The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
A cyst is an epithelium-lined sac containing fluid or semisolid material. In the formation of a cyst, the epithelial cells first proliferate and later undergo degeneration and liquefaction. The liquefied material exerts equal pressure on the walls of the cyst from within. Cysts grow by expansion and thus displace the adjacent teeth by pressure. May can produce expansion of the cortical bone. On a radiograph, the radiolucency of a cyst is usually bordered by a radiopaque periphery of dense sclerotic bone. The radiolucency may be unilocular or multilocular. Odontogenic cysts are those which arise from the epithelium associated with the development of teeth. The source of epithelium is from the enamel organ, the reduced enamel epithelium, the cell rests of Malassez or the remnants of the dental lamina.
A cyst is an epithelium-lined sac containing fluid or semisolid material. In the formation of a cyst, the epithelial cells first proliferate and later undergo degeneration and liquefaction. The liquefied material exerts equal pressure on the walls of the cyst from within. Cysts grow by expansion and thus displace the adjacent teeth by pressure. May can produce expansion of the cortical bone. On a radiograph, the radiolucency of a cyst is usually bordered by a radiopaque periphery of dense sclerotic bone. The radiolucency may be unilocular or multilocular. Odontogenic cysts are those which arise from the epithelium associated with the development of teeth. The source of epithelium is from the enamel organ, the reduced enamel epithelium, the cell rests of Malassez or the remnants of the dental lamina.
Includes most common tumors of oral cavity including scc,bcc, melanoma, ameloblastoma, odontoma, fibromas, pindborg tumors etc.
Presented by Dr. Binaya Subedi
Fibro-osseous lesions of the jaws
Fibrous dysplasia
Cemento-osseous dysplasia
Focal cemento-osseous dysplasia
Periapical cemento-osseous dysplasia
Florid cemento-osseous dysplasia
Ossifying fibroma
Juvenile aggressive ossifying fibroma
Cherubism
Fibro-osseous lesions (FOL) are characterized by replacement of normal bone architecture by collagen fibers and fibroblasts containing calcified tissue.
They include a wide variety of lesions of developmental, dysplastic and neoplastic origins with clinical and radiographic presentation and behavior.
Because of the histological similarities between diverse diseases, proper diagnosis requires correlation of history, clinical and radiographic findings.Fibrous Dysplasia
2. Reactive (dysplastic lesions arising in the tooth-bearing area (presumably of periodontal origin).
a. Periapical cemento-osseous dysplasia
b. Focal cemento-osseous dysplasia
c. Florid cemento-osseous dysplasia
3. Fibro-osseous neoplasms (widely designated as cementifying fibroma, ossifying fibroma or cemento-ossifying fibroma.Bone dysplasias
a. Fibrous dyspla i. Monostoticii. Polyostotic
iii. Polyostotic with endocrinopathy (McCune-Albright)
iv Osteofibrous dysplasia
b. Osteitis deformansc. Pagetoid heritable bone dysplasias of childhood
d. Segmental odontomaxillary dysplasia
2. Cemento-osseous dysplasias
a. Focal cemento-osseous dysplasia b. Florid cemento-osseous dysplasia
3.Inflammatory/reactive processes
a. Focal sclerosing osteomyelitisb. Diffuse sclerosing osteomyelitis
c. Proliferative periostitis
4. Metabolic Disease: hyperparathyroidism
5. Neoplastic lesions (Ossifying fibromas)
a. Ossifying fibromab. Hyperparathyroidism jaw lesion syndrome
c. Juvenile ossifying fibroma i. Trabecular typeii. Psammomatoid type
d. Gigantiform cementomas
Odontogenic keratocyst (OKC) is the cyst arising from the cell rests of dental lamina. It can occur anywhere in the jaw, but commonly seen in the posterior part of the mandible. Radiographically, most OKCs are unilocular when presented at the periapex and can be mistaken for radicular or lateral periodontal cyst.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Includes most common tumors of oral cavity including scc,bcc, melanoma, ameloblastoma, odontoma, fibromas, pindborg tumors etc.
Presented by Dr. Binaya Subedi
Fibro-osseous lesions of the jaws
Fibrous dysplasia
Cemento-osseous dysplasia
Focal cemento-osseous dysplasia
Periapical cemento-osseous dysplasia
Florid cemento-osseous dysplasia
Ossifying fibroma
Juvenile aggressive ossifying fibroma
Cherubism
Fibro-osseous lesions (FOL) are characterized by replacement of normal bone architecture by collagen fibers and fibroblasts containing calcified tissue.
They include a wide variety of lesions of developmental, dysplastic and neoplastic origins with clinical and radiographic presentation and behavior.
Because of the histological similarities between diverse diseases, proper diagnosis requires correlation of history, clinical and radiographic findings.Fibrous Dysplasia
2. Reactive (dysplastic lesions arising in the tooth-bearing area (presumably of periodontal origin).
a. Periapical cemento-osseous dysplasia
b. Focal cemento-osseous dysplasia
c. Florid cemento-osseous dysplasia
3. Fibro-osseous neoplasms (widely designated as cementifying fibroma, ossifying fibroma or cemento-ossifying fibroma.Bone dysplasias
a. Fibrous dyspla i. Monostoticii. Polyostotic
iii. Polyostotic with endocrinopathy (McCune-Albright)
iv Osteofibrous dysplasia
b. Osteitis deformansc. Pagetoid heritable bone dysplasias of childhood
d. Segmental odontomaxillary dysplasia
2. Cemento-osseous dysplasias
a. Focal cemento-osseous dysplasia b. Florid cemento-osseous dysplasia
3.Inflammatory/reactive processes
a. Focal sclerosing osteomyelitisb. Diffuse sclerosing osteomyelitis
c. Proliferative periostitis
4. Metabolic Disease: hyperparathyroidism
5. Neoplastic lesions (Ossifying fibromas)
a. Ossifying fibromab. Hyperparathyroidism jaw lesion syndrome
c. Juvenile ossifying fibroma i. Trabecular typeii. Psammomatoid type
d. Gigantiform cementomas
Odontogenic keratocyst (OKC) is the cyst arising from the cell rests of dental lamina. It can occur anywhere in the jaw, but commonly seen in the posterior part of the mandible. Radiographically, most OKCs are unilocular when presented at the periapex and can be mistaken for radicular or lateral periodontal cyst.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Benign connective tissue tumors 2/ dental implant courses by Indian dental ac...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
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Cysts &tumors of salivary glands /certified fixed orthodontic courses by Indi...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Benign connective tissue tumors 1/ dental implant courses by Indian dental ac...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
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Benign salivary gland tumor part 1 / dental crown & bridge coursesIndian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
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Benig tumors of jaw/certified fixed orthodontic courses by Indian dental acad...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
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benign tumors of oral cavity including epithelial, connective tissue. muscle tissue and nerve tissue tumors.. hemangiomas included.. beautiful high def histopathological pictures included
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Opportunity for Dentists (BDS/MDS )to relocate to United kingdom -Register as a DENTAL HYGIENIST/ DENTAL THERAPIST without Board exams and after approval you can register in GDC as a DH/DT and start working as a DH/DT Immediately and get paid.
You can complete the whole process in 3-4 months.Salary range for DH/DT is around 2500-3500 Pounds per month.
Eligibility / requirements-
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at the appropriate level.(Within 2 yrs of application date )
2: A recent primary dental qualification that has been taught and examined in English..(Within 2 yrs of application date )
3: A recent pass in a language test for registration with a regulatory authority in a country where the first language is English.
If you are interested Please contact us for more details.
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Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals
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I –Aligners are made with FDA approved transparent thermoplastic materials using 3D scanning, 3D Printing and finally Trays with Pressure vacuum formers.
Dear Doctor,
Indian Dental Academy Now offers comprehensive online Orthodontics course.
Course includes:
1.whiteboard lecture presentations
2.Case Discussions
3.with hundreds of pictures.
4.Demo on Models
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6. subtitles in your own language
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Thanks & Regards
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--
Indian Dental Academy
Leader in continuing dental education
www.indiandentalacademy.com
skype:indiandentalacademy
+919248678078
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
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The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
How to Split Bills in the Odoo 17 POS ModuleCeline George
Bills have a main role in point of sale procedure. It will help to track sales, handling payments and giving receipts to customers. Bill splitting also has an important role in POS. For example, If some friends come together for dinner and if they want to divide the bill then it is possible by POS bill splitting. This slide will show how to split bills in odoo 17 POS.
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
How to Make a Field invisible in Odoo 17Celine George
It is possible to hide or invisible some fields in odoo. Commonly using “invisible” attribute in the field definition to invisible the fields. This slide will show how to make a field invisible in odoo 17.
The Indian economy is classified into different sectors to simplify the analysis and understanding of economic activities. For Class 10, it's essential to grasp the sectors of the Indian economy, understand their characteristics, and recognize their importance. This guide will provide detailed notes on the Sectors of the Indian Economy Class 10, using specific long-tail keywords to enhance comprehension.
For more information, visit-www.vavaclasses.com
Students, digital devices and success - Andreas Schleicher - 27 May 2024..pptxEduSkills OECD
Andreas Schleicher presents at the OECD webinar ‘Digital devices in schools: detrimental distraction or secret to success?’ on 27 May 2024. The presentation was based on findings from PISA 2022 results and the webinar helped launch the PISA in Focus ‘Managing screen time: How to protect and equip students against distraction’ https://www.oecd-ilibrary.org/education/managing-screen-time_7c225af4-en and the OECD Education Policy Perspective ‘Students, digital devices and success’ can be found here - https://oe.cd/il/5yV
Instructions for Submissions thorugh G- Classroom.pptxJheel Barad
This presentation provides a briefing on how to upload submissions and documents in Google Classroom. It was prepared as part of an orientation for new Sainik School in-service teacher trainees. As a training officer, my goal is to ensure that you are comfortable and proficient with this essential tool for managing assignments and fostering student engagement.
Ethnobotany and Ethnopharmacology:
Ethnobotany in herbal drug evaluation,
Impact of Ethnobotany in traditional medicine,
New development in herbals,
Bio-prospecting tools for drug discovery,
Role of Ethnopharmacology in drug evaluation,
Reverse Pharmacology.
2. Neoplasm(Willis definition 1952)
A Neoplasm can be defined as
‘an abnormal mass of tissue,
the growth of which exceeds
and is uncoordinated with that of the normal tissues
and persists in the same excessive manner
after cessation of the stimuli which evoked the change’
www.indiandentalacademy.com
3. Benign Tumors
1. Slow growing
2. Uncoordinated growth
3. limited Growth Potential
4. Spread by Direct Extension
5. Resemble the tissue of origin,
histologically.
www.indiandentalacademy.com
8. Squamous Papilloma
It is a benign proliferation of stratified squamous epithelium,
resulting in a papillary or verruciform mass.
Caused by HPV (Human papilloma virus).
HPV types 6 and 11.
HPV comprises a large family (>100) of double stranded
DNA viruses of papova virus subgroup –A.
HPV can be identified by in situ hybridization, PCR and
immuno-histochemical analysis.
These viruses have a incubation period of 3 to 12 months.
www.indiandentalacademy.com
10. Clinical features:
Tongue, lips, buccal mucosa, labial mucosa and rarely in
hard palate.
Soft, painless, usually pedunculated, exophytic nodule with
numerous finger like surface projections that impart a
cauliflower or wartlike appearance.
At any age.
Projections may be pointed or blunted.
Lesions appear whitish, slightly red or normal depending on
amount of surface keratinisation.
Lesions are usually solitary and enlarges so rapidly
www.indiandentalacademy.com
11. • The common wart or verruca vulgaris, is a frequent tumor
of the skin analogous to oral papilloma.
• HPV 2, HPV 4 and HPV 40.
• Clinically pointed or verruciform surface projections, a
very narrow stalk.
• White in colour.
• Contagious.
• Oral lesions appear to arise through autoinoculation by
finger sucking or fingernail biting.
www.indiandentalacademy.com
14. keratoacanthoma
Self –healing carcinoma, molluscum pseudo-
carcinomatosum, molluscum sebaceum, verrucoma.
Common low-grade malignancy that originates in the
pilosebaceous glands.
It clinically and histologically resembles epidermoid
carcinoma and it is frequently mistaken as cancer.
www.indiandentalacademy.com
15. Etiology
Genetic and viral – both etiological factors have been
demonstrated.
HPV 9, 11, 13, 16, 18, 24, 25, 33, 37 and 57.
Trauma and chemicals such as coal tar and mineral oil.
www.indiandentalacademy.com
16. Clinical features:
Age and sex: 50 to 60 year age and common in males.
Site : intraoral lesion is uncommon. If present, mostly on
the lips. On sun-exposed areas.
Appearance: The lesion appears as an elevated umbilicated
or crateriform with depressed central core. And appears as
dome shaped.
Lip: on the lower lip the tumor shows smooth, raised,
rolled borders with a central plug of hard keratin.
www.indiandentalacademy.com
17. Color : It is yellowish brown in color.
Size : It grows to a size of 1 to 2 cms.
Signs: lesion appear fixed to the surrounding tissues.
Progress: it begins as a small, firm nodules that develop to
full size over a period of 4 to 8 weeks and persist as static
lesions for another 8 weeks. After that it undergoes
spontaneous regression over the next 6 to 8 weeks by
expulsion of keratin core with resorption of the mass.
www.indiandentalacademy.com
19. Differential dignosis
Keratinizing squamous cell carcinoma – cancerous lesion
usually fails to exhibit a smooth, round, regularity which is
present in keratoacanthoma.
Actinic keratosis.
Verrucous carcinoma.
Warty dyskeratoma – are usually small i.e. <0.5 cm as
compared to keratoacanthoma.
www.indiandentalacademy.com
20. Treatment
It often resolves spontaneously without treatment.
The lesion may be treated by surgical excision as the scar
remaining from excision will be more cosmetic than that
resulting from spontaneous regression .
www.indiandentalacademy.com
21. Benign tumors of connective tissue
origin
Oral fibromas
Giant cell fibroma
Myxofibroma
Peripheral ossifying fibroma
Central ossifying fibroma
Central giant cell granuloma
Giant cell tumor of bone
Lipoma
Myxoma
Chondroma
Osteoma
www.indiandentalacademy.com
22. Fibroma
Most common benign soft tissue tumor in the oral cavity.
Most of these lesions are infact hyperplasia or reactive
proliferation of fibrous tissue.
www.indiandentalacademy.com
23. Clinical features:
It can occur at any age but it is common in 3rd 4th and 5th
decades.
Female predilection.
Site : it occurs on gingiva, tongue, buccal mucosa and palate.
Appearance : it is most often sessile dome shaped or slightly
pedunculated with smooth contour.
Consistency : it can range from soft and myxomatous to
firm and elastic.
www.indiandentalacademy.com
25. Differential diagnosis
Myxofibroma – it is softer on palpation when compared
to fibroma.
Neurofibroma
Neurilemoma
Giant cell fibroma.
Minor salivary gland tumors.
www.indiandentalacademy.com
27. Giant cell fibroma
It is a well described benign hyperplastic lesion of oral
mucosa.
First described by Weathers and Callihan in 1974.
Clinical features:
It occurs at any age
It is common in gingiva followed by tongue, palate, buccal
mucosa and lips
Asymtomatic.
It appears usually small, raised, peduculated, papillary
lesion less than 1cm in diameter.
www.indiandentalacademy.com
30. Myxofibroma
Some areas of Fibroma undergo myxomatous
degeneration
Clinical features:
It is most commonly seen on palate, lip and gingiva.
It is softer than fibroma and appears less pale.
www.indiandentalacademy.com
32. Peripheral Ossifying Fibroma
Ossifyjng fibroid epulis
Peripheral exophytic growths that exclusively occur in
interdental gingiva, which appears pale pink to cherry red.
According to some, these develop from pyogenic granulomas
that undergo fibrous maturation and subsequent calcification.
Predominently seen in young adults.
Most common in female population.
Most common in anterior region (Incisor – Cuspid region).www.indiandentalacademy.com
34. Radiographic features
there is no apparent underlying bone involvement visible
on the radiographs.
on rare ocassion, there may be superficial erosion of the
bone.
www.indiandentalacademy.com
35. Treatment
Surgical excision
The mass should be excised down to periosteum as the
recurrence is more likely if the base of the lesion is
allowed to remain.
www.indiandentalacademy.com
37. Central ossifying fibroma
It is a central neoplasm of bone.
There is considerable similarity and even overlap in the
histologic features of central cementifying fibroma.
These two are separate benign tumors identical in nature
except for the cell undergoing proliferation.
Osteoblasts in the case of ossifying fibroma and
cementoblasts in cementifying fibroma.
www.indiandentalacademy.com
38. Clinical features:
It occurs in any age but, more common in young adults
and females.
Most common in the mandible.
It is relatively slow growing tumor, asymptomatic until
the growth produces a noticeable swelling and mild
deformity.
Displacement of teeth may be an early C/F.
As it is slow growing the cortical plates of bone and
overlying mucosa or skin are invariably intact.
www.indiandentalacademy.com
40. Radiographic features
The neoplasm presents extremely variable R/G appearance
depending upon its stage of development.
The lesion is always well circumscribed and demarcated
from the surrounding bone.
In early stages, COF paradoxically appears as a radiolucent
lesion.
As the tumor bone apparently matures, there is increasing
calcification hence, radiolucent areas become flecked with
opacities.
Ultimately the lesion appears as radiopaque mass
www.indiandentalacademy.com
43. Fibrous dysplasia
Diffuse and rectangular.
Blends with surrounding
normal bone.
Jappears more fusiform.
2nd to 3rd decade.
more common in maxilla.
Ground glass/ orange
peel/finger print/wispy
cotton.
COF
Round and localized.
Sharply defined margins
Dome shaped and nodular.
3rd to 5th decade.
More common in mandible.
Appears mottled with
mixed R/O & R/L.
www.indiandentalacademy.com
44. Central giant cell granuloma
It was first described by Jaffe in 1953.
Jaffe believed that the jaw lesions were not true neoplasms
and represented a local reparative reaction.
Because the clinical behavior of many of these lesions has
been inconsistent with a reparative process, the term
“reparative” has been omitted today.
It is a Benign lesion that usually occurs in the Mandible
and the Maxilla.
www.indiandentalacademy.com
45. WHO definition:
“An Intraosseous lesion consisting of cellular fibrous tissue containing
multiple foci of hemorrhage, aggregations of multinucleated giant cells
and occasionally trabeculae of woven bone.”
Classification:
The central giant cell granuloma was classified as a True
Neoplasm and a reactive proliferate process at the same
time because of its Histologic features, dynamic Biologic
characteristics, and variable clinical patterns.
Based on its clinical behavior, CGCG has been classified as
one of the following:
1 Nonaggressive.
2 Aggressive
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46. clinical features:
Age: Normally it appears before the age of 30.
CGCG occurs most commonly in young adults and has a
female predilection
The clinical behavior of CGCG can vary from benign to
rather aggressive.
The clinical behavior of the lesion varies from an
asymptomatic osteolytic lesion that grows slowly without
expansion, to an aggressive, painful process accompanied by
root resorption, cortical bone destruction, and extension
into the soft tissues.
www.indiandentalacademy.com
47. Site:
In 72.2% of the Male patients with CGCG, the, lesion was
located in the mandible and in males 27.8% in the Maxilla.
In 61.7% of the Female Patients, the lesions appeared in
the mandible.
Occurs twice as often in the Mandible than in the Maxilla
and can be confined to the tooth-bearing areas of the jaws.
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48. Nonaggressive type
characterized by
a slow
asymptomatic growth Non
perforating
Rarely causing Root
resorption.
low tendency to recur.
Aggressive type characterized
by
Pain,
Rapid Growth,
Expansion
Perforation of cortical bone,
Radicular resorption.
high tendency to reccur.
destroys bone,
resorbs teeth,
displace anatomical structures:
Teeth,
Mandibular canal,
Floor of maxillary antrum.
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50. Radiographic Features :
CGCGs were small Apical Lesions and Large
Multilocular Lesions with a diameter of more than 4 cm.
It appears as Unilocular radiolucency as often as with a
Multilocular one ,the majority of CGCGs proved to be
unilocular (57.7%) and only 42.3% multilocular.
Root resorption as a sign of local aggressive biologic
behavior was evident in 60% of the aggressive lesions,
which is more frequent than in other reports.
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51. Treatment
The traditional treatment of CGCG of the jaws has
been Surgical Excision either by curettage or en bloc
resection, depending on the following factors:
Aggressive versus Nonaggressive behavior,
location, size, and radiographic appearance.
Therefore, the surgical approach is based on the
clinical and radiographic characteristics of each case.
Other treatments have included radiation and
systemic injections of calcitonin.
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53. The following Protocol was used in
each patient:
1. Pretreatment Biopsy to establish the diagnosis.
2. Laboratory investigations of parathyroid hormone (PTH),
calcium, and phosphorus to rule out hyperparathyroidism.
Blood cell count and differential count were measured.
3. Intralesional injections of a solution of Kenacort-A
(10mg/mL, triamcinolone aqueous suspension )and
either Lidocaine 2% with epinephrine 1:200,000,
Marcaine, or Bupivacaine, 50% mixture by volume.
The solution was administered with a 5-cm disposable
syringe with a 1 in 22G needle in all the cases.
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54. 4. The average dosage of the aforementioned solution was 6
ml for adults, which is equivalent to 30 mg of
triamcinolone, and 5 ml for the pediatric patients,which is
equivalent to 25 mg of triamcinolone.
5. The solution was injected by clinically estimating the site
where the cortical bone was more expanded and therefore,
it was thinnest at that point. The bone was not trephinated.
Once inside the lesion, the needle was redirected to inject
small amounts into different areas.
6. The treatment was terminated when there was a significant
amount of resistance caused by the bone being formed and
calcified, thus avoiding the need for trephination.
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55. Calcitonin Treatment:
Calcitonin-subcutaneous injection-50 IU daily
continued over a year’s period
Epinephrine-1:1 ratio-6 weeks, once weekly.
Calcitonon inhibits the activity of multinucleated giant
cells in CGCG which possess specific osteoclast
characteristics of lacunar bone resorption.
Calcitonon nasal spray 200u/spray once or twice daily
can also be used.
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56. Giant cell tumor of bone
Synonym : Osteoclastoma.
It is a distinctive neoplasm of undifferentiated cells.
Multinucleated giant cells apparently result from fusion of
the proliferating mononuclear cells.
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57. Clinical features:
It is more common in females and mostly occurs in 3rd
decade.
Pain of variable severity is a predominant symptom.
It occurs most commonly in long bones.
Swelling , weakness, limitation of the joint and
pathologic fracture are common findings.
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58. Treatment
Removal of the tumor by curettage is the most widely
accepted therapy.
Secondary malignant change is usually to pure
fibrosarcoma or osteosarcoma.
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59. Lipoma
Benign tumor of the fat tissue.
Most common mesenchymal neoplasm, which occurs on the
trunk and proximal portions of the extremities.
Lipomas in the oral & maxillofacial region are less frequent.
Pathogenesis is uncertain, but more common in obese people.
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61. Clinical features:
Oral lipomas are usually soft, smooth-surfaced nodular
masses that can be sessile or pedunculated .
A subtle or more obvious yellow hue often is detected
clinically, deeper lesions may appear pink.
Buccal mucosa and buccal vestibule are most common sites
in the oral cavity.
Tongue, floor of the mouth and lips are less common sites.
Mostly they occur in middle age and rare in children.
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62. Treatment
Surgical excision.
Intramuscular lipomas have a high recurrence rate because
of their infiltrative growth pattern but, this variant is rare
in the oral and maxillofacial region.
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64. Myxoma
This is a heterogenous group of soft tisssue tumors which
have H/A of abundant myxoid ground substance.
Myxoid consists of muco-polysaccharides, mainly
hyaluronic acid.
Stout described myxoma as a true neoplasm made up of
tissue resembling primitive mesenchyme.
Tumor rarely infiltrates adjacent tissues.
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65. Clinical features:
Most soft tissue myxomas are deep seated lesions occurring
in the skin or the subcutaneous tissues, GI tract,
GU tract, Liver, Spleen, Parotid gland.
It can occur at any age without sex predilection.
Intra oral soft-tissue myxomas are extreme rare lesions.
Some of the myxomas are nerve sheath myxoma arising
from perineural cells of peripheral nerves.
Mostly occur in the oral cavity on the tongue buccal
mucosa and retromolar area.
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67. Treatment
Surgical treatment is necessary.
Recurrence is common, but this is not of grave concern,
since the tumor does not metastasize.
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68. Chondroma
It is a benign central tumor composed of mature cartilage
It is well recognized entity in certain areas of the bony
skeleton.
It is uncommon in maxilla and mandible.
Chondroma seldom develops in membrane bones,
particularly if no vestigial cartilaginous rests are present.
As maxilla and mandible rarely contain such remnants
hence is uncommon.
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69. Clinical features:
This tumor can occur at any age with out any sex
predilection.
They occur as a painless slowly progressive swelling of the
jaw.
It causes loosening of the teeth.
Overlying mucosa is rarely ulcerated.
Anterior maxilla b/n central incisors and posterior
mandible, condylar or coronoid process are the most
common sites.
These may occur peripherally but they come under
choristomas.
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70. Radiographic features
Roentgenogram shows an irregular radiolucent or mottled
area in the bone.
Chondroma is a destructive lesion and causes root
resorption of the teeth adjacent to it.
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71. Treatment
Surgical excision as the tumor is radio-resistant.
The tumor is of considerable clinical importance as it has
more propensity to undergo malignancy.
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72. Osteoma
Benign neoplasm characterized by a proliferation of either
compact or cancellous bone, usually in the endosteal or
periosteal location.
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73. Clinical features:
It is an uncommon lesion in the oral cavity.
It can occur at any age mostly in young adults.
The tumor of periosteal origin manifests itself as a
circumscribed swelling of the jaw.
It is a slow growing tumor.
The tumor of endosteal origin is slower topresent clinical
manifestations, since considerable growth must occur
before there is expansion of the cortical plates.
Multiple osteomas of the jaws as well as long bones and
skull are characteristic manifestations of Gardner’s
syndrome.
Rarely, pain is associated with this tumor.
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74. Radiographic features
The central lesion usually appears with in the jaw as a well-
circumscribed radiopaque mass.
Sometimes., this may be diffuse,then it must be
differentiated from chronic sclerosing osteomyelitis.
Periosteal form of the disease is manifested as a sclerotic
mass.
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75. Treatment
Surgical excision if the tumor if it is causing difficulty or
if a prosthetic appliance is to be constructed, particularly
when the tumor lies close to the surface of the alveolar
bone.
Recurrence is extremely rare.
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76. Benign tumors of Nerve tissue origin
Neurofibroma
Neurilemmoma
MEN syndrome
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77. Neurilemmoma
Synonym : Schwannoma
It is a benign neural neoplasm of schwann cell origin.
It is relatively uncommon, although 25-48% cases occur in
head and neck region.
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79. Clinical and radiographic features:
It is a slow-growing, encapsulated tumor that typically
arises in association with a nerve trunk.
As it grows it pushes the nerve aside.
Lesion is more common in young and middle aged adults.
Tongue is most common location for oral neurilemomas.
Rarerly, tumor arises centrally with in bone and may
produce bony expansion.
Pain and paresthesia are usual for intrabony tumors.
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80. Treatment :
Surgical excision.
Recurrence and malignant transformation is extremely rare.
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81. Neurofibroma
It is a most common type of peripheral nerve neoplasm.
It arises from a mixture of cell types, including schwann
cells and perineural fibroblasts.
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82. Clinical and radiographic features:
They arise as solitary tumors or be a component of
neurofibromatosis.
Most common in young adults.
They present as solitary, slow- growing, soft, painless lesions
which vary in size from small nodules to larger masses.
Skin is the most frequent location.
Intraorally tongue and buccal mucosa are the most common
sites.
Rarely, tumor arise centrally within bone.
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83. Neurofibroma in the ventral surface
of the tongue
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88. MEN syndrome
Multiple endocrine neoplasia syndrome.
It is characterised by tumors of neuroendocrine origin.
Synonym : MEN III or multiple mucosal neuroma
syndrome.
It was initially described by Wagemann in 1922.
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89. The disease is associated with -
1.Adrenal pheochromocytoma
2.Medullary thyroid carcinomas
3.Diffuse alimentary tract ganglioneuromatosis
4.Multiple small submucosal neuroma nodules of the upper
aerodigestive tract.
The affected individual has a tall, lanky, marfanoid body type,
with a narrow face with muscle wasting.
Adrenal and thyroid tumors do not present until puberty.
MEN syndromes are caused by mutations of the RET proto-
oncogene, an imporatant regulator of neural crest
development and the receptor of gliadelivered neurotrophic
factor (GNAD)
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90. Clinical features:
The oral mucosal neuroma of this disease presents as a 2-7
mm yellowish white, sessile, painless nodule of the lips,
anterior tongue and buccal commissures.
Usually there are 2-8 neuromas with deeper lesions having
normal coloration.
More neuromas in the lips and produce enlargement –
“Bumpy lip” appearance.
Similar nodules are seen on the eyelids, producing eversion
of the lid and also on sclera.
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91. Lab – investigations
When a medullary thyroid carcinoma is present, serum
and urinary calcitonin levels are elevated.
When a pheochromocytoma is present theremay be
increase in the serum levels of vanillylmandelic acid
(VMA) and altered epinephrine/nor-epinephrine ratios.
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92. Treatment
Mucosal neuromas are asymptomatic and self-limiting.
Surgical excision can be done for aesthetic purposes.
Other family members should be evaluated for MEN –III.
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94. Leiomyoma
Leiomyomas are benign tumors of the smooth muscle that
most commonly occur in the uterus, G.I.tract and skin.
Leiomyomas of the oral cavity are rare, most of these
probably have their origin from smooth muscle. The three
types are:
1. Solid leiomyomas
2. Vascular leiomyomas
3. Epithelioid leiomyomas
Almost all the oral tumors are either solid or vascular in
type.
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95. Clinical & Radiographic features:
It can occur at any age and is usually a slow growing firm
mucosal nodule.
Solid type are typically normal in colour and angiomyomas
may exhibit a blue hue.
Most common sites are lips, tongue, palate and cheek which
together account for 80% of cases.
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97. Rhabdomyoma
Benign neoplasms of skeletal muscle are called
“Rhabdomyomas”.
Rhabdomyomas of head and neck can be divided in to
two categories:
1.Adult type
2. Fetal type
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98. Adult 1.Adult typehabdomyo
- Most common in males and middle aged people.
- Most common sites are floor of the mouth, soft palate and
ventral surface of the tongue.
- Tumor appears as a nodular mass.
- Laryngeal and pharyngeal tumors often lead to airway
obstruction.
Fetal 2. Fetal typerhabdomyo
- Usually occur in young children.
- Most common locations are face and pre-auricular region.
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99. Treatment
Both the variants are treated by surgical excision.
Recurrence is rare.
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101. Pleomorphic adenoma
Synonym : Benign Mixed tumor
Most common salivary neoplasm.mino
It is derived from a mixture of ductal and myoepithelial
elements.
Both the terms pleomorphic adenoma and mixed tumor
used to describe the unusual histopathologic features.but
neither term is entirely accurate.
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104. Clinical features:
It appears as a painless, slow growing, firm mass.
It is more common in females and occurs b/n 3rd and 5th
decade.
Most tumors of the parotid occur in the superficial lobe and
present as a swelling overlying the mandibular ramus infront
of the ear.
Facial palsy and pain are rare.
Initially the tumor is movable but becomes less mobile as it
grows larger. If neglected the lesion can grow to large
proportions.
About 10% of parotid mixed tumors occur within the deep
lobe of the gland beneath the facial nerve.
Sometimes, these lesions grow in medial direction b/n the
ascending ramus and stylo-mandibular ligament, resulting in a
dumbbell shaped tumor that appears as a mass of the lateral
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105. Tumors of the hard palate usually are excised down to the
periosteum, including the overlying mucosa.
The palate is the most common site for minor gland mixed
tumors, accounting for 60% of the intraoral examples.
This is followed by the upper lip (20%) and buccal mucosa
(10%).
Palatal tumors always occur on the posterolateral aspect of
the palate, presenting as smooth surfaced, dome –shaped
masses.
If the tumor is traumatized, secondary ulceration may
occur.
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106. Treatment and Prognosis
These tumors are best treated by surgical excision.
For lesions in the superficial lobe of the parotid gland,
Superficial Parotidectomy with Identification and
preservation of the facial nerve is recommended.
For lesions in the deep lobe of the parotid, total
Parotidectomy is usually necessary, also with the
preservation of the facial nerve.
Submandibular tumors are best treated by total removal of
the gland with the tumor.
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107. With adequate surgery, the prognosis is excellent, with a
cure rate of more than 95%.
The risk of recurrence is less for tumors of minor glands.
Conservative enucleation of parotid tumors often results in
recurrence, with management of these lesions made
difficult as a result of multifocal seeding of the primary
tumor bed.
Malignant degeneration is a potential complication,
resulting in carcinoma.
The risk of malignant transformation is probably small
around 5% of all cases.
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108. Oncocytoma
Synonym: Oxyphilic adenoma.
It is a benign salivary gland tumor composed of large
epithelial cells known as “Oncocytes”.
It is a rare salivary neoplasm, representing approximately
1% of all salivary gland tumors.
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109. Clinical features:
The oncocytoma is predominently a tumor of older adults,
with apeak prevalence in the eight decade of life.
It is more common in female population.
85% to 90% occur in major salivary glands especially the
parotid gland.
The tumor appears as a firm, slowly growing, painless
mass that rarely exceeds 4 cm in diameter.
Parotid oncocytomas occur in the superficial lobe and are
clinically indistinguishable from other benign tumors.
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110. Treatment and prognosis
These are best treated by surgical excision.
In the parotid gland, this usually entails partial
parotidectomy.
Submandibular tumors are best treated by total removal of
the gland with the tumor.
Tumors of minor salivary glands should be removed with a
small margin of normal surrounding tissue.
The prognosis after removal is good, with low rate of
recurrence.
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111. Warthin’s tumor
Synonym: Papillary cyst adenoma lymphomatosum.
It is a benign neoplasm that occurs almost exclusively in the
parotid gland.
It represents the second most common benign parotid
tumor, accounting for 5% to 14% of all parotid neoplasms.
A traditional hypothesis suggests that they arise from
heterotopic salivary gland tissue found within the parotid
lymphnodes
Studies have demonstrated that strong association between
the development of this tumor and smoking.
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112. Smokers have a eightfold greater risk for Warthin tumor
than do Non-smokers.
Epstein-barr virus also have been implicated in the
pathogenesis of Warthin tumor.
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113. Clinical features:
It usually appears as a slowly growing painless, nodular
mass of the parotid gland
It may be firm or fluctuant on palpation.
The tumor most frequently occurs in the tail of the parotid
near the angle of the mandible.
In 5% to 14% of cases it occurs bilaterally – unique feature
of Warthin’s tumor.
These bilateral tumors occur at different times.
In rare instances, warthin’s tumor occur with in the
submadibular gland and minor salivary glands
It occurs most commonly in adults, with a peak prevalence
in the 6th and 7th decades of life.
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114. Treatment and Prognosis
Surgical removal is the treatment of choice .
Recurrence rate is around 6% to 12%.
Malignant transformation is very rare.
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115. Canalicular adenoma
It is an uncommon tumor that occurs almost exclusively in
the minor salivary glands.
It comes under Monomorphic adenoma as it has uniform
microscopic structure.
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116. Clinical features:
It has striking predilection for the upper lip, with nearly
75% occuring in this location.
It is the second most common tumor of the upper lip and
rarely occurs in the buccal mucosa.
Occurs in older females with peak prevalence in the 7th
decade of life.
It appears as a slowly growing, painless mass.
It may be firm or fluctuant on palpation.
The overlying mucosa appears bluish and can be mistaken
for mucocele.
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118. Treatment & Prognosis
It is treated by local surgical excision.
Recurrence is uncommon.
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119. Basal cell adenoma
Benign salivary tumor that derives its name from the
basaloid appearance of the tumor cells.
It is a rare neoplasm that represents only 1% to 2% of all
salivary tumors.
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120. Clinical features:
It is primarily a tumor of parotid gland with around 75% of all
cases.
Minor salivary glands represent the second most common site,
specifically the glands of upper lip and buccal mucosa.
Most common in older females around 7th decade.
It appears as slowly growing, freely movable mass similar to
pleomorphic adenoma.
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121. Treatment and Prognosis
Complete surgical excision
Recurrence is rare
Malignant counter part of this tumor is basal cell
adenocarcinoma.
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