Showing posts with label Oral Medicine & Oral Pathology. Show all posts
Showing posts with label Oral Medicine & Oral Pathology. Show all posts

Cysts of the Jaws and Neck: Classification

 

Cysts of the Jaws and Neck 

Cysts can be classified in three types.

Odontogenic Cysts  

  1. Periapical (Radicular) Cyst  
  2. Lateral Periodontal Cyst  
  3. Gingival Cyst of the Newborn  
  4. Dentigerous Cyst  
  5. Eruption Cyst  
  6. Glandular Odontogenic Cyst  
  7. Odontogenic Keratocyst  
  8. Calcifying Odontogenic Cyst  

Nonodontogenic Cysts  

  1. Globulomaxillary Lesion  
  2. Nasolabial Cyst  
  3. Median Mandibular Cyst  
  4. Nasopalatine Canal Cyst  

Pseudocysts  

  1. Aneurysmal Bone Cyst  
  2. Traumatic (Simple) Bone Cyst  
  3. Static Bone Cyst (Stafne’s Bone Defect)  
  4. Focal Osteoporotic Bone Marrow Defect  
  5. Soft Tissue Cysts of the Neck  
  6. Branchial Cyst/ Cervical Lymphoepithelial Cyst  

Oral Leukoplakia

Oral leukoplakia

Oral leukoplakia (OL) is a clinical term for a nonremovable white lesion that is not easily recognisable as any particular condition and therefore requires further investigation.

Oral leukoplakia manifests as patches that are bright white and sharply defined. The surfaces of the patches are slightly raised above the surrounding mucosa.

Oral leukoplakia may be homogenous (uniform lesion often with a fissured surface), or nonhomogeneous (with surface irregularity and textural or colour variation for example speckled-see below given photograph.

Oral Lichen Planus

Oral Lichen Planus on left mucosa [1]


Question: What is oral lichen planus?

Answer: It is a chronic inflammatory condition that affects the skin, nails, hair, and mucous membranes, characterised by purplish, itchy, flat eruptions.


Question: How common is the condition?

Answer: It is a common condition in India. Its cases are reported more than 10 lakh per year in India. 


Question: How much time does it need for recovery?

Answer: It can last several years or remains lifelong.



Question: Is the condition treatable? 

Answer: Treatments can help manage conditions. There is no known cure present. 

 

Question: Does diagnosis require lab tests or imaging? 

Answer: Its diagnosis rarely requires lab tests or imaging. 

 

 

 

Condition Highlights 

  1. It commonly occurs for ages 35-50. 
  2. It is more common in females. 
  3. Family history may increase likelihood to occur. 

 

Odontogenic Keratocyst

 

 

 

Image Source: Recurrence of odontogenic keratocysts and possible prognostic factors: Review of 455 patients (researchgate.net)

Dentigerous/Follicular Cysts

Dentigerous (Follicular) Cysts are the second most commonly occurring odontogenic cysts after periapical cyst and the most common developmental cysts of the jaws. By definition, a dentigerous cyst is attached to the tooth cervix (enamel-cementum junction) and encloses the crown of the unerupted tooth.

Photograph1: Dentigerous cyst surrounding the crown of right mandibular third molar and going upward in ascending ramus. [1]

Etiology and Pathogenesis of Dentigerous Cyst 

A dentigerous cyst originates from the enamel organ remnant or reduced enamel epithelium. The expansion of the dentigerous cyst is related to epithelial proliferation, release of bone-resorbing factors, and an increase in cyst fluid osmolality. 

Clinical Features of Dentigerous Cyst 

Dentigerous cysts are most commonly seen associated with third molars and maxillary Canines. The peak incidence of dentigerous cysts occurs between twenty to 40 years. Males have more predilection with a ratio of l.6 to 1.  

Dentigerous cysts are generally symptomless. The delayed eruption is the most common indication of dentigerous cyst formation. This cyst can achieve significant size, occasionally causes cortical bone expansion but rarely reaches a size that predisposes the patient to a pathologic fracture. 

Radiographically, a dentigerous cyst manifests as a well-defined, unilocular or sometimes multilocular radiolucency with corticated margins in attached with the crown of an unerupted tooth. The concerned unerupted tooth is mostly displaced. In the mandible the related radiolucency may extend superiorly from the third molar site into the ramus or anteriorly and inferiorly along the body of the mandible. In maxillary dentigerous cysts in the canine region, extension into the maxillary sinus or to the orbital floor may be seen.

Histopathology.

The cyst is lined by stratified squamous epithelium. In a noninflamed dentigerous cyst the epithelial lining is nonkeratinized. It remains approximately four to six cell layers thick. Sometimes, numerous mucous cells, ciliated cells, and rarely, sebaceous cells may be found in the lining of the epithelium. The epithelium-connective tissue junction is generally flat. But when secondary inflammation established, epithelial hyperplasia may be noted.

Photomicrography 2: showed a thin non-keratinized epithelial lining composed of 2–3 layers of cuboidal epithelial cells and a fibrous connective-tissue wall loosely arranged. The arrow indicates an occasional mucous cell (bar = 0.2 mm) [1]

Differential diagnosis

When it is small, it is difficult to differentiate a dentigerous cyst from a large but normal dental follicle. When larger, the differential is essential that of lytic lesions of the jaw and includes:

  1. periapical cyst
  2. aneurysmal bone cyst
  3. ameloblastoma
  4. odontogenic keratocyst
  5. fibrous dysplasia
  6. Stafne cyst

Treatment

Removal of the associated tooth and enucleation of the soft tissue part is definitive therapy in most cases. When cysts affect significant portions of the mandible, exteriorization or marsupialization of the cyst is done to allow for decompression and subsequent shrinkage of the lesion followed by surgical enucleation. 

Ref:

  1. https://jcda.ca/article/c59
  2. https://radiopaedia.org/cases/dentigerous-cyst-9
  3. https://www.pathologyoutlines.com/topic/mandiblemaxilladentigerous.html
  4. https://www.nature.com/articles/modpathol2016191

Oral Ulcers: Clinical features, Causes & Treatment

Traumatic ulcers in healing stage caused by sharp teeth

An ulcer is a tissue defect which has penetrated the epithelial-connective tissue border, with its base at a deep level in the submucosa, or even within muscle or periosteum. An ulcer is a deeper breach of the epithelium than an erosion or an excoriation, and involves damage to both epithelium and lamina propria.

Oral Manifestations of Leukaemia

The oral manifestation of leukaemia can be summarized as follows.

In acute leukaemia- localized or generalized gingival hyperplasia is generally observed. It mainly affects the interdental papillae and the marginal gingiva.