Cysts of the Jaws & Neck
What are the two periapical/radicular cyst variants? Which is associated with necrotic pulp and which is related to healthy pulp?
Lateral radicular cyst - necrotic pulp
Residual/perio cyst - healthy pulp
Moth-like appearance
Irregular borders
Punched out RLs
Irregular tooth resorption
Widened PDL
What are the 7 common symptoms of jaw cancer?
Hard/firm swelling
Localized pain
Shallowing/destruction of the vestibule
Tooth mobility/bone loss
Lack of healing
Persistence
Paresthesia
What is the most common mesenchymal tumor in adults?
Lipoma
T/F: Osteopetrosis results in very dense bone that appears radiopaque on radiographs.
True
For a PARL to be seen, the loss of which anatomical structure(s) must occur?
The loss of the buccal/lingual cortical plate
Rate the following odontogenic tumors from least likely to most likely to recur.
Ameloblastic fibro-odontoma
Ameloblastoma
Odontoma
Odontoma > ameloblastic fibro-odontoma > ameloblastoma
A patient presents for routine care, but you notice that they keep complaining of persistent pain to the knees. You write a med consult and proceed with taking x-rays that reveal several "sunburst ROs". What is your DDx and what associated disease is this patient now at risk for?
Osteosarcoma (the most common primary bone cancer)
*Know the variants (pictured)
Associated with the risk of developing Pagets disease
What is the most common soft tissue sarcoma in pediatric patients?
Rhabdomyosarcoma
Which two conditions are associated with aortic dissections/aneuryms?
Marfan Syndrome & Ehlers Danlos
According to the legendary Dr. Brooks, what are the Big 3 most common odontogenic cysts from least to most common and their associated locations?
3rd most common: Odontogenic keratocyst
Locations: Posterior jaws, man. molars & the crown of unerupted teeth
2nd most common: Dentigerous/follicular cyst
Locations - impacted/unerupted 3rd molars, max. canines & unerupted sites of the jaw
Most common - Periapical/radicular cyst
Locations - maxilla & permanent dentition
A patient presents with the chief complaint of swelling in the jaw, which is usually painless. You take an X-ray, which reveals a "soap-bubble/honeycomb" appearance in the posterior angle of the mandible. What would be your DDx for this patient?
Additional info - biopsy came back as a benign tumor
BONUS: What are the 4 subtypes of this tumor?
Ameloblastoma
Unicystic - luminal & intraluminal
Conventional - mural & solid/multicystic
What is telangiectasia and which cancer is this a key clinical presentation for?
Skin/mucosa with superficial blood vessels
Key presentation for chondrosarcoma (cancer of the cartilage)
What is the etiology for fibroma/focal fibrous hyperplasia (FFH) formation and what does it arise from?
Trauma
Arises from collagen buildup
Serum alkaline phosphatase (ALK)
Your pt presents for routine care. You notice that the patient's face is enlarged and has multiple skin lesions. A pano (pictured) was taken to reveal many PARLs. What is your DDx for this patient?
BONUS - Which cyst is this a variant of?
Nevoid Basal Cell Carcinoma
A variant of OKC (for the love of Jesus please also know the recurrence rate!)
Your patient presents for their routine care visit and after taking a panoramic radiograph you notice some snowflake-like RLs/ROs. The patient didn't report any concerns of pain or discomfort. A biopsy was done to reveal the following histopathology of what appears to be duct-like structures (pictured) What is your DDx for this patient?
BONUS - Where else is this odontogenic tumor commonly found and how does it present?
Adenomatoid Odontogenic Tumor (AOT)
What is the benefit of taking bisphosphonates for bone cancer treatment & what radiation dosage makes a patient susceptible to osteoradionecrosis of the jaw?
Bisphosphonates is the ideal treatment for bone disease/cancer and helps to prevent bone fractures.
Radiotherapy of >60 gy units makes patients more susceptible to developing ONJ.
What are the syndromes associated with the following neoplasms?
Mucosal Neuromas of Multiple Endocrine Neoplasia
Schwannoma/Neurilemmoma
Palisaded Encapsulated Neuroma (PEN)
Neurofibroma
NF1 - Neurofibroma
NF2 - Schwannoma/Neurilemmoma
MENIIB - Mucosal Neuromas of Multiple Endocrine Neoplasia
PEN - not associated with a syndrome
A patient with hyperparathyroidism would experience (increased/decreased) parathyroid hormone (PTH) & (increased/decreased) serum calcium.
Increased for both
What cyst of the jaws/neck presents as an oval corticated RL (pictured) and favors the inferior alveolar canal location-wise?
Static Bone Cyst/Stafne Bone Defect
Which of the following odontogenic tumors exhibits amyloid deposition upon histopathological examination, in addition to scattered calcifications in the posterior mandible?
A) Cementoblastoma
B) Calcifying epithelial odontogenic tumor/ Pindborg tumor
C) Odontogenic myoma
D) Complex odontoma
Calcifying Epithelial Odontogenic Tumor/ Pindborg tumor
Additional facts to know - associated with unerupted teeth, can horizontally resorb roots & can present as well-circumscribed, unilocular or multilocular with calcifications
10yr old patient presents with swelling on #14. Upon taking a radiograph, you notice root resorption of #13 & #15 as well. A biopsy was performed to reveal a starry sky histopathology (pictured). What is your DDx for this patient and what condition does this patient most likely have?
BONUS - What is the most common variant of this malignancy?
Burkitt Lymphoma
Most common variant - endemic
Associated with Epstein-Barr virus
Soft tissue myxomas are commonly associated with which rare genetic disorder?
Carney's Complex
Your patient presents for routine care and you notice that they are gazing upward for the entire appt which you find peculiar and make note of. Your pano (pictured) reveals multiple multilocular lesions along both sides of the body the mandible and jaw regions, but not the condyle and histopathology slide depicts many central giant cell granulomas. What is your DDx?
Cherubism
Another key clinical feature - many displaced teeth