3. Benign Odontogenic tumors
CLASSIFICATION
1) odontogenic epithelium without odontogenic
ectomesenchyme
II) Odontogenic epithelium with odontogenic ectomesenchyme
with or without hard tissue formation
111)Odontogenic ectomesenchyme with or without included
odontogenic epithelium.
5. II). Odontogenic epithelium with odontogenic ectomesenchyme with or
without hard tissue formation
1. Ameloblastic fibroma
2. Ameloblastic fibrodentinoma
3. Ameloblastic fibro-odontoma
4. Odontoameloblastoma
5. odontoma
6. 111).Odontogenic ectomesenchyme with or without included
odontogenic epithelium.
1. Odontogenic fibroma
2. Myxoma (myxofibroma)
3. Cementoblastoma (benign cementoblastoma, true
cementoma)
7. General treatment of jaw
lesions
Gold,Upton and Marx in 1991 have presented a
standardised surgical terminology for the excision of
lesions in the bone.
All excisions of the lesions involving jaw bones can be
described by the following terminologies :-
Enucleation
Curettage [Involves removal of the pathologic tissue by
means of vigorous scraping.]
Marsupialisation
Recountouring
Resection without continuity defect
Resection with continuity defect
Disarticulation
8. Principles of treatment of jaw
tumors
Complete eradication of the lesion
Preservation of normal tissue as permissible as
possible
Excision with least morbidity
Restoration of tissue loss form & function
Long term follow up
9. ENUCLEATION
PRINCIPLE: enucleation allows for the cystic cavity to be
covered by a mucoperiosteal flap and the space fills with blood
clot, which will eventually organize and form normal bone.
ADVANTAGES:
• Primary closure of wound
• Rapid healing
• Postoperative care is reduced
• Thorough examination of the entire cystic lining can be done.
10. DISADVANTAGES:
• Cannot observe the healing of cavity as with
marsupialization
• Weakening of jaws
• Damage to adjacent vital structures
• Pulpal necrosis
11. Marsupialization
Principle: Marsupialization/decompression, refers to
creating a surgical window in the wall of the cyst, and
evacuation of the cystic contents.
This process decreases intra-cystic pressure and
promotes shrinkage of the cyst and bone fill. The only
portion that is removed is the piece removed to produce
the window.
12. Advantages:
Simple procedure
Spares vital structures
Allows eruption of teeth
Prevents oronasal, oroantral fistulae
Prevents pathological fractures
Reduces operating time
Reduces blood loss
Helps shrinkage of cystic lining
Allows endosteal bone formation to take place
Alveolar ridge is preserved
13. Disadvantages:
Pathologic tissue is left in situ
Histological examination of the entire cystic lining is not
done
Prolonged healing time
Inconvenience to the patient
Prolonged follow up visits
Periodic irrigation of the cavity
Regular adjustments of plug
Periodic changing of pack
Secondary surgery may be needed
Formation of slit like pockets that may harbor food stuffs
Risk of invagination and new cyst formation
15. This is the treatment of choice for small aggressive
lesions with high recurrence rate.
Intraoral approach is used for lesions anterior to the
ramus of the mandible, whereas those lesions involving
the ramus of the mandible are approached extraorally
17. INDICATION
Lesions that have tendency to recur
Lesions that extend close to inferior or posterior border
of mandible,the maxillary sinus or the nasal cavity.
Lesion close to the borderbof the jaw with the possibility
of postoperative pathologic fracture
18. Maxillectomy
In case of tumors involving the maxilla partial or total
maxillectomy are done
19. Partial maxillectomy is done through an intraoral approach
For hemimaxillectomy an extraoral approach known as Weber
Fergusson approach is indicated for adequate access into the
sinus and orbital areas.
An incision is made to split the lip along the philtrum upto and
around the alar base, continuing along the lateral surface of
nose upto medial canthus of the eye
20.
21. Intraorally the incision is continued down through the
gingival margin.
It is connected with a horizontal incision at the depth of the
labiobuccal vestibule,extending back to the maxillary
tuberosity.
From here the incision is turned medially across the
posterior edge of the hard palate.
It then turns 90 degree anteriorly several millimeters to
proximal side of midline.
22. Lip incision is made from the skin to the mucous
membrane,continuing intraorally to the buccal sulcus incision
extending posteriorly to the tuberosity.
A subperiosteal flap is elevated extending superiorly till the
infraorbital rim, thus exploring the lateral surface of the
maxilla and zygoma
Infraorbital nerve and vein are ligated and sectioned
A cut is made in the zygoma along the zygomaticomaxillary
suture extending to the orbital floor
a cut is made at the frontal process of maxilla extending to
the nasal fossa
23. Two cuts are connected along the orbital floor
Cut is then extended into the hard palate
Pterygoid plates are seperated using a curved
osteotome to separate maxilla
Sectioned maxilla removed
Skin graft can be used
Defect is packed with a tincture benzoin guaze and
maintained with a maxillary splint or obturator
Skin incisions are closed in layers
24. 1 .AMELOBLASTOMA
Ameloblastoma is defined as“usually unicentric, non-
functional, intermittent in growth , anatomically benign and
clinically persistent.”
Is a true neoplasm of odontogenic epithelial origin.
25. ORIGIN
Origin may be from:
Cell rests of enamel organ
Remanants of hertwigs sheath
Epithelial rests of malassez
Epithelium of odontogenic cysts
Basal cells of the surface epithelium of jaws
27. CLINICAL FEATURES
No significant sex predilection.
Age : 20-60 years
Swelling and facial assymetry chief complaint
Swelling is typically asymptomatic
Average size is 4.3cms
Discovered due to local effects such as tooth mobility,occlusal
alterations and failure of eruption of teeth.
More than 80% of the cases occur in the mandible
ramus area involvement 3 times more common than the other
areas
28. R/F
Radiographically this lesion may appear as soap bubble
,honey comb ,tennis racket pattern .
In some places , cortices are expanded and spared ,and
in other regions ,they are destroyed
Root resorption is a common finding
30. Management
AIM OF Rx:
Complete eradication of the lesion
Reconstruction of the resultant defect
1. Radical and conservative surgery
2. Curettage[usually not considered as Rx modality since intraosseus
multicystic lesions recurrence rate is 55-100% after curettage & for
intraosseus unicystic lesions -18-25%]
3. Chemical and electrocautery
4. Radiation
5. Combination of surgery and radiation
31. Rx for intraosseus
solid/multicystic ameloblastoma:
Enbloc resection or marginal resection without
continuity defect.
Segmental resection with continuity defect .
Partial maxillectomy [tumour confined to maxilla
without orbital floor involvement ]
Total maxillectomy [Orbital floor involved but not
the peri orbital area]
Total maxillectomy with orbital exentration[tumor
involving orbital contents ]
Skull base resection along with neuro surgical
procedure [tumor involving the skull bone ]
32. 2. ADENOMATOIDODONTOGENICTUMOR[AOT]
1ST recognised by Stafne
Uncommon tumor
Occurs mostly in association with unerupted permanent
teeth {maxillary cuspid[74%]}
It is now considered as hamartomatous malformation
[Hamartoma : An abnormal proliferation of tissues,
native to that part. It is a focal malformation which
resembles a neoplasm, grossly & Microscopically]
33. CLINICAL FEATURES
Age :10-20 yrs [rare after 30yrs ]
F.M65%> MALE
Site ;maxilla :anterior region
Vast majority of the lesions measured between 1.5cms-
3.ocms
it is seen to occur in the gingiva or within jaw bones
34. RADIOGRAPHIC FEATURES
Unilocular radiolucency surrounding crown of impacted
teeth extend apically beyond CEJ.
TREATMENT
Conservative excision or enucleation
35. 3. Calcifying epithelial
odontogenic tumour
First described by pindborg in 1956
Some suggest that ceot arises from stratum intermedium
Others say it arises from dental lamina
36. Clinical features
Occurs in middle age
It occurs more in the mandible
than in maxilla in the ratio of
2:1
An extraosseous CEOT also
occurs which is similar to
intraosseous tumor
37. RADIOGRAPHIC FEATURES
It shows considerable radiographic variation
Combined pattern of mixed radiolucent and radiopaque pattern seen.
Honey comb pattern also seen.
Scattered flecks of calcification seen throughout the radiolucency
giving rise to descriptive term of a driven snow appearance.
38.
39. 4.AMELOBLASTIC FIBROMA
Relative uncommon tumor
Simultaneous proliferation of both epithelial and
mesenchymal components without formation of enamel
and dentin
Classic example of mixed tumor
40. CLINICAL FEATURES
Occurs commonly in the molar region of mandible
Slight predilection for males
Does not infiltrate between trabeculae of bone instead it
enlarges by gradual expansion
Discovered on routine examination
41. 5. ODONTOMA
It represents a hamartomatous malformation rather than
neoplasm
The enamel and dentin formed are laid down in a
disorganized manner because the odontogenic cells
formed fails to reach normal stage of
morphodifferentiation
42. Compound composite odontoma-the enamel and dentin
are laid down in such a fashion that the structures bear
considerable anatomic resemblance to normal teeth
Complex composite odontoma-when dental calcified
tissues are simply an irregular mass bearing no
resemblance to normal teeth
43. CLINICAL FEATURES
Occurs most frequently in the 2nd to 3rd decades
No gender predilection
Occurs more in the mandible
Some cases reported to occur in the condyles
It is not rapidly growing
44. 7.CEMENTOBLASTOMA
It appears to be a true neoplasm of functional
cementoblasts which form a large mass of cementum or
cementum like tissue on the tooth root
45. CLINICAL FEATURES
Occurs under 25 years of age.
No gender predilection.
Mandible affected 3 times more than maxilla.
Mandibular6 is most affected.
Tooth involved is vital.
Lesion is slow growing.
46. RADIOLOGIC FEATURES
Tumor mass attached to tooth root and appears as well
circumscribed dense radioopaque mass often surrounded
by a thin,uniform radiolucent line
MANAGEMENT
Enucleation can be done.
Tooth attached can be extracted with the lesion
