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2. or neoplasms, are
new growth of
abnormal tissue arising
around the oral cavity
as in other parts of the
body.

3. • History and Examination
• Biopsy
• Imaging

4. • Duration
• Mode of Onset and
progress
• Exact size and shape
• Change in character of
the lesion
• Associated symptoms
• Similar swellings
• Loss of body weight
• Recurrence
• Habit

5. Inspection
• Number
• Shape and Size
• Site or Anatomical
location
• Color
• Surface texture
• Pedunculated/Sessile
• Overlying skin
Palpation
• Consistency of the
lesion
• Presence of pulsation
• Fixidity
• Lymph node
examination

6. • Bleeding
• Duration >2 wks
• Erythroplasia
• Fixidity
• Rapid growth
• Induration
• Ulceration

7. Odontogeni
c
Tumors
Fibro-
Osseous
Lesions
Other
Lesions
• Odontoma
•Ameloblastoma
• Ameloblastic fibroma
• Ameloblastic Fibro-
odontoma
• Adenomatoid
odontogenic Tumor
• Ameloblastic
fibrosarcoma
• Ameloblastic
odontoma
• Myxoma
• Cementoblastoma
• Squamous
odontogenic tumor
• Central ossifying
Fibroma
• Central giant cell
granuloma
• Osteoma
• Osteoid osteoma
• Osteoblastoma
• Chondroblastoma
• Fibrosarcoma
• Osteosarcoma
•Chondrosarcoma
• Ewing sarcoma
• Hemangioma
• Eosinophilic
granuloma
• Neurilemmoma
• Neurofibroma
• Neuroectodermal
tumor
• Lymphoma
• Intraosseous salivary
gland malignancies
• Neurofibrosarcoma

8. benign tumor consisting of ce
mentum, dentin, enamel, and
pulp tissue that may or may
not be arranged in
the form of teeth Mosby's Medical Dictionary, 8th
edition. © 2009, Elsevier.
TYPES:
• Ameloblastic odontoma
• Composite odontoma
• Compound odontoma
• Radicular odontoma

9. an epithelial neoplasm with a basic str
ucture resembling the enamel organ
and suggesting
derivation from ameloblastic cells. It is
usually benign but aggressive.
Mosby's Medical Dictionary, 2nd edition.
© 2008, Elsevier.
TYPES:
• Solid/Mucocystic
Ameloblastoma
• Unicystic
Ameloblastoma
• Peripheral

10. an epithelial neoplasm with a basic str
ucture resembling the enamel organ
and suggesting
derivation from ameloblastic cells. It is
usually benign but aggressive.
Mosby's Medical Dictionary, 2nd edition.
© 2008, Elsevier.
TYPES:
• Solid/Multicystic
Ameloblastoma
• Unicystic
Ameloblastoma
• Peripheral

11. • General principles
• Age
• Histology
• Previous radiotherapy
• Field change
• Histology
• Stage
• Site of Disease

12. • Aggressiveness of the Lesion
• Anatomic Location
o Maxilla vs Mandible
o Proximity to Adjacent vital
structures
o Size of tumor
o Intraosseous vs extraosseous
location
• Duration of the Lesion
• Reconstructive efforts

13. A. Enucleation and/or curettage
B. Resection
1. Marginal (Segmental
Resection)
2. Partial Resection
3. Total Resection
4. Composite Resection

14. Local removal of tumor by
instrumentation in direct contact with
the lesion; used for very benign types
of lesions
TECHNIQUE:
The technique for enucleation
or curettage of jaw tumors is
not unlike that described for
cysts. However, additional
procedures, such as sectioning
large calcified masses with
burs in odontomas and

15. Resection of a tumor without disruption
of the continuity of the bone
GENERAL PRINCIPLE:
the resected specimen
should include the lesion
and 1-cm bony margins
around the radiographic
boundaries of the lesion.

16. TECHNIQUE:
A full-thickness mucoperiosteal flap
is developed and stripped from the
bone to be removed.

17. TECHNIQUE:
Air-driven surgical saws or burs are
then used to section the bone in the
planned locations, and the segment is
removed.

18. TECHNIQUE:
Soft tissue closure

19. Resection of a tumor by
removing a full-thickness
portion of the jaw (In the
mandible, this can vary from
a small continuity defect to a
hemimandibulectomy. Jaw
continuity is disrupted.)

20. TECHNIQUE:
A full-thickness mucoperiosteal flap
is developed and stripped from the
bone to be removed.

21. TECHNIQUE:
Air-driven surgical saws or burs are
then used to section the bone in the
planned locations, and the segment is
removed.

22. TECHNIQUE:
Reconstruction of mandible with a
large bone plate

23. Resection of a tumor by removal of the
involved bone (e.g., maxillectomy and
mandibulectomy)

24. Resection of a tumor with bone,
adjacent soft tissues, and
contiguous lymph node
channels (This is an ablative
procedure used most
commonly for malignant
tumors.)

26. • Radiotherapy
• Chemotherapy
• Surgery

27. Radiation prevents the cells from
multiplying by interfering
with their nuclear material.
Fractionation of the delivery of
radiation means that smaller
increments of radiation (i.e.,
fractions) are given over several
weeks, which allows the healthier
normal tissues time to recover
between doses.

28. Chemicals that act by interfering
with rapidly growing tumor cells
are used for treating many types
of malignancies.
As with radiation the chemicals
are not totally selective but affect
normal cells to some extent. Most
of these agents are given
intravenously.

29. The surgical procedures for
excision of oral malignancies
vary with the type and extent of
the lesion.
Small lesions – Excision
Large lesions – Extensive surgery

30. • Vermilionectomy and Mucosal
Advancement Flap
• Wedge Excision and Primary Closure
• Block Excision with Karapandzic Flap
Reconstruction
• Wedge Excision with an Abbe Flap
• Block Excision with the Webster
Modification of Bernard Cheiloplasty
• Excision with Free Microvascular Flap
Reconstruction

31. Also known as lip shave, is indicated
for actinic keratosis with or without
dysplasia
Must be performed from commissure to
commissure
Partial or total excision of the
exposed vermilion area of the lip
The key step in mucosal advancement
flap is to undermine labial mucosa deep
to minor salivary glands and superficial
to the posterior aspect of the orbicularis
oris

33. When the excision involves up to a
third of a lower lip, wedge excision
may be performed with linear primary
closure.
The wedge excision should not cross
the labiomental fold since
hypertrophic scars tend to occur in
this location.
One contraindication is extention of
the lip cancer to the oral commissure.

35. Cancer excision involving half and two
thirds of the upper and lower lip.
Surgical Steps for Karapandzic Flap:
1. Superiorly, continue the incisions
into the nasolabial fold
2. Raise only skin and mucosa
3. May selectively cut portions of the
orbicularis oris near the original
commissure

37. Abbe-Estlander Flap is a modification
involving the commissure of the lips
In Abbe flap, a triangular wedge of the
lower lip (usually midline) is transferred
into the upper lip and vascularized by the
labial artery.
Ideal for lesions involving 1/3 to 2/3
of the lip

39. Requires the development of Burow’s
triangles in its implementation.
Indicated for cancers involving more
than two thirds of the lower lip
Burow’s Triangles are designed so
that the medical vertical limb is
incorporated into the nasolabial fold.

41. When neck dissection is planned as
part of such cancer surgery and the
carotid artery and internal jugular
vein will be dissected and preserved.
Defects created by excision of cancer
of the entire lower lip and adjacent
facial soft tissues may be
reconstructed with a distant flap.

42. The large available skin paddle from
the forearm permit reconstruction of
large defects involving the entire
lower lip and surrounding facial skin.