Benign and malignant lesion of jaws and maxilla Etiology Types Imaging Management Common types of jaw lesions

1. BENIGN AND MALIGNANT
LESIONS OF JAW,MAXILLA
AND TONGUE
Capt;Ye Yint Aung
PG-2nd Year
ORL-HNS

2. CLASSIFICATION
• The tumours of oral cavity can be classified as follows:
1. Benign tumours
(a) Solid
(b) Cystic
2. Premalignant lesions
3. Malignant lesions
(a) Carcinoma
(b) Nonsquamous malignant lesions

3. I. BENIGN TUMOURS
SOLID TUMOURS
1. Papilloma
2. Fibroma (Fibroepithelial Polyp)
3. Haemangioma
4. Lymphangioma
5.Torus
6. Pyogenic Granuloma
7. Pregnancy Granuloma
8. Granular Cell Myoblastoma or Granular Cell Tumour
9. Minor Salivary Gland Neoplasms
10.Solitary Fibrous Tumour

4. Papilloma
• Papillomas are common in the oral cavity.
• Peak incidence is in the third to fifth decades.
• Most of them appear on the soft and hard palate, uvula, tongue and lips.
• Mostly they are less than 1 cm in size, pedunculated and white in colour.
• Their surface is irregular but sometimes smooth.
• Treatment is excisional biopsy. Recurrence is rare.

5. Fibroma (Fibroepithelial Polyp)
• It is a smooth, mucosa-covered pedunculated tumour, usually about 1 cm in size
and soft to firm in consistency.
• It can occur anywhere in the oral or oropharyngeal mucosa.
• The usual cause is chronic irritation.
• It is easily treated by conservative surgical excision.

6. Haemangioma
• Mucosal haemangiomas can occur in the oral cavity or oropharynx.
• They are mostly seen in children.
• Three types of haemangiomas are known: capillary, cavernous and mixed.
• When haemangiomas are present at birth or in young children, they should be
observed for some period as spontaneous regression can occur.
• In patients of 40–50 years, haemangioma-like dilated veins (phlebostasis) may
occur on the oral or lingual mucosa.

7. • An infected haemangioma may be difficult to differentiate from a pyogenic
granuloma.
• Haemangiomas that are large and persistent or those which continue to grow are
problematic.
• Use of cryosurgery or laser is not possible in large diffuse lesions.
• Sclerotherapy has also not been found effective.
• However, microembolization alone or as a preoperative adjunct to surgery has
been found very useful.

9. CYSTIC LESIONS
1. Mucocele
• Most common site is the lower lip.
• It is a retention cyst of minor salivary glands of the lip.
• The lesion appears as a soft and cystic mass of bluish colour.
• Treatment is surgical excision.

11. 2. Ranula
• It is a cystic translucent lesion seen in the floor of mouth on one side of the
frenulum and pushing the tongue up.
• It arises from the sublingual salivary gland due to obstruction of its ducts.
• Some ranulae extend into the neck (plunging type).
• Treatment is complete surgical excision if small, or marsupialization, if large.
• Often it is not possible the ranula completely because of its thin wall or
ramifications in various tissue planes.

13. 3. Dermoid
• A sublingual dermoid is median or lateral, situated above the mylohyoid.
• It shines through the mucosa as a white mass in contrast to the translucent nature
of the ranula.
• A submental dermoid develops below the mylohyoid and presents as a
submental swelling behind the chin.

14. II. PREMALIGNANT LESIONS
1. Leukoplakia
2. Erythroplakia
3. Melanosis and mucosal hyperpigmentation

16. III. MALIGNANT LESIONS
CARCINOMA ORAL CAVITY
Sites of cancer in the lip and oral cavity (AJCC, 2002)
1. Mucosal lip (from junction of skin—vermilion border to line of contact of upper
and lower lip).
2. Buccal mucosa (includes mucosa of cheek and inner surface of lips up to line of
contact of opposing lip).
3. Anterior two-thirds of tongue (oral tongue).
4. Hard palate.
5. Lower alveolar ridge.
6. Upper alveolar ridge.
7. Floor of mouth.

18. CARCINOMA ORAL CAVITY
Aetiology
• Compared to western countries, India has high incidence of oral cancers.
• Age adjusted incidence rate in India is 44.8 and 23.7 in males and females,
respectively, compared to 11.2/100,000 in USA.
• Several aetiological factors are responsible.
(6-S aetiology, i.e. smoking, spirits, sharp jagged tooth, sepsis, syndrome of
Plummer–Vinson and syphilitic glossitis.)

20. Carcinoma Oral Tongue
• Carcinoma involving anterior two-thirds of tongue is commonly seen in men in
the age group of 50–70 years.
• It may also occur in younger age group and in females.
• It may also develop on a pre-existing leukoplakia, long-standing dental ulcer or
syphilitic glossitis. Vast majority are squamous cell type.
Site; Most common site is middle of the lateral border or the ventral aspect of the
tongue. Uncommonly, the tip or the dorsum may be involve

21. Spread; Locally, it may infiltrate deeply into the lingual musculature causing
ankyloglossia or may spread to the floor of mouth, alveolus and mandible.
Lymph node metastases go to the submandibular and upper jugular nodes (from the
lateral border of tongue) and to the submental and jugulo-omohyoid group (from
the tip).
Bilateral or contralateral nodal involvement can also occur.

22. Clinically, cancer of the oral tongue presents as:
(a) An exophytic lesion like a papilloma
(b) A nonhealing ulcer with rolled edges, greyish white shaggy base and induration
(c) A submucous nodule with induration of the surrounding tissue

23. Symptomatology
(a) Early lesions are painless and remain asymptomatic for a long time.
(b) Pain in the tongue locally at the site of ulcer.
(c) Pain in the ipsilateral ear; it is due to common nerve supply of the tongue
(lingual nerve) and ear (auriculo temporal) from the mandibular division of the
trigeminal nerve.
(d) A lump in the mouth.
(e) Enlarged lymph node mass in the neck.
(f) Dysphagia, difficulty to protrude the tongue, slurred speech and bleeding from
the mouth are late features.

25. Treatment
• Aim of treatment is to treat primary tumour in the tongue, control neck disease
(nodal metastasis) and preserve function of the tongue as much as possible.
• Small tumours (T1N0) give equal results if treated with radiotherapy or surgery.
• T2N0 tumours can also be treated by radiotherapy including the neck nodes to
eliminate micrometastases.

26. • They can also be treated by surgical excision with prophylactic neck dissection.
Stage III or IV tumours require combined treatment with surgery and
postoperative radiotherapy.
• It gives better results than either modality alone.
• Block dissection neck is always done.

27. • Depending on the size and extent of the primary lesion of the tongue, surgery
may consist of hemiglossectomy including a portion of the floor of mouth,
segmental or hemimandibulectomy and block dissection of neck nodes-the so-
called “commando operation.”

28. NONSQUAMOUS MALIGNANT LESIONS
In addition to carcinoma, other malignant lesions that involve the oral cavity are:
1. Minor Salivary Gland Tumours
2. Melanoma
3. Lymphoma
4. Kaposi Sarcoma

29. Reference
• PL. Dhingra.(2017), Diseases of ear, nose and throat & head and neck surgery
book.

30. THANK YOU