cyst 2 l Oral Pathology MCQs

 

Developmental cyst ; Epstein's pearls , Bohn's nodules , Median anterior maxillary  , Globulomaxillary , Nasoalveolar ,  Traumatic bone , Benign cervical lymphoepithelial , Epidermoid and dermoid cyst (describing histopathology , clinical feature and treatment of each disease) l Oral Pathology MCQs for dental students

Developmental cyst

Epstein's pearls

• Are small white or yellow cystic nodules (1 to 3 mm in size) often seen along the median palatal raphe of the mouth of newborn infants.

• These cystic keratinizing nodules occur in 65-85% of newborns.

• Epstein nodules arise from the entrapped epithelium along the line of fusion of palate.

• They do not require treatment because they resolve spontaneously over the first few weeks of life. They were described by alois epstein.

Bohn's nodules

• Are keratin filled cysts which lie scattered over the palate and are most numerous along the junction of the hard and soft palate.

• These nodules are derived from the remnant of palatal salivary glandular structure.

• Bohn's nodules appear as smooth whitish bumps or nodules. Bohn's nodules are also seen along lingual and buccal parts of the dental ridges, away from the midline.

• These nodules are 1 to 3 mm in size, and filled with keratin. They are benign, and usually disappear within the first three months of life.

• Bohn's nodules are named after german pediatrician heinrich bohn

Median anterior maxillary cyst

• Is also referred to as nasoplatine duct cyst or incisive canal cyst.
• The nasopalatine duct cyst is a developmental, nonneoplastic cyst that is considered to be the most common of the nonodontogenic cysts.
• Median anterior maxillary cyst is one of many pathologic processes that may occur within the jawbones, but it is unique in that it develops in only a single location, which is the midline anterior maxilla.

Histopathology of median anterior maxillary cyst

• The cyst arises from the epithelial remnant of nasopalatine duct. Nasoplatine duct is an embryologic structure consisting of duct of epithelial cells lying within the incisive canal.
• The nasopalatine ducts ordinarily undergo progressive degeneration; however, the persistence of epithelial remnants may later become the source of epithelia that gives rise to cyst, from either spontaneous proliferation or proliferation following trauma, bacterial infection, or mucous retention.
• These cyst unless infected are asymatomatic, can occur at any age but are frequent in 4th to 6th decade of life. Males are affected more than females.

Radiographically median anterior maxillary cyst

• The cyst appears as round or heart shaped bilaterally symmetrical radiolucency in the midline between or above the roots of the maxillary central incisors.

Treatment median anterior maxillary cyst

• The cyst should be removed prior to insertion of denture in edentulous to avoid any predisposition to acute infection.

Globulomaxillary cyst

• Is usually an asymptomatic cystic lesion lying between the maxillary lateral incisors and canine.
• The cyst originate from the proliferation of epithelium trapped along the line of fusion between globular portion of the medial nasal process and the maxillary process.

Radiographically globulomaxillary cyst

• The cyst appears as an inverted, pear shaped radiolucent area between the roots of lateral incisor and the canine. The cyst may occur bilaterally.

The treatment globulomaxillary cyst

• Surgical excision of the cyst. Globulomaxillary cyst was described by thoma

Nasoalveolar cyst

• Is also known as klestadťs cyst or nasolabial cyst. The cyst arise due to the proliferation of epithelium along the the junction of the globular process, the lateral nasal process, and the maxillary process.

Clinically and histopathology nasoalveolar cyst

• The cyst is located near the attachment of the ala over the maxilla and may cause swelling in the mucobuccal fold and in the floor of the mouth.
• The cyst should be excised surgically.

Median mandibular cyst

• Is an extremely rare cyst which arises from the proliferation of epithelial remnant entrapped in the median mandibular fissure at the time of fusion of the bilateral mandibular arches.

• The lesion is usually asymptomatic. The surgical excision of the cyst is the treatment if needed.

Thryoglossal tract cyst

• Is a developmental fibrous cyst. The cyst arises from the remnant of thryoglossal tract.

Pathogenesis and histopathology of thryoglossal tract cyst

• It may be seen along the embryonic thyroglossal tract between the foramen caecum of the tongue and the thyroid głand.

• Upper respiratory tract infection may be predisposing factor for the appearance of the cyst. The cyst appear as cystic midline mass lying to one side of the midline.

• The cyst may be seen near the tongue, near the foramen caecum, in the floor of the mouth,or near the thyroid or cricoids cartilage.

• The cyst is usually asymptomatic except when it lie near the tongue and cause dysphagia.

• The treatment is the complete surgical excision

Benign cervical lymphoepithelial cyst or brachial cleft cyst

• Are congenital epithelial cysts, which arise from the remnant of the brachial arches or pharyngeal pouches and appear on the lateral aspect of the upper neck close to the anterior border of sternocleidomastoid muscle.

Pathogenesis and histopathological feature of benign cervical lymphoepithelial cyst

• At the fourth week of embryonic life, the development of 4 branchial (or pharyngeal) clefts results in 5 ridges known as the branchial (or pharyngeal) arches, which contribute to the formation of various structures of the head, the neck, and the thorax.

• The second arch grows caudally and, ultimately, covers the third and fourth arches.

• The buried clefts become ectoderm-lined cavities, which normally involute around week seven of development.

• If a portion of the cleft fails to involute completely, the entrapped remnant forms an epithelium-lined cyst with or without a sinus tract to the overlying skin.

• These cyst may be seen some times at the angle of the mandible, in the submandibular area, in the preauricular and parotid area. The cyst are usually asymptomatic.

• The treatment is the complete surgical removal.

Epidermoid and dermoid cyst

• Originate primarily from the embryonic germinal epithelium. Epidermoid and dermoid cysts are benign lesions encountered throughout the body.

• They represent less than 0.01% of all oral cavity cysts.

• The cysts can be defined as epidermoid when the lining presents only epithelium, dermoid cysts when skin adnexa are found, and teratoid cysts when other tissue such as muscle, cartilage, and bone are present.

• These lesions are predominantly seen in young. In oral cavity, floor of the mouth, submaxillary and sublingual area are the common site of occurrence.

• The epidermoid cyst typically remains less than 1 cm in diameter. The cyst is almost always superficial, producing a sessile nodule with a white or yellow-white discoloration.

• The dermoid cyst is usually found in the oral floor midline above the myeloid muscle, although the occasional dumbbell-shaped cyst will penetrate through a hiatus in the muscle and extend into the sub mental area, imparting a double chin appearance in this location.

• Dermoid cyst may become infected, and may interfere with swallowing or the proper function of the tongue. The treatment is surgical excision.

Stafne bone cyst

• Is an unusual form of slightly aberrant salivary gland tissue wherein a developmental inclusion of glandular tissue is found within or, more commonly, adjacent to the lingual surface of the body of the mandible within a deepand well-circumscribed depression.
• This cyst is regarded as developmental rather than pathologic defects. A predilection for males over females has been reported.

Radio graphically stafne bone cyst:  

• The lesion usually appears as an ovoid radiolucency located between the inferior alveolar canal and the inferior border of the mandible in the region of the second or third molars.

• It can be differentiated from the traumatic or hemorrhagic bone cyst, which by location almost invariably lies superior to the inferior alveolar canal.

• The cyst generally represent benign developmental anomalies that normally do not require any treatment.

• The cyst is also known as static bone cavity, linguał mandibular bone cavity, static bone cyst, and latent bone cyst.

Traumatic bone cyst

• Is known as solitary bone cyst, hemorrhagic cyst, extravasation cyst, unicameral bone cyst, simple bone cyst, and idiopathic bone cavity.
• It is an uncommon nonepithelial lined cavity of the jaws. The lesion is mainly diagnosed in young patients most frequently during the second decade of life.
• The previous trauma is said to be the main etiology in the causation of traumatic bone cyst.
• The trauma initiates a subperiostal hematoma that causes a compromised blood supply to the area, leading to osteoclastic bone resorption.
• The majority of traumatic cyst are located in the mandibular body between the canine and the third molar.

Clinically of the lesion:

1. Is asymptomatic in the majority of cases and is often accidentally discovered on routine radiological examination usually as an unilocular radiolucent area with a
2. “scalloping effect” the definite diagnosis of traumatic cyst is invariably achieved at surgery. The cystic cavities when
3. Opened surgically are generally either empty or filled with a small amount of straw-colored fluid. The recommended

Treatment for traumatic bone cyst:

• Is surgical exploration followed by curettage of the bony walls.