RL Odontogenic Lesions Flashcards
1
Q
Odontogenic Radiolucent Lesions
A
- Cysts
- Radicular cyst
- Lateral periodontal cyst
- Dentigerous Cyst
- Eruption Cyst
- Odontogenic keratocyst
- Tumors
- Ameloblastic fibroma
- Ameloblastoma
- Odontogenic myxoma
2
Q
What is a cyst
A
- Pathological sack or cavity with a central lumen lined by epithelium
- Filled with fluid or semisolid contents
- Surrounded by CT
- Cysts arise from epithelial remnants
- 3 components
- Lumen, epithelial lining, CT wall
3
Q
Overview of Cysts
Growth
Size
A
- Cysts are slowly growing and asymptomatic (unless inflammed) resulting in well-defined, often corticated borders
- Cysts are persistent and progressive and can become large and destructive if not treated
- Do not infiltrate surrounding bone
- Treatment varies from simple enucleation or aggressive curettage
4
Q
Cysts radigraphic apperance
A
- Usually well circumscribed radiolucent lesion that often demonstrates a corticated border
5
Q
To diagnose a specific type of cyst one must correlate 3
A
- CLinical features
- Radiographic features
- Microscopic features
6
Q
Odontogenic Cysts
Inflammatory 4
A
- Radicular Cyst
- Residual Cyst
- Buccal bifurcation cyst
7
Q
Odontogenic Cysts Developmental 5
A
- Dentigerous cyst
- Eruption cyst
- Keratocystic odontogenic tumor (odontogenic keratocyst)
- Lateral periodontal cyst
- Calcyfying odontogenic cyst (only mixed, all other are radiolucent)
8
Q
Where does epithelium come from for odontogenic cysts
A
- Dental lamina
- Reduced enamel epithelium
- E[ithelial rests (of Malassez) from Hertwigs root sheath
9
Q
Odontogenic cysts of the jaw
Origin of epithelial rests–> source of rests–> Name of cyst
A
- Rests of malassez–> Epithelial root sheath–> Radicular Cyst
- Reduced enamel epithelium–> enamel organ–> Dentigerous cyst
- Dental lamina rests–> dental lamina–> Keratocytic odontogenic tumor , Lateral periodontal cyt, gingival cyst
10
Q
Radicular Cyst (periapical Cyst)
Pathogenesis, origin and sequence
A
- Associated with necrotic debris and bacteria of non-vital pulp
- Origin of pithelium is rests of Malassez
- Pulp necrosis–> inflammation–> radicular granuloma–> keratinocyte growth factor–> proliferation of epithelial rests
11
Q
Radicular Cyst (periapical cyst)
occurence
growth
A
- One of the most common cysts of jaws
- Grow slowly, dont reach large size
- Asymptomatic unless acutely inflammed
12
Q
Radicular Cyst
X ray app
A
- Periapical, well circumscribed, radiolucent lesion
- Loss of lamina dura
- Cannot be differentiated from periapical granuloma and abcess
- Corticated borders
- May form laterally
13
Q
Healing radicular cyst radiographic app
A
- Original outline still seen
- Bone grows inward
- Has a rolled border apperance
14
Q
Lateral Periodontal Cyst
Arise from
Common
Assoc with
Tx
Xray
A
- Arise from epithelium
- Most in the PM, canine, lateral incisor area
- Mandible>max
- Assoc with vital or non-vital teeth
- Tx enucleation
- xray
- well defined radiolucent lesion
- relatively small, less than 1 cm
- Not diagnostic
15
Q
Dentigerous Cyst (follicular cyst)
Occurence
Patho
Attached to
Common teeth affected
Symptoms
Xray
A
- Most common developmental odotogenic cyst
- Patho: Proliferation of reduced enamel epithelium
- Attached to the CEJ of an unerupted tooth or odontoma
- Most common with max 3rds and max canines
- SYmptoms
- small are asymptomatic
- Can grow large–> bony expansion
- Pain and swelling when infected
- Xray
- Well defined and often corticated border
- May be extensive and destructive
- Unilocular or multiocular
- Can displace the affected tooth
- Can result in root resorption of adjacent teeth
16
Q
Dentigerous Cyst
TX
Why
A
- Enucleation and removal of the affected tooth
- Marsupialization followed by excision for larger lesions (not commonly done)
- Little tendency to recur wehn completely removed
- Why remove
- for definitive micro dx
- Can cause extensive destruction of bone
- Resortion of adjacent tooth
- Displacement of teeth
- Neoplastic transformation
- Ameloblastoma
- Squamous cell carcinoma
- Central mucoepidermoid carcinoma
17
Q
Eruption Cyst
What is it
Consists of
Appears as
Common in
Tx
A
- ST analogue of the dentigerous cyst
- Consists of cystic fluid and/or blood accumulated btw erupting tooth and the dental follicle
- Appears as soft, translucent swelling in mucosa
- sometimes purple if blood present
- Common in children under 10
- Usually no tx bc tooth will erupt
- Enucleation and extraction of assoc tooth
- Marsupilization
- excellent prognosis
18
Q
Ododntogenic Keratocyst
Arises
Location
growth
A
- Arises from cell rests of dental lamina
- Can occur in any odotogenic location in jaws
- Most common in body and ramus of mand
- Tends to grow anterior-posterior direction in mand
- typically does not cause expansion in the bosy of the mandible
- More growth potential than other odotogenic cysts
- Higher rate of recurrence
- Large may be assoc with pain, drainage, paresthesia, do not expand into jaws
- Aggressive behavior and tx
- Assoc with nevoid basal cell carcinoma syndrome
19
Q
Odontogenic Keratocyst
xray findings
A
- Assoc with unerupted tooth in some cases
- Well defined radiolucent area
- smooth corticated margin
- Unilocular or multiocular
- Usually displaces teeth
20
Q
Odontogenic Keratocyst
Tx prognosis
A
- Surgical excision with peripheral ostectomy, carnoy solution
- Avg recurrence rate of 30%
- Most recu within 5 yrs, but may not recur until 10yrs or more–> long term clinical and radiographic follow up
- Occasionally, lcal resection and bone grafting necessary
21
Q
Lesions that can app radiographically similar to odontogenic keratocyst 9
A
- Dentigerous cyst
- Lateral periodontal cyst
- Nasoapalatine cyst
- Radicular cyst
- Residual cyst
- Primordial cyst
- Globulomaxillary cyst
- Idiopathic bone cavity
- Ameloblastoma and other benign odontogenic tumors
22
Q
Gorlin Syndrome
Common clinical findings 5
Tx
A
- Common clinical findings
- Multiple basal cell carcinoma at young age
- Multiple odontogenic keratocysts
- Calcified falx cerebri
- Rib anomalies
- Palmar plantar pits
- Tx
- Keratocysts enucleation
23
Q
A
