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CMS2 > Surgical Management of Cysts > Flashcards

Surgical Management of Cysts Flashcards

1
Q

what is a cyst?

A

a pathological cavity containing fluid or gas and which is not created by the accumulation of pus

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2
Q

what is the mechanism of cyst growth?

A
  • 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)
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3
Q

what are the key features of cysts?

A

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

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4
Q

what are examples of non-epithelial lined bone cysts (2)

A

solitary bone cyst
aneursymal bone cyst

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5
Q

what are examples of soft tissue cysts?

A

salivary gland cyst
dermoid cyst
thyroglossal duct cyst

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6
Q

what are odontogenic radicular cysts derived from?

A

epithelial cell remnants of mallasez within the PDL

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7
Q

how can radicular cysts arise?

A

trauma/RCT

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8
Q

what are the management options for a small/large cyst?

A

if the cyst is small enough –> RCT and monitor
if the cyst is larger –> enucleation, histopathology and primary closure

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9
Q

what is a residual cyst?

A

a radicular cyst which persists after extraction (essentially, the radicular cyst without the tooth)

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10
Q

if a patient presented with a lesion and with altered sensation what would you be suspicious of?

A

malignancy (as this would corrode the nerve or compress it)

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11
Q

where do you often find lateral periodontal cysts?

A

in the canine/premolar region

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12
Q

where do lateral periodontal cysts arise from?

A

epithelial cell rests of Malassez

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13
Q

what is the management of lateral periodontal cyst?

A

treatment - enucleation +/- extraction of adjacent teeth if they are involved/there is an issue

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14
Q

are the adjacent teeth in a lateral periodontal cyst vital or non-vital?

A

vital

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15
Q

what age do dentigerous cysts usually occur?

A

20-50years - uncommon in children

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16
Q

when would a dentigerous cyst become symptomatic?

A

often when infected

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17
Q

what are dentigerous cysts frequently associated with?

A

unerupted third molars and canines

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18
Q

what are the implications of dentigerous cysts?

A

as they are attached to the neck of the tooth, they can prevent its eruption and may displace the tooth

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19
Q

what is the management of dentigerous cysts?

A
  • treatment of large cysts: marsupialisation
  • or if appropriate to remove the whole cyst: enucleation + extraction of tooth
20
Q

what are eruption cysts

A

benign cysts that appear om the mucosa of a tooth prior to eruption

21
Q

are eruption cysts painful?

A

rarely painful or become infected

22
Q

what is the management of eruption cysts?

A
  • usually burst spontaneously or remove cyst (de-roof)
23
Q

what do odontogenic keratocysts arise from?

A

remnants of the dental lamina

24
Q

what is the management of OKC?

A

enucleation

25
Q

what is an ameloblastoma?

A

neoplasm

26
Q

where are ameloblastomas commonly located?

A

mandible (posterior) - ramus

27
Q

what is stafne bone cyst

A

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.

28
Q

where are stafne bone cyst often located?

A

seen below the ID canal

29
Q

what is the management of stafne bone cyst?

A

conservative = keep under supervision and monitor

30
Q

what is an aneurysmal bone cyst?

A

often blood filled spaces with some giant cells - however, not a true cysts as epithelial lining is often not present

31
Q

what is the management of aneurysmal bone cyst?

A

enucleation and get some histology (very rarely can have dysplastic changes)

32
Q

what is a solitary bone cyst?

A

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

33
Q

what is the management of solitary bone cysts?

A

curretage or enucleation

34
Q

what are nasopalatine duct cysts

A

the most common type of non-odontogenic cysts

35
Q

what radiographic best shows a naso-palatine duct cyst?

A

upper standard occlusal

36
Q

what shape do naso-palatine duct cysts usually appear on x-ray?

A

round/pear shaped

37
Q

what is the management of naso-palatine duct cysts?

A

enucleation (recurrence is often high)

38
Q

What are red flags when managing cysts?

A
  • 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
39
Q

when would you use a conservative approach in the management of cysts?

A

if it is a small residual cyst OR patient is not fit for surgery

40
Q

what is marsupialisation also known as and how is it carried out?

A
  • 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
41
Q

what are the advantages of marsupialisation?

A

simple, vital structures preserved, preservation of teeth

42
Q

what are the disadvantages of marsupialisation?

A

hygiene (the patient has to keep it clean)
compliance
can be lengthy
requires 2nd procedure

43
Q

what is enucleation?

A

removal of the cyst

44
Q

what are the advantages of enucleation?

A

entire specimen removed
curative

45
Q

what are the disadvantages of enucleation?

A
  • 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
46
Q

what is resection/wide local excision?

A

more commonly done in riskier cysts/big cysts that are likely to cause issues
- best chance of cure!

47
Q

what are the disadvantages of resection/wide local excision?

A

significant deformity
reconstructive challanges

CMS2 (24 decks)

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