Path 6: Cysts Of The Oral Region

Front 1

Apical periodontal cyst:

1) Also known as?
2) Where is it located?
3) What are 2 sources it can arise from?
4) 2 variations?
5) Symptomatic or asymptomatic?
6) Associated tooth is ALWAYS
7) What size can it grow to?
8) What commonly happens to the tooth and adjacent teeth?
9) How does it look radiographically?
10) What is usually bigger, cyst or granuloma?
11) How does it look histologically? (Lined by, lumen will with, what does the lining show)
12) What is mandatory and why?
13) Do they recur?
14) What can form?

Back 1

1) Periapical cyst
2) Apex of **NONVITAL TOOTH**
3) Epihtelial cell rests of Malassez, epithelium from gingival crevice, sinus lining, or lining of a fistulous tract
4) Lateral radicular cyst (develops along lateral aspect of root), residual periapical cyst (remains after tooth has been removed)
5) Asymptomatic unless acute exacerbation
6) Nonvital
7) Very large sizes if left untreated
8) Root resoprtion, displacement of adjacent teeth
9) Well circumscribed but can be ill-defined lucency around apex of tooth, loss of lamina dura
10) Cyst
11) Lined by stratified squmaous epithelium w/ wall of granulation and/or fibrous CT, lumen can be filled w/ cellular debris or fluid, lining can show hyperplasia, metaplasia, and even malignant transformation
12) Biopsy mandatory - any number of odontogenic and nonodontogenic lesions can mimic PA cysts
13) No, not after appropriate therapy
14) Fibrous scars

Front 2

Lateral periodontal cyst:

1) What is it?
2) What is the diagnosis reserved for?
3) Symptomatic or asymptomatic?
4) Most occur in what area of the mouth?
5) What ages?
6) Gender?
7) Radiographic features?

Back 2

1) Rare developmental cyst (<2% of jaw cysts)
2) Cysts in the lateral periodontal region in which inflammatory cyst or OKC has been excluded
3) Asymptomatic, detected on routine X-ray
4) Lower canine-premolar area
5) 50-70
6) No gender predilection
7) Well-circumscribed oval lucency located laterally to roots, occasionally multilocular appearnace (botryoid odontogenic cysts

Front 3

Dentigerous cyst:

1) How does it look? How is it developed?
2) Most commonly seen around what part of the mouth?
3) What ages does it most commonly affect?
4) Size?
5) What can it cause in the bone? How can it affect the tooth it's around, and adjacent teeth?
6) How does it look radiographically? What does it NEVER look like?
7) How big does it have to be to qualify as a dentigerous cyst? Otherwise, what is it diagnosed as?
8) Treatment?
9) Prognosis?
10) What does it show histologically?
11) Other D/D besides dentigerous cyst?
12) What is mandatory and why?

Back 3

1) Encloses crown of tooth attached at CEJ, crowns fully formed. Developed by accumulation of fluid between reduced enamel epithelium and crown.
2) Lower thirds, upper canines
3) 10-30
4) Large sizes
5) Painless expansion of bone, can displace tooth for considerable distance, can resorb root of adjacent teeth
6) Typically, unilocular lucency. NEVER multilocular OR show calcifications!
7) At least 3-4 mm in diameter (diameter of pencil), or else enlarged follicle
8) Careful enucleation with removal of unerupted tooth
9) Very good
10) Squamous epithelium (regular epithelium on top)
11) Unilocular ameloblastoma, OKC
12) Biopsy - many other dangerous lesions like unilocular ameloblastoma or OKC can be associated with impacted or unerupted teeth

Front 4

Eruption cyst:

1) Also called?
2) This is the soft tissue analogue of?
3) What color is it and why?
4) Treatment?

Back 4

1) Eruption hematoma
2) Dentigerous cyst
3) Purple or brown - blood in the cystic fluid
4) Usually ruptures spontaneously - usually no tx required

Front 5

Odontogenic keratocyst:

1) What kind of cyst is it?
2) What does it arise from?
3) What ages usually affected?
4) Where is it most commonly found?
5) What direction does it usually grow in?
6) If you have multiple OKCs, what should you suspect?
7) How does it look radiographically?
8) 25-40% are associated with?
9) Histopathologically, how does it look? (Wall, basal layer)
10) Recurrence?

Back 5

1) Developmental odontogenic cyst
2) Cell rests of the dental lamina
3) 10-40 years old
4) Mandible (60-80%) - involves post body and ramus
5) AP direction within the medullary cavity without causing obvious expansion
6) Nevoid basal cell carcinoma (Gorlin-Goltz) syndrome
7) Usually well-defined radiolucency, smooth and often corticated margins, large lesions esp in post body and ramus appear multilocular
8) Unerupted tooth
9) Thin, friable wall, lining has uniform layer of stratified squamous epithelium 6-8 cells in thickness, thin layer of wavy or corrugated parakeratin. Basal layer has palisaded layer of cuboidal or columnar darkly staining ep cells
10) High recurrence after tx due to friable lining or remaining "cystlets), rate is 30%, lots of recurrences may not be until 10+ years, need long term f/u

Front 6

Calcifying odontogenic cyst

1) Also known as?
2) What kind of cyst is it?
3) May be associated with what other tumors?
4) Predominantly found where?
5) Mean age of occurrence?
6) Gender predilection?
7) how does it look radiographically?
8) How does it look histologicaly?
9) Tx and prognosis?

Back 6

1) Gorlin cyst
2) Non-neoplastic
3) Other recognized odontgenic tumors, most commonly odontomas
4) Intraosseously - incisor - canine area
5) 33
6) None
7) Unilocular, well-defined radiolucency, opaque structues within lesion (irregular calcifications or tooth-like densities seen in 50%
8) Variable number of ghost cells within epithelial component - ghost cells have lost nuclei but preserve basic cell outline
9) Simple enucleation, prognosis good, few recurrences after tx

Front 7

Glandular odontogenic cyst:

1) When was it first reported?
2) How does it present?
3) X-ray findings?
4) Where is it most commonly found?
5) Recurrence?
6) Tx? Follow-up for how long?

Back 7

1) 1992
2) Painless, slow growing swelling
3) Large, multiloculated, well-defined lucency
4) Anterior mandible
5) Aggressive - has 25-55% recurrence following enucleation/curettage
6) Enucleation w/ peripheral ostectomy for unilocular & marginal resection or partial jaw resection in multilocular cases; marsupialization followed by 2nd phase surgery if approaching vital structures. Follow up for 3 years

Front 8

Nasopalatine duct cyst:

1) Also known as?
2) Most common ________ cyst
3) Arises from?
4) Age it normally affects? Gender predilection?
5) Symptoms?
6) How does it look radiographically?
7) Any lucency __ mm or smaller considered to be a normal foramen
8) Tx? What is a danger?

Back 8

1) Incisive canal cyst
2) Non-odontogenic cyst
3) Remnants of nasopalatine duct
4) 40-60 y/o MALES
5) Pain, swelling, drainage - but most are asymptomatic
6) Well defined lucency - midline anterior maxilla between and apical to #8 and #9, round to oval heart shape, 1-2.5 cm but can be larger
7) 6 mm
8) Enucleate, but cyst wall can have contents of incisive canal - will be numb!

Front 9

Traumatic bone cyst:

1) What is it also called?
2) Common where? What part of the mouth is it restricted to?
3) What causes it?
4) What ages does it normally affect?
5) Symptomatic or asymptomatic?
6) What does it look like radiographically?
7) Tx?

Back 9

1) Simple bone cyst
2) Jaws - mandible, premolar and molar region
3) Trauma to bone causes intra-osseous hematoma that doesn't heal normally
4) 10-20 years old
5) Asymptomatic
6) Lucent defect w/ dome-like projections that scallop between roots
7) Surgical exploration usually curative