Cysts And Tumours Of The Orofacial Region

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Cysts And Tumours Of The Orofacial Region Definition

Cyst: It is pathological cavity containing fluid, semi fluid or gas, which is usually lined by epithelium & is not formed by the accumulation of pus

Tumour: It is defined as an abnormal new, uncoordinated growth in the body which results from excessive, autonomous, purposeless proliferation of cells which continues even after cessation of stimuli

Cysts And Tumours Of The Orofacial Region Important Notes

1. Classification Of cyst

Epithelial Cyst:

  • Odontogenic cysts

Developmental Cysts:

  • Primodial cyst
  • Gingival cysts of Infants
  • Dentigerous cyst
  • CEOC

Inflammatory Cysts:

  • Radicular cyst
  • Residual cyst
  • Paradental cyst

Non-odontogenic Cysts

  • Naso palatine cyst
  • Globulomaxillary cyst
  • Nasolabial cyst

Non-Epithelial Cyst:

  • Simple bone cyst
  • Traumatic bone cyst
  • Solitary bone cyst
  • Aneurysmal bone cyst

Read And Learn More: Oral and Maxillofacial Surgery Question and Answers

2. Classification Of Tumours:

  • Benign Tumours:
    • Epithelial Origin
      • Ameloblastoma
      • CEOT
    • With Mesenchymal Origin
      • Ameloblastic fibroma
      • CEOC
      • Odontoma
    • With Epithelial & Mesenchymal Origin:
    • Odontogenic fibroma
    • Odontogenic fibroma
  • Malignant Tumours:
    • Odontogenic carcinoma
      • Malignant ameloblastoma
      • Primary intraosseous carcinoma
    • Odontogenic sarcoma
      • Ameloblastic fibrosarcoma
      • Ameloblastic fibrodentinosarcoma
    • Odontogenic carcinosarcoma

3. Aspirates In Different Cysts:

Cysts And Tumours Of The Orofacial Region Aspirates In Different Cysts

4. Methods Of Treatment Of Cysts:

  • Enucleation
  • Marsupialization
  • Combination of enucleation and marsupialization
  • Enucleation and curettage

5. Enucleation:

  • Enucleation is shelling out of the entire cystic lesion without rupture
  • The majority of smaller cysts are treated by enucleation
  • By it pathological examination of entire cyst can be undertaken

6. Marsupialization:

  • Marsupialization refers to creating a surgical window in the wall of the cyst, evacuating the contents of cyst and maintaining continuity between the cyst and the oral cavity
  • The only portion of the cyst that is removed is the piece removed to produce the window
  • Marsupialization is simple procedure to perform
  • The disadvantage is that pathologic tissue is left in situ without thorough histologic examination

7. Indications Of Marsupialization

  • If the cyst is closer to vital structures
  • If unerupted tooth is involved in the cyst
  • In larger cysts
  • In an unhealthy patient
  • In young children

8. Combination Of Marsupialization And Enucleation:

  • In this first marsupialization is performed followed by enucleation
  • The advantage of this technique is the development of a thickened cystic lining which makes secondary enucleation an easier procedure

9. Enucleation And Curettage:

  • After enucleation, a curette or bur is used to remove 1-2 mm of bone around the entire periphery of the cystic cavity to remove any remaining epithelial cells that are present in the periphery which may proliferate into a recurrency of the cyst
  • Indications:
    • Odontogenic keratocyst
    • Any cyst that recurs after what was deemed a thorough removal

10. Segmental Resection Of The Mandible:

  • For it, a combination of Hinds and Risdon incisions are placed at least 2 cm below and parallel to the inferior and posterior borders of the mandible
  • Care should be taken to prevent the damage of mandibular branch of the facial nerve

11. Moore And Weber Fergusson Incision:

  • Moore And Weber Fergusson Incision is given for hemimaxillectomy
  • The incision starts from the inner canthus of eye runs along the area of the nose and then drops down the midline upto the philtrum of the lip
  • If there is involvement of lymph nodes, radial neck dissection or commando operation is carried out

12. Tumours:

Cysts And Tumours Of The Orofacial Region Tumours

Cysts And Tumours Of The Orofacial Region Long Essays

Question 1. Classification of odontogenic tumours. Describe in detail ameloblastoma.
Or
Define and classify Ameloblastoma. Discuss in detail the management of Ameloblastoma of the right body of the mandible.
Or
Define tumours & classify odontogenic tumours
Answer:

Classification Of Odontogenic Tumours:

1. Benign Tumours:

  • Epithelial origin:
    • Ameloblastoma
    • CEOT
  • With mesenchymal origin:
    • Ameloblastic fibroma
    • CEOC
    • Odontoma
  • With epithelial & mesenchymal origin:
    • Odontogenic fibroma

2. Malignant Tumours:

  • Odontogenic Carcinoma:
    • Malignant ameloblastoma
    • Primary intraosseous carcinoma
  • Odontogenic Sarcoma:
    • Ameloblastic fibrosarcoma
    • Ameloblastic fibrodentinosarcoma
  • Odontogenic carcinosarcoma:

Definition Of Ameloblastoma :

Ameloblastoma is a benign, but locally invasive polymorphic neoplasms consisting of proliferating odontogenic epithe- lium which is usually in a follicular or plexiform pat- tern lying in a fibrous stroma

Clinical Features of Ameloblastoma:

  • Sex: Both sex
  • Age 1st to 7th decade

Types Of Ameloblastoma:

  1. Solid Or Multicystic Ameloblastoma:
    • Slow-growing locally invasive tumours
    • High recurrence rate
  2. Unicystic Type:
    • The lesion can be enucleated Rarely seen in maxilla
    • The recurrence rate is low
  3. Peripheral Ameloblastoma:
    • Does not invade bone
    • Treated in the early stages of development

Features Of Ameloblastoma:

  • Swelling & pain in the region
  • Inflammation
  • Tension
  • Dental trauma
  • Ulceration of mucosa
  • Loosening of teeth
  • Epistaxis
  • Nasal obstruction

Radiological Features Of Ameloblastoma:

  • Unilocular or multi locular radiolucency
  • Soap bubble appearance of the lesion
  • Border is clear
  • Resorption of the teeth

Management Of Ameloblastoma:

  1. For intraosseous marginal resection
  2. Segmental resection
    • Aggressive resection

Jackson’s Guidelines:

  • Tumour confined to maxilla without orbit floor i involvement-Partial maxillectomy
  • Tumour involving orbital floor-Total maxillectomy
  • Tumour involving orbital contents – Total maxillae tomy with exenteration
  • Tumour involving skull bone-Neurological procedure

Question 2. Classify cysts of oral cavity. Describe in detaill about clinical features, radiological features & management of OKC,
Or
Classify jaw cysts. Describe clinical features, radiological features, pathogenesis and management of odontogenic keratocyst.
Or
Define OKC
Answer:

Classification Of Keratocyst:

1. Epithelial Cysts

  • Odontogenic Cysts:
    • Developmental cysts:
      • Primordial cyst
      • Gingival cysts of infants
      • Dentigerous cyst
      • CEOC
    • Inflammatory Cysts:
      • Radicular cyst
      • Residual cyst
      • Paradental cyst
  • Non odontogenic Cysts:
    • Naso palatine cyst
    • Globulomaxillary cyst
    • Nasolabial cyst

2. Non-Epithelial Cyst:

  • Simple bone cyst
  • Traumatic bone cyst
  • Solitary bone cyst
  • Aneurysmal bone cyst

Odontogenic Keratocyst:

  • Pathogenesis:
    • Odontogenic keratocyst arises from
      • Dental lamina
      •  The primordium of developing tooth germ
      • The basal layer of oral epithelium
  • Develops due to cystic degeneration of cells of stellate reticulum in developing tech germ

Clinical Features Of Keratocyst:

  •  Age: 23 decades
  • Sex:  Common in males
  • Site: Mandible

Features Of Keratocyst:

  • Asymptomatic
  • Secondary infection, causes expansion of cortical pilates
  • Mobility of teeth
  • Pattu & tenderness of the site

Radiological Features Of Keratocyst:

  • Unilocular or multilocular radiolucency
  • Margitus: Well-defined sclerotic margins
  • Expansion of cortical plates
  • Soap bubble appearance

Management Of Keratocyst:

1. Enucleation Of cyst:

  • Smaller single cyst through intraoral approach
  • Unilocular lesions through marginal excision
  • Large multilocular lesions

Cysts And Tumours Of The Orofacial Region Keratocystic Odontogenic Tumour Of Enucleation Of Cyst

Question 3. Define cyst. Describe the pathogenesis, clinical features, radiographic appearance of radicular cyst , Treatment, Aetiology
Or 
Radicular cyst 
Answer:

Definition Of Cyst:
Cyst is a pathological cavity containing fluid, semi-fluid or gas, which is usually lined by epithelium & is not formed by the accumulation of pus

Radicular Cyst:

  • Pathogenesis:
    1. Phase Of Initiation:
      • Bacterial infection
      • Leads to stimulation of cell rest of Malassez
    2.  Phase of proliferation:
      • Excessive & exuberant proliferation of cell rests
    3. Phase Of Mystification:
      • Deprivement of nutrition of central cells
      • Results in necrosis
      • Formation of cyst
    4.  The Phase Of Enlargement: Enlargement Of The Cavity Due To:
      • Higher osmotic tension of the cystic fluid
      • Release of bone-resorbing factors

Clinical Features Of Cyst:

  • Sex: Common in males
  • Age: Young age
  • Site: Common in maxillary anterior
  • Non-vital tooth
  • Smaller cysts are asymptomatic
  • Larger lesions produce slow enlarging, bony hard
    swelling
  • Expansion & distortion of cortical plates
  • Severe bone destruction
  • The springiness of jaw bones
  • Pain if secondary infected
  • Intraoral or extraoral pus discharge
  • Pathological fractures
  • Formation of abscess called “cyst abscess”

Radiological Features Of Cyst:

  • The unilocular radiolucent area around the apex of nonvital tooth
  • Border: Sclerotic
  • Diameter: Less than 1 cm
  • Discontinuity of lamina dura

Treatment Of Cyst:

  • Non-vital tooth
  • Extraction
  • RCT
  • Smaller cyst
  • Removed through socket
  • Larger cyst
  • Marsupalization

Aetiology Of Cyst:

  • Dental caries
  • Fractured tooth
  • Thermal/Chemical injury to the pulp
  • Latrogenic injury to pulp

Question 4. Differentiate between benign & malignant tu- mours.
Answer:

Differentiate Between Benign & Malignant Tumours

Cysts And Tumours Of The Orofacial Region Tumours

Cysts And Tumours Of The Orofacial Region Short Essays

Question 1. Dentigerous cyst.
Answer:

Clinical Features Of Dentigerous Cyst:

  • Sex: Common in males
  • Age: 1& 3rd decade
  • Site: Mandibular 3rd molar, maxillary canines, maxillary 3rd molar
  • Expansion of bone
  • facial asymmetry
  • Displacement of adjacent teeth
  • Resorption of adjacent teeth

Radiological Features:

  • Unilocular, well-defined radiolucency
  • Margins – Sclerotic

Types Of Dentigerous Cyst:

  • Central covering the crown of an unerupted tooth
  • Circumferential covering the crown from all the sides
  • Lateral covering crown from side

Cysts And Tumours Of The Orofacial Region Radiological Presentation Of Dentigerrous Cysts

Management of Dentigerous cyst:

  • Marsupialization in children
  • Enucleation in adults

Question 2. CEOC.
Answer:

Clinical Features Of CEOC:

  • Age: Second decade of life
  • Sex: Both sexes
  • Site: Mandibular premolars
  • Anterior of maxilla
  • Features: Bony hard swelling of the jaw
  • Expansion & distortion of cortical plates
  • Vital tooth
  • Gingival swelling
  • Causes perforation of cortex
  • Pain is rarely present

Radiological Features Of CEOC:

  • Unilocular or multilocular radiolucent area
  • Border: well corticated
  • Internal structure: radiopaque calcified foci present

Treatment Of CEOC:

  • Simple enucleation

Question 3. Marsupialization.
Answer:

Marsupialization

Marsupialization refers to creating a surgical window in the wall of the cyst & evacuation of the cystic contents

Indications Of Marsupialization:

  • Young age
  • Proximity to vital structures
  • In case of eruption of teeth
  • In larger cyst
  • In vital teeth

Advantages Of Marsupialization:

  • Simple
  • Spares vital structures
  • Allows eruption of teeth
  • Prevents OAF
  • Prevents fractures
  • Less time
  • Reduces blood loss
  • Bone formation

Disadvantages Of Marsupialization:

  • Prolonged healing
  • Prolonged follow up Periodic irrigation
  • Periodic changing of pack
  • Risk of new cyst formation

The technique of Marsupialization:

Cysts And Tumours Of The Orofacial Region The Technique of Marsupialization

Cysts And Tumours Of The Orofacial Region Surgical Procedureb Of Marsupilization Of Cyst

Question 4. Enucleation:
Answer:

Enucleation

Enucleation allows for the cystic cavity to be covered by a mucoperiosteal flap & the space is filled with a blood clot which organizes & forms normal bone

Indication Of Enucleation:

  • OKC
  • Recurrent cyst

Advantages Of Enucleation:

  • Primary closure Rapid healing
  • Postoperative care is less

Disadvantages Of Enucleation:

  • Weakens the mandible
  • Damage vital structures
  • Pulpal necrosis

Technique Of Enucleation:

Cysts And Tumours Of The Orofacial Region technique Of Enucleation

Question 5. Osteoma.
Answer:

Osteoma

Benign neoplasm of osseous origin

Clinical Features Of Osteoma:

  • Age: Second-fifth decade
  • Sex: Common in females
  • Site: Jawbones, soft tissues

Presentation Of Osteoma:

  • Nodular, exophytic growth. Either solitary or multiple
  • Expansion of cortical plates
  • Displacement of teeth
  • Predispose to sinusitis Nasal discharge
  • Syndrome associated

Radiographic Features Of Osteoma:

  • Well circumscribed
  • Round or oval dense radiopacities

Treatment Of Osteoma:

  • Surgical excision

Question 6. Myxoma.
Answer:

Myxoma

  • True neoplasm
  • Made up of tissues that often resemble primitive mes enzyme

Clinical Features Of Myxoma:

  • Age: At any age
  • Sex: Both
  • Site: Iaw bones, salivary gland

Presentation Of Myxoma:

  • Non-descript, firm, nodular growth

Treatment Of Myxoma:

  • Radical surgery

Question 7. AOT 
Answer:

AOT 

Origin: Reduced enamel epithelium

Clinical Features Of AOT:

  • Age: Young age
  • Sex: Female
  • Site: Maxillary anterior region

Presentation Of AOT:

  • Slow enlarging, small, bony hard swelling
  • Elevation of upper lip
  • Displacement of teeth
  • Expansion of cortical plates
  • Asymptomatic
  • Nodular swelling over gingiva

Treatment Of AOT:

  • Surgical enucleation

Question 8. Pinborg tumour
Answer:

Clinical Features Of Pinborg:

  • Age: Middle age
  • Sex: Both
  • Site: Mandible , over gingiva

Presentation Of Pinborg Tumour:

  • Slow enlarging bony hard swelling Expansion of cortical plates
  • Displacement of teeth
  • Pain
  • Paresthesia.
  • Maxillary lesions lead to nasal airway obstruction Nodular swelling over gingiva

Radiographic Features Of Pinborg Tumour:

  • Well-defined, unilocular, radiolucent area
  • Interior small radiopaque foci

Treatment of AOT:

  • Surgical enucleation

Question 9. Globulomaxillary cyst.
Answer:

Globulomaxillary Cyst

  • A common type of developmental cyst
  • Arises in the bone suture, between maxilla & pre maxilla

Clinical Features Of Globulomaxillary Cyst:

  • Asymptomatic
  • If secondary infected, causes pain & discomfort
  • Small swelling between canine & premolar
  • Vital teeth

Radiographic Features Of Globulomaxillary Cyst:

  • Inverted pear-shaped radiolucent area between roots of the upper lateral incisor & canine
  • Divergence of the roots

Treatment Of Globulomaxillary Cyst:

  • Surgical excision

Question 10. Traumatic bone cyst.
Answer:

Traumatic Bone Cyst

  • Pseudo cyst
  • Lined by fibrous tissue

Clinical Features Of Traumatic Bone Cyst:

  • Ages: Young age
  • Sex: Common in males
  • Site: Mandibular body, symphysis or ramus Maxillary anterior region

Presentation Of Traumatic Bone Cyst:

  • Asymptomatic
  • Painful, bony hard swelling Expansion of cortical plates
  • Displacement of teeth
  • Pain
  • Paresthesia of lip
  • Vital teeth

Radiographic Features Of traumatic Bone Cyst:

  • Unilocular or multilocular radiolucent lesion
  • Well demarcated
  • Scalloping between roots

Treatment Of Traumatic Bone Cyst:

  • Surgical exploration

Question 11. Nasolabial cyst.
Answer:

Nasolabial Cyst

Soft tissue cyst of the nasolabial fold

Origin Of Nasolabial Cyst:

  • The lower part of the embryonic nasolacrimal duct

Clinical Features Of Nasolabial Cyst:

  • Age: 30-50 years
  • Sex: Common in females
  • Site: Soft tissue of anterior maxillary vestibule

Presentation Of Nasolabial Cyst:

  • Small, painless swelling of the upper lip
  • Distorts the nostrils
  • Projects into the floor of the nose
  • Radiographic Features:
  • Saucerization of the underlying bone

Treatment Of Nasolabial Cyst:

  • Surgical excision

Question 12. Odontomes
Answer:

Odontomes

  • Common hamartomatous odontogenic lesions with limited growth potential

Types Of Odontomes: 

  1.  Complex odontoma: Consists of a mass of haphazardly arranged enamel, dentin & cementum
  2. Compound odontoma: Consists of collections of numerous small, discrete, tooth-like structures

Clinical Features Of Odontomes:

  • Age: Children & young adults
  • Sex: Both
  • Site: Compound in Maxilla Complex in the mandible

Presentation Of Odontomes:

  • Small asymptomatic lesion Expansion of cortical plates
  • Displacement of teeth Impacted or retained deciduous teeth
  • Pain, inflammation
  • Ulceration
  • Fistula formation

Radiographic Features Of Odontomes:

  • Compound – A bag of teeth appearance
  • Complex  – Sunburst appearance

Treatment Of Odontomes:

  • Surgical enucleation

Cysts And Tumours Of The Orofacial Region Short Question And Answers

Question 1. Theories of cystic expansion.
Answer:

Theories Of Cystic Expansion

  •  Harris Theory:
    • According to him, cystic expansion involves
  • Mural Growth:
    • Peripheral cell division.
    • Accumulated contents
  • Hydrostatic:
    • Secretion
    • Transudation & exudation
    • Dialysis
  • Bone Resorbing Factors:

Question 2. Gorlin’s syndrome.
Answer:

Clinical Features Of Gorlin’s Syndrome:

  1.  Facial:
    • Frontal bossing
    • Prominent Supraorbital ridges
    • Hypertelorism
    • Mandibular prognathism
  2. Skeletal Anomalies Of :
    • Bifid ribs
    • Bifid spine
    • Bridging of sella
    • Shortening of metacarpals
    • Calcification of falx cerebri
  3. Skin Lesions:
    • Milia
    • Dyskeratosis
    • Basal cell nevi
  4. Cysts:
    • Multiple keratocyst
  5. Soft Tissue Anomalies:
    • Ovarian fibromata
    • Lipomas

Question 3. Aneursymal bone cyst.
Answer:

Aneursymal Bone Cyst

An aneurysmal bone cyst is a cystic lesion involving hone anywhere in the body

Clinical Features Of Aneurysmal Bone Cyst:

  • Age- Second decade of life
  • Sex – Common in females
  • Site Mandibular molar- Ramus area and maxillary posterior area
  • Present as rapidly enlarging, diffuse, firm swelling of the Jaw
  • Causes facial asymmetry
  • Swelling is painful
  • Expansion and thinning of bone results in egg- Shell crackling
  • Perforation of cortical bone
  • Pathological fracture of affected jawbone Paraesthesia of regional teeth
  • Difficulty in mouth opening due to impingement on the capsule of TMJ
  • Maxillary lesions cause nasal bleeding, pressure sensation in the eye and nasal obstruction

Question 4. Carnoy’s solution
Answer:

Carnoy’s Solution

  • Carnoy’s Solution is a chemical cauterization agent
  • Indicated in the treatment of keratocystic odontogenic tumours
  • Carnoy’s Solution contains:
  • 100% ethanol
  • Chloroform
  • The glacial acetic acid in a ratio of 6:3:1 with added ferric chloride
  • Carnoy’s Solution provides a tissue fixation property used in histology and a tissue cauterization property utilized in chemical curettage

Cysts And Tumours Of The Orofacial Region Viva Voce

  1. Complete resection is done if the tumour invades the lower border of the mandible
  2. Marsupialization decreases intra-cystic pressure and promotes shrinkage of the cyst and bone fill
  3. Aspiration helps to distinguish between a cyst and tumour
  4. Large ranulas can be best treated by marsupialization
  5. Recurrent ranulas are best treated by sublingual gland excision
  6. Marsupialization is the best method to treat large cysts
  7. Bifid mandibular canal is common in neurofibroma- tosis
  8. Junctional nevus has the maximum potential to become melanoma
  9. Retention cysts are commonly seen in the lower lip
  10. Bohn’s nodules are cystic swellings in neonates
  11. The protein content of periapical and dentigerous cysts is 5-11 gm/dl
  12. Complete enucleation of cyst in the palatal area carries the danger of tear of the nasal mucosa
  13. During enucleation, the incision should be placed on the firm bony base
  14. Treatment of keratocyst is excision
  15. The global maxillary cyst occupies a bony region between the maxillary lateral incisor and canine
  16. Ranula is a retention cyst
  17. Mucocele should be treated by enucleation of the cyst and minor salivary gland
  18. A branchial cyst occurs on the lateral side of the neck.
  19. Pindborg’s tumour is treated by excision
  20. Adenoameblastoma is managed by enucleation
  21. Chondromas are radioresistant
  22. Keratocyst has the highest rate of recurrence

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