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Surgical management of cysts Flashcards

1
Q

Define a cyst

A

Pathological cavity containing fluid or gas
Most are lined by epithelium

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2
Q

What is mechanism of cyst growth? (4)

A
  • Inflammation causes epithelial proliferation
  • Cells in cyst breakdown
  • Increased osmotic pressure draws water in
  • Bone resorbs - collagenases and prostaglandins released by fibroblasts and osteoclasts
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3
Q

Appearance of a cyst on a radiograph?

A

Well defined radiolucencies

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4
Q

How do cysts appear near to mucosal surface?

A

Bluish

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5
Q

Do cysts displace or resorb teeth and why?

A

Displace as they grow slowly

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6
Q

Are cysts symptomatic, if so when?

A

Generally symptomless unless infected

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7
Q

Can cysts cause fractures? Why

A

Rarely large enough to cause fractures

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8
Q

What is nature of cyst which extends into soft tissues?

A

Compressible and fluctuant

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9
Q

What might a cyst feel like when there is high risk of infection?

A

Egg shells breaking

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10
Q

What are the 3 main types of cyst?

A

Odontogenic
Non odontogenic
Non-epithelial lined bone cysts

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11
Q

Types of Odontogenic cyst?

A

Inflammatory
Developmental

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12
Q

Name 2 examples of odontogenic inflammatory cysts

A

Radicular cyst
Paradental cyst

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13
Q

Name 4 examples of odontogenic developmental cysts

A

Dentigerous cyst
Odontogenic keratocyst
Eruption cyst
Lateral periodontal cyst

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14
Q

Type of non odontogenic cyst?

A

Developmental

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15
Q

Name 2 examples of non odontogenic developmental cysts

A

Nasopalatine cyst
Nasolabial cyst

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16
Q

Name 2 examples of non epithelial lined bone cysts

A

Solitary bone cyst
Aneurysmal bone cyst

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17
Q

Which is the most common odontogenic cyst?

A

Radicular cyst

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18
Q

What age does radicular cyst present in?

A

Rare before 10
Between 20 - 60 years

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19
Q

Which gender are radicular cysts more common in?

A

Males

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20
Q

What is a radicular cyst derived from (cellularly)?

A

Epithelial cell remnants of Mallasez in PDL

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21
Q

How would a small radicular cyst be treated?

A

RCT and monitor

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22
Q

How would a large radicular cyst be treated?

A

Enucleation, histopathology and primary closure

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23
Q

Where would you commonly find lateral periodontal cysts?

A

Canine / premolar region

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24
Q

How would you treat a lateral periodontal cyst?

A

Enucleation
+/- XLA adjacent teeth

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25
Where would you find a dentigerous cyst?
Surround crown of unerupted / PE third molar / canine
26
Which group of patients are dentigerous cysts present in?
2x more common in males 20 - 50 years
27
Where can dentigerous cysts attach to, what is their impact?
Attach to neck of the tooth at CEJ, prevent its eruption and can displace tooth
28
What is the tx options for dentigerous cysts?
Marsupialisation OR Enucleation if appropriate + XLA
29
How would you manage an eruption cyst?
Leave to burst spontaneously Burst Remove cyst roof
30
What was an odontogenic keratocyst previously known as?
Neoplasm
31
What does an OKC arise from?
Dental lamina remnants
32
What types of patients do OKCs appear in?
20 - 30 years peak age Can present later though
33
Where are OKCs found?
Mandible, 50% in angle of
34
Where do OKCs extend to?
Path of least resistance Through the ramps and body of mandible prior to expanding
35
What is the triad associated with OKCs?
OKCs Multiple Basal Cell Naevi Skeletal anomalies
36
What is tx for OKC?
Enucleation Risk of recurrence
37
What type of cyst is an ameloblastoma?
Odontogenic
38
Where can ameloblastoma be found?
Mandible and ramus
39
Radiographic features of ameloblastoma?
Rounded Radiolucent Well defined Multi-locular, honey comb pattern, usually OR uni-cystic
40
What type of cyst is a Stafne bone cyst?
Non odontogenic Developmental
41
Where can you find Stafne bone cysts?
Below IAN canal
42
How would you manage a Stafne bone cyst?
Conservatively Non surgically
43
What type of cyst is an aneurysmal bone cyst?
Non odontogenic
44
What does an aneurysmal bone cyst typically contain?
Blood filled spaces interspersed with giant cells and fibroblasts
45
Where are aneurysmal bone cysts generally found?
More common in mandible than maxilla
46
What is tx for aneurysmal bone cyst?
Enucleation
47
What type of cyst is a solitary bone cyst?
Non odontogenic Non epithelial lined AKA Pseudo cyst
48
What do solitary bone cysts contain?
Blood stained serous fluid / gas
49
What is tx for solitary bone cyst?
Curettage / enucleation
50
What is the most common non odontogenic cyst?
Naso-palatine duct cyst
51
Where does nato-palatine duct cyst arise from?
Epithelial remnants of nasopalatine duct
52
What type of radiograph is naso-palatine duct cyst best seen on? What is its appearance?
Upper standard occlusal Round / pear shaped At naso-palatine foramen
53
What is tx for naso-palatine duct cyst?
Enucleation
54
What is the issue with enucleation of naso-palatine duct cysts?
Recurrence due to poor technique Cyst is lined with stratified squamous and ciliated columnar epithelium
55
What should cyst assessment include?
- History - Exam - Special tests and investigations - plain radiographs, CBCT, vitality testing, biopsy
56
What is considered a red flag?
Altered sensation (lips, chin, tongue) - IAN involvement Sudden mobility of teeth (no perio) Sudden onset of swelling
57
What are the 5 different tx options for cysts?
Conservative Decompression Enucleation Enucleation + curettage Resection + margin
58
What does conservative tx involve?
Monitor Pt unfit for surgery / does not want surgery High risk of complications
59
What does decompression tx involve?
Marsupialisation Open window into cavity to reduce pressure Reduces cyst size for enucleation
60
Advantages of marsupialisation
Simple Preserves teeth and vital structures
61
Disadvantages of marsupialisation
Hygiene Compliance Lengthy procedure
62
Advantages of enucleation
Removal of entire cyst Curative
63
Disadvantages of enucleation
Technically challenging Can damage vital structures Risk of fracture with large cysts
64
What does resection tx involve?
Excision of lesion with margin of clinically normal looking tissue
65
What are the advantages of resection?
Best chance of cure
66
What are the disadvantages of resection?
Significant deformity Reconstructive challenges

CMS (10 decks)

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