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Jaw cysts and odontogenic tumours

Max Robinson, Keith Hunter, Michael Pemberton, and Philip Sloan

in Soames' & Southam's Oral Pathology

Odontogenic cysts and tumours arise from inclusion of tooth-forming epithelium and mesenchyme in the jaw bones during development. Cysts also arise from non-odontogenic epithelium trapped during ... More

Odontogenic cysts and tumours arise from inclusion of tooth-forming epithelium and mesenchyme in the jaw bones during development. Cysts also arise from non-odontogenic epithelium trapped during fusions or from vestigial structures. In addition, bone cysts that can arise at other skeletal sites may also occur in the jaws. Odontogenic cysts and tumours may be classified according to their putative developmental origins and biology. The classification of jaw cysts is shown in Fig. 6.1. Odontomes are hamartomatous develop­mental lesions of the tooth-forming tissues. Odontogenic tumours are uncommon and are usually benign. Ameloblastoma is the most com­mon odontogenic tumour and is described in detail. The other odon­togenic tumours are rare and only the principal features are presented. Very rare congenital lesions of possible odontogenic origin are men­tioned in the final section. A cyst may be defined as pathological cavity lined by epithelium with fluid or semi-fluid contents. However, clinically, the term encompasses a broader range of benign fluid-filled lesions, some of which do not possess an epithelial lining. The preferred definition is, therefore, ‘a pathological cavity having fluid or semi-fluid contents that has not been created by the accumulation of pus’. Cysts are commonly encountered in clinical dentistry and are generally detected on radiographs or as expansions of the jaws. Most cysts have a radiolucent appearance and are well circumscribed, often with a corticated outline. At least 90% of jaw cysts are of odontogenic origin. The clinico-pathological features of jaw cysts are summarized in Table 6.1. The incidence of the four most common jaw cysts are provided in Table 6.2. The epithelial lining of odontogenic cysts originates from residues of the tooth-forming organ. • Epithelial rests of Serres are remnants of the dental lamina and are thought to give rise to the odontogenic keratocyst, lateral periodon­tal, and gingival cysts. • Reduced enamel epithelium is derived from the enamel organ and covers the fully formed crown of the unerupted tooth. The dentiger­ous (follicular) and eruption cysts originate from this tissue, as do the mandibular buccal and paradental cysts. • Epithelial rests of Malassez form by fragmentation of Hertwig’s epi­thelial root sheath that maps out the developing tooth root. Radicular cysts originate from these residues. Less

Neck lumps

Max Robinson, Keith Hunter, Michael Pemberton, and Philip Sloan

in Soames' & Southam's Oral Pathology

Whilst dental healthcare professionals naturally focus on assessment of the teeth and the supporting tissues, they also have an important role in assessing the whole oro-facial complex and the ... More

Whilst dental healthcare professionals naturally focus on assessment of the teeth and the supporting tissues, they also have an important role in assessing the whole oro-facial complex and the neck. Assessment of the neck is particularly important, not least, because it contains the regional lymph nodes that are involved in immune surveillance of the head and neck region. The neck also contains the major salivary glands: the sub­mandibular gland and the tail of the parotid gland. Mid-line structures include the hyoid bone, larynx, and trachea, along with the thyroid gland and parathyroid glands. The assessment of these anatomical structures should form part of the routine clinical examination. The dis­covery of an abnormality in the neck, which may not have been noticed by the patient, may expedite the diagnosis of significant disease and facilitate a timely intervention. A through understanding of the anatomy of the neck is essential and informs the clinical examination. It is also important to understand the concept of the anatomical levels that map out the lymph node groups of the neck (Chapter 1; Fig. 1.2). Accurate assessment of the neck is usually best achieved by a combination of visual inspection and palpation, with the patient in a slightly reclined position, the clinician standing behind the patient. Any lumps, e.g. enlarged lymph nodes, are described by anatomical site, size, consistency (cystic, soft, rubbery, hard), whether the lump is mobile or fixed to the underlying tissue, and if palpation elic­its pain or discomfort. The combination of these parameters will help to formulate the differential diagnosis; for example, an isolated hard lump that is fixed to underlying structures is likely to represent meta­static cancer, whereas, bilateral soft lumps that are mobile and painful to palpation are likely to represent lymphadenitis as a consequence of systemic infection. Ultrasound examination can be used to ascertain important informa­tion about a neck lump such as the site (precise anatomical location, superficial or deep), size, consistency (solid or cystic), and multi-focality. Doppler settings can help to establish the vascularity of a lesion and its proximity to major vessels. Less

Functional appliances

Claire Nightingale and Jonathan Sandy

in Illustrated Questions in Orthodontics

Question 4.1 What is this? How frequently does it occur? What causes it? Describe the mechanism and timing of palatal shelf closure.

Oral medicine and oral pathology

Nicholas Longridge, Pete Clarke, Raheel Aftab, and Tariq Ali

Katharine Boursicot and David Sales (eds)

in Oxford Assess and Progress: Clinical Dentistry

The mouth has often been looked at as a window into the body, and this is no truer than in oral medicine. The oral mucosa is a highly adapted and robust tissue, which, at the same time, can be very ... More

The mouth has often been looked at as a window into the body, and this is no truer than in oral medicine. The oral mucosa is a highly adapted and robust tissue, which, at the same time, can be very susceptible to changes in homeostasis. Dysregulation of the immune system, alter­ations in cellular signalling pathways, or insult from exogenous stimuli can lead to an array of weird and wonderful oral lesions. Clinicians today are likely to see changes to the oral mucosa on a regular basis— from common ulcers, bony lumps, or white patches to more exotic pigmented lesions or unusual lumps. It is therefore vital to have good basic knowledge of common conditions and be able to iden­tify lesions that need urgent referral and treatment. It is important to take a thorough medical history, as many oral symptoms can be associ­ated with systemic conditions or changes in medication. A temporal link can be a good indicator of causation from medication changes. Having a strategic method of constructing a list of differential diag­noses, such as the surgical sieve, can be a great aide- memoire to ensure all the pertinent questions and investigations have been completed. However, it must be noted that many conditions cannot be accurately diagnosed without histological examination, and therefore, referral for specialist input is commonplace. Oral medicine can be a tricky discipline, fraught with challenging pa­tients to manage, particularly those with chronic conditions. Conversely, the diagnostic challenges make for a thoroughly rewarding and stimu­lating discipline. The questions in this chapter will test your knowledge of disease symptoms, links to medical conditions, and patient management. Key topics include: ● Patient assessment and diagnosis ● Investigations ● Basic histology ● Infections (bacterial, viral, and fungal) ● Ulcers ● Soft tissue swelling ● Bony lumps ● Systemic conditions ● White, red, pigmented, and mixed patches ● Oral cancer ● Pharmacology. Less

Exam 2

Rebecca Hanlon, John Curtis, Hulya Wieshmann, David White, Caren Landes, and Val Gough

in Long Cases for the Final FRCR 2B

Case 2.1 Clinical details A 22-year-old male presenting to accident and emergency following minor facial trauma. Imaging Orthopantomogram (OPG) X-ray. Axial CT image of the ... More

Case 2.1 Clinical details A 22-year-old male presenting to accident and emergency following minor facial trauma. Imaging Orthopantomogram (OPG) X-ray. Axial CT image of the mandible. Whole-body 99mTc-MDP bone scan. Axial HRCT images...Less

Best of Five Answers

Caroline Patterson and Meg Coleman

in Revision Notes for the Respiratory Medicine Specialty Certificate Examination

D. Mycoplasma, Chlamydia, and (variably) Leigonella are considered atypical pathogens in pneumonia. All may cause a ‘flu like illness followed by a dry cough. Features of Mycoplasma include ... More

D. Mycoplasma, Chlamydia, and (variably) Leigonella are considered atypical pathogens in pneumonia. All may cause a ‘flu like illness followed by a dry cough. Features of Mycoplasma include autoimmune haemolytic anaemia (secondary to cold agglutinins), thrombocytopenia, SIADH, erythema multiforme (target...Less

Head and neck syndromes

Nicholas Longridge, Pete Clarke, Raheel Aftab, and Tariq Ali

Katharine Boursicot and David Sales (eds)

in Oxford Assess and Progress: Clinical Dentistry

A comparatively small chapter, syndromes of the head and neck are gen­erally rare. It is unlikely that the majority of clinicians will diagnose or treat patients affected by many of the syndromes ... More

A comparatively small chapter, syndromes of the head and neck are gen­erally rare. It is unlikely that the majority of clinicians will diagnose or treat patients affected by many of the syndromes discussed. However, it is highly likely that clinical findings or presenting features may find their way into undergraduate academic examinations. Most syndromes are presented in the literature as a specific list of associated clinical findings, and many are still referred to eponymously. Some of the syndromes with oral manifestations can also be associated with more sinister conditions and, as such, a broad knowledge of the common syndromes with orofacial manifestations is important. It is highly advised to read the chapter on syndromes of the head and neck in the Oxford Handbook of Clinical Dentistry. Key topics include: ● Syndromes associated with hypodontia ● Syndromes affecting orofacial development ● Syndromes linked with gastrointestinal conditions ● Syndromes subsequent to infections. Less

Oogenesis in Crustaceans: Ultrastructural Aspects and Selected Regulating Factors

Mariusz K. Jaglarz and Szczepan M. Bilinski

in Reproductive Biology: The Natural History of the Crustacea, Volume 6

This chapter explores ultrastructural aspects of crustacean oogenesis. It focuses on various cellular processes associated with female germline development in selected crustacean groups. Oogenesis in ... More

This chapter explores ultrastructural aspects of crustacean oogenesis. It focuses on various cellular processes associated with female germline development in selected crustacean groups. Oogenesis in crustaceans comprises four stages: proliferation of germline cells, previtellogenesis, vitellogenesis, and formation of egg coverings. The greater part of oogenesis occurs in the ovary. In Crustacea, two structurally and functionally distinct types of ovary are recognized: panoistic and meroistic. In panoistic ovaries, all germline cells differentiate into oocytes, and this type of ovarian organization occurs in a great majority of crustaceans, including Malacostraca. In contrast, in the meroistic ovaries, oogonial cells are connected by intercellular bridges and form characteristic linear cysts. Within each cyst, only one cell becomes an oocyte, and the remaining cells differentiate into nurse cells. Meroistic ovaries are typical for Branchiopoda and Ostracoda: Podocopida. Ultrastructural studies reveal that the nucleus and cytoplasmic organelles of the oocyte are highly synthetically active in the panoistic ovary, whereas in the meroistic type, oocyte development is supported, to some extent, by accompanying nurse cells. During previtellogenesis, oocytes accumulate large numbers of various organelles, e.g. ribosomes, mitochondria, and cisternae of endoplasmic reticulum. The oocyte cytoplasm also contains characteristic disc-shaped bodies and cortical granules. A comparative analysis of the proteinaceous yolk formation in different crustaceans reveals two distinct types of vitellogenesis (autosynthesis and heterosynthesis), and indicates that a mixed type prevails in these arthropods. In most crustacean species, germline cells associate with somatic follicle cells that may fulfill several functions during oogenesis.Less

Colorectal Surgery

Richard G. Molloy, Graham J. MacKay, Campbell S. Roxburgh, and Martha M. Quinn (eds)

in SBAs and EMIs for the General Surgery FRCS

Questions Single Best Answers A 73 year old male presents with left iliac fossa pain and diarrhoea. On examination he has LIF peritonism and inflammatory markers are raised with a WCC 18 × 10/L ... More

Questions Single Best Answers A 73 year old male presents with left iliac fossa pain and diarrhoea. On examination he has LIF peritonism and inflammatory markers are raised with a WCC 18 × 10/L and CRP 240mg/L. A CT scan confirms diverticulitis...Less

Head and Neck Surgery

Stuart Winter and Declan Costello (eds)

in MCQs for ENT: Preparation for the FRCS (ORL-HNS)

Questions In the course of performing a parotidectomy, you are having difficulty identifying the facial nerve. Which of the following would be least useful in identifying the nerve? Following the ... More

Questions In the course of performing a parotidectomy, you are having difficulty identifying the facial nerve. Which of the following would be least useful in identifying the nerve? Following the posterior belly of digastric Identifying the tip of the styloid process...Less

Adventure Travellers

Dom Colbert

in MCQs in Travel Medicine

There has been a remarkable increase in adventure and extreme travel in recent years. This includes travel in remote areas, mountain climbing, e.g. Kilamanjaro, living in rough and dangerous ... More

There has been a remarkable increase in adventure and extreme travel in recent years. This includes travel in remote areas, mountain climbing, e.g. Kilamanjaro, living in rough and dangerous situations, and working in slums and shanty towns. Young adults, students, and backpackers constitute the majority of adventure travellers. They also constitute a group that is the most careless about health and most loathe spending money on a pre-travel consultation. Chapter 10 is devoted to special activities, which is a natural continuation of adventure travel. Less

Establishing the Diagnosis

Daniel A. Brinton and Charles P. Wilkinson

in Retinal Detachment: Priniciples and Practice

The differential diagnosis of rhegmatogenous retinal detachment includes secondary (nonrhegmatogenous) retinal detachment and other entities that may simulate a retinal detachment. ... More

The differential diagnosis of rhegmatogenous retinal detachment includes secondary (nonrhegmatogenous) retinal detachment and other entities that may simulate a retinal detachment. Nonrhegmatogenous detachments are categorized as exudative (serous) and tractional detachments. Conditions that may be mistaken for retinal detachment include retinoschisis, choroidal detachment or tumors, and vitreous membranes. Sometimes benign findings in the peripheral retina are mistaken for retinal breaks. The most prominent feature of the fundus is the optic nerve head or disc, the only place in the human body that affords a direct view of a tract of the central nervous system. The foveola, the functional center of the fundus, is located in the center of the fovea, which has a diameter of about 5°. The macula is centered on the fovea and has a diameter of about 17°. The multiple branches of the central retinal artery are readily identifi ed by their bright red color and relatively narrow caliber. The multiple tributaries of the central retinal vein are recognized by their dark red color and relatively wider caliber. In a darkly pigmented fundus, the choroidal vessels in the posterior pole can be obscured from view, but in an eye with minimal pigment, they are readily visible. The venous tributaries of the choroid that make up the vortex veins are usually easily seen. The most prominent features of the choroidal venous system are the vortex ampullae, of which there are usually four (but sometimes more). They are located approximately in the 1-, 5-, 7-, and 11-o’clock meridians, just posterior to the equator. The horizontal meridians are usually identifiable by their radially oriented, long posterior ciliary nerves, and infrequently the long posterior ciliary artery can be seen adjacent to the nerve. The nerve is relatively broad and has a yellow color, and the artery is identifiable by its red color. The artery is usually inferior to the nerve temporally, and superior to it nasally (Figure 5–1). Less

Gynaecology and genitourinary medicine

Kevin Hayes (ed.)

in Oxford Assess and Progress: Clinical Specialties

Gynaecological practices are changing constantly, with more emphasis on management in primary care, conservative, rather than surgical, management of conditions, and an increase in ... More

Gynaecological practices are changing constantly, with more emphasis on management in primary care, conservative, rather than surgical, management of conditions, and an increase in sub-specialization such as gynaecological oncology and urogynaecology. This chapter reflects these changes and covers the commonest areas in this interesting field. Sexual health is a specialty in its own right. The number of cases of sexually transmitted infections are rising in the UK, despite efforts to raise awareness of safe sex, so knowledge of their presentations is important. The UK also has the highest rate of teenage pregnancy in Europe, and the Government has set targets to improve access to contraceptive advice for women. In recent years, astounding advances have been made in the treatment of human immunodeficiency virus (HIV) infection, and people with HIV can now expect to have a much better quality of life. Although this chapter primarily focuses on diseases affecting women, we have included questions on the sexual health of men to represent the full spectrum of sexual health practice. Less

Post- operative care

Sambit Mukhopadhyay and Medha Sule (eds)

in Tasks for Part 3 MRCOG Clinical Assessment

abstract This task assesses the following clinical skills: • Patient safety • Communication with colleagues • Applied clinical knowledge You are the ST5 on duty. Your ST1 who is taking her first on- ... More

abstract This task assesses the following clinical skills: • Patient safety • Communication with colleagues • Applied clinical knowledge You are the ST5 on duty. Your ST1 who is taking her first on- call in the department has just received a phone call from the out- of- hours surgery, and you have accepted to see this lady in the emergency. She had a laparoscopy done three days ago, for suspected endometriosis. Now, she presented with right sided loin pain and mild fever. The GP thinks she is significantly tender in her right loin on examination. You have advised to bring her in to rule out ureteric injury. Your ST1 wants to discuss this case with you before the patient arrives in emergency. You are expected to answer the questions of the trainee and demonstrate your teaching skills. You have 10 minutes for this task (+ 2mins initial reading time). Please read the instructions to candidate and the actor. Allow the candidate to conduct the interview undisturbed unless they are straying off the track of the question (in which case you can show them their instructions again). This conversation is going to be among two professionals where the ST5 should demonstrate the following teaching skills: • Ability to set objectives and structure the session. • Establish the background knowledge of the learner • Identify their learning needs • Use appropriate diagrams or refer to appropriate reference readings/ evidence to support teaching • Allow the ST1 to make contribution in the discussion, invite questions, check understanding, address concerns and facilitate learning by giving some relevant task • Give feedback and gather feedback • Plan a follow- up meeting to check learning Record your overall clinical impression of the candidate for each domain (e.g. should this performance be pass, borderline, or a fail). Less

Musculoskeletal and trauma

RWK Lindsay, JSJ Gillespie, RM Kelly, R Sathyanarayana, and PA Burns

in SBAs for the Final FRCR 2A

Questions A 50-year-old man who has been previously well presents with low back pain. Plain film reveals an osteolytic midline lesion in the lower sacrum containing secondary bone sclerosis in the ... More

Questions A 50-year-old man who has been previously well presents with low back pain. Plain film reveals an osteolytic midline lesion in the lower sacrum containing secondary bone sclerosis in the periphery, as well as amorphous peripheral calcifications. A lateral film shows anterior displacement...Less

Genito-urinary, adrenal, obstetrics and gynaecology, and breast

RWK Lindsay, JSJ Gillespie, RM Kelly, R Sathyanarayana, and PA Burns

in SBAs for the Final FRCR 2A

Questions E. coli, with or without an underlying diagnosis of diabetes mellitus, is the most common pathogen behind many urological conditions. All of the following conditions are most commonly due ... More

Questions E. coli, with or without an underlying diagnosis of diabetes mellitus, is the most common pathogen behind many urological conditions. All of the following conditions are most commonly due to E. coli infection except one, which one? Xanthogranulomatous pyelonephritis (XGP). B....Less

Jaundice

Hugo Farne, Edward Norris-Cervetto, and James Warbrick-Smith

in Oxford Cases in Medicine and Surgery

The metabolism of bilirubin in humans is summarized in Figure 14.1 and can be divided into three sequential steps: 1 Production of unconjugated bilirubin. Red blood cells are broken down by ... More

The metabolism of bilirubin in humans is summarized in Figure 14.1 and can be divided into three sequential steps: 1 Production of unconjugated bilirubin. Red blood cells are broken down by macrophages (mainly in the spleen), which degrade haemoglobin into iron and unconjugated (water insoluble) bilirubin. The iron is stored inside transferrin proteins. Unconjugated bilirubin travels to the liver bound to albumin. In disease, unconjugated bilirubin can be produced by haemolysis of red cells intravascularly, rather than in the spleen. 2 Conjugation of bilirubin. Liver hepatocytes uptake unconjugated bilirubin and conjugate it to glucuronate, thus making water soluble, conjugated bilirubin. 3 Excretion of bilirubin. Once conjugated, bilirubin is secreted into the bile canaliculi. Conjugated bilirubin flows with bile down the bile ducts and into the duodenum. Inside the bowel, conjugated bilirubin is metabolized by bacteria into colourless products (urobilinogen, stercobilinogen). Some of these can be reabsorbed by the gut and excreted via the kidneys, but the vast majority are oxidized in the gut into coloured pigments (urobilin, stercobilin) which give faeces their brown colour. Consequently, if there is complete obstruction of the bile ducts there will be no flow of conjugated bilirubin into the gut, no conversion into urobilinogen, and therefore not even a trace of urobilinogen in the urine. The terminology is confusing because different people mean different things. If you are going to use this terminology, make sure that you and your colleagues agree on the definitions. Nonetheless, this is what people usually mean: • Prehepatic jaundice: this refers to jaundice caused by an excessive production of bilirubin. Remember that bilirubin is produced by the breakdown of haemoglobin in the blood vessels or the spleen, hence the term prehepatic. • Hepatic jaundice: for some people, this means any jaundice due to pathology in the liver (anatomically), such as points 3, 4, and 5 in Figure 14.1, and can thus include problems with hepatocytes (e.g. hepatitis) or with the bile canaliculi (e.g. primary sclerosing cholangitis, PSC). Less

Central nervous and head and neck

RWK Lindsay, JSJ Gillespie, RM Kelly, R Sathyanarayana, and PA Burns

in SBAs for the Final FRCR 2A

Questions A 9-year-old male presents to the paediatric A&E department with a history of increasing drowsiness over the last 24 hours. Neurological assessment reveals that there is absence of upward ... More

Questions A 9-year-old male presents to the paediatric A&E department with a history of increasing drowsiness over the last 24 hours. Neurological assessment reveals that there is absence of upward gaze. A CT brain is requested which reveals hydrocephalus, with marked dilatation of the...Less

Epidemiological and Geographical Considerations

Dom Colbert

in MCQs in Travel Medicine

It is useful to have a good knowledge of geography and to have at least a globe or atlas in the clinic so that the patient can point out a planned itinerary. Appropriate internet facilities must be ... More

It is useful to have a good knowledge of geography and to have at least a globe or atlas in the clinic so that the patient can point out a planned itinerary. Appropriate internet facilities must be available so that information on local diseases, current outbreaks, and required immunizations can be accessed speedily. Less

Oral medicine and oral surgery in children

A. Crighton and J.G. Meechan

in Paediatric Dentistry

Children experience a variety of oral medicine and oral surgical problems, of which some last into adulthood and some resolve with or without intervention by the dentist or doctor. Even where the ... More

Children experience a variety of oral medicine and oral surgical problems, of which some last into adulthood and some resolve with or without intervention by the dentist or doctor. Even where the same pathology is found in both adults and children the approach to management and the issues of delivering dental care may be very different in each group. This Chapter reviews conditions of the orofacial region, oral soft tissues, and bone that are frequently found in children or require a particular approach to their management in a paediatric population. The examination of the child starts as soon as the dentist and the child meet. Observations about a child’s weight, height, and development for his/her age, the attachment to the parent or siblings, and even the clothing worn by the child can be important. Apart from being a good starter to a conversation, the child’s new clothes or shoes can suggest a period of growth. Facial and perioral observation is best completed when seeing the child initially, as first impressions of swelling or asymmetry can be investigated later during the standard clinical examination. Although the history will elicit the findings needed to diagnose dental as well as non-dental conditions, the information needed for non-dental conditions and the impact that these conditions have on the child need particular exploration. When at all possible the child should be the source of the information—usually supported by the views of a parent—but it is important to have the child as the focus for initial information gathering. Be careful not to interpret the language used too literally—not every ‘ulcer’ turns out to be such, and always ask ‘What do you mean by …’ if the child or parent uses a word with a particular meaning to the dentist. Many ulcers subsequently turn out to be ‘sore bits’ with questioning—let the child use language with which they are comfortable. Always ask the child for permission before starting an extra- or intraoral examination of the soft tissues and explain what is going to happen. Less