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OS II > sx management of odontogenic cysts > Flashcards

sx management of odontogenic cysts Flashcards

1
Q

most common odontogenic cyst?

A

PA cyst

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2
Q

when is it a good idea to refer PA cysts?

A

when they are close to vital structures such as IAN

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3
Q

how is PA border on radio?

A

well defined opaque rim= slow growing

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4
Q

what can occur with extraction if sockets are not well debrided?

A

residual cysts, must be removed if found

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5
Q

dentigerous cysts

A

occur around crown of unerupted teeth, often 3rd molars

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6
Q

what cysts like to recur?

A

OKC

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7
Q

OKC destruction

A

can destroy lots of bone

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8
Q

common pattern with okc on radio

A

scalloped

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9
Q

can dentists tx odontogenic cysts

A

in some cases yes, but must be able to know when to refer

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10
Q

What is a Cyst ?
* def?
* The cystic cavity, within the oral regions, is almost always lined by?
* The cyst’s lumen usually contains?

A

“A benign pathologic cavity within bone or in soft tissues, generally formed by a connective tissue wall.”
The cystic cavity, within the oral regions, is almost always lined by epithelium.
The cyst’s lumen usually contains fluids, keratin or cellular debris

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11
Q

Histopathology of cysts

A

 “A” points to the connective tissue wall that forms the cyst.
 “B” points to the various types of epithelium that can line a cyst developing within the oral regions.

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12
Q

Odontogenic Cyst - Introduction
* Odontogenic cyst can be defined as a cyst in which lining of lumen is derived from?
* Variety?

A

Odontogenic cyst can be defined as a cyst in which lining of lumen is derived from epithelium produced during tooth development.
Variety of odontogenic cysts.
Uniquely derived from tissues of developing teeth

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13
Q

Classification of Odontogenic Cysts

A

 Histogenic Classification (Based on where the cyst is derived from)
 Inflammatory vs Developmental

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14
Q

Cyst derived from rest cell of Malassez

A

Periapical cyst
Residual cyst

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15
Q

Cyst derived from reduced enamel epithelium

A

Dentigerous cyst
Eruption cyst

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16
Q

Cyst derived from dental lamina (Rest of Serrae)

A

Odontogenic keratocyst
Dental lamina cyst of new born
Lateral periodontal
Glandular cyst

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17
Q

Unclassified cyst

A

Paradental cyst

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18
Q

inflammatory cysts

A

 Radicular Cyst
 Paradental Cyst

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19
Q

developmental cysts

A

 Dentigerous Cyst
 Odontogenic keratocyst
 Developmental lateral periodontal Cyst
 Glandular odontogenic Cyst

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20
Q

most common developmental cyst

A

dentigerous cyst

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21
Q

odontogenic cysts diagnosis
 Complete history
 Thorough clinical examination
 Plain radiographs
 CT Scan/ MRI

A

 Complete history: Pain, loose teeth, occlusion, swellings, delayed tooth eruption. Dysesthesia and Paresthesia (Not so common, tend to displace not compress nn)
 Thorough clinical examination: Inspection, palpation.
 Plain radiographs: Panorex, Occlusal, Periapical radiographs
 CT Scan/ MRI: For larger lesions

22
Q

when removing a tooth with cyst what should always be done

A

tissue sample of cyst sent for histo exam to confirm diagnosis

23
Q

1st step to cyst exam

A

radiogrpah

24
Q

what should be done when planning a biopsy of cyst

A

Aspiration To rule out vascular lesions, cystic Lesions, solid tumors and inflammatory conditions.
best with large lesions, can help to establish a dif dx

25
Q

what needle gauge is used for aspiration

A

18g

26
Q

obtaining tissue samples for odontogenic cyst diagnosis

A

 Obtain tissue sample
 Incisional biopsy – Larger lesions prior to definitive therapy
 Excisional biopsy – Smaller cysts

27
Q

Odontogenic Cysts – Common Surgical Treatment options

A

 Curettage
 Enucleation
 Marsupialization
 Marsupialization followed by cystectomy
 Enucleation followed by Peripheral ostectomy
Resection a possibility

28
Q

Curettage

A

 Curettage describes a surgical scraping of the cyst from the bony walls of the maxilla or mandible with a special instrument called a curette that has a scoop, at its tip.
 For this procedure, it is important to create a bony window to expose the cyst in the maxilla or mandible.

29
Q

Marsupialization

A

 Marsupialization refers to creating a surgical window in the wall of cyst & evacuation of cystic contents.
 This process decreases intracystic pressure & promotes shrinkage of cyst & bone fill (endosteal bone formation)
**used when close to vital strucutures **

30
Q

how do we prevent infection with marsuprialisation

A

acrylic plug

31
Q

what is placed in cyst, esp. OKC, to prevent recurrence

A

often use iodophorm gauze

32
Q

another tx options for OKC

A
  • Enucleation followed by use of Carnoys solution
  • Enucleation followed by peripheral ostectomy and removal of overlying attached mucosa + use of Carnoys solution
  • Surgical resection for very large –recurrent lesions
33
Q

follow up schedule for OKCs

A
  • 1st year: every 6mo
  • after year 1: once sa year
  • after 5 yrs: every 2 years
34
Q

Carnoy solution

A

substance used as a complementary treatment after the conservative excision of odontogenic keratocyst. The application of Carnoy’s solution promotes a superficial chemical necrosis and is intended to reduce recurrence rates.
The application of Carnoy’s solution, a chemical solution composed of 60% ethanol, 30% chloroform, and 10% acetic acid, in conjunction with surgery, is known to reduce the rate of KOT recurrence. An FDA ban in 2013 on the use of chloroform for compounding led a number of surgeons to adopt a modified Carnoy’s solution in the use of Odontogenic Keratocyst

35
Q

Marsupialization: Indications
 Anatomical considerations
 Surgical access
 Assistance in eruption of teeth
 Extent of surgery
 Size of cyst

A

 Anatomical considerations – Proximity of cyst to vital structures like maxillary sinus, Neurovascular bundle.

 Surgical access – If access to all portions of cyst is difficult.

 Assistance in eruption of teeth – In a young patient with a dentigerous cyst, it permits eruption of unerupted teeth.

 Extent of surgery – Marsupialization is preferred in a unhealthy or debilitated patient , because it is simple & less stressful for patient.

 Size of cyst – In a very large cyst, there is a risk of fracture of jaw during enucleation procedure

36
Q

Marsupialization: Relative Contraindications

A

Recurrent Odontogenic Keratocyst
Recurring Cysts
Smaller Cysts (< 2X2 cm)

37
Q

Marsupialization: Advantages
 Simple?
 Spares?
 Even quite large cyst?
 eruption?
 Prevents what in maxilla?

A

 Simple procedure to perform (biggest pro)
 Spares vital structures eg. blood vessels, nerves
 Even quite large cyst can be dealt under Local anesthesia as anesthesia of deeper recesses is not essential.
 Allows eruption of teeth (no damage to tooth)
 Prevents oronasal, oroantral fistulae in the maxilla

38
Q

Marsupialization: Advantages
 Reduces?
 Prevents?
 blood loss/ shrinkage
 bone formation?
 Alveolar ridge?

A

 Reduces operating time.
 Prevents intraoperative fractures.
 Reduces blood loss, helps in shrinkage of cystic lining.
 Allows for endosteal bone formation to take place.
 Alveolar ridge is preserved.

39
Q

Marsupialization: Disadvantages
 Pathologic tissue?
 Histologic examination of entire cystic lining?
 post op care?
 tastes and smell?
 pack/plug?
 Secondary surgery?
 healing time ?

A

 Pathologic tissue is left in situ.
 Histologic examination of entire cystic lining is not done.
 The need for regular postoperative care, occurs over a substantial period of time.
 Unpleasant taste and smell may occur due to accumulation of stagnant saliva & food debris in cystic cavity.
 Changing of pack and adjustment of plug.
 Secondary surgery may be needed.
 Longer healing time.

40
Q

Enucleation
 Enucleation means?
 This procedure is usually indicated for removal of cyst that is?
 Enucleation allows for cystic cavity to be covered by? which allows?

A

 Enucleation means shelling out the entire cystic lesion without rupture.
 This procedure is usually indicated for removal of cyst that is not very large in size and has minimum risk of injury to vital anatomical structures during the surgical procedure.
 Enucleation allows for cystic cavity to be covered by a mucoperisteal flap & the space fills with blood clot, which will eventually organize & form normal bone.

41
Q

eunucleation tool

A

currete

42
Q

Enucleation: Indications
 Treatment of?
 Recurrence?
 Should be employed with any cyst that can be?

A

 Treatment of Common types of odontogenic cysts (odontogenic keratocysts, Radicular cysts, Dentigerous cyst etc.,)
 Recurrence of cystic lesions of any cyst type.
 Should be employed with any cyst of jaw that can be safely removed without unduly sacrificing the adjacent structures.

43
Q

Enucleation: Relative Contraindications
 Dentigerous cyst associated with?
 pt ages?
 Medically compromised or debilitated patients?
 Proximity?
 size of cysts?

A

 Dentigerous cyst associated with teeth other than the third molars that would erupt normally in the oral cavity and be functional.
Young patients with erupting teeth.
 Medically compromised or debilitated patients who require extensive surgical
procedure to treat the cyst.
 Proximity to vital structures.
 Very large cysts, may cause fracture of jaw.

44
Q

Enucleation: Advantages
 pathological tissue?
 Tissue available for?
 recurrence?
 Healing time?
 Enucleation with primary closure eliminates need for?

A

 Entire pathological tissue is removed.
 Tissue available for histopathological examination.
 Chances of recurrence are less.
 Healing time is reduced.
 Enucleation with primary closure eliminates need for repeated appointments for packing, irrigation, adjustment of plug etc

45
Q

Enucleation: Disadvantages
 In young patients?
 Removal of large cyst?
 Damage to?
 Adjacent tooth?

A

 In young patients, the unerupted teeth in a dentigerous cyst will have to be removed
with the lesion.
 Removal of large cyst may make mandible more prone for fracture.
 Damage to adjacent vital structures.
 Adjacent tooth may be devitalized.

46
Q

Combination of Marsupialization and Cystectomy

A

 Cystectomy after Marsupialization (decompression) is a conservative technique that decreases the size of the cystic cavity and reduces the risk of intrabony defects, which could be induced by primary enucleation.
 In addition, it can also save the adjacent anatomic structures- As the surgery is carried out in 2 stages

47
Q

stages of combined marsupialization and cystectomy

A

 Stage 1 – Marsupialization
 Stage 2 - Cystectomy

48
Q

Combination of Marsupialization and Cystectomy
 Stage 1

A

 In these cases, the Marsupialization(decompression) is performed usually on on huge cystic lesions of the mandible.
 During this process, a decrease in the size of the lesion and the growth of normal oral tissues was observed. The size of the lesion decreased until the time of cystectomy.

49
Q

Combination of Marsupialization and Cystectomy
stage 2

A

Cystectomy is carried out later after the size of the cyst decreases considerably in size over a period of time and surgery could be performed under local anesthesia.

50
Q

Enucleation followed by Peripheral ostectomy

A

exactly what it says, prevent recurrence is main goal

51
Q

Curretage followed by Peripheral ostectomy

A

 Peripheral ostectomy is defined as a peripheral bone. reduction with
powered hand-piece and rotary instruments, done after enucleation of the cystic lesion

OS II (14 decks)

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