A cyst is an epithelium-lined sac containing fluid or semisolid material. In the formation of a cyst, the epithelial cells first proliferate and later undergo degeneration and liquefaction. The liquefied material exerts equal pressure on the walls of the cyst from within. Cysts grow by expansion and thus displace the adjacent teeth by pressure. May can produce expansion of the cortical bone. On a radiograph, the radiolucency of a cyst is usually bordered by a radiopaque periphery of dense sclerotic bone. The radiolucency may be unilocular or multilocular. Odontogenic cysts are those which arise from the epithelium associated with the development of teeth. The source of epithelium is from the enamel organ, the reduced enamel epithelium, the cell rests of Malassez or the remnants of the dental lamina.
Fibro-osseous lesions of the jaws
Fibrous dysplasia
Cemento-osseous dysplasia
Focal cemento-osseous dysplasia
Periapical cemento-osseous dysplasia
Florid cemento-osseous dysplasia
Ossifying fibroma
Juvenile aggressive ossifying fibroma
Cherubism
Fibro-osseous lesions (FOL) are characterized by replacement of normal bone architecture by collagen fibers and fibroblasts containing calcified tissue.
They include a wide variety of lesions of developmental, dysplastic and neoplastic origins with clinical and radiographic presentation and behavior.
Because of the histological similarities between diverse diseases, proper diagnosis requires correlation of history, clinical and radiographic findings.Fibrous Dysplasia
2. Reactive (dysplastic lesions arising in the tooth-bearing area (presumably of periodontal origin).
a. Periapical cemento-osseous dysplasia
b. Focal cemento-osseous dysplasia
c. Florid cemento-osseous dysplasia
3. Fibro-osseous neoplasms (widely designated as cementifying fibroma, ossifying fibroma or cemento-ossifying fibroma.Bone dysplasias
a. Fibrous dyspla i. Monostoticii. Polyostotic
iii. Polyostotic with endocrinopathy (McCune-Albright)
iv Osteofibrous dysplasia
b. Osteitis deformansc. Pagetoid heritable bone dysplasias of childhood
d. Segmental odontomaxillary dysplasia
2. Cemento-osseous dysplasias
a. Focal cemento-osseous dysplasia b. Florid cemento-osseous dysplasia
3.Inflammatory/reactive processes
a. Focal sclerosing osteomyelitisb. Diffuse sclerosing osteomyelitis
c. Proliferative periostitis
4. Metabolic Disease: hyperparathyroidism
5. Neoplastic lesions (Ossifying fibromas)
a. Ossifying fibromab. Hyperparathyroidism jaw lesion syndrome
c. Juvenile ossifying fibroma i. Trabecular typeii. Psammomatoid type
d. Gigantiform cementomas
Fibro-osseous lesions of the jaws
Fibrous dysplasia
Cemento-osseous dysplasia
Focal cemento-osseous dysplasia
Periapical cemento-osseous dysplasia
Florid cemento-osseous dysplasia
Ossifying fibroma
Juvenile aggressive ossifying fibroma
Cherubism
Fibro-osseous lesions (FOL) are characterized by replacement of normal bone architecture by collagen fibers and fibroblasts containing calcified tissue.
They include a wide variety of lesions of developmental, dysplastic and neoplastic origins with clinical and radiographic presentation and behavior.
Because of the histological similarities between diverse diseases, proper diagnosis requires correlation of history, clinical and radiographic findings.Fibrous Dysplasia
2. Reactive (dysplastic lesions arising in the tooth-bearing area (presumably of periodontal origin).
a. Periapical cemento-osseous dysplasia
b. Focal cemento-osseous dysplasia
c. Florid cemento-osseous dysplasia
3. Fibro-osseous neoplasms (widely designated as cementifying fibroma, ossifying fibroma or cemento-ossifying fibroma.Bone dysplasias
a. Fibrous dyspla i. Monostoticii. Polyostotic
iii. Polyostotic with endocrinopathy (McCune-Albright)
iv Osteofibrous dysplasia
b. Osteitis deformansc. Pagetoid heritable bone dysplasias of childhood
d. Segmental odontomaxillary dysplasia
2. Cemento-osseous dysplasias
a. Focal cemento-osseous dysplasia b. Florid cemento-osseous dysplasia
3.Inflammatory/reactive processes
a. Focal sclerosing osteomyelitisb. Diffuse sclerosing osteomyelitis
c. Proliferative periostitis
4. Metabolic Disease: hyperparathyroidism
5. Neoplastic lesions (Ossifying fibromas)
a. Ossifying fibromab. Hyperparathyroidism jaw lesion syndrome
c. Juvenile ossifying fibroma i. Trabecular typeii. Psammomatoid type
d. Gigantiform cementomas
Odontogenic keratocyst (OKC) is the cyst arising from the cell rests of dental lamina. It can occur anywhere in the jaw, but commonly seen in the posterior part of the mandible. Radiographically, most OKCs are unilocular when presented at the periapex and can be mistaken for radicular or lateral periodontal cyst.
Benign, locally aggressive tumor of odontogenic epithelium, Previously called adamantinoma, Second most common odontogenic tumor after odontoma, Mandible is most common site, Usually asymptomatic and can be found incidentally on routine dental examinations
Includes most common tumors of oral cavity including scc,bcc, melanoma, ameloblastoma, odontoma, fibromas, pindborg tumors etc.
Presented by Dr. Binaya Subedi
Gingival cyst of newborn /orthodontic courses by Indian dental academy Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Odontogenic keratocyst (OKC) is the cyst arising from the cell rests of dental lamina. It can occur anywhere in the jaw, but commonly seen in the posterior part of the mandible. Radiographically, most OKCs are unilocular when presented at the periapex and can be mistaken for radicular or lateral periodontal cyst.
Benign, locally aggressive tumor of odontogenic epithelium, Previously called adamantinoma, Second most common odontogenic tumor after odontoma, Mandible is most common site, Usually asymptomatic and can be found incidentally on routine dental examinations
Includes most common tumors of oral cavity including scc,bcc, melanoma, ameloblastoma, odontoma, fibromas, pindborg tumors etc.
Presented by Dr. Binaya Subedi
Gingival cyst of newborn /orthodontic courses by Indian dental academy Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
mixed radiolucent and radiopaque lesions / oral surgery coursesIndian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
Odontogenic tumors vi/certified fixed orthodontic courses by Indian dental ac...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Jaw lesion radiology ppt ppt . This powerpoint presentation includes important anatomy, radiographs and important pathology of jaw lesion with its imaging feature as well as its Xray ct mri image. This will help alot. this will help for radiology resident as well as ent resident and event dentist.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
2. Outline
1. INTRODUCTION
2. CLASSIFICATION
3. CAUSES
4. HISTOPATHOLOGY
5. CLICAL FEATURES
6. RADIOGRAPHIC FEATURES
7. DIFFERENTIAL DIAGNOSIS
8. TREATMENT
9. PRINCIPLE OF TREATMENT
A. Types of Flaps.
B. Surgical removal the of the cyst .
3. INTRODUCTION
• A cyst is an epithelium-lined sac
containing fluid or semisolid material.
In the formation of a cyst, the epithelial
cells first proliferate and later undergo
degeneration and liquefaction. The
liquefied material exerts equal pressure
on the walls of the cyst from within.
4. INTRODUCTION
• Cysts grow by expansion and thus
displace the adjacent teeth by pressure.
May can produce expansion of the
cortical bone. On a radiograph, the
radiolucency of a cyst is usually
bordered by a radiopaque periphery of
dense sclerotic bone. The radiolucency
may be unilocular or multilocular
5. INTRODUCTION
• Odontogenic cysts are those which
arise from the epithelium associated
with the development of teeth. The
source of epithelium is from the
enamel organ, the reduced enamel
epithelium, the cell rests of Malassez or
the remnants of the dental lamina.
8. Causes
• A periapical cyst develops from a preexisting
periapical granuloma, which is a focus of chronically
inflamed granulation tissue in bone located at the
apex of a nonvital tooth.
• Periapical granulomas are initiated and maintained
by the degradation products of necrotic pulp tissue
9. Histopathology
• The periapical cyst is lined by non
keratinized stratified squamous
epithelium of variable.
Transmigration of inflammatory
cells through the epithelium is
common, with large numbers of
(PMNs) and fewer numbers of
lymphocytes involved.
10. Histopathology
• The underlying supportive
connective tissue may be
focally or diffusely infiltrated
with a mixed inflammatory
cell population.
11. Clinical features
• Frequency:It is most common cystic lesion of jaw
comprising about approximately 52% of jaw cystic lesions.
• Age: found in 4th & 5th decades of life.
• Sex: It is more common in males 58% than females.
• Race: White patients more than Black patients.
• Site: It occurs with frequency of 60% occurs in maxillary
anterior region. Most commonly at apices of teeth.
12. Radiographic features
• Location: In most cases the epicenter of a radicular cyst is
located approximately at the apex of a nonvital tooth.
• Periphery and shape: The periphery usually has a well
defined cortical border. It will become ill-defined if infected.
• Internal structure: In most radicular cysts is radiolucent.
• Effects on surrounding structures: If a radicular cyst is
large, displacement and resorption of the roots of adjacent
teeth.
13.
14. Differential Diagnosis
• Periapical abscess. Ill defined margin.
• Apical granuloma. may be difficult and in some cases impossible.
A round shape, a well-defined cortical border, and a size greater
than 2 cm in diameter are more characteristic of a cyst.
• Early stage of periapical cemental dysplasia. tooth are vital.
• Apical scar.
• Periapical surgical defect.
17. Causes
• When the necrotic tooth is extracted but the cyst lining is
incompletely removed, a residual cyst may from months to
years after the develop initial extirpation If either or the a
residual cyst original periapical cyst remains
untreated, continued growth can cause significant bone
resorption and weakening of the mandible or maxilla.
19. Clinical features
• A Residual cyst is a cyst that develops
• after incomplete removal of the original cyst.
• Usually asymptomatic.
• Unilocular, round or oval, well--defined, usually well
corticated.
• It can cause bone expansion and displacement of the adjacent
teeth.
20. Radiographic features
• Location: In both jaw but more in the mandible. Found at
periapical location, in place of an extracted tooth.
• Periphery and shape: The periphery usually has a well defined
cortical border.
• Internal structure: In most cases the internal structure of
radicular cysts is radiolucent.
• Effects on surrounding structures: large cyst , displacement
and resorption of the roots of adjacent teeth may occur.
21.
22. Differential Diagnosis
• Keratocyst: residual cyst has greater potential for
expansion compared with a keratocyst.
• Stafne developmental salivary gland defect is located
below the mandibular canal
25. Causes
• Dentigerous cyst develops from proliferation of the
enamel organ remnant or reduced enamel
epithelium.
26. Histopathology
• The supporting fibrous connective
tissue wall of the cyst is lined by
stratified squamous epithelium.
In an uninflamed dentigerous cyst
the epithelial lining is
nonkeratinized and tends to be
approximately four to six cell
layers thick.
27. Histopathology
• On occasion, 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, although in
cases in which there is secondary
inflammation, epithelial byperplasia
may be noted.
28. Clinical features
• Dentigerous cysts are most commonly
seen in association with third molars
and maxillary canines, which are the
most commonly impacted teeth. The
highest incidence of dentigerous cysts
occurs during the second and third
decades. There is a greater incidence in
males, with a ratio of 1.6 to 1 reported.
29. Clinical features
• Symptoms are generally absent, with
delayed eruption being the most
common indication of dentigerous cyst
formation. This cyst is capable of
achieving significant size, occasionally
with associated cortical bone expansion
but rarely to a size that predisposes the
patient to a pathologic fracture.
30. Radiographic features
• Location: most common sites are mandibular third molar, maxillary
canine, maxillary third molar. Associated with the crown of an un-
erupted and displaced tooth.
• Periphery and shape: The periphery usually has a well defined
cortical border. Attached to the CEJ.
• Internal structure: most cases is radiolucent surrounding the crown.
• Effects on surrounding structures: Large cysts tend to expand the
outer plate (usually buccally).
31.
32. Differential Diagnosis
• Hyperplastic follicle The size of the normal follicular space is 2
to 3 mm. If the follicular space exceeds 5 mm, a dentigerous
cyst is more likely.
• Odontogenic keratocyst ,does not expand the bone to the
same degree as a dentigerous cyst, is less likely to resorb
teeth, and may attach farther apically on the root instead of at
the cementoenamel junction.
33. Differential Diagnosis
• Ameloblastjc fibroma
• Cystic ameloblastoma The internal structure in both of them
differentiate
• Adenomatoid odontogenic tumors
• Calcified odontogenic cysts Both can surround the crown and
root of the involved tooth. Evidence of a radiopaque internal
structure should be sought in these two lesions.
36. Causes
• The origin of this cyst is believed to be related to proliferation
of rests of dental lamina.
• The lateral periodontal cyst has been pathogcnetically linked
to the gingival cyst of the adult; t the former is believed to
arise from dental lamina remnants within bone, and the latter
from dental lamina remnants in soft tissue between the oral
epithelium and the periosteum (rests of Serres).
37. Histopathology
• The close relationship between the two
entities is further supported by their
similar distribution in sites containing a
higher concentration of dental lamina
rests, and their identical histology. By
contrast, periapical cysts are most
common at the apices of teeth, where
rests of Malassez are more plentiful.
38. Clinical features
• Age : Adults
• Location : Lateral periodontal membrane especially
mandibular , cuspid and premolar area
• Usually asypmtomatic ; associated tooth is vital ;origin from
rests of dental lamina ;
• some keratocysts are found in a lateral root position
;gingival cyst be soft tissue of adult may counterpart
39. Radiographic features
• Location: 50-75% of lateral periodontal cysts develop in the
mandible, mostly in a region extending from the lateral incisor
to the second premolar.
• Periphery and shape: well-defined radiolucency with a
prominent cortical boundary and a round or oval shape.
• Internal structure: usually is radiolucent.
• Effects on surrounding structures: Large cysts can displace
adjacent teeth and cause expansion
40.
41. Differential Diagnosis
• Small OKC
• Mental foramen
• Small neurofibroma
• Radicular cyst at the foramen of an accessory pulp canal.
• The multiple (botryoid) cysts with a multilocular
appearance may resemble a small ameloblastoma.
44. Causes
• There is general agreement that OKCs develop from dental
lamina remnants in the mandible and maxilla. However, an
origin of this cyst From extension of basal cells of the
overlying oral epithelium has also been suggested.
• Genetic
45. Histopathology
• The epithelial lining is uniformly thin, generally ranging from 8
to 10 cell layers thick.
• The basal layer exhibits a characteristic palisaded pattern with
polarized and intensely stained nuclei of uniform diameter.
The luminal epithelial cells are parakeratinized and produce an
uneven or corrugated profile.
46. Histopathology
• Additional histologic features that may
occasionally be encountered include
budding of the basal cells into the C.T
wall and microcyst formation.
• The fibrous connective tissue
component of the cyst wall is often free
of inflammatory cell infiltrate and is
relatively thin.
47. Clinical features
• Age: Any age , especially adults
• Location : Mandibular molar ramus area favored ; may be
found dentigerous , in position of lateral root , periapical , or
primordial cyst
• OKCs are relatively common jaw cysts They occur at any age
and have a peak incidence within the second and third
decades.
48. Radiographic features
• Location : The most common is the posterior body of the
mandible (90% posterior to the canines)and ramus (more
than 50%). This type of cyst occasionally has the same
pericoronal position asdentigerous cyst.
• Periphery and shape Usually : with a cortical border unless
become secondarily infected. The cyst may have a smooth
(round or oval shape), or it may have a scalloped outline.
49. Radiographic features
• Internal structure
• most commonly is radiolucent.
• The cystic cavity contain keratin.
• In some cases curved internal septa may be present, giving
the lesion a multilocular Appearance.
50. Radiographic features
• The effects on surrounding structures : It grow along the
internal aspect of the jaws, causing minimal expansion except
for the upper ramus and coronoid process, where
considerable expansion may occur. OKCs can displace and
resorbe teeth but to a slightly lesser degree than dentigerous
cysts. The inferior alveolar nerve canal may be displaced
inferiorly. In the maxilla this cyst can invaginate and occupy
the entire maxillary antrum
51.
52. Differential Diagnosis
• Dentigerous cyst OKC
• Ameloblastoma, AB has a greater propensity to expand.
• Odontogenic myxoma, multilocular with fine straight septa.
• A simple bone cyst often has a scalloped margin and minimal
bone expansion.
• several OKCs are found, these cysts may constitute part of a
basal cell nevus syndrome.
53. Treatment
Wide (local) surgical excision for prevent the
recurrence
or
Marsupialization - the surgical opening of the
(KCOT) cavity and a creation of a marsupial-
like pouch, so that the cavity is in contact with
the outside for an extended period.
55. Causes
• COGs are believed to be derived from odontogenic epithelial
remnants within the gingiva or within the mandible or maxilla.
56. Histopathology
• Most COCs present as well-
delineated cystic proliferations with
a fibrous connective tissue wall lined
by odontogenic epithelium.
Intraluminal epithelial proliferation
occasionally obscures the cyst
lumen, thereby producing the
impression of a solid tumor.
57. Histopathology
• The basal epithelium may focally be quite prominent, with
hyperchromatic nuclei and a cuboidal to columnar pattern.
Above the basal layer are more loosely arranged epithelial
cells, sometimes resembling the stellate reticulum of the
enamel organ. The most prominent and unique microscopic
feature is the presence of ghost cell keratinization.
58. Histopathology
• The ghost cells are anucleate and
retain the outline of the
cell membrane. These cells
undergo dystrophic mineralization
characterized by fine basophilic
granularity, which may eventually
result in large sheets of calcined
material On occasion.
59. Clinical features
• Age: Any age
• Location : Maxilla favored ; gingiva second most common site
• No distinctive age gender, gender, or locationLucent to mixe
d radiographic patterns
60. Radiographic features
• COCs may present as unilocular or multilocular radiolucencies
with discrete, welldemarcated margins. Within the
radiolucency there may be scattered, irregularly sized
calcifications. Such opacities may produce a salt-and-pepper
type of pattern, with an equal and diffuse distribution. In
some cases mineralization may develop to such an extent that
the radiographic margins of the lesion are difficult to
determine.
66. Types of Flaps
1. Trapezoidal flap.
• Advantage : Provides excellent
access, allows surgery to be performed
on more than two teeth, produces no
tension in the tissues allows easy
reapproximation of the flap to its original
position.
• Disadvantages: Produces a defect in the
attachedgingiva
67. Types of Flaps
2. Triangular Flap.
• Advantage : Ensures an adequate blood
supply, satisfactory visualization, very
good stability .
• Disadvantages: Limited access to long
roots, tension is created when the flap is
held with a retractor, and it causes a
defect in the attached gingiva.
68. Types of Flaps
3. Envelope Flap.
• Advantage : Avoidance of vertical
incision and easy reapproximation to
original position
• Disadvantages: Difficult reflection
(mainly palatally), great tension with a risk
of the ends tearing, limited visualization
in apicoectomies, limited
access, possibility of injury of palatal
vessels and nerves, defect of attached
gingiva
69. Types of Flaps
4. Semilunar Flap.
• Advantage : Small incision and easy
reflection, no recession of gingivae
around the prosthetic restoration.
• Disadvantages: The incision being
performed right over the bone lesion due to
miscalculation, scarring in the anterior
area, difficulty of reapproximation , limited
access and visualization, tendency to tear.
70. Surgical removal the of the cyst
• Enucleation: This technique involves complete removal of
the cystic sac and healing of the wound by primary intention.
This is the most satisfactory method of treatment of a cyst
and is indicated in all cases where cysts are involved, whose
wall may be removed without damaging adjacent teeth and
other anatomic structures.
71. Surgical removal the of the cyst
• The surgical procedure for treatment of a cyst with
enucleation includes the following steps:
1. Reflection of a mucoperiosteal flap.
2. Removal of bone and exposure of part of the cyst.
3. Enucleation of the cystic sac.
4. Care of the wound and suturing.
72. Surgical removal the of the cyst
Panoramic radiograph showing an
extensive radicularlesion at the region
of teeth 22, 23, 24
Clinical photograph of case
73. Surgical removal the of the cyst
Removal of maxillary cyst, with labial access. Incision for creating a trapezoidal flap.
Reflection of flap and exposure of surgical field.
74. Surgical removal the of the cyst
Removal of bone at the labial aspect respective to the lesion.
Osseous window created to expose part of the lesion.
75. Surgical removal the of the cyst
Removal of cyst from bony cavity, using hemostat and curette.
Surgical field after removal of lesion.
76. Surgical removal the of the cyst
Operation site after placement of sutures.
Panoramic radiograph and clinical photograph taken 2 months after the surgical procedure.
77. Surgical removal the of the cyst
• Marsupialization This method is usually employed for the
removal of large cysts and entails opening a surgical window
at an appropriate site above the lesion. In order to create the
surgical window, initially a circular incision is made, which
includes the mucoperiosteum, the underlying perforated
(usually) bone, and the respective wall of the cystic sac
78. Surgical removal the of the cyst
• Marsupialization: After this procedure, the contents of the cyst
are evacuated, and interrupted sutures are placed around the
periphery of the cyst, suturing the mucoperiosteum and the cystic
wall together . Afterwards, the cystic cavity is irrigated with saline
solution and packed with iodoform gauze ,which is removed a week
later together with the sutures. During that period, the wound
margins will have healed, establishing permanent communication.
Irrigation of the cystic cavity is performed several times
daily, keeping it clean of food debris and avertinga potential
infection.
79. Surgical removal the of the cyst
Marsupialization method. Circular incision includes mucosa and periosteum.
Exposure of buccal cortical plate and removal of portion of bone with round bur
Enlargement
of osseous
window with
rongeur
80. Surgical removal the of the cyst
Exposure of cyst
after removal of
bone
Suturing of wound
margins with
cystic wall
81. Surgical removal the of the cyst
Packing of cystic
cavity with
iodoform gauz
Cystic cavity after
insertion of
gauze