Lecture for undergraduate medical (MBBS) students

1. JAW TUMOURS
DR. SUNIL K S GAUR
SENIOR RESIDENT

2. CLASSIFICATION

3. Jaw Tumours
From gums
(Epulis)
From dentition
(Odontogenic)
From
mandible/maxilla
Surface tumours
• Congenital epulis
• Fibrous epulis
• Pregnancy epulis
• Giant cell epulis
• Myelomatous
epulis
• Sarcomatous
epulis
• Carcinomatous
epulis
• Ameloblastoma
• Composite
odontoma
(hamartoma)
• Compound
• Complex
• Cysts
• Dentigerous
• Radicular
• Mesodermal
• Odontogenic
fibroma
• Odontogenic
• Osteoma
• Osteoblastom
a
• Osteoclastom
a
• Osteosarcoma
• Secondaries
• Fibrous
dysplasia
• Torus
palatinus
• Torus
mandibularis
• Carcinoma
extending to
jaw
• Ossifying
fibroma
• Osteofibrosis
of maxilla
• Ivory osteoma
• Leontiasis
ossea

4. EPULIS

5. INTRODUCTION
• Swelling arising from the mucoperiosteum of gums
• Mostly on anterior teeth in interdental areas, commonly in
maxilla
• Firm, pink in color, non-ulcerated
• More common in females

6. CONGENITAL EPULIS
• Seen in newborn
• Clinical features:
• Well localised swelling from
the gum
• Bleeds on touch
• Treatment:
• Excision

7. FIBROUS EPULIS
• Commonest type
• It is a fibroma arising from
periodontal membrane
• Clinical features:
• Painless
• Well localised, non-tender
• Grey-pink swelling, bleeds on touch
• Treatment:
• Biopsy to rule out squamous cell
carcinoma
• Excision with adjacent tooth extraction
(otherwise reccurs)

8. EPULIS (CONTD.)
• Pregnancy epulis
• Occurs in pregnant female due
to inflammatory gingivitis.
• Usually resolves after delivery
• Carcinomatous epulis
• SCC
• Sarcomatous epulis
• Fibrosarcoma
• Myelomatous epulis
• Seen in leukemia patients
• Resolves with treatment of
leukemia
• Granulomatous epulis
• Mass of granulation tissue
around a caries tooth

9. ODONTOGENIC TUMOURS

10. AMELOBLASTOMA
• Most common odontogenic tumour
• Aka, Adamantinoma, Eve’s disease, Multilocular cystic disease
of the jaw
• Arises from dental epithelium
• Histologically, a variant of basal cell carcinoma
• Locally malignant tumour – not spread by lymphatics or blood
• Histology:
• Cords of odontogenic epithelium with ameloblast like cells

11. AMELOBLASTOMA
(CONTD.)
• Clinical features:
• Usually in mandible, near
the angle
• Gradually progressive,
attains large size
• Painless
• Smooth and hard with
eggshell crackling

12. AMELOBLASTOMA (CONTD.)
• Investigations:
• Orthopantomogram (OPG) x-ray – Shows honeycomb appearance
• Biopsy
• CT scan
• Treatment:
• Segmental resection of mandible
• Hemi-mandibulectomy with reconstruction

13. COMPOSITE ODONTOMAS
• Hamartoma containing all 4 layers – dentin, enamel, cementum,
pulp (normal cells in normal site but abnormal organization)
• Once fully calcified, they don’t develop further
• Two types:
• Compound odontomas
• Complex odontomas
• Treatment:
• Resection

15. COMPOSITE ODONTOMAS (CONTD.)
COMPOUND ODONTOMAS
• Most commonly seen in the
anterior maxilla
• More common
• Consists of a collection of
numerous small teeth
• It is usually diagnosed by the
radiographic identification of
multiple small tooth
structures
COMPLEX ODONTOMAS
• Most commonly seen in the
posterior mandible
• Less common
• Consists of a mass of enamel,
dentin, cementum, and pulp
that does not morphologically
resemble a tooth (irregular
mass)
• Appears radiographically as a
radiopaque mass.

16. DENTIGEROUS CYST
• Aka, Follicular odontome
• Unilocular cyst from dental epithelium of unerupted tooth
• Common in lower jaw
• Commonly seen in relation to molars and pre-molars
• Investigation:
• OPG – Tooth within the cyst
• Treatment
• Small – Excision
• Large – Marsupialization and then excision
• Unerupted tooth should be extracted
• Complication:
• Can turn into Adamantinoma

17. DENTAL CYST
• Aka, Radicular cyst, Periapical cyst
• Occurs under the chronically infected dead erupted tooth
• Clinical features:
• Smooth, tender swelling in relation to caries tooth causing expansion of
jaw bone
• Investigation:
• OPG
• Treatment:
• Antibiotics
• Excision with extraction of infected tooth
• Complication:
• Can cause osteomyelitis of the jaw

18. ODONTOGENIC MYXOMA
• 2nd most common odontogenic tumour
• 2/3 occur in mandible, 1/3 in maxilla
• Myxomas are benign but prone to recurrence
• Clinical features:
• Fusiform swelling
• Can infiltrate widely
• Investigations:
• OPG- Radiolucent area with scalloped margins or soap-bubble
appearance
• Treatment:
• Wide excision

19. ODONTOGENIC FIBROMA
• It’s a rare benign tumour of all age groups
• Frequently affects the mandible
• Clinical features:
• Slow growing asymptomatic mass which eventually expands the jaw
• Investigations:
• OPG – sharply defined rounded lucent area in a tooth-bearing region
• Treatment:
• Enucleation and curettage

20. THANK YOU.