autosomal Dominant
    • ​PTCH1 gene mutation
30
Q

What syndrome would a mutation in PTCH1 produce?

A

Gorlin Syndrome AKA Nevoid BCC Syndrome AKA Gorliln-Goltz Syndrome

31
Q

Gorlin Syndrome: Most common clinical findings (>50%)

A
  • Multiple BCCs
  • Multiple odontogenic keratocysts
  • Calcified falx cerebri
  • Rib abnormalities
  • Palmar plantar pits
  • Ocular hypertelorism
  • Enlarged head
  • Spina bifida
32
Q

Gorlin Syndrome: Px

A
  • ​Most anomalies are minor and non-life threatening
  • Px depends on behavior of skin cancers
  • Keratocysts tx’d w/ enucleation
  • Pts should avoid sunlight
  • Jaw cysts tx’d by enucleation
  • Deformities may result from operations
33
Q

Gingival cyst of the adult

A
  • ST counterpart of lateral periodontal cyst
  • Predilection for MN K9/PM area
  • Pts in 5th & 6th decades of life
  • Found on facial gingiva or alveolar mucosa
  • Technically a peripheral lateral periodontal cyst
  • Painless, dome-like bluish or blue grey swelling
34
Q

Gingival cyst of the adult: Tx

A
  • Simple excision
  • Excellent px
  • No recurrence
35
Q

Gingival cyst of the newborn:

Bohn’s nodules; Epstein’s pearls

A
  • Reported in up to 50% of all newborns
  • Small, superficial, keratin-filled cysts on alveolar mucosa
  • Alveolar mucosa of infants
  • More common in MX alveolus
36
Q

Gingival cyst of the newborn: Tx

Bohn’s nodules; Epstein’s pearls

A
  • Lesions spontaneously rupture
  • Excellent px
  • No tx indicated
  • Rarely seen after 3mo
  • No recurrence
37
Q

Tumor

A

Mass of tissue; no lumen

38
Q

Odontogenic tumors arise from one or more tissues present in tooth development, which are:

A
  • Dental lamina
  • Enamel organ
    • Ameloblasts, enamel
  • Dental papilla
    • Odontoblasts, dentin, pulp
  • Dental follicle
    • Cementoblasts, cementum, PDL, alveolar bone
39
Q

WHO classification of odontogenic tumors tissue of origin

A
  • Odontogenic epithelium w/ mature stroma w/o odontogenic ectomesenchyme
  • Odontogenic epithelium w/ ectomesenchyme w/ or w/o HT
  • Mesenchyme and/or ectomesenchyme w/ or w/o odontogenic
40
Q

Odontogenic epithelium w/ mature stroma w/o odontogenic ectomesenchyme

A
  • Ameloblastoma, central or peripheral
  • Calcifying epithelial odontogenic tumor
  • Adenomatoid odontogenic tumor
  • Keratocystic odontogenic tumor
  • Squamous odontogenic tumor
41
Q

Odontogenic epithelium w/ ectomesenchyme w/ or w/o HT

A
  • Ameloblastic fibroma
  • Ameloblastic fibro-odontoma
  • Odontoma: Compouund & complex
  • Calcifying cystic odontogenic tumor (calcifying odontogenic cyst)
42
Q

Mesenchyme and/or ectomesenchyme w/ or w/o odontogenic epithelium

A
  • Odontogenic fibroma
  • Odontogenic myxoma
  • Cementoblastoma
43
Q

Where would you find odontogenic tumors?

A
  • Areas where teeth can form
  • Most are central (w/in jaws)
  • Others are peripheral (on the gingiva)
44
Q

RL Odontogenic Tumors

A
  • Ameloblastoma
  • Ameloblastic fibroma
  • Central odontogenic firbroma
  • Odontoenic myxoma
45
Q

Prevalence of ameloblastic subtypes

A

Multicystic > Unicystic > Peripheral

46
Q

Ameloblastoma

A

​RL Odontogenic Benign Tumor

  • Most common in molar/ramus area of the MN
  • 20-40yo, but occurs across all age ranges - don’t go based on age for this one
  • No mineralized pdt ⇒ RL
  • Unilocular or multilocular
    • Classically multilocular
      • ​Key: Soap bubble w/ round septations and expansions
  • Always RL
  • Slowly growing; locally aggressive
  • Locally infiltrates surrounding bone
  • Painless swelling of the jaw
  • Significant expansion of cortices and fracture on lingual
47
Q

Ameloblastoma: Tx

A

​RL Odontogenic Benign Tumor

  • Marked tendency to recur if tx’d by curettage
  • More extensive surgical removal is necessary: Removal of 1-2cm of surrounding bone past rad margins
    • Tumor islands infiltrate bone, so we want to make sure that we remove them all
48
Q

Unicystic Ameloblastoma

A

​RL Odontogenic Benign Tumor

  • A variant of ameloblastoma that resembles an odontogenic cyst
  • All tumor lines the cystic cavity and grows into the lumen; no invasion of CT wall
    • Cystic cavity lined by ameloblastic epithelium
  • Less aggressive than solid type
  • Affects younger pts (10-20yo)
  • Circumscribed RL around molar
  • Mimics other lesions
49
Q

Unicystic Ameloblastoma: Tx

A

​RL Odontogenic Benign Tumor

  • Dx is difficult - need rads, gross and microscopic confirmation
  • Enucleation or curettage
  • Initially enucleated
  • 10% recurrence
  • Careful enucleation w/ removal of unerupted tooth; usually resection no necessary
  • Tooth can be left in some cases
50
Q

Peripheral Ameloblastoma

A

​RL Odontogenic Benign Tumor

  • Painless lesion of gingiva or alveolar mucosa
  • Same histopathology as intra-osseous form
51
Q

Peripheral Ameloblastoma: Tx

A

​RL Odontogenic Benign Tumor

  • Innocuous behavior
  • Tx’d w/ local excision
52
Q

Ameloblastic Fibroma

A

​RL Odontogenic Benign Tumor

  • Consists of both odontogenic epithelium and ectomesenchyme
  • Occurs in younger pts - 1st or 2nd decade
    • ​Occur in pts YOUNGER THAN 20yo
  • Slightly more common in males
  • Small lesions are asymptomatic; large lesions cause swelling
  • Typical location is posterior MN
53
Q

Ameloblastic Fibroma: Rad

A

​RL Odontogenic Benign Tumor

  • Typical odontogenic RL lesion
  • Does not infiltrate surrounding bone
  • Well-defined, RL, well corticated, expansion of the MN, displaced teeth, directional resorption of roots
54
Q

Ameloblastic Fibroma: Tx

A

​RL Odontogenic Benign Tumor

  • Enucleation or curettage
  • Good px
    • ​Lower recurrence rates
  • ​Initial tx more conservative
  • More aggressive tx for recurrent lesions
  • A rare malignant variant exists
55
Q

If you see multilocular, think..

A

Ameloblastoma

OKC

Myxoma

56
Q

Central Odontogenic Fibroma

A

RL Odontogenic Benign Tumor

  • Consists of ectomesenchymal tissue similar to dental follicle
57
Q

Central Odontogenic Fibroma: Rad

A

​RL Odontogenic Benign Tumor

  • Typical RL odontogenic cyst/tumor
  • Does not infiltrate bone
58
Q

Central Odontogenic Firboma: Tx

A

​RL Odontogenic Benign Tumor

  • Conservative surgical removal – enucleations, curettage
59
Q

Odontogenic Myxoma

A

​RL Odontogenic Benign Tumor

  • Ectomesenchymal tumor
  • Found in young adults (25-30yo)
  • No gender predilection
  • If small, no changes; larger lesions cause asymptomatic swelling
  • Gelatinous appearance
  • Infiltrates surrounding bone
  • Dental papilla-like tissue
60
Q

Odontogenic Myxoma: Rad

A

​RL Odontogenic Benign Tumor

  • Well-defined or poorly defined borders
  • “Honeycomb” or “tennis racket” appearance
  • Infiltrates surrounding bone
  • Key: Straight perpendicular septations
    • ​Multilocular or septated appearance
61
Q

Odontogenic Myxoma: Tx

A

​RL Odontogenic Benign Tumor

  • Need to remove some normal surrounding bone
  • Req’s more aggressive tx
62
Q

What are the RL Odontogenic Lesions?

A
  • Inflammatory
    • Radicular (Periapical) Cyst
    • Residual Cyst
    • Buccal Bifurcation Cyst
  • Developmental
    • Dentigerous (Follicular) Cyst
    • Eruption Cyst
    • Keratocystic Odontogenic Tumor
      • AKA Odontogenic Keratocyst
    • Lateral Periodontal Cyst
    • Gorlin Syndrome
      • AKA Nevoid BCC Syndrome, Gorlin-Goltz Syndrome
    • Gingival Cyst of the Adult
    • Gingival Cyst of the Newborn
  • Tumors
    • Ameloblastoma
    • Unicystic Ameloblastoma
    • Peripheral Ameloblastoma
    • Ameloblastic Fibroma
    • Cental Odontogenic Fibroma
    • Odontogenic Myxoma

Oral Path 2 (11 decks)

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