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646473-Part_1_Study_Guide_OP_Exa - PART 1 STUDY GUIDE FOR...

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PART 1 STUDY GUIDE FOR D10 ORAL PATH EXAM #4 - DR. KAHN REVISED Odontogenic Cysts and Tumors 1. Dentigerous Cyst- appearance, sites, tumors that may arise from its lining Surrounds the crown of an unerupted tooth and is attached at cementoenamel junction • Accumulation of cyst fluid between crown and reduced enamel epithelium lining the follicle • Clinical features – Most common sites -Unerupted third molar followed by maxillary canine – Rarely involves a primary tooth – Wide age range but most are in patients between 10 - 30 yrs – White, male prevalence – Small cysts • Asymptomatic • Discovered only on routine x-ray exam –Large cysts -Painless jaw swelling -Facial asymmetry -Uncommon • Usually prove to be OKC on microscopic exam –Painful, if infected • Radiographic – Hyperplastic follicle vs. cyst - Unilocular -Well-circumscribed radiolucency extending at least 3 - 4 mm from tooth crown surface • ‘Multilocular’ – Almost never confirmed on gross examination of tissue – Tooth displacement can be significant – 50% cause root resorption • Histology – Typically inflamed cyst wall • Dense fibrous tissue – Non-inflamed cyst wall • Loosely arranged fibrous tissue with glycosaminoglycan ground substance – Epithelium • Hyperplastic squamous with focal mucus or ciliated cells 11 - Tumors which may potentially arise from epithelial cyst lining – Ameloblastoma – Epithelial dysplasia - - -> squamous cell carcinoma – Mucoepidermoid carcinoma • Treatment - Extraction of the impacted tooth - Curettage of the bony cavity to remove any remnants of soft tissue -Submission of the tissue for histopathologic examination 1
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-Follow up radiographs at 6 months for evidence of bone healing – Marsupialization is occasionally indicated to reduce the size of the radiolucency prior to cystectomy 2. Eruption Cyst (eruption hematoma)-clinical setting Variant of dentigerous cyst – Tooth in the process of erupting -Soft tissue cyst only – No radiographic findings •Histology • Surface mucosa over cyst roof •Treatment • Fenestration or unroofing cyst to facilitate eruption 3. Odontogenic Keratocyst-all features • Etiology – Remnants of the dental lamina • Incidence – 3-11% of odontogenic cysts • 60% found in patients 10 – 40 yrs. of age • > males - 60 - 80% posterior mandible – Esp. posterior body and ramus • Small cysts – Asymptomatic • Large cysts – Pain, swelling, drainage • Radiographic Well-defined radiolucency – Unilocular or multilocular – Most are solitary lesions • Multiple lesions suggests BCNS association – Unerupted tooth associated 25 - 40% – Root resorption is less common than for dentigerous or radicular cysts Histology – highly characteristic – Thin connective tissue wall – Lumen contains clear serum or cheesy keratin debris (malodorous) – Squamous epithelium uniform 6 -10 cells thick • Corrugated parakeratin surface • Basal layer has palisaded hyperchromatic nuclei with picket fence
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646473-Part_1_Study_Guide_OP_Exa - PART 1 STUDY GUIDE FOR...

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