This document discusses various non-odontogenic tumors and tumor-like lesions of the orofacial region. It begins by covering non-odontogenic bone tumors including both benign lesions like ossifying fibroma, osteoma, central giant cell granuloma, and malignant lesions such as osteosarcoma. It then discusses other non-neoplastic bone diseases and soft tissue tumors, providing details on specific lesions like cherubism, fibrous dysplasia, hemangioma and fibroma. For each lesion, it describes characteristics such as location, appearance, symptoms and treatment.

1. NON-ODONTOGENIC TUMORS &
TUMOR LIKE LESIONS OF THE
OROFACIAL REGION
DR. HAYDAR MUNIR SALIH
BDS, PHD (BOARD CERTIFIED)

2. The most important
aspect of clinical
examination is for the
clinician to know what
you look for ..
Leonardo da vinci call
this
Saper vedere or..
‘Knowing how to see’

3. NONODNTOGENIC TUMORS
I. NON- ODONTOGENIC BONE TUMORS
A. Benign:
Ossifying Fibroma
Juvenile Ossifying Fibroma
Osteoma
Osteoblastoma and Osteoid
Osteoma
Central Giant Cell Granuloma
Chondroma
Hemangioma
B. Malignant:
Osteosarcoma
Chondrosarcoma
Ewing Sarcoma
Langerhans cell
histocytosis
Metastatic Tumors to
the Jaws

4. NONODNTOGENIC TUMORS
II. OTHER NON-NEOPLASTIC BONE DISEASES
Osteogenesis Imperfecta
Osteopetrosis
Cleidocranial Dysplasia
Fibrous Dysplasia
Paget’s Disease of Bone
Cherubism
Simple Bone Cyst
Aneurysmal Bone Cyst

5. NONODNTOGENIC TUMORS
III.SOFT TISSUE TUMORS
A. Benign:
Fibroma
Giant Cell Fibroma
Pyogenic Granuloma
Peripheral Giant Cell
Granuloma
Peripheral Ossifying Fibroma
Lipoma
Neurofibroma
Melanotic Neuroectodermal
Tumor of Infancy
Hemangioma and
Vascular Malformations
Lymphangioma

6. NONODNTOGENIC TUMORS
B. Malignant (sarcomas):
Fibrosarcoma
Angiosarcoma
Liposarcoma
Rhabdomyosarcoma
Metastases to the Oral Soft Tissues

7. OSSIFYING FIBROMA
The mandibular premolar and molar area is the most
common site.
Larger tumors result in a painless swelling of the involved
bone
The lesion most often is well defined and unilocular
varying degrees of radiopacity are noted. Root divergence
or resorption of roots of teeth associated with the tumor
may be seen.
Large lesions demonstrate a characteristic downward
bowing of the inferior cortex of the mandible.
Treatment: enucleation

8. OSSIFYING FIBROMA

9. OSSIFYING FIBROMA

10. JUVENIL OSSIFYING FIBROMA

11. OSTEOMA
Osteomas are benign tumors composed of mature
compact or cancellous bone. essentially restricted to the
craniofacial skeleton
Osteomas of the jaws may arise on the surface of the
bone, as a polypoid or sessile mass (periosteal, peripheral,
or exophytic osteoma), or they may be located in the
medullary bone (endosteal or central osteoma)
osteomas appear as circumscribed sclerotic masses
Larger osteomas of the mandibular body causing
symptoms or cosmetic deformity are treated by
conservative surgical excision

12. PERIPHERAL OSTEOMA

13. PERIPHERAL OSTEOMA

14. ENDOSTEAL OSTEOMA

16. GARDENER SYNDROME

17. GARDENER SYNDROME

18. OSTEOBLASTOMA & OSTOID OSTEOMA
They are closely related benign bone tumors that arise from
osteoblasts.
Classically, the distinction depends on the size of the lesion, with
osteoid osteoma being smaller than 2 cm and osteoblastoma being
larger than 2 cm
the osteoid osteoma appears as a well-circumscribed radiolucent
defect the osteoblastoma may appear as a well-defined or ill-defined
radiolucent lesion often with patchy areas of mineralization
Most cases of osteoid osteoma and osteoblastoma are treated by local
excision or curettage

19. AGGRESSIVE OSTEOBLASTOMA

20. OSTOID OSTEOMA

21. CENTRAL GIANT CELL GRANULOMA
Giant-cell granulomas are hyperplastic rather
than neoplastic.
More common in females and approximately
70% arise in the mandible. Lesions are more
common in the anterior portions of the jaws
central giant cell lesions appear as radiolucent
defects, which may be unilocular or multilocular.

22. CENTRAL GIANT CELL GRANULOMA

23. CENTRAL GIANT CELL GRANULOMA
central giant cell lesions of the jaws may be divided into
two categories
1. Nonaggressive lesions make up most cases, exhibit
few or no symptoms, demonstrate slow growth, and do
not show cortical perforation or root resorption of
teeth involved in the lesion.
2. Aggressive lesions are characterized by pain, rapid
growth, cortical perforation, and root resorption. They
show a marked tendency to recur after treatment,
compared with the non- aggressive types

24. NON AGGRESSIVE CENTRAL GIANT CELL
GRANULOMA

25. AGGRESSIVE GIANT CELL GRANULOMA

26. Differential diagnosis of giant cell lesions of
the jaws
Hyperparathyroidism. Histologically indistinguishable from giant
cell granuloma but serum calcium levels are raised)
Cherubism. lesions are symmetrical, near the angles of the
mandible
Aneurysmal bone cysts. may contain many giant cells but
consist predominantly of multiple blood-filled spaces
Fibrous dysplasia. Only limited foci of giant cells. No defined
margins radiographically. Growth ceases with skeletal maturity

27. HYPERPARATHYRODISM

28. CHONDROMA
Chondromas are benign tumors composed of mature
hyaline cartilage
Most gnathic examples have been found in the condyle
or anterior maxilla of adult patient
chondromas typically appear as radiolucencies with
central areas of radiopacity. It is wise to consider any
lesion diagnosed as chondroma of the jaws to represent
a potential chondrosarcoma

29. CHONDROMA

30. HEMANGIOMA OF BONE
hemangiomas cause progressive painless swellings
which, when the overlying bone is resorbed, may
become pulsatile. Teeth may be loosened and there
may be bleeding, particularly from the gingival margins
involved by the tumor
there is a rounded or pseudoloculated radiolucent area
with ill-defined margins or a soap-bubble appearance
wide en bloc resection is the only practical treatment

31. HEMANGIOMA OF BONE

32. HEMANGIOMA OF BONE

33. Osteosarcoma
Excluding hematopoietic neoplasms, osteosarcoma is the
most common type of malignancy to originate within
bone
The maxilla and mandible are involved with about equal
frequency
Swelling and pain are the most common symptoms.
Loosening of teeth, paresthesia, and nasal obstruction (in
the case of maxillary tumors) also may be noted

34. OSTEOSARCOMA

35. SUNBURST APPEARANCE OF
OSTEOSARCOMA

36. CODMANS TRIANGLE
OSTEOSARCOMA

37. LANGERHANS CELL HISTOCYTOSIS
It is a disorder in which excess immune system cells
called Langerhans cells build up in the body excess
immature Langerhans cells usually form tumors called
granulomas.
Three forms are recognized;
1. Solitary eosinophilic granuloma
2. Multifocal eosinophilic granuloma (including
Hand-Schuller-Christian disease)
3. Letterer-Siwe syndrome.

38. HISTCYTOSIS X (Solitary eosinophilic
granuloma)

39. Hand-Schuller-Christian disease

40. METASTATIC TUMORS TO THE JAW
Although metastasis to a jaw bone may arise
from primary carcinomas of any anatomic site,
carcinomas of the breast, lung, thyroid, prostate,
and kidney give rise to the majority of gnathic
metastases
pain or swelling of the jaw, and there may be
paraesthesia or anaesthesia of the lip. There is
typically an area of radiolucency with a hazy
outline.

41. METASTATIC TUMORS TO THE JAW

42. “
”
II. OTHER NON-NEOPLASTIC
BONE DISEASES

43. OSTEOGENESIS IMPERFECTA (BRITLE
BONE SYNDROME)
Osteogenesis imperfecta characterized by
impairment of collagen maturation
It is a rare disorder in addition to bone fragility, some
affected individuals also have blue sclera, altered
teeth, hypoacusis (hearing loss), long bone and spine
deformities, and joint hyper- extensibility.
Care must be taken during dental extractions, but
fractures of the jaws are uncommon in this disease

44. OSTEOGENESIS IMPERFECTA

45. OSTEOPETROSIS (MARBEL BONE DISEASE)
characterized by a marked increase in bone
density resulting from a defect in remodeling
caused by failure of normal osteoclast
function
anemia is common. Osteomyelitis is a
recognized complication and prevention of
dental infections is important.

46. OSTEOPETROSIS (MARBEL BONE DISEASE)

47. CLEIDOCRANIAL DYSPLASIA
Partial or complete absence of clavicles allows the
patient to bring the shoulders together in front of
the chest. This disorder is one of the few
recognizable causes of delayed eruption of the
permanent dentition. Many permanent teeth may
remain embedded in the jaw and frequently
become enveloped in dentigerous cysts

48. CLEIDOCRANIAL DYSPLASIA

49. CHERUBISM

50. CHERUBISM
the disease usually occurs between the ages of 2 and 5 years.
In mild cases the diagnosis may not be made until the patient
reaches 10 to 12 years of age. The clinical alterations typically
progress until puberty, then stabilize and slowly regress.
The cherub like facies arises from bilateral involvement of the
posterior mandible that produces angelic chubby cheeks. In
addition, there is an “eyes upturned to heaven” appearance
Radiographically, the lesions are typically multilocular, expansile
radiolucencies The appearance is diagnostic as a result of
their bilateral location.

51. CHERUBISM

52. CHERUBISM “eyes upturned to heaven”

53. CHERUBISM

54. FIBRO-OSSOUS LESIONS
Fibro-osseous lesions are a diverse group of processes
that are characterized by replacement of normal bone by
fibrous tissue
Fibrous dysplasia
Cemento-osseous dysplasia
Periapical cemental dysplasia
Focal cemento-osseous dysplasia
Florid cemento-osseous dysplasia
Fibro-osseous neoplasms
Cemento-ossifying fibroma

55. MONOSTOTIC FIBROUS DYSPLASIA
monostotic fibrous dysplasia are diagnosed during the
second decade of life
The maxilla is involved more often than the mandible. Teeth
involved in the lesion usually remain firm but may be
displaced by the bony mass.
The chief radiographic feature is a fine “ground- glass”
opacification

56. MONOSTOTIC FIBROUS DYSPLASIA

57. “ground- glass” OPACIFICATION

58. Jaffe-Lichtenstein syndrome

59. CAFÉ AU LAIT

60. McCune-Albright syndrome

61. PAGETS DISEASE OF THE BONE
Paget’s disease of bone is a condition characterized by abnormal and
anarchic resorption and deposition of bone, resulting in distortion and
weakening of the affected bones. The cause of Paget’s disease is
unknown
Bone pain, which may be quite severe, is a common complaint.
The patchy sclerotic areas often are described as having a “cotton
wool” appearance On radiographic examination, the teeth often
demonstrate extensive hypercementosis.

62. PAGETS DISEASE (Lion face)

63. PAGETS DISEASE (Cotton wool )

64. FIBROMA
The fibroma is the most common “tumor” of the oral
cavity
the most common location is the buccal mucosa
along the bite line
typically appears as a smooth-surfaced pink nodule
that is similar in color to the surrounding mucosa.
The irritation fibroma is treated by conservative
surgical excision; recurrence is extremely rare

65. FIBROMA

67. SURGICAL EXCISION OF FIBROMA

68. PYOGENIC GRANULOMA
 The pyogenic granuloma is a common tumor like growth of the
oral cavity that traditionally has been considered to be non-
neoplastic in nature
 The surface is characteristically ulcerated and ranges from pink to
red to purple, depending on the age of the lesion
 the mass is painless, although it often bleeds easily because of its
extreme vascularity
 Gingival irritation and inflammation that result from poor oral
hygiene may be a precipitating factor in many patients
 Pyogenic granulomas of the gingiva frequently develop in
pregnant women, so much so that the terms pregnancy tumor or
granuloma

69. PYOGENIC GRANULOMA

70. PYOGENIC GRANULOMA SURGICAL
EXCISION

71. PERIPHERAL GIANT CELL GRANULOMA

72. PERIPHERAL OSSFYING FIBROMA

73. LIPOMA
 The lipoma is a benign tumor of fat
 Oral lipomas are usually soft, smooth-
surfaced nodular masses that can be sessile
or pedunculated.
 The buccal mucosa and buccal vestibule are
the most common intraoral sites and account
for 50% of all cases
 treated by conservative local excision, and
recurrence is rare

74. LIPOMA

75. LIPOMA

76. SURGICAL EXCISION OF LIPOMA

77. NEUROFIBROMA
 Neurofibromas can arise as solitary tumors or be a
component of neurofibromatosis Solitary tumors are
most common in young adults and present as slow-
growing, soft, painless lesions that vary in size from
small nodules to larger masses.
 The tongue and buccal mucosa are the most common
intraoral sites
 The treatment for solitary neurofibromas is local
surgical excision, and recurrence is rare.

78. NEUROFIBROMA

79. NEUROFIBROMATOSIS TYPE I

80. MELANOTIC NEUROECTODERMAL
TUMOUR OF INFANCY
 This rare tumour, which arises from the neural crest,
may appear in the anterior maxilla in the first few
months of life. It is usually painless, and slowly
expansive, but occasionally grows rapidly.
 Radiograpically, there is an area of bone destruction,
frequently with ragged margins, and displacement
of the developing teeth
 Conservative treatment is usually curative but, even
when excision is incomplete, recurrence is rare

81. MELANOTIC NEUROECTODERMAL
TUMOUR OF INFANCY

82. INFANTILE HEMANGIOMA & VASCULAR MALFORMATION
 hemangiomas are considered to be benign tumors of
infancy that display a rapid growth phase with endothelial
cell proliferation, followed by gradual involution
Hemangiomas are the most common tumors of infancy,
occurring in 5% to 10% of 1-year-old children
 During the first few weeks of life, the tumor will
demonstrate rapid development
 The proliferative phase usually lasts for 6 to 10 months,
after which the tumor slows in growth and begins to
involute

83. INFANTILE HEMANGIOMA

84. INFANTILE HEMANGIOMA & VASCULAR MALFORMATION
 About half of all hemangiomas will show complete resolution
by 5 years of age, with 90% resolving by age 9
 On the other hand, vascular malformations are structural
anomalies of blood vessels without endothelial proliferation.
By definition, vascular malformations are present at birth and
persist throughout life.
 They can be categorized according to the type of vessel
involved (capillary, venous, arteriove- nous) and according
to hemodynamic features (low flow or high flow).

85. SLOW- FLOW VASCULAR
MALFORMATION

86. ARTEROVENOUS VASCULAR
MALFORMATION (FAST FLOW)

87. EMBOLIZATION

88. METASTASIS TUMORS TO THE ORAL CAVITY
 The mechanism by which tumors can spread to the oral cavity
is poorly understood. Primary malignancies from immediately
adjacent tissues might be able to spread by a lymphatic route;
however, such a mechanism cannot explain metastases from
tumors from lower parts of the body
 One possible explanation for blood-borne metastases to the
head and neck, especially in the absence of pulmonary
metastases, is Batson’s plexus, a valve less vertebral venous
plexus that might allow retrograde spread of tumor cells,
bypassing filtration through the lungs

89. METASTASIS TUMORS TO THE ORAL CAVITY

91. Q1 : name the cyst with have the higher tendency
to cause root resorption of adjacent teeth ?
Q2: name the odontogenic tumor that occur
commonly in anterior part of maxilla ?