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67 Cards in this Set

  • Front
  • Back

Dentigerous cyst - definition

A developmental odontogenic cyst that surrounds the crown of an impacted tooth.

Dentigerous Cyst - Synonyms

Follicular cyst

Dentigerous cyst- aetiology

Fluid accumulation between the REE and enamel surface, results in a cyst where crown is situated in the lumen.

Dentigerous cyst- epidemiology

Most common devrlopmental odontogenic cyst .


Seldom primary tooth is involved mostly ass/permanent impacted tooth


10% impacted teeth form dentigerous cyst.

Dentigerous cyst - c/f

1.Common site- 3rd molar regions , maxi canine region


2.Solitary (mostly) rarely bilateral.


3.Potentially capable of becoming an aggressive lesion.


4.Expansion of bone.


5.facial asymmetry .


6.Extreme tooth displacement n root resorpn.


7.pain


8.if in mandi 3rd molar region hollowing out of entire ramus is possible.


9.the molar mqy be displaced to compress inferior border of mandible.


10.in case of maxi canines symptoms may resemble sinusitis or cellulitis.

Dentigerous cyst- r/f

Radiolucency of more than 5 mm surrounding an impacted tooth or a part of it.


A slight sclerotic boundary may be formed by bone activity

Dentigerous Cyst- classification

On the basis of radiological variations-



1. Central type


Crown is enveloped symmetrically. Leads to displacement of tooth.



2. Lateral type


Dilatation from one aspect of crown.


Usually seen in partially erupted molar



3. Circumferential type


Entire tooth appears to be enveloped by the cyst.


Dentigerous cyst- h/p

1. Thin connective tissue wall- loose fibrous


2.Thin layer of SSE ( rete pegs- sec infecn)


3. Islands of odontogenic epithelium


Cell rests small and inactive.


4. Rushton bodies within lining epithelium.


5. Pleuripotentiality- mucous cell , sebaceous cells may be seen.

Dentigerous cyst - asso syndrome

Maroteaux Lamy syndrome


Cleidocranial dysplasia


(Bilateral and multiple cysts are found)

Dentigerous cyst - d/d

1. Enlarged dental follicle - histologically identical . (Normal follicle 3-4 mm)



2. Odontogenic fibroma / odontogenic myxoma - due to fibrous connective tissue wall.



3. Ameloblastoma- when islands of Odontogenic epithelium are present in sufficient no.



Dentigerous Cyst- Complications

1. Development of ameloblastoma from cystic epithelium or od ep cell rests.



2. Development of epidermoid carcinoma.



3. Mucoepidermoid carcinoma.

OKC- definition

A common cystic lesion of jaw which arises from the remanents of dental lamina.

OKC- Synonyms

Reclassification of OKC as Keratocystic Odontogenic Tumor (KOT) , WHO (2005)


Because of-


1. Aggressive behaviour


2. High recurrence rate.


3. Expansion is due to potential of epithelial proliferation instead of osmotic pressure. Higher proliferation rate


4. Basal epithelial layer proliferates into underlying connective tissue.


5. GENETICS



OKC- Asso syndrome

Nevoid Basal Cell CA Syndrome (Gorlin's syndrome).

OKC- Aetiology

1. Through remanents of dental lamina


2. Through extension of basal cells of overlying oral epithelium i.e. basal cell hamartia formation.

OKC- c/f

1. Wide age distribution


2. Slight male predilections


3. Mandible》 maxilla


4. Ramus,3rd》 1st 》 2nd molar 》 ant. region in mandible.


5. 3rd molar》 cuspid region in maxilla.


6. Pain soft tissue swelling.


7. Facial asymmetry in large cysts (rarely).


8. Parethesia of lip or teeth.


9. Sec infecn- maxi》mandi.


OKC- r/f

1.Unilocular mostly.


2. Multilocular cyst represents central cavity with satellite cysts.


3.Well defined peripheral rim.


4.occasionally scalloping border.


5. May mimic dentigerous cyst (with crown)


6. Buccal expansion is less common.


7. Lingual expansion is seen in mandibular lesions


8. Anterio- posterior growth is characteristic feature.


9. Less often root resorption is seen.


10. Tooth displacement is common.


OKC - h/p

Lining epithelium-


1.Thin and uniform (6-8 cell layer)


2.parakeratinised surface (corrugated, rippled, wrinkled)


polarised basal cells - picket fence/ tombstone appearance.


3. P prominent, palisading, polarised basal cells - picket fence/ tombstone appearance. 4.Mitotic activity present (neoplastic fashion)


4.Mitotic activity present (neoplastic fashion)


5.Secondary infections lead to thickening of epithelium, rete pegs and ulceration.



Connective tissue wall


1. Small islands of epithelium


2. May be small satelliteor daughter cysts (microcyst). Or simply folding of epithelium (pseudocyst).



Cystic lumen


1. Filled with thick creamy material.


2. Keratin may be present in abundance.


3.Cholesterol clefts


4. Hyaline bodies


OKC - d/d

1. Ameloblastoma- large multilocular OKC in molar ramus region may appear similar to conventional ameloblastoma.



2. Dentigerous cyst- sometimes OKC may enclose a crown in cystic cavity.

OKC- t/t

Thin wall makes enucleation difficult especially in large multilocular lesions.


This may be one of the cause of higher recurrence rate.



1. Marsupialisation


2. Enucleation and primary closure.


3. Enucleation and packing open

OKC - complications

1. Recurrence- due to


Friable and thin wall


Tendency of the lesion to proliferate (presence of dental lamina follicles)



2. Dysplastic and neoplastic transformations-


Very rare (like epidermoid carcinoma).

Rushton bodies

1.Linear often curved hyaline bodies


2.Variable stainability (may react like Hb)


3.uncertain origin (may be hematogenous)


4.questionable nature


5.unknown significance


6. Found in radicular cysts, residual cysts , dentigerous cysts epithelium linings .

Eruption Cyst - definition

Odontogenic cyst with h/p of a dentigerous cyst that surrounds a tooth crown that has erupted from the bone but not the soft tissue.

Eruption cyst - synonyms

Eruption hematoma

Eruption cyst- aetiology and pathogenesis

Tooth impeded in its eruption within soft tissue (particularly dense fibrous tissue of gingiva) overlying the bone.

Eruption cyst- c/f

1.In childern of different ages.


2.Adults with delayed eruption.


3.Deci/permanent tooth involved.


4.circumscribed, fluctuant, translucent swelling of alveolar ridge over the site of erupting tooth.


5. Sometimes more than 1 cyst present.


Eruption cyst- r/f

Soft tissue shadow without any bone loss.


Eruption cyst- h/p

CYST WALL-


Dense connective tissue with mild inflammatory infiltration.


Basophillic hue (++ acid mucopoplysaccharides in ground sub)



EPITHELIAL LINING-


Reduced enamel epithelium origin.


2-3 cell layer thick with foci of ++ thickness.

Eruption cyst- t/t

No treatment reqd for cyst


Surgical intervention aids with eruption.

Dermoid cyst- definition

A hamartomatous tumour containing multiple sebaceous glands and almost all skin adnexa (nail like , tooth like, cartilage, bone like str)

Dermoid cyst - synonyms

Dermoid cystic tumour


Cystic teratoma



Ovarian cystic teratoma


Cystic tumour of ovary


Cystic tumour of omentum


Congenital cyst of spine


Spinal dermoid cyst.

Dermoid cyst- c/f

1. Young children


2. Site- face neck scalp


3. May be intracranial, intraspinal or perispinal


4. Appearance -above mylohyoid msl- midline sublingual swelling


Below mylohyoid- submental swelling


swelling



Dermoid cyst - h/p

Epithelium LINING


Lined by orthoker SSE


Exhibit hair follicle, sebaceous gland and erector pilli muscle



Connective tissue wall


Narrow zone of compressed tissue forms capsule.



Cavity lumen


Filled with sebum, keratin, hair shafts




Dermoid cyst- t/t

Surgical excision

Epidermoid cyst- definition

Result of implantation of epidermoid elements and subsequent cystic transformation


Epidermoid cyst- c/f

1. 30-40 yrs


2. M:F = 2:1


3. Site- face, trunk, neck extremeties, scalp


4. Appearance- firm, round , mobile, flesh coloured to yellow or white subcutaneous nodule of variable size.


5. Smelly cheese like discharge


6. Sec infecn- pain and tenderness.


7. Oral type- difficulty in feeding swallowing and speaking.


Epidermoid cyst- h/p

Epithelium LINING-


SSE with glandular differentiation



Cystic lumen


Desquamated keratin disposed in lamellar pattern.




Dystrophic calcification


Connective tissue wall Dystrophic calcification Reactive foreign bodiesMelanin and keratin may be present


Reactive foreign bodies


Melanin and keratin may be present




COC- definition

A rare well circumscribed, solid or cystic lesion derived from odontogenic epithelium that resembles follicular ameloblastoma but contain ghost cells and spherical calcifications.

COC- synonyms

Calcifying Odontogenic cyst


Keratinising &/or Calcifying epithelial odontogenic cyst (not CEOT)


Gorlin cystor Gorlin Gold cyst


Cystic Keratinising Tumor




COC- Classification

On the basis of site of the lesion-


1. Intra osseous


2. Extra osseous



On the basis of tendency of lesion


Gorlin cyst


1. Cystic lesion



Dentinogenic ghost cell tumor-


2. Neoplastic lesion (solid)



Odontogenic ghost cell carcinoma


3. Malignant neoplastic lesion


COC - c/f

1. Not common


2. Solid form is even more rare


3.slight predilections for 20-30 yrs


4. Almost equal in both genders and equal in maxi and mandi.


5. Appearance- painless expansible lesion.


If extraosseous may present as painless swelling or nodule on gingiva.


6. No pathognomic features.

COC - r/f

1.Radiolucency or


2.radiolucency with foci of ossification (particularly in asso with odontoma)


3.Cortical expansion in some cases


COC- h/p

EPITHELIAL LINING-


1. SSE 2-3 cell layer thick


2. Stellate reticulum like cells over ameloblast like cells.


3. Cells undergo ghost cell keratinisation


4. The cyst is generally found in asso with odontoma . The dentinoid material may be mixed in epithelium.


5. Sometimes dentinoid proliferates to make the lesion solid.


6. Dystrophic calcification of ghost cells may be seen.



Ghost cells of Gorlin Cyst-


1. Nuclear remanants present prominent nuclear membranes present


2. Cyto organelles remanents present


3. Larger, vacuolated cells compared to normal keratotic squamous cells.

COC- d/d

Ghost cells are often seen in-


1.Odontomas


2.Ameloblastoma


3.Ameloblastic fibro odontoma


4.Ameloblastic odontoma

COC- t/t

For non malignant lesion-


Enucleation with curettage.


Recurrence is seen



COC- Complications

Conservative treatment may lead to recurrence .


Very rarely COC may develop into its malignant counterpart.

Benign cervical Lymphoepithelial Cyst- definition

Develops from entrapped salivary duct epithelium in the lymph nodes of lateral neck.

Benign cervical lymphoepithelial cyst- synonyms

Branchial cleft cyst- just because of site of the cyst i.e. lateral neck


Nothing to do with pathogenesis.

Benign cervical lymphoepithelial cyst- c/f

1. Site- lateral neck close to angle of mandible ant. to SCM msl


2. Age distribution- 10-60 yrs


3. May be small to large lesion


4.Swelling in the region , may be progressive or intermittent.


5. Generally asymptomatic.


6. Well circumscribed movable swelling.


Benign cervical lymphoepithelial cyst- h/p

Cystis embeded in circumscribed mass of lymphoid tissue



EPITHELIAL LINING


1. SSE



CONNECTIVE TISSUE CAPSULE


1. Rich in inflammatory infiltration



CYSTIC LUMEN


1. Thin watery fluid to thick gelatenious material

Benign cervical lymphoepithelial cyst- t/t

Local surgical excision

Lateral periodontal cyst- definition

A slow growing developmental odontogenic cyst derived from one or more rest of dental lamina, containing an embryonic lining of one to three cuboidal cells and distinctive focal thicknings (plaques).

Lateral periodontal cyst- variants

Multicystic varient- Botryoid odontogenic cyst.

Lateral periodontal cyst- aetiology and pathogenesis

Origin-


1. As a dentigerous cyst from lateral surface of crown.


2. Proliferation of rests of malassez in PDL.


3.As Periodontal cyst of supernumerary teeth germ.


4. Cystic transformation of rests of dental lamina.

Lateral periodontal cyst- c/f

1. Chiefly in adults.


2. Male predilection.


3. Site- lateral surface of root of an erupted tooth


Mandi bicuspid,cuspid, incisor 》maxi incisor


4. Asymptomatic


5. If infected , appears like pd abcess.

Lateral periodontal cyst- r/f

1.Radiolucent area in apposition to lateral surface of tooth root.


2.Mostly less than 1cm


3.Smoetimes distinctive sclerotic bone birder can be seen.


4.Botryoid type shows multilocular lesion.

Lateral periodontal cyst- h/f

EPITHELIAL LINING


1. REE like


2. non ker


3. 2-3 cell layer thick


4. Glycogen rich cytoplasm of clear cells.


5. Focal thickened plaques of cells project into lumen area. ( ^ in botryoid type)



CONNECTIVE TISSUE CAPSULE


1. Rests of dental lamina may be found


2. Clear cells (^ in botryoid type)


3. Sec infcn- inflammatory infiltration


4. A zone of hyalinisation subjacent to epithelium.



Lateral periodontal cyst- t/t

Surgical enucleation- unilocular type.


Periapical cyst- definition

Most common odontogenic cyst.


It is an inflammatory cyst.

Periapical cyst- synonyms

Radicular cyst


Apical periodontal cyst


Root end cyst

Periapical cyst- aetiology

Infected tooth which leads to necrosis of pulp.


Toxins exit at the apex of the root, leading to PA inflammation.


This activates rests of Malassez


Leads to formn of PA granuloma.


Epithelium undergoes necrosis


Granuloma becomes cyst.

Periapical cyst- Pathogenesis

Necrotis pulp


Tooth fracture


Improper restoration



In midst of rich vascular area provided by PA granuloma, rest of Malassez proliferate n form a large mass of cells



With continuous growth, nutrition deprivement and liquifaction necrosis occurs.


Formn of cavity leads to development of PA cyst.



Islands of squamous epithelium developed from rests of Malassez are also found in PA Granuloma without cystic transformation , referred to as BAY CYST.


Periapical cyst- c/f

1. Most common jaw cyst.


2. Any age . Rarely in primary dentition.


3. Asymptomatic


4. May undergo acute exacerbation. Leading to formation of PA abcess.


Periapical cyst- h/f

CONNECTIVE TISSUE CAPSULE


1. Mature , collagenous CT Wall.


2.^lymphocytes, plasma cells.


3.erythrocytes and areas of haemorrhage


4. Occasional spicules of dystrophic bone.


5. Multinucleated giant cells and cholesterol clefts.



EPITHELIAL LINING


1. SSE (If in vicinity to max sinus , resp ep can be seen)


2. Discontinuous many times. (Areas of intense inflammation. )


3.Rarely mucous producing ep. ( metastatic transformation of rests of Malassez)


4. Rushton bodies present



CYSTIC LUMEN


1. Filled with pale eosinophillic fluid, low in protein concentration.


2. Occasionally cholesterol abundant


3. Rarely keratin seen.


Periapical cyst- r/f

1. Para or peri apical round or oval radiolucency with marked radio opaque rim.


2. Rarely root resorption is seen.

Periapical cyst- t/t

1. Tooth extraction and careful curettage


2. RCT with apicectomy.


Naso alveolar cyst

1. Nasolabial or klestadt cyst.


2. Arises at junction of globular portion of medial nasal process, lateral nasal process and maxillary process.


3. Soft tissue cyst


4. No r/f