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Cyst Flashcards

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1
Q

Cyst lining of Radicular Cyst is derived from?

A

Epithelial cell rests of Malassez

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2
Q

Etiology of Radicular Cyst

A
  1. Dental caries
  2. Pulp necrosis
  3. Apical periodontitis
  4. Formation of periapical granuloma
  5. Stimulation of epithelial rests of Malassez
  6. Periapical cyst formation
  7. Cyst expansion
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3
Q

Clinical Findings of a Radicular Cyst

A
  1. Non-vital tooth
  2. Slowly progressive, symptomless swelling
  3. Pain or sinus tract when infected
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4
Q

What is a Residual Cyst?

A

Radicular cyst may present after incomplete removal of involved tooth

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5
Q

Radiographic Findings of a Radicular Cyst

A

L: Root apex or lateral aspect of the tooth
E: Well-defined, well-circumscribed, corticated margin
S: Larger in size >1cm, round and unilocular
I: Radiolucent
O: Non-vital tooth, root resorption, bony expansion (erosion or bulging of buccal and lingual cortical plates)

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6
Q

Demographics of a Radicular Cyst

A
  1. Most common odontogenic cyst
  2. 4th-5th decade
  3. Males
  4. Maxilla
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7
Q

Histopathologic Findings of a Radicular Cyst

A

Epithelial Lining

Central cavity lined by non-keratinised, stratified squamous epithelium

Connective Tissue Stroma

  1. Collagenous
  2. Surrounding bone resorption
  3. Cholesterol clefts

Lumen (Cyst fluid)
1. Contents similar to periapical granuloma
2. Watery and opalescent fluid

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8
Q

Investigations of Radicular Cyst

A
  1. Correlate clinical and radiographic appearance
  2. Vitality testing
  3. Aspiration of cyst fluid
  4. Incisional biopsy for large lesion. Excisional biopsy can be performed following surgical excision
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9
Q

Differential Diagnosis of Radicular Cyst

A
  1. PA granuloma
  2. In anterior mandible: Early phase of PA cemento-osseous dysplasia
  3. In posterior mandible: Traumatic bone cyst
  4. Odontogenic tumours, giant cell lesions, metastatic disease and osseous tumours (vital teeth)
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10
Q

What is a Dentigerous Cyst?

A

The cyst surrounds the crown of tooth and is attached to the neck (CEJ)

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11
Q

The cyst lining of a Dentigerous Cyst is derived from?

A

Reduced enamel epithelium (REE)

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12
Q

What is the pathogenesis of a dentigerous cyst?

A
  1. Compression of follicle by impacted tooth
  2. Increased pressure on REE → Increase fluid transudation into REE → pooling of transudate between REE and enamel

OR

  1. Periapical inflammation from deciduous teeth
  2. Inflammation of REE of permanent tooth → Inflammatory exudate between REE and enamel
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13
Q

Clinical features of a Dentigerous Cyst

A
  1. Asymptomatic, hard bony swelling or facial swelling
  2. Infected lesion can be painful
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14
Q

Demographics of Dentigerous Cyst?

A
  1. Second most common type of odontogenic cyst
  2. 2nd to 3rd decade
  3. Males
  4. Mandible
  5. Commonly impacted teeth: 3rd molars and maxillary canines (Mand 8s > Max 8s > Max 3s)
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15
Q

Radiographic Findings of a Dentigerous Cyst

A

L: Pericoronal to impacted tooth, attached to CEJ
E: Well-defined, corticated borders
S: Unilocular
I: Radiolucent
O: Displacement of maxillary sinus floor, IDN and teeth, root resorption

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16
Q

Histopathological Findings of a Dentigerous Cyst

A

Epithelial Lining

Stratified squamous to cuboidal, non-keratinised

Connective tissue stroma
Collagenous

Cyst fluid
- Yellowish (straw-coloured fluid)
- Water and electrolytes
- Degenerating epithelial and inflammatory cells, serum proteins (from inflammatory exudate)

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17
Q

Investigation for Dentigerous Cyst

A
  1. Correlate with clinical and radiographic appearance
  2. Vitality testing to rule our radicular cyst
  3. Aspiration of cyst fluid
  4. Incisional biopsy for large lesion. Excisional biopsy can be performed following surgical excision
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18
Q

Differential Diagnosis of Dentigerous Cyst

A

Other unilocular pericoronal radiolucent lesions
1. Hyperplastic follicle
2. Unicystic ameloblastoma

Unilocular radiolucent lesions
3. OKC and odontogenic tumours

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19
Q

Management of Dentigerous Cyst

A
  1. Cyst enucleation and extraction of involved tooth
  2. Excisional biopsy

Rare recurrence

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20
Q

What is an Eruption Cyst?

A

Soft tissue variant of dentigerous cyst

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21
Q

What is the origin of an eruption cyst?

A

Separation of REE from crown of tooth

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22
Q

Demographics of Eruption Cyst

A
  1. Children <10 years old
  2. Deciduous mandibular central incisor, first permanent molar and deciduous maxillary incisor
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23
Q

Clinical features of an Eruption Cyst

A
  1. Soft, dome-shaped, bluish swelling in gingiva overlying erupting tooth
  2. Asymptomatic unless infected
  3. Fluctuant and sessile
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24
Q

Histopathological Findings of Eruption Cyst

A
  1. Thin stratified squamous epithelium, non-keratinizes
  2. Separated from oral mucosa by CT/lamina propria
  3. Cyst lumen filled with RBCs
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25
Management of an Eruption Cyst
1. Spontaneous rupture upon tooth eruption 2. Removal of tissue overlying crown of tooth or roof of cyst
26
What is Odontogenic Keratocyst?
Cyst of odontogenic origin where lining epithelium is similar to developing tooth germ and uniformly produces keratin
27
Unique Characteristics of OKC
1. Peculiarly infiltrative growth 2. Aggressive nature 3. Strong tendency to recur after removal 4. Associated with nevoid basal cell syndrome
28
OKC is derived from?
Remnants of dental lamina (Cell rests of Serres)
29
What is the pathogenesis of OKC?
1. Active epithelial growth - Over-expression of anti-apoptotic protein (Bcl-2 staining) and mutation of PTCH tumour suppressor gene 2. Bone resorbing factors - Overexpression of proteolytic enzymes (MMP 2 and MMP9) 3. Hydrostatic pressure (Minimal role)
30
Demographics of OKC
1. 2nd to 3rd and 5th decade 2. Males 3. Posterior mandible (Maxillary 3rd molar) 4. Unerupted teeth (25-40% of cases)
31
Clinical Features of OKC
1. Asymptomatic unless infected 2. Infected OKCs may present with pain, swelling and/or drainage 3. Grow in anterior-posterior direction within medullary cavity of bone 4. Extensive bone destruction without obvious bone expansion
32
Radiographic Features of OKC?
L: Posterior body or ramus of mandible E: Well-defined, corticated, scalloped margins S: Unilocular I: Radiolucent O: -
33
Histopathological Findings of OKC
**Epithelial lining** 1. Parakeratinised aggressive type or Orthokeratinised non-aggressive type 2. Stratified epithelium + Palisaded layer of tall columnar basal cells 3. Parakeratinised type: Luminal surface is thin eosinophilic layer of parakeratin that has corrugated appearance 4. Weakly attached to underlying connective tissue (Recurrence after enucleation) 5. Thickness of 7-10 cells **Connective tissue stroma** 1. Thin friable wall and composed of loose collagenous (Difficult to enucleate) 2. Presence of satellite cysts (Recurrence potential) **Lumen** Creamy or cheesy keratin debris
34
Investigation for OKC
Diagnosis based on histological examination
35
Differential Diagnosis of OKC
1. Ameloblastoma 2. Radicular cyst
36
Management of OKC
1. Aggressive behaviour and strong tendency to recur 2. Enucleation with curettage
37
What are the reasons for high recurrence rate of OKC after treatment?
1. Thin friable cyst wall → Difficult to enucleate intact 2. Epithelial lining is weakly attached to underlying connective tissue → Easily separates off 3. Finger-like extensions into cancellous bone → Difficult to remove lining 4. Satellite cysts in CT wall which may be left behind 5. Active epithelial proliferation compared to other odontogenic cysts
38
What is a Lateral Periodontal Cyst?
Slow-growing, non-expansile developmental odontogenic cyst on lateral root surface of tooth
39
Where is lateral periodontal cyst derived from?
Rests of dental lamina
40
Pathogenesis of Lateral Periodontal Cyst
1. Proliferation of cell rests of Serres 2. Epithelial islands 3. Cystic degeneration
41
Demographics of Lateral Periodontal Cyst
1. 5th-6th decade 2. Males 3. Posterior mandible 4. Premolar-canine region (80%)
42
Clinical Features of Lateral Periodontal Cyst
1. Asymptomatic 2. Painful soft tissue swelling at mid-root area
43
Radiographic Findings of Lateral Periodontal Cyst
L: Between roots of 2 vital teeth E: Well-defined S: Small, unilocular I: Radiolucent O: -
44
Histopathological Findings of Lateral Periodontal Cyst
*Epithelial lining** 1. Non-keratinised 2. Thickness: Thin 2-3 cells 3. Some areas may exhibit focal thickenings *Connective Tissue* Fibrous connective tissue stroma
45
Management of Lateral Periodontal Cyst
Conservative enucleation
46
What are some Odontogenic Cysts (Developmental)?
1. Epstein's pearls, Bohn's nodule, Dental lamina cyst 2. Dentigerous cyst 3. OKC 4. Lateral periodontal cyst
47
What is a Nasopalatine Duct Cyst?
Intraosseous developmental cyst of the midline of anterior palate
48
Where is Nasopalatine Duct Cyst derived from?
Remnants of embryonic nasopalatine duct within incisive canal
49
Demographics of Nasopalatine Duct Cyst
1. 4th-6h decade 2. Males
50
Clinical Features of Nasopalatine Duct Cyst
1. Asymptomatic 2. Slow growing 3. Swelling on palate in midline 4. Dome-shaped bluish enlargement overlying incisive canal
51
Radiographic Findings of Nasopalatine Duct Cyst
L: Midline between roots of central incisors E: Well-defined S: Oval-heart-shaped, Unilocular I: Radiolucency O:-
52
Histopathological Findings of Nasopalatine Duct Cyst
**Epithelial Lining** Vary from pseudostratified columnar to stratified squamous epithelium **Connective Tissue** Fibrous CT stroma + Neurovascular bundle representative of nasopalatine nerves and vessels
53
Investigations for Nasopalatine Duct Cyst
Biopsy
54
Management of Nasopalatine Duct Cyst
Surgical enucleation
55
What are some Cyst-like Lesions?
1. Simple bone cyst 2. Stafne bone defect 3. Aneurysmal bone cyst
56
Describe a Simple Bone Cyst
An empty bone cavity that lacks an epithelial lining
57
Radiographics Findings of Simple Bone Cyst
L: Mandible E: Well-defined but irregular edges S: Interradicular scalloping I: Radiolucent O:-
58
Management of Simple Bone Cyst
Induction of bleeding by scraping inside the cavity
59
Describe a Stafne Bone Defect
Anatomic Indentation of posterior lingual surface that gives a false appearance of a cyst Commonly due to submandibular gland pressing onto lingual surface of mandible
60
Radiograph Findings of Stafne Bone Defect
L: Beneath IDN E: Sharply circumscribed S: Oval I: Radiolucent O: -
61
Investigations of Stafne Bone Defect
Sialography reveals the presence of salivary gland within the defect
62
What is a Primordial Cyst?
Developmental odontogenic cyst, located in area where a tooth should have formed but is missing
63
Describe an Aneurysmal Bone Cyst
Intraosseous accumulation of variable-sized, blood-filled spaces surrounded by cellular fibrous CT and reactive bone
64
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