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CMS > Surgical management of cysts > Flashcards

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
Q

Where would you find a dentigerous cyst?

A

Surround crown of unerupted / PE third molar / canine

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26
Q

Which group of patients are dentigerous cysts present in?

A

2x more common in males
20 - 50 years

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27
Q

Where can dentigerous cysts attach to, what is their impact?

A

Attach to neck of the tooth at CEJ, prevent its eruption and can displace tooth

28
Q

What is the tx options for dentigerous cysts?

A

Marsupialisation
OR
Enucleation if appropriate + XLA

29
Q

How would you manage an eruption cyst?

A

Leave to burst spontaneously
Burst
Remove cyst roof

30
Q

What was an odontogenic keratocyst previously known as?

31
Q

What does an OKC arise from?

A

Dental lamina remnants

32
Q

What types of patients do OKCs appear in?

A

20 - 30 years peak age
Can present later though

33
Q

Where are OKCs found?

A

Mandible, 50% in angle of

34
Q

Where do OKCs extend to?

A

Path of least resistance
Through the ramps and body of mandible prior to expanding

35
Q

What is the triad associated with OKCs?

A

OKCs
Multiple Basal Cell Naevi
Skeletal anomalies

36
Q

What is tx for OKC?

A

Enucleation
Risk of recurrence

37
Q

What type of cyst is an ameloblastoma?

A

Odontogenic

38
Q

Where can ameloblastoma be found?

A

Mandible and ramus

39
Q

Radiographic features of ameloblastoma?

A

Rounded
Radiolucent
Well defined
Multi-locular, honey comb pattern, usually
OR uni-cystic

40
Q

What type of cyst is a Stafne bone cyst?

A

Non odontogenic
Developmental

41
Q

Where can you find Stafne bone cysts?

A

Below IAN canal

42
Q

How would you manage a Stafne bone cyst?

A

Conservatively
Non surgically

43
Q

What type of cyst is an aneurysmal bone cyst?

A

Non odontogenic

44
Q

What does an aneurysmal bone cyst typically contain?

A

Blood filled spaces interspersed with giant cells and fibroblasts

45
Q

Where are aneurysmal bone cysts generally found?

A

More common in mandible than maxilla

46
Q

What is tx for aneurysmal bone cyst?

A

Enucleation

47
Q

What type of cyst is a solitary bone cyst?

A

Non odontogenic
Non epithelial lined
AKA Pseudo cyst

48
Q

What do solitary bone cysts contain?

A

Blood stained serous fluid / gas

49
Q

What is tx for solitary bone cyst?

A

Curettage / enucleation

50
Q

What is the most common non odontogenic cyst?

A

Naso-palatine duct cyst

51
Q

Where does nato-palatine duct cyst arise from?

A

Epithelial remnants of nasopalatine duct

52
Q

What type of radiograph is naso-palatine duct cyst best seen on? What is its appearance?

A

Upper standard occlusal
Round / pear shaped
At naso-palatine foramen

53
Q

What is tx for naso-palatine duct cyst?

A

Enucleation

54
Q

What is the issue with enucleation of naso-palatine duct cysts?

A

Recurrence due to poor technique
Cyst is lined with stratified squamous and ciliated columnar epithelium

55
Q

What should cyst assessment include?

A
  • History
  • Exam
  • Special tests and investigations - plain radiographs, CBCT, vitality testing, biopsy
56
Q

What is considered a red flag?

A

Altered sensation (lips, chin, tongue) - IAN involvement
Sudden mobility of teeth (no perio)
Sudden onset of swelling

57
Q

What are the 5 different tx options for cysts?

A

Conservative
Decompression
Enucleation
Enucleation + curettage
Resection + margin

58
Q

What does conservative tx involve?

A

Monitor
Pt unfit for surgery / does not want surgery
High risk of complications

59
Q

What does decompression tx involve?

A

Marsupialisation
Open window into cavity to reduce pressure
Reduces cyst size for enucleation

60
Q

Advantages of marsupialisation

A

Simple
Preserves teeth and vital structures

61
Q

Disadvantages of marsupialisation

A

Hygiene
Compliance
Lengthy procedure

62
Q

Advantages of enucleation

A

Removal of entire cyst
Curative

63
Q

Disadvantages of enucleation

A

Technically challenging
Can damage vital structures
Risk of fracture with large cysts

64
Q

What does resection tx involve?

A

Excision of lesion with margin of clinically normal looking tissue

65
Q

What are the advantages of resection?

A

Best chance of cure

66
Q

What are the disadvantages of resection?

A

Significant deformity
Reconstructive challenges

CMS (10 decks)

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