Cancer Jaw Cysts

Front 1

bone cysts occur most commonly in which bone? why?

Back 1

mandible

epithelium from odontogenic elements (teeth) and from embryonic rests

Front 2

what differentiates a cyst vs pseudocyst?

Back 2

the presence of an epithelial lining

Front 3

when are jaw cysts diagnosed?

Back 3

get really big

get infected

incidentally on scan (dental X-ray)

...small uninfected cysts are asymptomatic

Front 4

what is the most common jaw cyst?
what is the second?

Back 4

radicular cyst (odontogenic and inflammatory)
odontogenic developmental cyst

Front 5

where do ganglion cysts form?

Back 5

TMJ

Front 6

where do radicular cysts occur?

Back 6

around the base of non vitalized teeth

Front 7

whats the difference between odontogenic and non odontogenic developmental cysts?

Back 7

odontogenic developmental cysts {keratocysts and dentigerous cysts} - occur around unerrupted or impacted teeth

non odontogenic developmental cysts - occurr from epithelial embryonic rests

Front 8

what is the mechanism by which most cysts expand?

Back 8

osmotic pressure gradient draws water in causing expansion

Front 9

what can be done to prevent cysts from forming and/or eroding away a lot of bone?

Back 9

remove nonvital, impacted, or unerupted teeth

Front 10

how can you test the vitality of a tooth? (poor man/non dentist test)

Back 10

ice

Front 11

what does a radicular cyst look like on panorex?

Back 11

smooth, oval or round, uni to multilocular with surrounding dense periphery of reactive bone

Front 12

best imaging?

Back 12

panorex or CT depending on size and how much you're concerned about the inferior alveolar nerve.

Front 13

Lets say you FNA a jaw cyst (a large cyst that has eroded the cortex so FNA is possible) What to you make of...
straw colored fluid with cholesterol crystals?

inability to remove fluid?

whitish/pale yellow material?

blood?

Back 13

straw color/cholesterol = benign odontogenic cyst. the fluid will shimmer in the light.

no fluid = cancer

white stuff = odontogenic keratocyst - consists of desquamated cells and keratin debris.

blood = aneurysm of the bone or vascular lesion

Front 14

how should bony lesions be managed for biopsy?

Back 14

small lesions - excise

large lesions - incisional biopsy

Front 15

what are the 6 main categories of jaw cysts?

Back 15

(1) cysts
(2) odontogenic tumors
(3) benign nonodontogenic tumors
(4) inflammatory jaw lesions
(5) malignant nonodontogenic neoplasms of the jaw
(6) metabolic and genetic jaw diseases.

Front 16

what kind of cancer can arise in a benign odontogenic cyst?

Back 16

carcinoma. can be ameloblastoma (dentigerous cyst)
very rare
should be treated aggressively

Front 17

developmental odontogenic cysts: there are 7 kinds

Back 17

Dentigerous (follicular cyst)
OKC
Calcifying odontogenic (Gorlin) cyst
Eruption cyst
Gingival cyst of newborn (Alveolar...)
Lateral periodontal cyst (botyroid cyst)
Glandular cyst

Front 18

Dentigerous cyst

Back 18

Epithelial-lined, developmental, odontogenic cysts.

Second most common type of jaw cyst associated with the crown of an impacted, unerupted, or developing tooth.

Well-defined, radiolucent, sometimes expansile lesion.

Usually slow growing and benign.

Initially asymptomatic unless long-standing with significant enlargement or secondary infection.

Usually discovered on routine dental X-rays.

Requires histopathologic examination for diagnosis.

Front 19

dentigerous cysts are most commonly found on the...

Back 19

upper canines and lower 3rd molars

Front 20

where does a dentigerous cyst come from?

Back 20

the residual enamel lining, separated from the enamel but still within the bone, collects material and expands by osmotic force from the inflammatory infiltrate into the cyst

..etiology is impacted teeth

Front 21

what does a dentigerous cyst look like?

Back 21

round to oval, smooth edges, assoc with impacted tooth

Front 22

path of a dentigerous cyst will show?

Back 22

thin NON keratinized epithelial lining

inflammation can result in epithelial hyperplasia.
may also see cholesterol clefts, giant cells, and hemosiderin

Front 23

how do you treat a dentigerous cyst?
what is the success rate?

Back 23

enucleation and removal of associated tooth.

consider marsupialization if very large.

very high, rarely recur.

Front 24

how do you help a mandibular defect close by secondary intention?

Back 24

pack with 1/4 inch gauze, slowly remove over a week, irrigate frequently to prevent accumulation of debris

Front 25

what is an eruption cyst?

Back 25

just like a dentigerous cyst, but with an erupting tooth.

takes on a bluish hue on the alveolar ridge ....with tooth inside can be seen on panorex
- typically occur with molars in children < 10 yrs
- results from hemorrhage into the space between crown and enamel
- they will rupture spontaneously, but unroofing will alleviate pain
- tooth is viable and should be left alone
- x

Front 26

OKC odontogenic keratocyst.
- now referred as a keratocystic odontogenic TUMOR

Back 26

A developmental odontogenic cyst occurring in the tooth-bearing areas of the jaws or posterior to the mandibular third molar.

Has a parakeratinized epithelial lining.

May be a component of basal cell nevus syndrome (ie, Gorlin–Goltz syndrome - BCC, intracranial ca+, MR, ).

Has an aggressive clinical behavior with a high recurrence rate after treatment.

Front 27

what is the growth pattern of an OKC?

Back 27

mural (not evening expansile like a cyst)

Front 28

what does the histopathologic etiology of OKC?

Back 28

not sure..

considered either some of the basal cell components of the epithelium vs *epithelium in rests of the lamina vs enzymatic action in the fibrous cyst wall

Front 29

what part of the mandible is typically involved with OKCs?

Back 29

the posterior mandible and ramus (60-80% of OKC's are found in the mandible)

Front 30

what are the features of basal cell nevus syndrome?

Back 30

(1) OKCs of the jaws, (2) multiple basal cell carcinomas, (3) an enlarged occipitofrontal circumference, (4) mild ocular hypertelorism, (5) epidermal cysts, (6) palmar or plantar pits, (7) calcified ovarian cysts, (8) calcified falx cerebri, (9) rib abnormalities, (10) spina bifida, (11) short fourth metacarpals, (12) vertebral anomalies, and (13) pectus excavatum.

Front 31

what does an OKC look like on scan?

Back 31

large, expansile lesions reveal a locally destructive, multilocular lesion that can displace teeth, resorb tooth roots, deflect the mandibular canal inferiorly, and displace the maxillary sinus floor superiorly

Front 32

what does the FNA of an OKC look like? what stain differentiates it from a nonodontogenic cyst?

Back 32

white cheezy.....cholesteatoma.

cytokeratin-10

Front 33

what is the histopath of OKC (keratinized odontogenic tumor)

Back 33

parakeratinized epithelium of 6-10 layers with palisading and sometimes budding to form daughter cysts.

Front 34

Gingival (alveolar) cyst of new born

Back 34

whitish papules on the mucosa of the alveolar process of neonates

are the remnants of the dental lamina

will involute on their own after self rupture

Front 35

lateral periodontal cyst vs botyroid odontogenic cyst

Back 35

- occur on the lateral aspect of the mandibular premolar
- from embryonic rests of the periodontal membrane
- associated tooth may or may not be vital
- cyst can displace the nerve
- tx is cyst enucleation, usually do not recur
- botyroid is the more aggressive variabt

Front 36

calcifying odontogenic cyst (gorlin cyst...not gorlin syndrome)

Back 36

A rare odontogenic, developmental cyst with occasionally aggressive behavior.
Occurs equally frequently in the maxilla and the mandible; most cases are reported in the incisor or canine region
- "ghost cell" keratinization of the epithelial lining
- unilocular or multilocular and well-delineated radiolucency
- remove cyst by enucleation

Front 37

glandular odontogenic cyst

Back 37

This recently described odontogenic developmental lesion is uncommon.

Occurs in the tooth-bearing areas of the jaws.

nonkeratinized epithelium, with localized areas of mucus and clear cells in a pseudoglandular pattern

Front 38

Nonodontogenic Cysts: there are 2

Back 38

nasolabial / nasoalveolar cysts

nasopalatine (incisive canal) cysts

Front 39

nasolabial cysts

Back 39

Rare nonodontogenic developmental cyst.

Occurs as a unilateral swelling (10% incidence of bilateral occurrence) of the upper lip lateral to the midline, superficial to the maxilla.

typically in adult females

thought to be due to remnants of nasolacrimal epithelium given then pseudostratified columnar epithelium, which frequently demonstrates cilia and goblet cells

tx with transoral excision or transnasal marsupialization

Front 40

nasopalatine / incisive canal cyst

Back 40

Relatively common nonodontogenic, developmental cyst.

Occurs in the palatal midline behind the maxillary central incisors in the region of the incisive canal.

embryonic remnants of the nasopalatine duct

heart shape on periapical Xray.

ok to follow if very small or unsure if wide incisive foramen

tx with surgical enucleation via a palatal flap. recurrence is rare

Front 41

there are 3 types of pseudocysts

Back 41

traumatic bone cysts
aneurysmal bone cysts
static bone cysts

Front 42

aneurysmal bone cyst

Back 42

Rare intraosseous jaw lesion characterized by blood-filled spaces associated with a fibroblastic tissue containing multinucleated giant cells and osteoid and woven bone.

thought to be a reactive vascular malformation

multilocular jaw mass with cortical expansion is characteristic

Appears more frequently in the mandible than in the maxilla.

complete excision is needed (curretage has high recurrence rates associated)

Front 43

traumatic bone cyst

Back 43

empty or possibly fluid-filled bone cavity that appears to scallop the roots of vital teeth.

- aka solitary, simple, hemorrhagic cyst

Rather than an epithelial lining, there is a fibrous or granulation tissue component, or no identifiable lining.

Usually identified on routine dental radiographic examination.

- will heal on their own, but accelerated by surgical removal...bone will fill in 6-12 months... surgery is indicated to r/o more concerning etiologies

Front 44

static bone cyst

Back 44

A mandibular anatomic defect that has a cyst-like appearance on X-ray.

May occur in the incisor or in the cuspid or premolar regions of the lingual aspect of the mandible.

Usually a unilateral phenomenon but may occur bilaterally

seen in middle aged ppl, developmental in nature, does not involve tooth roots

no tx. imaging is pathognomonic

Front 45

ganglion cysts

Back 45

2 types
(1) those with walls that consist of fibrous connective tissue
(2) those with walls that are lined by synovial cells.

Ganglions should be considered when evaluating preauricular swellings. The surgical removal with histopathologic examination of the excised tissue is the treatment of choice for jaw cysts in most cases.