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
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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
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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
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4
Q

Cysts radigraphic apperance

A
  • Usually well circumscribed radiolucent lesion that often demonstrates a corticated border
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5
Q

To diagnose a specific type of cyst one must correlate 3

A
  • CLinical features
  • Radiographic features
  • Microscopic features
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6
Q

Odontogenic Cysts

Inflammatory 4

A
  • Radicular Cyst
  • Residual Cyst
  • Buccal bifurcation cyst
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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)
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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
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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
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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
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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
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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
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13
Q

Healing radicular cyst radiographic app

A
  • Original outline still seen
  • Bone grows inward
  • Has a rolled border apperance
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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
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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
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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