• Created by: dn16ak
  • Created on: 22-12-20 17:19
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  • Cysts
    • Definition
      • A pathological cavity space which often has an epithelial lining. Its filled with fluid/semi-fliud/gas (NOT pus)
    • Classification
      • Odontogenic (tooth-related)
        • Inflammatory
          • Radicular 65%- inflammation,cell rests of malaise, peak age 30/40s, common location U1's.  Presents at non-vital tooth (test vitality of neighbouring teeth to check if cyst), develops within PA granuloma (from caries). Clinically nt likely to see buccal bone expansion. Radiographicunilocular well defined well corticated (white border) radiolucency at apex of non-vital tooth. CBCT may be needed
            • Treatment - RCT (not great for large cysts) or surgical XLA (enucleate/remove lining of cyst)
            • Complications - can form residual cyst if retained after XLA
          • Residual cysts - develops after incomplete removal of radicular cyst, age 40/50s, at XLA sites, well defined unilocular corticated radiolucency.
            • Treatment - Surgical enucleation
            • Complications - can reoccur
        • Developmental
          • Dentigerous 20% - developmental, epithelium derived from REE covering crown before eruption. Age 30/40s. Attached at CEJ surrounding crown of unerupted tooth (8's/3's). Late buccal expansion means attachment site confirmed either surgically/pathologically. NOT from X-ray. Cray shows unilocular well corticated radiolucency. Tx - surgical removal/uncover tooth. Complications - no recurrence.
          • OKC 5% - in children - 20s. if multiple then suspect GGS. Most common on mandible and rams. Usually multilocular. Sudden onset. Tx - enucleation or marsupilisation (opening cavity). Can recur, difficult to remove multiple. Differential diagnosis - dentigerous if associated with tooth
          • eruption - in children, primary and secondary dentition, in relation to erupting tooth. blue swelling. will resolve on their own, need monitoring. if symptomatic may need surgical exposure.
          • lateral periodontal - REE, 40-60s, incidental finding, occurs between vital teeth. Unilocular and well defined. Enucleation. Can reoccur.
          • gingival - epstein pearls on hard palate or bohns nodules on gingivae. Little white lumps, v common 50%, just monitor
      • Non-odontogenic 5%
        • Fissure
          • nasopalatine 5%, arises from duct which exits behind upper centrals, 40-50s, occurs on hard palate behind U1's. Differential for radicular costs in upper maxilla so vitality test. Heart shape X-ray. Excision - raised palatal flap. Can reoccur
          • Nasolabial - 30s, in women, over nasolabial fold, asymmetry of face. Ala distorted. No pain, fluid-filled. May see IO swelling. Aesthetic issue.
          • Median palatine - sometimes mistaken for nasolabial, more posterior on hard palate. Nasopalatine duct. Symmetrical. Enucleation. Low reoccurrence.
        • Bone - solitary bone cyst, aneurysmal bone cyst
        • Soft tissue - Mucocele (mucous extravasation on lower lips due to trauma if on FoM then Ranula. Retention cyst in older ages from obstructed salivary duct. Excision.
    • Pathogenesis
      • Source
        • Inflammatory - PDL rests of malaassez (remnants) of Hertwigs Root sheath.
        • Dentigerous - reduced enamel epithelium
        • Odontogenic keratocyst - dental lamina glands of Serres
        • Nasopalatine - duct epithelium
        • Mucous retention - salivary duct epithelium
      • Stimulus of  proliferation + cavitation
        • Inflammation - site specific necrotic pulp PA granuloma cyst
          • Inflammatory cells secrete CYTOKINES IL-1, IL-6 and GROWTH FACTORS EGF/TGF.
        • Genetic - gorlin goltz syndrome. ?Links to tumour suppressor gene causing multiple OK's
      • Mechanism of enlargement
        • Inflammation causes cell proliferation, causes increased protein content
          • fluid accumulates within cyst and increases positive pressure
            • displacement in soft tissue causes resorption of bone hence cyst increases in size to fill space


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