• Odontogenic & Non Odontogenic
• Odontogenic & Non Odontogenic
Giant Cell Lesion Fibro osseous Lesion
Swellings of Jaws
•As the name indicates, odontogenic tumors
are derived from odontogenic tissues.
–Odontogenic tissues are those which take part in
•Odontogenic Tumors are most common types
of neoplasm of jaws.
• Benign but locally invasive
neoplasm derived from one of the
following odontogenic epithelium;
– Surface epithelium
– Reduced enamel
– Remnants of dental lamina
– Rest cells of Malessez
– Lining of dentigerous cyst
• It is rare & accounts for 1% of all
tumors of oral cavity.
• BUT, Ameloblastoma
is common in our
TYPES OF AMELOBLASTOMA
Ameloblastoma On the basis of Clinical & Radiological
Central / Intra Osseous
Peripheral / Extra
• Most common neoplasm of
• Usually in 3rd – 5th decade.
– Rare in children & elderly
– Mostly in posterior region of
• No specific gender
• Locally invasive but does
– That’s why called benign.
• About 80% of
Ameloblastoma occur in
• Usually asymptomatic & slow growing.
• Results in facial deformity & jaw
• In maxilla even large lesion of
Ameloblastoma produce very little
expansion because lesion can extend
into sinuses & beyond.
• Characteristics of Jaw Expansion by
–Bony hard, non tender, ovoid
or fusiform outline.
–in advanced cases egg shell
crackling due to thinning of
THE ORAL CAVITY
ENORMOUS MASS ON
THE RIGHT MANDIBLE.
(LATE FEATURES) OF AMELOBLASTOMA
•Perforation of bone
neoplasm into soft
R A D I O G R A P H I C
F E A T U R E S O F
A M E L O B L A S T O M A
Rounded & Cyst like
defined margins and
appear as multilocular
– SOAP BUBBLE or
A panoramic radiograph displays a well defined multilocular
radiolucency with scalloped border (arrowheads) extending from the
right second mandibular premolar to the mandibular ramus. Extensive
root resorption of the right second mandibular premolar and thinning of
the cortical plate is detected. Note that the inferior alveolar nerve canal
has been displaced inferiorly to the inferior cortex of the mandible
• Conventional ameloblastoma are usually made of mixture of
solid neoplasm & cysts.
• They have variety of patterns histologically but there are some features
which are common to all histological variety of ameloblastoma;
–Presence of neoplastic ameloblasts
with Palisaded appearance & reverse
polarization (presence of nuclei away from
• Most common type of ameloblastoma.
• Characterized by; islands of follicles of epithelial
cells in a connective tissue stroma.
– Outer layer of these islands have well organized, tall
columnar ameloblasts like cells with reverse polarity
which are surrounding core of polyhedral or angular
– small cysts may be present within follicle or stoma
– Here islands of epithelium are not interconnected.
• Here epithelium forms cords or strands and
trabeculae of small, darkly stained epithelial
cells which may lack reverse polarization and
does not resemble any stage of ameloblasts
present in less cellular stroma.
• This variant give Fish – net appearance.
• It has similar histological appearance to follicular
ameloblastoma, except difference in;
– Squamous metaplasia of core cells (stellate &
angular cells) occurs producing prickle cells &
keratin in core.
• this variant is sometimes confused with
squamous cell carcinoma.
• Rare type
• Arranged as trabecular pattern
with peripheral cells cuboidal
rather than columnar.
• Mistaken with basal cell carcinoma.
• In this appearance of epithelium & stroma is also
similar to follicular ameloblastoma but difference in
it is; central / core cells & some ameloblasts at
peripheral cells undergo degenerative changes &
form sheets of large PINK / eosinophilic granular
cells in the center of island.
• In this epithelium,
arranged in small
islands or cords
in dense & highly
BEHAVIOR OF AMELOBLASTOMA
• Although ameloblastoma is benign, but some cells of this
ameloblastoma may infiltrate the narrow spaces without
causing swelling and destruction of bone.
• So that’s why simple curettage or enucleation of lesion cannot
be done due to high recurrence.
• So surgical resection with small normal tissue is best
treatment option. (wide excision)
MANAGEMENT OF MULTICYSTIC
• Diagnosis is confirmed by biopsy.
• Treatment of choice is wide excision – taking upto 2 cm of
normal bone around margin of lesion.
– Simple enucleation can cause Recurrence because of probability of
invasion in surrounding space.
• Regular radiographic follow up for detecting any recurrence.
MANAGEMENT OF MULTICYSTIC
• Maxillary Ameloblastoma are dangerous because;
–Bone is thinner in mandible.
–Neoplasm spread easily to following areas in maxilla.
• Maxillary sinus
• Pterygomaxillary fossa
• It is defined as ameloblastoma having single cyst or appear as single cyst.
• However, ameloblastoma radiographically appearing as single cyst can be Multicystic
like mural ameloblastoma
Explanations for a Unicystic presentation of
The two patterns on the left are true
ameloblastoma while that on the right is a
conventional ameloblastoma with one very
FEATURES OF UNICYSTIC
• Mostly b/w 10 – 20 years of age.
• Mostly in posterior mandible.
• Sometimes arises with
• Radiological Features
– Appear as unilocular radiolucency
– Tumor cells forming cyst wall
are flattened & can be
mistaken for those or non –
• In this type, ameloblastoma is present in gingival or alveolar soft tissues and does not
• These lesion may arise from;
– Basal cells of oral epithelium
– Extra osseous rests of dental lamina.
• Histologically similar to intra osseous ameloblastoma.
MALIGNANT OR METASTASIZING
• It is distant or metastasized ameloblastoma.
• Metastasis usually occur to lung.
• Although it is benign and truly speaking does not metastasize
but in some conditions as described under they may move
from oral cavity to other places;
– Aspiration of some cells of ameloblastoma into lungs during surgery.
– Surgically disrupting primary site
– Incomplete removal
• It arises when dysplastic changes occur in the primary
• Histologically poorly differentiated and shows
• Metastasize to lymph nodes.
• If metastasis is present, prognosis is poor.
• Clinically primary &
have same all clinical
histological & other
• Usually lungs.
• Primary has features of
secondary show dysplasia
& malignant .
• Metastasize to lymph