Download to read offline
More Related Content
Similar to tumorsofjawbones-2.ppt describing details of all jaw tumours
tumorsofjawbones-2.ppt describing details of all jaw tumours
- 1. TUMORS OF JAWBONES TUMOR / NEOPLASM – Abnormal new growth which results from Excessive, Autonomous, Uncoordinated ,Purposeless Proliferation of Cells which continues its growth even after cessation of stimuli.
- 2. TUMORS OF JAWBONES BENIGN TUMOR MALIGNANT TUMOR Grows slowly Rapid growth Encapsulated Poorly circumscribed, Irregular Adjoining structures Compressed Invasion of adjoining structures Not Fixed Fixed to sorrounding structures No Tendency Tendency towards Ulceration & Hemorrhage Exhibits no Metastasis Metastasis present
- 3. TUMORS OF JAWBONES • All Tumors - 2 components Parenchyma - Proliferating Tumor Cells - Nature & Evolution Supportive Stroma – Fibrous Connective Tissue & Blood Vessels – Provide Framework on which Parenchymal Tumor Cells Grow • Suffix ‘ oma’ - Benign Tumor Malignant tumors of Epithelial Origin - CARCINOMAS Malignant tumors of Mesenchymal Origin - SARCOMAS • BENIGN JAW TUMORS – 2 TYPES ODONTOGENIC TUMORS NONODONTOGENIC TUMORS
- 4. BENIGN JAW TUMORS •CLASSIFICATION OF ODONTOGENIC TUMORS ( KRAMER, PINDBORG , SHEAR – 1992) A. ODONTOGENIC EPITHELIUM 1. Ameloblastoma 2. CEOT / Pindborg’s Tumor 3. Clear Cell Odontogenic Tumor 4. Squamous Odontogenic Tumor B. Odontogenic Epithelium with Odontogenic Ectomesenchyme With / Without Dental Hard Tissue Formation 1. Ameloblastic Fibroma 2. Ameloblastic Fibrodentinoma 5. Compound Odontome 3. OdontoAmeloblastoma 6. Complex Odontome 4. Adenomatoid Odontogenic Tumor ( AOT)
- 5. CLASSIFICATION OF ODONTOGENICTUMORS C. Odontogenic Ectomesenchyme with / without Odontogenic epithelium 1. Odontogenic Fibroma 2. Myxoma 3. Benign Cementoblastoma NON ODONTOGENIC TUMORS (WHO Classification) A . OSTEOGENIC NEOPLASMS Cemento Ossifying Fibroma B. NON NEOPLASTIC BONE LESIONS Fibrous Dysplasia Cemento Osseous Dysplasia - Periapical Cemento Osseous Dysplasia - Focal Cemento Osseous Dysplasia - Florid Cemento Osseous Dysplasia
- 6. Classification Of NonOdontogenic Tumors C. CEMENTO OSSEOUS DYSPLASIAS Cherubism Central Giant Cell Granuloma
- 7. General Principles inManagement of Jaw Lesions • HISTORY OF LESION Duration – Long without Pain – Benign Neoplasm Short , Rapid Growth – Malignant Lesion Mode of Onset - H/o Trauma - Osteogenic Sarcomas Rapid growth – Benign Slow growth - Malignant Site & Shape Progress of Lesion – Stationary, Continous, Intermittent Change in Character of Lesion – Ulcerations, Fluctuation Associated Symptoms – Pain , Paresthetia, Tenderness, Lymphadenopathy, Difficulty in breathing Trismus Recurrence Loss of Body weight Habits
- 8. General Principles inManagement of Jaw Lesions • INSPECTION Number Size Shape Color Surface Skin Over Swelling Pedunculated / Sessile • PALPATION Consistency Pulsations Fixity Lymph Node Examination • IMAGING Plain Radiographs CT Scans MRI Angiographic Studies Bone Scans / Scintigraphy
- 9. BIOPSY • EXFOLIATIVE CYTOLOGYASPIRATION BIOPSY FNAC EXCISIONAL BIOPSY INCISIONAL BIOPSY Exfoliative Cytology - Malignancy ,Scrapings are transfered to slide , stained & examined under microscope Aspiration Biopsy – Nature of lesion FNAC - Deep seated lesions ( salivary glands, neck, ) Excisional Biopsy Incisional Biopsy
- 10. General Principles inManagement of Jaw Lesions • Goal of Treatment Complete Eradication of lesion Preservation of normal tissue Excision with least morbidity Restoration of tissue loss, form , function Long term follow up • Gold ,Upton, & Marx 1991 – Terminology for Surgical Excisions Enucleation Curettage Marsupialization Recontouring Resection with Continuity Defect Resection without Continuity Defect Disarticulation
- 11. General Principles inManagement of Jaw Lesions • ENUCLEATION With / Without CURETTAGE - INDICATIONS - Small Benign Tumors , Non Aggressive - Tumors which tend to grow by Expansion rather than Infiltration - Distinct seperation between sorrounding bone & Lesion - Cortical margin of bone that separates Tumor / Cyst from bone Indicated in Following Tumors a) Odontogenic Tumors Odontoma Ameloblastic Fibroma Ameloblastic Fibroodontoma AOT Cementoblastoma
- 12. General Principles inManagement of Jaw Lesions B) Non Odontogenic Tumors Ossifying Fibroma Cherubism Osteoblastoma Central Giant Cell Granuloma C) Other Lesions Hemangioma Neurofibroma Neurilemmoma Eosinophilic Granuloma
- 13. General Principles inManagement of Jaw Lesions • MARGINAL RESECTION / PERIPHERAL OSTEOTOMY RESECTION WITHOUT CONTINUITY DEFECT EN – BLOC RESECTION INDICATIONS - Benign lesions with known H/O Recurrence - Lesions that are incompletely Encapsulated - Recurrent Lesions previously treated by Enucleation - Ameloblastoma, CEOT, Myxoma, Ameloblastic Odontoma, Squamous Odontogenic Tumor Benign Chondroblastoma , Hemangiomas • Allows for complete Excision of Tumor ,Continuity of Jaw Bone is maintained – Need for Secondary Cosmetic Surgery not required
- 14. General Principles inManagement of Jaw Lesions • SEGMENTAL RESECTION OF JAW - Infiltrative Lesions that have tendency to recur - Lesions which are close to Lower border, Posterior border of mandible, - Lesions that extend to Maxillary sinus / Nasal cavity - Malignant Lesions with high recurrence potential - Maxillary Ameloblastomas with high Recurrence rate
- 15.
- 23. AMELOBLASTOMA History - Cuzack –1827 - Robinson – Unicentric , NonFunctional , Intermittent in Growth, Anatomically Benign , Clinically Persisitent - WHO – True Neoplasm of Enamel Organ which does not undergo differentiation to the point of Enamel Formation - Benign but locally invasive Epithelial Odontogenic Neoplasm with strong tendency to recur - Origin - - Late Development Source Cell Rests of Enamel Organ Remnants of Dental Lamina Cell Rests of Malassez Follicular Sacs
- 24. AMELOBLASTOMA - Early EmbryonicSources – Disturbances of Developing Enamel organ Dental Lamina Tooth Buds - Basal Cells of Surface Epithelium - Epithelium of Primordial , Dentigerous , Lateral Periodontal Cyst - Heterotropic Epithelium from Pituitary Gland - Incidence - 18% of all Odontogenic Tumors 3 – 4 th decade of life - Site Mandible : Maxilla - 5:1 Mandible – Posterior molar - 60 % Blacks – Anterior Maxilla
- 25. AMELOBLASTOMA • Clinical Features EarlyStages – Asymptomatic Slow growing, Painless, Hard , NonTender, Ovoid Swelling Mobile Teeth, Ill Fitting Denture, Malocclusion, Exfoliation Nasal Obstruction Paresthetia Egg shell crackling Non Encapsulated – invades by destroying rather than pushing Transform in to Malignant form ( 2 – 4 %)
- 26. AMELOBLASTOMA • Radiological Features UnilocularRadiolucency - 6% Multilocular Radiolucency - 15% Honeycomb Appereance – Multilocular radiolucency with compartmentalized appearance due to Bony Septa – Giant cell lesions Fibro Myxoma Root Resorption ( 30%) Tooth Displacement Buccolingual cortical Expansion - 80% Neurovascular bundle – displaced Desmoplastic Ameloblastoma – Radioopaque – Dense Connectivetissue Anterior Maxilla / Mandible
- 27. AMELOBLASTOMA • Differential Diagnosis Multilocularlesions - Dentigerous Cyst OKC Cherubism Odontogenic Myxoma Giant cell granuloma ABC
- 28. AMELOBLASTOMA • TREATMENT Curettage –Should never be considered Unicystic Lesions – Recurrence Rate (18% – 25%) Multicystic Lesions - Recurrence Rate ( 55% - 100%) Microscopically infiltrates Bone beyond Tumor Interface Safe Margin of uninvolved bone of 2 cm should be removed • Multicystic Ameloblastoma – En Bloc Resection without Continuity Defect Segmental Resection with Continuity Defect - Cortical Bone perforated
- 29. AMELOBLASTOMA • RECONTRUCTION Immediate Reconstruction– Autogenous Free Bone Graft - Iliac / Rib Graft Autogenous Bone Marrow + Reconstruction Plate Bank Allogenic Bone Crib Reconstruction Plate with / without condylar process Vascularized Composite Pedicled Graft of Bone + Myocutaneos tissue
- 53. AMELOBLASTOMA • Tumor confinedto Maxilla without Orbital Floor involvement Partial Maxillectomy • Tumor involving Orbital Floor – Total Maxillectomy • Tumor involving Orbital Contents – Total Maxillectomy + Orbit Exonteration • Tumor involving Skull Base – Neurosurgical Procedure • Prognosis Multicystic Ameloblastoma – 50% Recurrence rate – 5 yrs Post op Long Term Follow up Must
- 54. CALCIFYING EPITHELIAL ODONTOGENICTUMOR - CEOT / Pindborg’s Tumor - Origin – Epithelial remnants of Enamel organ - 1% of all Odontogenic Tumors - 30 – 50 yrs - Mandible – molar - 50% associated with unerupted / embedded tooth - Painless slow growing , Nasal obstruction, Epistaxis - Uni / Multi locular radiolucency with circumscribed / diffuse border - Honey comb appereance - Driven Snow Appereance – scattered flakes of calcification seen around crown of embedded tooth - Recurrence – 15%
- 55. ADENOMATOID ODONTOGENIC TUMOR(AOT) - 3 – 7% of all Odontogenic Tumors - 10 – 20 yrs Females Maxilla ( 65%) – Anterior region - Associated with Impacted Canine – 74% - Painless swelling - Unilocular Radiolucency around crown of impacted tooth - well defined margins. Radiolucency shows Fine Calcifications – Snow Flakes - DD – Pindborg’s tumor , CEOC, Amelobastoma - Treatment Enucleation – encapsulated - Recurrence rare
- 65. ODONTOMA - Growth inwhich both Epithelial & Ectomesenchymal cells exhibit coplete / incomplete differentiation in to tooth formation - 1 – 2 decade - Complex - Mandible – 67% , Posterior Jaw - Compound - Maxilla , Anterior Jaw - Hamartomatous malformation - Composite lesion - COMPOUND – consist of calcified toothlike structures / miniatured Dwarfed tooth - COMPLEX COMPOSITE ODONTOMA Disorderly & Haphazard arrangement of Calcified Dental Structures - R / F - Compound – Radioopaque Mass with anatomic similarity to normal tooth Complex – Radioopaqe not resembling tooth - Treatment - Enucleation
- 66. CEMENTOBLASTOMA / TRUECEMENTOMA - Tumor of connective tissue forming cementum like calcification fused to tooth root - 10 – 20 yrs Premolar – Molar region - Mandibular lesions – attached to single tooth - Maxillary lesions – fused to 2 / more teeth - Slow growing lesion ,vital tooth , Resorption of cortical bone - R / F – Oval radioopaque mass with radiolucent periphery fused to single / multiple roots - DD – Condensing Osteitis, Cementifying Fibroma,Osteoblastoma - Treatment – Enucleation, Large lesions can be cut in to smaller pieces
- 67. CEMENTO OSSIFYING FIBROMA -Benign lesion arising from undifferentiated cells of Periodontal Ligament - 3 – 4 decade Females – 5:1 Mandible – Premolar molar - Painless slow persistent growth – Facial asymmetry - R/F – Early – Radiolucent Late – Radioopaque - Tr - Enucleation
- 68. OSTEOMA - Benign tumorsconsist if Mature compact / cancellous bone - Peripheral – surface of jaw bone as Polypoid / sessile mass Endosteal – develop centrally within medullary bone - Slow growing asymptomatic bony hard masses - R / F – Radioopaque mass - Tr – surgical excision
- 69. BENIGN OSTEOBLASTOMA - CentralBone tumor – actively proliferating Osteoblasts, multinucleated Giant cells in Osteoid tissue - Males , < 25yrs Post aspect of jaws - R / F – Sun ray appereance - Central opacity with thin rim of radiolucency - Tr – surgical excision
- 70. ODONTOGENIC FIBROMA - CentralBenign Odontogenic Tumor - Contains Fibrous CT stroma & inactive Odontogenic Epithelium - Intraosseous – Central Gingiva – Peripheral - Slow persistent growth, asymptomatic cortical expansion, Mandible - Males, Mean age 37yrs - R / F – Multiloculated radiolucency,well / ill defined sclerotic margin Root divergence / resorption - Tr – Enucleation & Curettage
- 71. ODONTOGENIC MYXOMA - Centralbenign slow growing , infiltrative tumor of jaws which cause destruction of cortex - Found in Tooth bearing areas of jaws Mandible Females - Children - R / F – Multilocular / soapbubble / honeycomb - Recurrence rate – 33% - Tr – Resection with / wthout continuity defect
- 72.