Surgical Pathologies Flashcards
What are the tumor lesions of the alveolar crest? (6)
- Odontoma
- Cementoma
- Ameloblastic fibroma
- Follicular cysts
- Haemorrhagic-aneurysmal bone cysts
- Aneurismal bone cysts
What is an odontoma?
Tumour-like malformation
What is an odontoma produced by?
excessive proliferation of the cells of the dental organ
What is an odontoma composed of?
composed of more than one type of tissue
What is a compound odontoma?
composed of multiple, generally small, tooth-like
structures on x-ray and microscopically
What is a complex odontoma?
Conglomerate mass of dental tissue and does not resemble a properly formed tooth or teeth on x-ray or under the microscope
Clinical symptoms of odontoma? (3)
- Asymptomatic.
- Small.
- Of slow growth.
How do we diagnosis odontoma? (2)
- clinic
- radiograph
What is the treatment of an odontoma?
Surgical removal before they produce eruption problems.
What is a cementoma?
Excessive proliferation of the cement in the apical area
Where is a cementoma more frequent?
More frequent in the mandible, at the premolars
What are the clinical symptoms of cementoma? (2)
- Asymptomatic
- Tooth may erupt without problems
How do you diagnose a cementoma? (2)
- clinic
- radiograph
How do you treat a cementoma? (3)
- Observation and control.
- Surgical extraction of the tooth with the cementoma.
- Apicectomy with root canal treatment.
What do we see radiographically on a cementoma? (5)
- Radiopacity.
- Circular.
- Solitary.
- Well defined lesion.
- Surrounded by a radiolucent halo.
What is an ameloblastic fibroma? (2)
- Benign tumor of mixed odontogenic origin
- Neoplastic proliferation of mesenchymal and epithelial components,
with no formation of hard dental tissues
Who does ameloblastic fibroma affect?
predominantly young individuals
Ameloblastic fibroma is a varity os the ____
Complex odontoma
Ameloblastic fibroma clinical symptoms? (4)
- It appears mainly in children.
- At the posterior teeth of the mandible.
- Slow growth.
- It produces dental retentions.
Ameloblastic fibroma diagnosis? (2)
- clinical
- radiographic
What do you see radiographically with an ameloblastic fibroma ?
well-defined unilocular/multilocular radiolucent lesion, with
sclerotic radiopaque margins.
What is the treatment for ameloblastic fibroma? (2)
- complete extirpation
- it rarely suffers relapses
What is a follicular/dentigerous cyst?
Odontogenic cysts that encloses the crown of an unerupted tooth by expansion of the follicle and is attached to its neck
What teeth commonly have a follicular cyst? (3)
Upper canine > 1st and 2nd premolar > 3rd molar
How do you diagnose a follicular cyst?
Radiograph
What is the treatment of a follicular cyst? (2)
- removal of the cyst.
- sometimes necessary to remove the affected tooth
What is a heamorrhagic-aneurysmal bone cyst (HABCs)?
Rare, benign, non-neoplastic, expansive and vascular locally destructive lesions
HBACs are generally considered ____
sequelae of an earlier trauma causing an overflow of blood into the bone
HBACs usually appear …. ? (2)
At the mandibular symphysis and at the molar and premolar area
HBACs do not intercede in the ____
eruption of the adjacent teeth
HBACs radiographically look like…?
radiotransparencies of variable size and shape, sometimes appearing between the dental roots
What is the treatment of HBACs?
careful curettage of the bone walls, with satisfactory
results characterized by progressive bone regeneration and the absence of
relapses
What is an aneurysmal bone cyst (ABC)?
rare benign lesions of bone
which are infrequent in craniofacial skeleton
ABCs are characterized by…
Rapid growth pattern with resultant bone expansion and facial asymmetry
ABCs are composed of ____ spaces separated by _____
- blood-filled spaces
- connective tissue septa containing fibroblasts,
osteoclast-type giant cells and reactive woven bone
Where do ABCs occur?
- 50% in the long bones
- 20% in the vertebral column
ABCs are more commonly found in…
The mandible than the maxilla
Age and gender affectation of ABCs? (2)
- younger people under 20 years of age
- no gender predilection
ABCs symptoms? (3)
- bone expanded, appears sytic resembling a honeycomb or soap bubble and is eccentrically balooned
- may be perforation of the cortex
- Periosteal reaction may be evident
ABCs radiographic evidence? (2)
- radiolucent, radiopaque or mixed
- roots may be displaced
ABC treatment? (3)
- surgical removal
- contained in a fibrous capsule
- may bleed a lot
What are the salivary gland pathologies? (6)
- Mucocele
- Ranula
- Sialadenitis
- Mumps
- Chronic sialadenitis
- Congenital absence of the
salivary glands
What is a mucocele?
Pseudocyst that has no epithelial shell
What is the most common benign lesion of the salivary glands?
Mucocele
What are the classifications of mucocele? (2)
- By extravasation: caused by a trauma.
* By retention: caused by an obstruction
Where is a mucocele found? (3)
Lower lip > oral mucosa > upper lip
Mucocele clinical symptoms? (2)
- Recurrent swelling with spontaneous drainage by rupture.
* Asymptomatic vesicle or bulla with a pink or bluish color, and their size may vary from 1 mm to several centimetres.
Mucocele treatment?
surgical removal if it is recurrent
What is a ranula?
Retention cyst of the sublingual salivary gland
Etiology of ranula? (2)
- Toddler and small children: congenit
* Older children and teenagers: traumatic
Differential diagnosis of ranula?
Lymphatic malformation
Ranula clincal symptoms? (4)
- Not painful
- Recurrent
- Rare to suffer infection
- They do not change of size
Ranula treatment?
- small children: wait
- Small ranula: surgical removal
- big ranula: marsupialization
- Be careful not to wound the conducts, glands, blood vessels and nerves
- If there is continuous relapse of the ranula, excision of the sublingual gland.
What is sialadenitis?
inflammation of the major salivary glands, usually bilateral
Etiology of sialadenitis? (3)
- Viral
- Bacterial
- Bilateral autoimmune parotitis
Viral etiology of sialadenitis? (3)
- Mumps
- CMV
- HIV
Bacterial etiology of sialadenitis? (2)
- Retrogressive
- the salivary glands are infected by bacteria present in the mouth
What does a sialogram for Bilateral autoimmune parotitis show?
snow storm image
What are the types of sialadenitis? (2)
- acute
- chronic
What is the treatment of sialadenitis? (3)
- analgesic
- antibiotics
- hydration
What are the mumps?
Inflammation of the parotid gland
Etiology of mumps? (4)
- Paramixovirus
- flu
- Coxsackie A virus
- HIV
When does mumps occur?
ages 5 - 15
Clinical symptoms of mumps?(8)
• Swelling • Fever • Headache • Pain when swallowing food • Painful palpation • Elastic resistance with no fluctuation • Redeness of the Stenon conduct • It may produce sterility in men
Mumps treatment? (3)
- Rest
- Isolation -> contagious
- Analgesics
What causes chronic sialadenitis? (3)
Physical pbstruction of the gland:
- calculus OR
- stenosis
Chronic sialadenitis clinical symptoms? (2)
- Pain while eating
* Pain constantly if it is over infected
When does recurrent presentation of chronic sialadenitis occur?
During childhood
Treatment of chronic siadenitis? (4)
- Antibiotic
- Antiinflammatory
- Calculus excision
- Salivary gland excision
When do we suspect congenital absence of the salivary glands? (4)
when externes caries appear in not frequent locations
How do we diagnose congenital absence of the salivary glands? (4)
- Occlusal and panoramic x-ray
- Sialography
- Tomography, magnetic resonance and ecography
- Gammagraphy
What is seen on an xray of congenital absence of the salivary glands?
several calculus will be seen
What is seen in a sialography with congenital absence of the salivary glands?
Stenosis of the conducts and alteration in the gland architecture
What is seen in a gammagraphy with congenital absence of the salivary glands?
The glands activity
What are the general factors of impacted teeth? (4)
- Syndromes
- Genetic
- hormonal
- unknown
What are the local factors of impacted teeth? (2)
- mechanic obstruction
- absence of space
What are the clinical symptoms of impacted teeth? (3)
- eruption delay
- teeth in a fan or interincisal diastema (mesiodens)
- ectopic eruption
What is seen radiographically for impacted teeth? (3)
- Cysts
- Root reabsorptions
- Ectopic eruption
Treatment of impacted teeth: before the treatment? (4)
Do an X-ray to verify the tooth position:
• The canine is palatal or buccal
• The second premolar frequently in palatal
We also determine the root development and establish the orthodontic treatment plan (plan traction and space recovery)
Impacted teeth treatment?
- Extraction (super numerary, thrd molars)
- Surgical exposure and orthodontic traction
When do you treat impacted canines, upper incisors, premolars and molars?
2/3 of root development or before the apical closure (afterwards it is very difficult)
When do you treat impacted molars?
½ radicular development.
Later there will be bigger risk of dilacerated roots, hooked roots.
What frenulums exist? (3)
- Upper labial frenulum
- Lower labial frenulum
- Lingual frenulum
What is the upper labial frenulum?
Fibroelastic band of tissue that originates at the lip and is
inserted in the adhered gingiva at the midline.
Histology of the frenulum?
Mucosa and connective tissue with elastic fibers
What do we do in primary dentition with an upper labial frenulum?
NEVER REMOVE IN PRIMARY DENTITION
What do we do in permanent dentition with an upper labial frenulum?
• Examine it if there is an interincisal diastema bigger than 1 mm.
• Check if there is a real frenulum hypertrophy doing the
papilla exam.
When do we do the upper labial frenulum treatment?
We usually wait until the permanent canines have erupted.
Upper labial frenulum treatment if the central incisors have erupted and there isn’t enough space for the lateral incisors?
Do it before the lateral incisors have erupted
Upper labial frenulum treatment if the lateral incisors have erupted and there isn’t enough space for the canines?
do it before the canines have erupted
What is the treatment for an upper labial frenulum?
Frenectomy and orthodontic treatment
What is a romboid frenectomy? (5)
- Apply cold on the area intermittently (for 2-3 hours after the surgery)
- Liquid or semiliquid diet for 3-4 days
- Avoid to pull the lip upwards
- Oral hygiene with saline solution
- Mandatory prescrption of: antibiotic, antinflamatoriy y analgesic.
A lower labial frenulum will be pathological if: (7)
• There is high insertion over the papilla • It limits the lower labial movements • It produces an accumulation of bacterial plaque • Chronic inflammation • Periodontal bags • Reatraction of the adhered gingiva • Bone loss
Lingual frenulum ankyloglosia: (4)
- There is compromised lingual mobility
- There is difficulty to eat and to pronounce the R and the S
- When they bring the tongue to the palate the tongue has a bifid aspect
- They cannot take the tongue out of the mouth
Treatment of lingual frenulum? (5)
- Bilateral nerve block
- Traction with suture
- Bisturi or electrobisturi
- Complete resection
- Check lingual mobility
