Surgical Management of Cysts Flashcards
what is a cyst?
a pathological cavity containing fluid or gas and which is not created by the accumulation of pus
what is the mechanism of cyst growth?
- inflammation causes epithelial proliferation
- cells in cyst centrally breakdown
- increased osmotic pressure draws water inwards; increasing the size of the cyst
- bone resorption (release of collagenases and PG’s by fibroblasts, osteoclast stimulating factors)
what are the key features of cysts?
form sharply defined radiolucency’s
grow slowly, displacing rather than resorbing teeth
- symptomless unless infected and are frequently change radiographic findings
- rarely large enough to cause pathological fractures
- form compressible and fluctuant swellings if extending into soft tissues
- appear bluish when close to mucosal surface
what are examples of non-epithelial lined bone cysts (2)
solitary bone cyst
aneursymal bone cyst
what are examples of soft tissue cysts?
salivary gland cyst
dermoid cyst
thyroglossal duct cyst
what are odontogenic radicular cysts derived from?
epithelial cell remnants of mallasez within the PDL
how can radicular cysts arise?
trauma/RCT
what are the management options for a small/large cyst?
if the cyst is small enough –> RCT and monitor
if the cyst is larger –> enucleation, histopathology and primary closure
what is a residual cyst?
a radicular cyst which persists after extraction (essentially, the radicular cyst without the tooth)
if a patient presented with a lesion and with altered sensation what would you be suspicious of?
malignancy (as this would corrode the nerve or compress it)
where do you often find lateral periodontal cysts?
in the canine/premolar region
where do lateral periodontal cysts arise from?
epithelial cell rests of Malassez
what is the management of lateral periodontal cyst?
treatment - enucleation +/- extraction of adjacent teeth if they are involved/there is an issue
are the adjacent teeth in a lateral periodontal cyst vital or non-vital?
vital
what age do dentigerous cysts usually occur?
20-50years - uncommon in children
when would a dentigerous cyst become symptomatic?
often when infected
what are dentigerous cysts frequently associated with?
unerupted third molars and canines
what are the implications of dentigerous cysts?
as they are attached to the neck of the tooth, they can prevent its eruption and may displace the tooth
what is the management of dentigerous cysts?
- treatment of large cysts: marsupialisation
- or if appropriate to remove the whole cyst: enucleation + extraction of tooth
what are eruption cysts
benign cysts that appear om the mucosa of a tooth prior to eruption
are eruption cysts painful?
rarely painful or become infected
what is the management of eruption cysts?
- usually burst spontaneously or remove cyst (de-roof)
what do odontogenic keratocysts arise from?
remnants of the dental lamina
what is the management of OKC?
enucleation
what is an ameloblastoma?
neoplasm
where are ameloblastomas commonly located?
mandible (posterior) - ramus
what is stafne bone cyst
Stafne bone cysts (SBC) are defined as pseudocysts of the jaw in the literature. These lesions are typically localized at lingual cortical surface of the mandible and generally included normal salivary gland tissue; but they do not contain an epithelial lining.
where are stafne bone cyst often located?
seen below the ID canal
what is the management of stafne bone cyst?
conservative = keep under supervision and monitor
what is an aneurysmal bone cyst?
often blood filled spaces with some giant cells - however, not a true cysts as epithelial lining is often not present
what is the management of aneurysmal bone cyst?
enucleation and get some histology (very rarely can have dysplastic changes)
what is a solitary bone cyst?
non-epithelial lined!! (so it is a pseudocyst)
can contain blood-stained serous fluid/gas filled)
aetiology is uncertain
- usually take the shape of the superior margins
what is the management of solitary bone cysts?
curretage or enucleation
what are nasopalatine duct cysts
the most common type of non-odontogenic cysts
what radiographic best shows a naso-palatine duct cyst?
upper standard occlusal
what shape do naso-palatine duct cysts usually appear on x-ray?
round/pear shaped
what is the management of naso-palatine duct cysts?
enucleation (recurrence is often high)
What are red flags when managing cysts?
- altered sensation/neurological involvement (particuarly ID nerve)
- altered sensation in lip, chin, tongue (v suspicious) - this could be malignant
- sudden mobility of teeth
- sudden onset of swelling
when would you use a conservative approach in the management of cysts?
if it is a small residual cyst OR patient is not fit for surgery
what is marsupialisation also known as and how is it carried out?
- also known as decompression
- open a window in the cyst and keep that window open (the cyst will reduce over time as the pressure will reduce)
- it reduces the size of a cyst to then enucleate and you can preserve vital structures
what are the advantages of marsupialisation?
simple, vital structures preserved, preservation of teeth
what are the disadvantages of marsupialisation?
hygiene (the patient has to keep it clean)
compliance
can be lengthy
requires 2nd procedure
what is enucleation?
removal of the cyst
what are the advantages of enucleation?
entire specimen removed
curative
what are the disadvantages of enucleation?
- can be technically challenging (depending on the size of a cyst)
- damage to vital structures particularly with large cysts
- risk of fracturing the mandible with large cysts
what is resection/wide local excision?
more commonly done in riskier cysts/big cysts that are likely to cause issues
- best chance of cure!
what are the disadvantages of resection/wide local excision?
significant deformity
reconstructive challanges
