Omfs Spring 2010 - Junior Course

Front 1

facts about the maxillary sinus (anatomical and location)

Back 1

- the largest para-nasal sinuses
- pyramidal shape
- lateral nasal bone forms its base
- asymmetry btw the sinuses exists in the same individual
- avg height = 3.5 cm; depth = 3.2 cm; width = 2.5 cm; and capacity = 15 cc
- lined w/ psuedo-stratified columnar ciliary epithelium

Front 2

underwood's septa

Back 2

the bony septa that divides the maxillary sinus

Front 3

functions of max sinus (all fxns not clearly known, these are those that have been proposed)

Back 3

- speech and voice resonance
- reduces weight of skull
- warms inspired air
- filtration of inspired air
- immunologic barrier (body defense)

Front 4

common inflammatory diseases of max sinus

Back 4

- bacterial infection
- bacterial infection secondary to viral infection
- fungal infection

Front 5

sinusitis - acute sinusitis

Back 5

- suppurtative (pus) or non-suppurative inflammation of mucosal lining of sinus (1 or both sinuses)
- often assoc. w/ hay fever and allergies, acute rhinitis (common cold), and/or bacterial infection infection due to dental sepsis/swimming/trauma
- headache, pain/tenderness, nasal obstruction, discharge, toxic manifestations, heavy filling w/ bending, nasal congestion

Front 6

treatment for acute sinusitis

Back 6

- rest, fluids, and oral hygiene
- antibiotics after C&S is done (looking for pneumococci and streptococci as most common)
- analgesics and antihistamines
- local treatment (decongestant and steam inhalation)

Front 7

chronic sinusitis

Back 7

- chronic type of infection that affects mucosal lining of one or both sinuses, resulting in mucous or pus collection
- consequence of non-resolved acute sinusitis; dental abscess; virulent organism w/ low resistance; foreign body dislodgement or trauma
- headache, nasal obstruction, nasal discharge, fatigue, hyposmia/anosmia (loss of smell/taste)
- treat w/ antibiotics, systemic decongestants, sinus wash-out

Front 8

mucosal polyps in sinus

Back 8

- polypoidal type of inflammation can lead to formation of multiple or single mucosal/polyps inside the sinus

Front 9

complications of sinusitis

Back 9

-orbital abscess and orbital cellulitis
- intracranial absesses/ meningitis
- cavernous sinus thrombosis
- spread of infection to neighboring sinuses, structures and organs
- osteomyelitis

Front 10

aspergillosis

Back 10

- oportunistic infection caused by maxillary sinus flora fungi called "aspergillosis aeroginosa", often in pts w/ compromised immune system
- --> obliteration of sinus space and erosion of bony components
- treat w/ surgical removal of associated lesion from max sinus

Front 11

name some bone metaplasias and benign tumors of maxillary sinus

Back 11

fibrous dysplasia, ossifying fibroma, transitional papilloma, osteoma, giant cell lesions

Front 12

name some maxillary sinus neoplasias (malignant)

Back 12

squamous cell carcinoma; adenocarcinoma; sarcoma (osteosarcoma); Ewing's sarcoma

Front 13

when examining the nasal passage, you look for...

Back 13

- nasal patency, pus discharge, nasal polyps, erythema (redness) or change in color of nasal mucosa

Front 14

intranasal maxillary antrostomy

Back 14

- the surgical creation of a hole in the lateral nasal wall btw the nasal passages and the max sinus cavity
- used to clear the infected sinus from stagnant secretions and establish drainage
- opening is made at level of inferior or middle meatus

Front 15

why is endoscopic sinus surgery performed

Back 15

to open blocked sinus passages

Front 16

oro-antral communication
- factors influencing the creation of this type of communication

Back 16

- invasion of max sinus and establishment of a direct communication w/ oral cavity (when you perforate the sinus while performing a dental procedure)
- teeth size and configuration of roots; hypercementosis; density of alveolar bone and thickness of sinus floor; size of sinus; relation of sinus to root of max teeth; rough extraction and misguided manipulation; apical pathosis; periodontal disease that erodes sinus floor; presence of cyst and neoplasm; invasive surgery (cleft palate or implant placement)

Front 17

define fistula

Back 17

- biological tract that connects an anatomical cavity w/ external surfaces or other anatomical cavity (unlike a sinus tract)
- always lined w/ stratified squamous epithelium and the patency of tract is preserved until epithelial cells are scraped off

Front 18

signs/symptoms of newly created oro-antral fistula

Back 18

- antral floor attached to root apices of extracted tooth/teeth
- fracture of alveolar process of tuberosity
- air stream passing from nostril
- bubbling of blood from socket or nostril
- change in speech tone and resonance
- radiographical evidence of sinus involvement

Front 19

displacement of tooth or root into the max sinus

Back 19

- mishap resultant from a neglected act by the operator while applying wrong force
- 3rd molar and 2nd premolar are most at risk of dislodgement

Front 20

management of investigation of foreign body displacement into max sinus

Back 20

- confirm suspicions w/ "nose-blowing technique" and x-rays
- cut flap; reduce alveolar bone height; retrieve object by permitting movement away from sinus; consider "Caldwell-luc approach"; undermine flap and replace across bony defect

Front 21

chronic oro-antral fistula (OAF) - persistent oro-antral communication

Back 21

- unrecognized (overlooked) fistula; untreated fistula; failure of spontaneous closure of OAF; failure of surgically repaired OAF
- reflux of food and drinks; loss of denture stability; intermittent episode of pain and tenderness; foul-tasting discharge; signs and symptoms of chronic sinusitis

Front 22

cyst

Back 22

- benign pathologic cavity w/in bone or in soft tissues, generally found by a connective tissue wall
- cyst lumen usually contains fluids, keratin, or cellular debris
- true cysts have epithelial lining (radicular, dentigerous cysts); no epithelial lining = psedo cyst (aneurysmal bone cyst, traumatic bone cyst)

Front 23

odontogenic cyst

Back 23

- cyst in which lining of lumen is derived from epithelium produced during tooth development
- from rest cell of Malassez = periapical cyst
- from reduced enamel epitheilum = dentigerous cyst
- from dental lamina = odontogenic keratocyst
- classified into either inflammatory (radicular or paradental cyst) or developmental cyst (dentigerous, OKC, etc.)

Front 24

radicular (periapical) cyst

Back 24

- most common (65%) cyst; originates from epithelial cell rests of Malassez in response to inflammation
- pulpless, nonvital tooth, small well-defined PA-lucency

Front 25

residual cyst

Back 25

- consequence of an improper surgical elimination of a radicular cyst
- clinically and histologically identical to radicular cyst
- lucency of variable size at site of previous tooth extraction

Front 26

paradental cyst

Back 26

- inflammatory cyst that develops on lateral surface of tooth root
- associated w/ partially impacted 3rd molars; result of inflammation of gingiva over and erupting molar

Front 27

dentigerous (follicular) cyst

Back 27

- most common developmental cyst (24%)
- result of accumulation of fluid btw reduced enamel epithelium and tooth crown
- unilocular lucency w/ well defined sclerotic margins

Front 28

developmental lateral periodontal cyst

Back 28

- arises from epithelial rests in periodontal ligament
- common in mandibular premolar region; middle-aged men
- interradicular lucency w/ well-defined margins

Front 29

odontogenic keratocyst (OKCs)

Back 29

- 11% of jaw cysts, may mimic any of other cysts, most often in mandibular ramus and angle
- high frequecy of recurrence (~62%)
- well-marginated lucency pericoronal, inter-radicular, or pericoronal, multilocular

Front 30

glandular odontogenic cyst

Back 30

- mandible (87%), usually anterior region
- very slow progressive growth (swelling, pain) - 40%
- unilocular or multilocular lucency

Front 31

non-odontogenic cysts

Back 31

- incisive canal cyst
- stafne bone cyst
- traumatic bone cyst
- surgical ciliated cyst (of maxilla)

Front 32

marsupialization

Back 32

- creating a surgical window in wall of cyst and evacuation of cystic contents
- basically: draining the cyst
- decreases intracystic pressure and promotes shrinkage of cyst and bone fill
- often done if cyst is near vital structures; if access is difficult; aids in eruption of teeth; in pts unable to undergo surgery; in very large cysts where removal might fracture the jaw
- not used for OKCs, recurring cysts, and smaller cysts ( < 2x2 cm)

Front 33

enucleation

Back 33

-removal of tumor, cyst, or other body structure in total w/out rupture
- allows for cystic cavity to be covered by a mucoperiosteal flap & space fill w/ blood clot, which will eventually organize and form normal bone

Front 34

name 3 epithelial odontogenic tumors

Back 34

- ameloblastoma
- adenomatoid odontogenic tumor (AOT)
- calcifying epithelial odontogenic tumor (CEOT)

Front 35

name 4 mesenchymal odontogenic tumors

Back 35

- odontogenic myxoma
- benign cementoblastoma
- odontogenic fibroma
- cementifying (ossifying) fibroma

Front 36

name 3 mixed odontogenic tumors (epithelial and mesenchymal)

Back 36

- odontomas
- ameloblastic fibroma
- ameloblastic fibrodontoma

Front 37

ameloblastoma

Back 37

- epithelial odontogenic tumor
- most common odontogenic tumor; muliticystic most common subtype (86%); middle-aged people; any part of both jaws most often in middle posterior of mandible
- benign, but locally invasive; late symptoms include painless swelling, loose teeth, malocclusion, or nasal obstruction; root resorption w/ mobility of teeth
- unencapsulated and infiltrates surrounding bone marrow; may be unilocular, but often become multilocular as they increase in size; well circumscribed soap-bubble appearance
- even though they are locally infiltrative, they do not metastasize
- ocassionally arise from dentigerous cysts

Front 38

adenomatoid odontogenic tumor (AOT)

Back 38

- epithelial odontogenic tumor
- often found in teenagers; middle and anterior portions of jaws; often assoc. w/ crown of impacted anterior tooth - maxilla - females; painless expansion often chief complaint
- unilocular lucency, often around crown of unerupted tooth (resembles dentigerous cyst)
- histologically has thick capsule of fibrous connective tissue; tumor fills the central cavity, there is little stroma; tumor cells frequently form ball-like structures referred to as "rosettes"

Front 39

calcifying epithelial odontogenic tumor

Back 39

- epithelial odontogenic tumor
- AKA pindborg tumor; RARE tumor; this is the most "unodontogenic" tumor of the 3 types in this category, the tumor cells do not resemble odontogenic tissue; aggressive tumor of epithelial derivation; chief sign is cortical expansion (painless)
- lucent, poorly defined, non-corticated borders; unilocular, multilocular, or "moth-eaten"; "driven snow" appearance (multiple radiopaque foci
- histolocially: islands of eosinophilic epithelial cells that infiltrate bony trabulae; nuclear hyperchromatism and pleomorphism; psammoms-like calcifications (lieseganerings)

Front 40

odontogenic myxoma

Back 40

- mesenchymal odontogenic tumor
- originates from dental papilla or follicular mesenchyme; slow growing, aggressively invasive; mostly in 20-30 y/o; unencapsulated, locally infiltrating
- no calcified matrix --> purely radiolucent
- histologically: spindle/stellate fibroblasts w/ basophilic ground substance

Front 41

resection of tumor; what do we want...

Back 41

clean margins - 1 cm of clean tissue above infiltration of tumor

Front 42

cementoblastoma

Back 42

- mesenchymal odontogenic tumor
- true neoplasm of cementoblasts; occurs around roots of lower posterior teeth; cortex expanded w/out pain; involved tooth is ankylosed
- on x-ray = ball of dense material attached to end of root (dense)
- histologically = radially oriented trabeculae from cementum, rim of osteoblasts
- excise w/ loss of tooth

Front 43

cementoblastoma

Back 43

- mesenchymal odontogenic tumor
- true neoplasm of cementoblasts; occurs around roots of lower posterior teeth; cortex expanded w/out pain; involved tooth is ankylosed
- on x-ray = ball of dense material attached to end of root (dense)
- histologically = radially oriented trabeculae from cementum, rim of osteoblasts
- excise w/ loss of tooth

Front 44

name 3 mixed odontogenic tumors

Back 44

odontomas, ameloblastic fibroma, ameloblastic fibro-odontoma

Front 45

name 3 mixed odontogenic tumors

Back 45

odontomas, ameloblastic fibroma, ameloblastic fibro-odontoma

Front 46

odontomas

Back 46

- a mixed odontogenic tumor
- tumors in which odontogenic differentiation is fully expressed; epithelium and ectomesenchyme realize their potential and make enamel and dentin respectively; radioDENSE
- two types: compound (looks like mal-formed tooth) and complex (little or no tendency to form tooth-like structures, dentin and enamel entwined in mass that DOES NOT LOOK LIKE TEETH)

Front 47

odontomas

Back 47

- a mixed odontogenic tumor
- tumors in which odontogenic differentiation is fully expressed; epithelium and ectomesenchyme realize their potential and make enamel and dentin respectively; radioDENSE
- two types: compound (looks like mal-formed tooth) and complex (little or no tendency to form tooth-like structures, dentin and enamel entwined in mass that DOES NOT LOOK LIKE TEETH)

Front 48

cementoblastoma

Back 48

- mesenchymal odontogenic tumor
- true neoplasm of cementoblasts; occurs around roots of lower posterior teeth; cortex expanded w/out pain; involved tooth is ankylosed
- on x-ray = ball of dense material attached to end of root (dense)
- histologically = radially oriented trabeculae from cementum, rim of osteoblasts
- excise w/ loss of tooth

Front 49

name 3 mixed odontogenic tumors

Back 49

odontomas, ameloblastic fibroma, ameloblastic fibro-odontoma

Front 50

odontomas

Back 50

- a mixed odontogenic tumor
- tumors in which odontogenic differentiation is fully expressed; epithelium and ectomesenchyme realize their potential and make enamel and dentin respectively; radioDENSE
- two types: compound (looks like mal-formed tooth) and complex (little or no tendency to form tooth-like structures, dentin and enamel entwined in mass that DOES NOT LOOK LIKE TEETH)
- found in youth; compound mostly in anterior - complex in posterior; mostly assoc. w/ unerupted tooth; limited growth potential, no pain or cosmetic deformity

Front 51

ameloblastic fibroma

Back 51

- mixed odontogenic tumor
- childhood tumor (12-14 y/o); posterior segment of mandible is most common location; local swelling or failure of teeth to erupt on time or in proper alignment
- unilocular or multilocular; purely -LUCENT lesions
- benign tumor, treated w/ vigorous curettage; recurrence is ~ 15%

Front 52

diagnosis of odontogenic tumors

Back 52

- complete history
- thorough physical examination
- plain radiographs
- CT scan for larger, aggressive lesions
- differential diagnosis
- obtain tissue sample (FNA, excisional biopsy, incisional biopsy)

Front 53

papilloma

Back 53

-benign tumor of epithelial origin
-numerous small finger like projections which --> rough "cauliflower" like surface
- any age, often caused by HPV (wart)

Front 54

pigmented cellular nevus

Back 54

- benign tumor of epithlial tissue origin
- congenital, developmental tumor like malformation of skin or mucous membrane that contains melanin pigment; composed of "nevus" cells
- well-circumscribed and may occur at any site intra-orally but are more commonly seen in anterior gingiva, lips and palate

Front 55

fibroma

Back 55

- benign tumor of connective tissue origin
- related to fibrous hyperplasia
- elevated lesion of normal color w/ a smooth surface and a sessile or pedunculated base

Front 56

central ossifying fibroma of bone

Back 56

-central tumor of bone and is a separate entity from fibrous dysplasia and other fibro-osseous lesions of bone
- mostly in young adults
- more common in mandible
- slow growing and asymptomatic until noticable swelling and deformity (displacement of teeth)
- lesion well-demarcated in x-rays

Front 57

peripheral giant cell granuloma

Back 57

- benign tumor of connetive tissue origin
- occurs peripherally in oral cavity
- often sequlae of trauma: extraction, calculus deposits, ill fitting dentures and poor restorations (originates from PDL or mucoperiosteum)

Front 58

central giant cell tumor of the bone

Back 58

- benign tumor of connective tissue origin
- female predilection; anterior portion of both arches, mandible preferred site
- lucent lesion; resorption of teeth very common; v-shaped bony ridges separating locules
- surgical curettage is most common treatment; non-surgical treatments available (systemic calcitonin, anti-angiogenic therapy w/ interferon, and intra-lesional corticosteroids)

Front 59

aneurysmal bone cyst

Back 59

- benign tumor of connective tissue origin
- <20 y/o; mandible most often; 50% present w/ pain in affected region; tooth displacement and external root resorption may also be seen
- 19% recurrence; if assoc. w/ vascular malformation - pre-operative super-selective embolization of feeding vessels is mandatory

Front 60

lipoma

Back 60

-benign tumor of connective tissue origin
- frequent in subcutaneous tissues of neck, rare intraoral
- slow growing composed of mature fat cells; yellowish and soft on palpation

Front 61

hemangioma

Back 61

- benign tumor of connective tissue origin
- proliferation of blood vessels (most cases are present at birth)
- central hemangiomas of maxilla and mandible have to be carefully diagnosed and managed; if in bone, the tumor is destructive

Front 62

lymphangioma

Back 62

- benign tumor of connective tissue origin
- tumor of lymphatic vessels; often present at birth

Front 63

myxoma

Back 63

- benign tumor of connective tissue origin
- tumor of soft tissues and made up of tissue resembling primitive mesenchyme
- benign, but can infiltrate into adjacent tissues
- very rare intraorally; if occue in jaw = odontogenic myxoma

Front 64

chondroma

Back 64

- benign tumor of connective tissue origin
- composed of mature cartilage and not very common in maxilla or mandible
- CAN UNDERGO MALIGNANT TRANSFORMATION
- may involve condyle or coronoid process

Front 65

osteoma

Back 65

- benign tumor of connective tissue origin
- proliferation of either compact or cancellous bone usually in endosteal or periosteal location
- NOT COMMON ORAL LESION

Front 66

leiomyoma

Back 66

- benign tumor of muscle tissue origin
- derived from SMOOTH muscle
- uncommon in oral cavity (due to absence of smooth muscle except in blood vessel walls and circumvallate papillae of tongue)
- MOST OCCUR ON POSTERIOR PORTION OF TONGUE

Front 67

rhabdomyoma

Back 67

- benign tumor of striated muscle origin
- most common on tongue and floor of mouth
- a painless, well circumscribed tumor mass that is slow growing

Front 68

neurofibroma

Back 68

- benign tumor of nerve tissue origin
- specifically arises from cells of sheath of schwann w/ intermingled neurites
- most frequently involves skin and oral mucosa and does not differ from the multiple form of the disease known and neurofibromatosis
- two types - many elevated smooth-surfaced nodules of variable size on trunk/face/extremities -- or -- deeper, more diffuse lesions which are often of greater proportions than superficial nodules; CAN UNDERGO MALGINANT TRANSFORMATION
- intraorally: nodules w/ same color of normal mucosa noted in tongue/buccal mucosa/palate; macroglossia in some cases
- no satisfactory treatment

Front 69

neurolemmoma

Back 69

- common tumor of sheath of schwann
- slow growing lesion, can occur anywhere in oral cavity
- can occur as a central lesion inside the bone; soft tissue lesion is a single well circumscribed nodule of varying size

Front 70

malignant tumors of oral cavity...some key facts

Back 70

-originate from epithelium, connective tissue, salivary glands, or metastatic disease
- 90% are squamous cell carcinoma: mostly on lip (38%), tongue (22%), front of mouth (17%), palate/tonsil (11%)

Front 71

what information does staging of malignancy provide

Back 71

prognosis, staging is heavily correlated w/ prognosis

Front 72

when removing malginancy, how deep do you remove from surrounding tissue

Back 72

1-2 cm
1st chance is best chance

Front 73

3 types of radiation for oral malignant tumors mentioned in Dr. Baur's lecture

Back 73

external beam, neutron beam, brachytherapy (iridium)

Front 74

external beam radiation or XRT (external radiation tx)

Back 74

dose: 1.8-2.0 Gy 5 days a week for 6-7 weeks
- the more undifferentiated the cells, the more effective the tx

Front 75

chemotherapy

Back 75

- more toxic to cells w/ rapid turnover

Front 76

how does cancer kill

Back 76

- tumor load - secretion of growth factors and enzymes (prevent normal cells from utilizing nutrients), anemia of chronic disease, pts lose weight and die from cardiopulmonary arrest
- infection - pneumonia (from being sedentary or bedridden); aspiration risk due to tumor, surgery, or XRT); narcotics (depress respirations
- complications of treatment - decreased WBC (increased infection); edema --> airway obstruction; surgery-carotid "blowout"
- comorbidities - treatment exacerbates pre-existing conditions
- paraneoplastic syndromes

Front 77

which is more commonly seen by general dentists: myofascial pain or internal derangement (of TMJ)

Back 77

myofascial pain - the most common cause of masticatory pain and dysfunction; it is muscular, often bilateral, and multifactorial (clenching, bruxism, stress, occlusion)
- treat w/ NSAIDS, analgesics, muscle relaxants, antidepressants, splint therarpy, and/or psychiatric evaluation

Front 78

anterior disk displacement w/ reduction

Back 78

- unilateral; joint (and muscle) tenderness; click or POPPING as disk reduces on closing or opening
- treatment - NSAIDS, analgesic, muscle relaxants; splint therapy, joint injections, physical therapy, surgery

Front 79

anterior disk displacement w/out reduction

Back 79

-usually unilateral; joint and muscle tenderness may be present; NO CLICKING or POPPING; deviation to affected side
-treatment - aside from surgery, prognosis is very poor for any treatment of displacement w/out reduction

Front 80

capsular edema (TMJ)

Back 80

-usually unilateral; pain, restricted motion; inability to bring posterior teeth together on affected side
-treatment - NSAIDS, rest

Front 81

ankylosis - intracapsular (TMJ)

Back 81

-usually unilateral; often hx of trauma
-severe restriction of opening w/ deviation to affected side
-treatmetn - surgery w/ physical therapy

Front 82

other causes of TMJ type pain that do not necessarily originate from TMJ disorder directly

Back 82

osteoarthritis, systemic arthritis, neoplasm, infection, extracapsular ankylosis, fracture