Surgical management of cysts Flashcards
Define a cyst
Pathological cavity containing fluid or gas
Most are lined by epithelium
What is mechanism of cyst growth? (4)
- Inflammation causes epithelial proliferation
- Cells in cyst breakdown
- Increased osmotic pressure draws water in
- Bone resorbs - collagenases and prostaglandins released by fibroblasts and osteoclasts
Appearance of a cyst on a radiograph?
Well defined radiolucencies
How do cysts appear near to mucosal surface?
Bluish
Do cysts displace or resorb teeth and why?
Displace as they grow slowly
Are cysts symptomatic, if so when?
Generally symptomless unless infected
Can cysts cause fractures? Why
Rarely large enough to cause fractures
What is nature of cyst which extends into soft tissues?
Compressible and fluctuant
What might a cyst feel like when there is high risk of infection?
Egg shells breaking
What are the 3 main types of cyst?
Odontogenic
Non odontogenic
Non-epithelial lined bone cysts
Types of Odontogenic cyst?
Inflammatory
Developmental
Name 2 examples of odontogenic inflammatory cysts
Radicular cyst
Paradental cyst
Name 4 examples of odontogenic developmental cysts
Dentigerous cyst
Odontogenic keratocyst
Eruption cyst
Lateral periodontal cyst
Type of non odontogenic cyst?
Developmental
Name 2 examples of non odontogenic developmental cysts
Nasopalatine cyst
Nasolabial cyst
Name 2 examples of non epithelial lined bone cysts
Solitary bone cyst
Aneurysmal bone cyst
Which is the most common odontogenic cyst?
Radicular cyst
What age does radicular cyst present in?
Rare before 10
Between 20 - 60 years
Which gender are radicular cysts more common in?
Males
What is a radicular cyst derived from (cellularly)?
Epithelial cell remnants of Mallasez in PDL
How would a small radicular cyst be treated?
RCT and monitor
How would a large radicular cyst be treated?
Enucleation, histopathology and primary closure
Where would you commonly find lateral periodontal cysts?
Canine / premolar region
How would you treat a lateral periodontal cyst?
Enucleation
+/- XLA adjacent teeth
Where would you find a dentigerous cyst?
Surround crown of unerupted / PE third molar / canine
Which group of patients are dentigerous cysts present in?
2x more common in males
20 - 50 years
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
What is the tx options for dentigerous cysts?
Marsupialisation
OR
Enucleation if appropriate + XLA
How would you manage an eruption cyst?
Leave to burst spontaneously
Burst
Remove cyst roof
What was an odontogenic keratocyst previously known as?
Neoplasm
What does an OKC arise from?
Dental lamina remnants
What types of patients do OKCs appear in?
20 - 30 years peak age
Can present later though
Where are OKCs found?
Mandible, 50% in angle of
Where do OKCs extend to?
Path of least resistance
Through the ramps and body of mandible prior to expanding
What is the triad associated with OKCs?
OKCs
Multiple Basal Cell Naevi
Skeletal anomalies
What is tx for OKC?
Enucleation
Risk of recurrence
What type of cyst is an ameloblastoma?
Odontogenic
Where can ameloblastoma be found?
Mandible and ramus
Radiographic features of ameloblastoma?
Rounded
Radiolucent
Well defined
Multi-locular, honey comb pattern, usually
OR uni-cystic
What type of cyst is a Stafne bone cyst?
Non odontogenic
Developmental
Where can you find Stafne bone cysts?
Below IAN canal
How would you manage a Stafne bone cyst?
Conservatively
Non surgically
What type of cyst is an aneurysmal bone cyst?
Non odontogenic
What does an aneurysmal bone cyst typically contain?
Blood filled spaces interspersed with giant cells and fibroblasts
Where are aneurysmal bone cysts generally found?
More common in mandible than maxilla
What is tx for aneurysmal bone cyst?
Enucleation
What type of cyst is a solitary bone cyst?
Non odontogenic
Non epithelial lined
AKA Pseudo cyst
What do solitary bone cysts contain?
Blood stained serous fluid / gas
What is tx for solitary bone cyst?
Curettage / enucleation
What is the most common non odontogenic cyst?
Naso-palatine duct cyst
Where does nato-palatine duct cyst arise from?
Epithelial remnants of nasopalatine duct
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
What is tx for naso-palatine duct cyst?
Enucleation
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
What should cyst assessment include?
- History
- Exam
- Special tests and investigations - plain radiographs, CBCT, vitality testing, biopsy
What is considered a red flag?
Altered sensation (lips, chin, tongue) - IAN involvement
Sudden mobility of teeth (no perio)
Sudden onset of swelling
What are the 5 different tx options for cysts?
Conservative
Decompression
Enucleation
Enucleation + curettage
Resection + margin
What does conservative tx involve?
Monitor
Pt unfit for surgery / does not want surgery
High risk of complications
What does decompression tx involve?
Marsupialisation
Open window into cavity to reduce pressure
Reduces cyst size for enucleation
Advantages of marsupialisation
Simple
Preserves teeth and vital structures
Disadvantages of marsupialisation
Hygiene
Compliance
Lengthy procedure
Advantages of enucleation
Removal of entire cyst
Curative
Disadvantages of enucleation
Technically challenging
Can damage vital structures
Risk of fracture with large cysts
What does resection tx involve?
Excision of lesion with margin of clinically normal looking tissue
What are the advantages of resection?
Best chance of cure
What are the disadvantages of resection?
Significant deformity
Reconstructive challenges
