Surgical management of Cysts and benign oral lesions

Question 1

What are characteristics of benign lesions?

Answer 1

a) don’t cause many issues
b) don’t metastasize
c) do no invade surrounding tissues
d) cells maintain contact one another

Question 2

What do benign lesions cause?

Answer 2

1) excessive accumulation of cells
2) pressure atrophy (adjacent parenchyma undergoes pressure atrophy while more resistant CT produces a fibrous capsule
3) could cause obstruction

Question 3

What is a feature in all cysts in the oral cavity?

Answer 3

root resorption

Question 4

What are characteristics of cysts in general?

Answer 4

a) rounded and encapsulated
b) cause tissue destruction (root resorption)
c) smaller than tumors in size and rate of growth is slow
d) rare but may cause ulceration and bleed only in surface lesions
e) can produce hormones ex: in endocrine tissues

Question 5

What are indication of removal of cysts?

Answer 5

1) pain
2) aesthetics
3) affecting function and continuous growth
4) pressure on adjacent structures ex: root resorption
5) weakening of structures and infection

Question 6

How do you remove soft tissue cysts?

Answer 6

Surgery - excision

also could do enucleation and curettage for other cysts.

Question 7

Which direction would you base your incision?

Answer 7

following the nature of skin “langer lines”

v.imp - reduce the chance of scars etc.

Question 8

What do you do if lesion too large?

Answer 8

1) create a small incision at the top
2) dissect out the mucocoeles itself without bursting the capsule
3) close it

Question 9

For example if a cyst is in upper arch what type os incisions would you do? (HINT: directions)

Answer 9

horizontal or vertical incisions.

Question 10

List other cysts that you would do incision.

Answer 10

a) fibrous tuberos : u cut part of bone then suture back together.
b) fibrous ridge

Others include: bony torus

Question 11

Does bony torus always need surgery?

Answer 11

No, only if it causes serious issues ex: pt. in lecture where foods always gets trapped.

Question 12

Define a Cyst.

Answer 12

Is a closed sac-like pocket of tissue that could be present anywhere in the body and may be filled with fluid, air, pus, or other material.

Note: the ones that form in the face are mostly benign

Question 13

What are the two types of Cysts of the jaw

Answer 13

Odontogenic and non odontogenic

Question 14

What are the types of Odontogenic cysts?

Answer 14

1) Developmental:
a) dentigerous
b) eruption & keratocyst
c) gingival and paradental

2) Inflammatory:
a) radicular and residual
b) lateral periodontal

3) Neoplastic:
a) cystic ameloblastoma
b) calcifying odontogenic cyst

Question 15

What are types of non-odontogenic cysts?

Answer 15

1) Developmental
a) nasopalatine
b) nasolabial

2) No epithelial lining
a) solitary bone cyst
b) aneurysmal bone cyst
c) stafne bone cyst

Question 16

Way of managing cysts? “removing”

Answer 16

a) enucleation: surgically remove intact surrounding capsule followed by wound closure.
b) curettage: scrapping
c) marsupialisation: forming a surface from outside the mouth into the interior of cyst/abscess.

Question 17

What is used to prevent infected haematoma in the cyst cavity? (Hint: antibiotic)

Answer 17

Gentamycin

Question 18

What is the difference between residual and radicular cysts?

Answer 18

a) radicular: apex of tooth and tooth is present (non vital)
b) residual: mature radicular cyst where tooth and source of infection is removed and occurs after.

Note: residual can occur after years.

Question 19

What is a unique cyst that is not actually a cyst and why?

Answer 19

Stafne bone cyst..

technically not a cyst, not lined, asymptomatic and always BELOW ID canal very dangerous to interfere with.

Question 20

Kissing molars are what type of cyst? (HINT: 7 & 8s crown’s facing each other)

Answer 20

subsequent dentigerous cysts

Question 21

what is
multilocular radiolucency
extends to ramus
invasive and can reoccur

Answer 21

Ameloblastomas

Question 22

Describe the process of marsupialisation.

Answer 22

a) decompressing cyst by creating large surgical window.
b) relieving intracystic pressure
c) resulting in reduction in size and eventually
d) disrupt lining and eventually will disappear.

Question 23

What are the advantages and disadvantages of enucleation?

Answer 23

A:
a) cyst cavity closed to the mouth.
b) little aftercare needed
c) complete lining available for histopathological examination.

D:
a) possible infection of clot in cavity
b) incomplete removal
c) hemorrhage
d) damage of apices and other structures
e) size of the cyst could weaken the mandible
f) closure could prevent visual inspection of cavity

Question 24

What are the advantages and disadvantages of
marsupialisation?

Answer 24

A:
a) less bone removal/avoid pathological fracture and damage
b) cavity accessible to visual inspection
D:
a) Patient needs to keep area clean
b) Whole lining not available for histology
c) Epithelial lining may be friable and difficult to suture
d) Several visits to repack cavity as it shrinks and repairs
e) Orifice may close up allowing cyst to reform and
Bony infill may not occur

Question 25

What is the difference between compound and complex odontomes?

Answer 25

compound: “d” looks like little teeth
complex: group of tissues

Question 26

What do you do to salivary gland obstructions “sialoliths”?

Answer 26

1) No active treatment or milking of the duct
2) Surgical removal incising through the duct wall to remove the stone.
3) Basket retrieval with a Dormier basket
4) Endoscopically guided stone removal
5) Lithotripsy to shatter the stone
6) Removal of the gland and associated stone

Question 27

List other ways of removing benign lesions.

Answer 27

a) laser
b) diathermy: production of eat to damage armful tissues.
c) cryotherapy: use of low temp. to treat tissue lesions.

Question 28

How is lesions removed by laser? “Light Amplification by Stimulated Emission of Radiation “

Answer 28

a) needs lasing medium ex: CO
b) electromagnetic energy
c) system of optimal amplification

1) hits tissue, temp rises and protein dentaure & thrombosis

Question 29

After that what happens at 100 water in cell

Answer 29

boils , steam ruptures cells and tissue vapourised.

b) possibly adjacent tissue heats up then blackens “carbonisation”

Question 30

list types of laser…

Answer 30

a) cutting: tissue vapourisation from heating cells to boiling point

b) coagulation – protein denaturation results in cell death and haemostasis

Question 31

When is cutting or coagulation laser procedures used?

Answer 31

hard tissue surgery

can be used for areas of oral epithelial dysplasia

Question 32

What are advantages and disadvantages of using laser?

Answer 32

A:
a) dry surgical field
b) reduction of blood loss, post op. oedema, pain and fibrosis.

D:
a) cost
b) complexity of equipment
c) no pathology specimen

Question 33

What are two types of diathermy procedure?

Answer 33

1) Monopolar – current generated passed from instrument tip through patient and is earthed via the common electrode plate
2) Bipolar – current passes from one instrument tip to another via a small volume of tissue

Question 34

Describe cryotherapy procedure of removing lesions.

Answer 34

Tissue denaturation using application of cold medium is employed.

Is good for fluid filled lesion.

Question 35

During cryotherapy what does tissue normally respond to?

Answer 35

1) change and rate in temperature
2) number of freeze/thaw cycles
3) The length of time the temperature is reduced

Question 36

What are the advantages and disadvantages of cryotherapy?

Answer 36

A:
1) No cutting involved
2) Tissue intact at end of procedure – NO BLEEDING (haemangioma)
3) Can do without LA (but kinder with LA)
4) Excellent with fluid filled lesions

D:
1) Cost of equipment
2) No pathology specimen
3) Large amount of swelling post op, as adjacent tissues which cooled down suffer partial damage
4) Ulceration post operatively & depigmentation