Includes most common tumors of oral cavity including scc,bcc, melanoma, ameloblastoma, odontoma, fibromas, pindborg tumors etc.
Presented by Dr. Binaya Subedi
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.
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.
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.
Introduction
Epidemiology
Etiology
Manifestations
TNM staging
Squamous cell carcinoma is defined as malignant epithelial neoplasm exhibiting squamous differentiation as characterised by the formation of keratin and/or the presence of intercellular bridges.
( Pindborg et al, 1997).
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.
Introduction
Epidemiology
Etiology
Manifestations
TNM staging
Squamous cell carcinoma is defined as malignant epithelial neoplasm exhibiting squamous differentiation as characterised by the formation of keratin and/or the presence of intercellular bridges.
( Pindborg et al, 1997).
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.
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.
mucogingival surgery or plastic surgery of muco-gingival tissue is a surgical procedure targeted to correct and eliminate anatomic, developmental and traumatic alterations of gingiva.
Erythema multiforme, Steven-Johnson syndrome and Toxic Epidermal NecrolysisBinaya Subedi
Erythema Multiforme is a common Vesiculobullous deramtological condition with mucosal manifestations trigged by Herpes virus infection and certain sulpha containing drugs.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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3.
Definition
Classification of tumors of oral cavity
Tumors of Epithelial origin
Benign
Malignant
Tumors of Connective Tissue Origin
Odontogenic Tumors
Contents
4.
Tumor:
“a swelling of the tissue.”
Neoplasia:
“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 that change.”
-Robin’s Basic Pathology (10th etd.)
Introduction
5.
According to GLOBOCAN 2012, lip and oral cavity
cancer is the 12th most common cancer in Asia and
ranks 8th among all the cancers in men.
Second most common cancer in men in south east
asia.
Introduction
6.
Classification
Based on Tissue of origin;
Non-Odontogenic Tumors
Tumors of Epithelial tissue origin
Tumors of Connective tissue origin
Tumors of Salivary gland origin
Tumors of Muscle tissue origin
Tumors of Nerve tissue origin
Metastatic tumors of jaws
Odontogenic Tumors
Based on differentiations
Benign tumors
Malignant tumors
9.
Squamous Papilloma
Associated with papilloma virus HPV 6 & 11, non-
contagious.
Virus-induced focal papillary hyperplasia of the mucosa,
similar to verruca vulgaris.
An exophytic, pedunculated, painless growth made up of
numerous, small finger-like projections, which result in a
lesion with a roughened, verrucous or ‘cauliflower’ surface.
Found most commonly on the tongue, lips, buccal mucosa,
gingiva & palate, esp. that area adjacent to the uvula.
10.
11. Treatment:
Excision, including the base of the mucosa into
which the pedicle inserts.
If properly excised, recurrence is very rare.
Other methods;
conservative surgical excision
curettage
liquid nitrogen cryotherapy
topical keratolytic agents (usually containing salicylic
acid and lactic acid)
12.
Low-grade malignancy that originates in the
pilosebaceous glands which is considered to be a
variant of invasive squamous cell carcinoma.
Sunlight, trauma, HPV, Chemical Carcinogens are
common etiological factors in genetically susceptible
and immuno-compromised host.
More common in fair-skinned people and in sun-
exposed areas
Keratoacanthoma
(self healing carcinoma, molluscum sebaceum,
verrucoma)
13.
14. Occurs in all age groups but incidence increases with
age.
Men: women =2:1
Face, neck and dorsum of upper extremities are the
most common sites.
Intraoral lesions are quite uncommon. May be seen
on lips.
Lesions are typically solitary elevated, umbilicated or
crateriform with a depressed central core or plug. Its
often painful and regional lymphadenopathy may be
present.
Treatment:
Surgical excision
15.
Hamartomas, i.e. benign proliferations of nevus cells
in either epithelium or CT
Can be congenital or acquired
Histologically,
Intradermal
Junctional
Mucosal
Most common mucosal type is the intramucosal
nevus, followed by the common Blue nevus.
Oral Nevi
Oral melanocytic nevus, nevocellular nevus, mole
16.
Usually occurs in White patients over 40 years, mostly
female on hard palate and buccal mucosa.
Asymptomatic, pigmented, brown black or blue colored,
well circumscribed, raised lesions.
Sometimes amelanotic, sessile growths which resemble
fibromas or papillomas.
Compound nevus; involving mucosal epithelium and CT
17.
18. White sponge nevus
• a condition characterized by
the formation of white patches
that appear as thickened,
velvety, sponge-like tissue.
• most commonly found on the
buccal mucosa
Treatment of oral nevus:
• Surgical excision
Congenital nevi have a greater risk for malignant transformation.
20.
Slow growing, rarely metastasizes but has ability to
produce significant local destruction.
Most frequently develops on the exposed surfaces of
the skin, face and scalp in middle aged or elderly fair
skinned persons.
It is thought to arise from pluripotent stem cells of
the basal cell layer as well as follicular structures.
Basal Cell Carcinoma
Rodent Ulcer
21.
Etiology:
UV light (chronic sun ray exposure)– most important
and common cause
Radiation like X-rays
Chemicals like arsenic
Immunosuppression
Syndromes like Xeroderma Pigmentosum and
Nevoid BCC syndrome
22. Clinical features :
• Most frequently in the fourth decade of life
• Male :female =2:1
• Most frequently seen on the middle third of face
• Does not arise from the oral mucosa so is not seen
intraorally except for invasion from an adjacent skin surface.
Subtypes of BCC;
• Nodular BCC
• Pigmented BCC
• Cystic BCC
• Superficial BCC
• Morpheaform and infiltrating BCC
23. A. Nodular BCC:
• Most common variety.
• It begins as a slightly elevated papule with a central
depression which ulcerates, heals over and then breaks
down again. Very mild trauma may cause bleeding.
• Eventually, the crusting ulcer which appears superficial
develops a smooth, rolled border representing tumor cells
spreading laterally beneath the skin.
B. Pigmented BCC
• In addition to the features seen in the nodular type, this
type contains black or brown pigmentation and are seen
more commonly in dark skinned people.
C. Cystic BCC
• May contain translucent blue-gray cystic nodules that may
mimic benign cystic lesions.
24. D. Superficial BCC
• presents as scaly patches or papules, commonly on the
trunk,
E. Micronodular BCC
• An aggressive variety, less prone to ulceration
• May have a seemingly well-defined border.
F. Morpheaform and infiltrating BCC
• aggressive types with sclerotic (scar-like) plaques or
papules, which may be mistaken for scar tissue.
• Border is usually not well defined and often extends well
beyond clinical margins.
• Ulceration, bleeding and crusting are common.
25.
26.
Treatment:
Small lesions (<1 cm)– surgical excision, laser
ablation or electrodissection and curettage, with 5
mm margins of normal appearing skin.
Large lesions – radical surgery or radiation therapy.
For sclerosing type or recurrent lesions, Mohs
Micrographic surgery should be used.
Prognosis is usually good as the tumor doesn’t
metastasize and recurrence is rare.
27.
Malignant neoplasm of squamous differentiation as
characterized by the formation of keratin pearsls
and/or the presence of intercellular bridges.
The most common malignant neoplasm of the oral
cavity.
Squamous cell carcinoma
(Epidermoid Carcinoma)
Note:
Unless specified oral carcinoma
always means Squamous cell
carcinoma
28. Etiology:
• Tobacco in its various forms, sespecially when coupled
with excess alcohol.
• High exposure to UV radiation
• Premalignant lesions and conditions (Leukoplakia)
• Poor oral hygeine
• Vitamin A and C deficiency
• Immunosuppressed
• Rare conditions like xeroderma pigmentosum
• HPV infection
Besides all the causes, tobacco and UV radiation is only
established causes of SCC. All other causes are supposed to
have synergistic effects on former two causes.
29. Clinical Features:
• Male: female = 2:1
• Mainly found in the elderly, after the fourth decade of life.
• Commonly affects vermilion border of lower lip, tongue,
floor of mouth, palate, gingiva, buccal mucosa in descending
order.
• The mortality rate is the lowest for lip cancer and highest for
the tongue.
• Clinically, two very characteristic features are ulceration
and an indurated margin.
• Any swellings, papules, discolorations that shows abrupt
increase in size, with change in surface texture with surface
ulcerations, change in surface colors any chronic non-
healing ulcers are all indicative of squamous cell carcinoma.
• Regional lymph nodes are enlarged and tender, simulating
metastatic tumor.
• Pain and difficulty in mastication are the common
complaints
30.
31. Carcinoma of Lips
• Chiefly occurs in the elderly men , in the lower lip.
Clinical features :
• Usually begins on the vermilion border of the lip to one side
of the midline.
• Often starts as a small area of thickening, induration, and
ulceration or irregularity of the surface. Later, it may create a
small crater-like defect or produce an exophytic, proliferative
growth.
• Generally, slow to metastasize when does, usually ipsilateral
and involves the submental or submandibular nodes. Contra
lateral metastasis may occur only if the lesion is near or
crosses the midline.
Treatment and Prognosis:
• Surgical excision with or without radiation
• Prognosis is good.
32.
33. Carcinoma of Tongue
• A relationship has been suggested between syphilis and tongue
carcinoma but nothing has been proved as yet.
Clinical features :
• Develops on the lateral border or ventral surface of the tongue.
• It presents as a painless mass or ulcer, which might become
painful if secondarily infected.
• May begin as a superficially indurated ulcer with slightly raised
borders and may develop into a fungating exophytic mass or
infiltrate the deep layers of the tongue, producing fixation and
induration.
• Lesions on the posterior portion are usually of a higher grade of
malignancy.
Treatment and Prognosis
• Surgical Excision with radiation (difficult to treat)
• Poor prognosis
34.
35. Carcinoma of floor of mouth
Clinical Features:
• An indurated ulcer of varying size, situated on one side of
the midline.
• More frequently in the anterior portion of the floor.
• Sometimes it may produce limitation of motion of the tongue
or slurring of speech.
• Contra lateral metastasis is common as the primary lesion
occurs most commonly near the midline, where lymphatic
cross-drainage occurs.
Treatment and Prognosis:
• Radiation better than surgery
• Smaller lesions recur, larger don’t.
• Fair prognosis
36.
37. Carcinoma of Buccal Mucosa
• It has a strong predilection of occurrence in men, almost ten
times more.
Etiology :
• Habitual quid of chewing tobacco for years.
Clinical features :
• Usually develops along or inferior to a line opposite the
plane of occlusion.
• Lesion is often a painful ulcerative one where induration
and infiltration of deeper tissues is common. Some lesions
may even be exophytic.
• Metastasis is very frequent.
Treatment :
• Combined use of surgery or x-ray radiation.
38.
39. Carcinoma of Gingiva
Clinical features :
• More commonly found in the mandibular gingiva.
• Initially presents as an area of ulceration, which may be
purely erosive or may exhibit an exophytic growth usually
arises more commonly in edentulous areas.
• Attached gingiva is more commonly involved than the
free gingiva.
• Erosion of the underlying bone is frequent.
• Metastasis is more common from the mandibular gingiva.
Treatment :
• Treatment is generally difficult
• Bad prognosis
40.
41. Carcinoma of Palate
• Not a common lesion of the oral cavity.
Clinical features :
• Poorly defined, ulcerated, painful lesion on one side of the
midline. It frequently crosses the midline and may extend
laterally to include the lingual gingiva or posteriorly to
involve the tonsilar pillar or even the uvula.
• It may invade the bone or occasionally the nasal cavity,
while infiltrating lesions of the soft palate may extend into
the nasopharynx.
• Metastasis occurs quite commonly.
Treatment :
• Both surgery and x-ray radiation are used.
• Prognosis is not very good.
42.
43. TNM Grading
Of SCC
Proposed by Pierre
Denoix 1940s
Adopted by
International
Union Against Cancer
(UICC) in 1968
44. Treatment of Oral SCC
a) Surgery
a) Excisional surgery
b) Cryosurgery
c) Curettage and electrodesiccation (electrosurgery)
d) Laser surgery
b) Chemotherapy
a) Radiation therapy
• Teletherapy
• Brachytherapy
As a thumb rule,
• Stage I and Stage II cancers surgery with or without
radiotherapy.
• Stage III Radiation therapy and surgery with or without
chemotherapy
• Stage IV cancers Supportive care
45. Radiation dose:
• A dose between 50 and 70 Gy, usually given over a 5- to 7-week period,
once a day, 5 days a week, 2 Gy per fraction.
Radioactive elements used:
192Ir, 137Cs ,125I, and 198Au.
Drugs Used in Chemotherapy:
• Bleomycin
• Cisplatin
• Methotrexate
• 5-flourouracil
46.
Verrucous Carcinoms
A warty, high grade variant of SCC.
It is a predominantly exophytic overgrowth of well
differentiated keratinizing epithelium having
minimal atypia, locally destructive margins.
Usually in elderly, on an average between 60-70
years.
Most commonly on buccal mucosa and gingiva.
47. Clinical features:
• Appears papillary, with a pebbly surface, which is sometimes
covered by a white leukoplakic film.
• Lesions on the gingiva may grow into the soft tissue and
invade and destroy the underlying bone.
• Regional lymph nodes are enlarged and tender, simulating
metastatic tumor.
• Pain and difficulty in mastication are the common complaints.
• Growth is usually slow and metastasis occurs late, if at all. It
may become more aggressive if irradiated.
Treatment and Prognosis:
• Conservative excision
• Risk of anaplastic transformation if irradiated.
48.
49.
Malignant Melanoma
A neoplasm of epidermal melanocytes.
One of the most biologically unpredictable and deadly of
all human neoplasias.
The third most common cancer of skin (after BCC and
SCC).
Previously believed to be developed from junctional
nevus, which is premalignant melanocytic dysplasia of
some kind.
It can arise de novo or from premalignant melanocytic
dysplasia.
50. Etiological factors :
A. Environmental factors :
• Sun exposure
• Artificial UV sources
• Socioeconomic status
• Fair skin, red hair
• No. of melanocytic nevi
B. Genetic factors :
• Familial melanoma
• Xeroderma pigmentosum
Risk factors for oral melanomas are unknown. Most of these
are thought to arise de novo.
Two growth phases:
• Radial Growth phase
• Vertical Growth phase
51. Cutaneous melanomas have been classified into :
• Superficial spreading melanoma
• Nodular melanoma
• Lentigo malignant melanoma
• Acral lentiginous melanoma
Oral manifestations :
• Twice as common in men than in women.
• Most cases occur between 40 and 70 years.
• Predilection for the palate and maxillary gingiva.
• Usually appears as a deeply pigmented area, at times
ulcerated and hemorrhagic, which tends to increase
progressively in size.
• Oral melanomas exist in superficial spreading, acral
lentiginous and nodular types.
52. ABCDE Rule in clinical diagnosis of Malignant Melanoma
ASYMMETRY
BORDER IRREGULARITY – with blurred, notched or
ragged edges.
COLOR IRREGULARITY – pigmentation is not uniform
black, brown, red, tan, white and blue can all appear
together.
DIAMETER – greater than 6 mm growth in itself is a sign.
ELEVATION
53.
Treatment and Prognosis
Surgical excision for oral melanomas, jaw resection
and lymph node dissection.
Women have a much better survival rates upto 50
years and then the rate declines.
Nodular and superficial spreading melanomas have
a much poorer prognosis than the LMM.
Oral melanomas have a much poorer prognosis than
the cutaneous ones.
55.
Most common benign soft tissue neoplasm of the
oral cavity.
Females: Males = 2:1
Most commonly on the buccal mucosa along the
plane of occlusion.
A well defined, slow growing lesion, most common
in the third, fourth, and fifth decades
Appears as an elevated nodule of normal color with
a smooth surface, and a sessile or pedunculated base.
Fibroma
(Irritational fibroma, focal fibrous hyperplasia)
57.
Giant Cell Fibroma
Clinical Features
The giant cell fibroma is typically an asymptomatic sessile
or pedunculated nodule, usually less than 1 cm in size
with papillary surface.
Mandibular gingiva is affected twice as often as the
maxillary gingiva.
The tongue and palate also are common sites.
Treatment and prognosis:
Surgical Excision
Fair prognosis, recurrence is rare.
58.
59.
Peripheral Ossifying
Fibroma
Reactive rather than neoplastic in nature.
Some peripheral ossifying fibromas are thought to
develop initially as pyogenic granulomas that
undergo fibrous maturation and subsequent
calcification.
Occurs exclusively on the gingiva in maxillary arch
incisor- cuspid region
Appears as a nodular mass, either pedunculated or
sessile, usually arises from the interdental papilla,
red to pink , and frequently ulcerated surface.
Peripheral clacifying fibroblastic granuloma, ossifying
fibroid epulis
60.
61.
Treatment and Prognosis:
Elimination of possible irritants
Local surgical excision
The mass should be excised down to periosteum
because recurrence is more likely if the base of the
lesion is allowed to remain.
62.
Neoplasm of bone with remarkable similarities with
central cementifying fibroma
3rd-5th decades of life, female predilection.
Typically asymptomatic with displacement of teeth
Radiographic Features:
well defined and unilocular with a sclerotic border.
depending upon calcification, completely
radiolucent to radio-opaque.
Central Ossifying Fibroma
65.
Pyogenic Granuloma
Misnomer
Non-neoplastic, painless, nodular growth arising
from the interdental papilla specially in anterior
region of maxilla.
Most commonly occurs in females, found to
associated with female sex hormones. Aggravates in
pregnancy thus called, pregnancy tumor.
Causes:
Gingival hyper-responsiveness to
local traumas or irritations.
66. Clinical Features:
• Buccal interdental papilla > lingual IP
• Maxilla > Mandible
• Anterior region > posterior region
• Red-to-purple, Smooth or lobulated, Pedunculated or
sessile, nodular lesion with increased vascularity & usually
ulcerated surface, ranging from few mm to centimeters.
• Soft to palpation, mature lesions are firm to touch and
reduced bleeding tendency.
67.
Treament:
Regress on its own after removal of local irritating
factors
Long standing fibrotic cases can be treated with
conservative surgical excision
68.
Relatively common tumor like growth of the oral cavity,
reactive lesion caused by local irritation or trauma eg:
tooth extraction, denture irritation or chronic infection
Clinical Features:
5th and 6th decades of life, mostly females, mandible is
affected more than maxilla, anterior and posterior region.
Occurs exclusively on gingiva or edentulous alveolar
ridge, presenting as red or reddish blue nodular mass,
pedunculated or sessile, with or without surface
ulceration, mostly less than 2 cm in size.
Peripheral Giant Cell
Granuloma
71.
Aka Giant Cell Tumor, Giant cell lesion, non-neoplastic
but aggressive lesion mimics neoplasm.
Mostly females, mandible more than maxilla, majority in
anterior region which frequently crosses midline.
Asymptomatic, however, may be associated with pain,
paresthesia, or perforation of the cortical bone plate
Radiographically, unilocular or multilocular radiolucent
lesion, well delinated but non-corticated borders.
Central Giant Cell
Granuloma
74.
Hemangioma
Benign neoplasm of vascular tissue origin, with
distinctive phases of proliferation and involution,
which is present at birth and regresses later.
Hemangioma of oral cavity isn’t that common, but
head & neck is most common site.
75. According to Watson and McCarthy,
• Capillary hemangioma.
• Cavernous hemangioma.
• Angioblastic or hypertrophic hemangioma.
• Racemose hemangioma.
• Diffuse systemic hemangioma.
• Metastasizing hemangioma.
• Nevus vinous, or port-wine stain
• Hereditary hemorrhagic telangiectasis
76.
77. Clinical Features:
• Occur in infants or children.
• Usually affects whites but rarely occurs in blacks.
• Female: male = 3:1.
• Most common site of occurrence is lip, tongue, buccal
mucosa, and palate.
• Most commonly affected facial bones are mandible,
maxilla, and nasal bones.
• Intramuscular hemangiomas in the oral region are most
commonly seen in the masseter.
• Oral lesions appears as a flat or raised, deep red or
bluish red lesion which is seldom well circumscribed.
• They are readily compressible and fill slowly when
relieved
• Two third of the central hemangiomas were located in
the mandible. They are bone destructive lesions, often
resembling cyst and causing root resorption, but vitality
of teeth is not affected.
78. Treatment and Prognosis:
Many congenital hemangiomas have been found to
undergo spontaneous regression at a relatively early age.
Cases which do not show such remission have been
treated by :
• Surgery
• Radiation therapy
• Sclerosing agents, such as sodium morrhuate or
psylliate, injected into the lesion
• Cryotherapy
• Prognosis is excellent since it does not become
malignant or recur.
79.
A benign hamartomatous hyperplasia of lymphatic
vessels, with three-fourths of all cases occurring in
the head and neck region.
Classification suggested by Watson and McCarthy;
simple lymphangioma
cavernous lymphangioma
cellular or hypertrophic lymphangioma
diffuse systemic lymphangioma
cystic lymphangioma or hygroma
Lymphangioma
80. Clinical Features:
• The intraoral form most commonly occurs on the tongue.
• Superficial lesions are manifested as papillary lesions
which may be of the same color or of a slightly redder hue.
• Deeper lesions appear as diffuse nodules or masses without
any significant change in surface texture or color.
• “The irregular nodularity of the surface of the tongue with gray
and pink projections, and when associated with macroglossia, is
pathognomonic of lymphangioma.”
• Lip involvement referred to as macrocheilia.
• An unusual form of lymphangioma occurs in the alveolar
ridge in neonates which exhibits small blue-domed fluid-
filled lesions on the alveolar ridges of black newborns.
81.
82.
Treatment and Prognosis :
Surgical excision is the treatment of choice, since the
lymphangioma is more radioresistant and insensitive
to sclerosing agents.
Spontaneous regression is rare.
Because of the nonencapsulated and ‘infiltrating’
nature of the lymphangioma, complete removal is
often impossible without excessive removal of
surrounding normal structures.
86.
Ameloblastoma
(Adamantinoma, adamantoblastoma, multilocular cyst)
Coined by Churchill in 1934 to replace ‘adamantinoma’ given by
Malassez in 1884.
“The ameloblastoma is a true neoplasm of enamel organ type
tissue which does not undergo differentiation to the point of
enamel formation.”
- WHO Definition
“A tumor that is ‘usually unicentric, nonfunctional, intermittent
in growth, anatomically benign and clinically persistent’.”
- Robinson
Second most common odontogenic neoplasm
87. Origin of Ameloblastoma:
Cell rests of the enamel organ, either remnants of the dental lamina or
remnants of Hertwig’s sheath, the epithelial rests of Malassez.
Epithelium of odontogenic cysts, particularly the dentigerous cyst, and
odontomas.
Disturbances of the developing enamel organ.
Basal cells of the surface epithelium of the jaws.
Heterotopic epithelium in other parts of the body, especially the
pituitary gland.
Presently, it is thought that it is likely the result of alterations or mutations
in the genetic material of cells that embryologically preprogrammed for
tooth development.
Genetics:
Overexpression of TNF-α, antiapoptotic proteins (Bcl-2, BclxL), and
interface proteins (fibroblast growth factor [FGF], matrix
metalloproteinases [MMPs]
88. Variants of Ameloblastoma
• Central (intraosseous) ameloblastoma – most common,
2nd common odontogenic tumor
• Peripheral (extraosseous) ameloblastoma – soft tissue
• Pituitary ameloblastoma (cranio pharyngioma, Rathke’s
pouch tumor)
WHO types of Ameloblastoma
Solid / multicystic
Extraosseous or peripheral
Desmoplastic
Unicystic
89. Clinical Features: Central Type
• 10 years through 90 years with peak at 33-39 years. Only
10% in below 10 years.
• No significant sex predilection
• Occurs in all areas of the jaws - mandible is the most
commonly affected area (more than 80%)
• Molar angle ramus area > 3 times more commonly than the
premolar and anterior regions combined.
• It may be either solid or unicystic type
• Usually asymptomatic and are discovered either during
routine radiographic examination or because of
asymptomatic jaw expansion
90.
91. Peripheral (extraosseous) Ameloblastoma
Occurs in the soft tissue outside and overlying the
alveolar bone.
Originate from either surface epithelium or remnants of
dental lamina
Slight predilection for males, 2 : 1 ratio of mandible over
the maxilla
Found as nodules on the gingiva, varied in size from 3
mm- 2 cm in diameter, resembles basal cell carcinoma of
gingiva.
Relatively innocuous, lacks the persistent invasiveness
of the intraosseous lesion
Very limited tendency for recurrence
92.
93.
Pitutary Ameloblastoma
Usually found in suprasellar area, grows as a
pseudoencapsulated mass
Patient may have endocrine disturbance, drowsiness
or even toxic symptoms.
Adamantinoma of long bones
True nature of the lesion is still unknown.
Occurred in the tibia in approximately 90%,
sometimes in ulna, femur and fibula
94. Radiographic Features:
Unilocular or multilocular radiolucency, with usually
smooth but in advanced lesions scalloped, sclerotic
margins.
tumor exhibits a compartmented appearance with septa of
bone extending into the radiolucent tumor mass which
gives it a Honey Comb or soap bubble.
97. Histological Features:
Six histopathologic subtypes
• Follicular
• Acanthomatous
• Plexiform
• Granular cell
• Basal cell
• Desmoplastic
• Disconnected islands, strands, and cords within the
collagenized fibrous CT stroma
• Consist of tall columnar cells with hyperchromatic nuclei,
reverse polarity of the nuclei, and subnuclear vacuole -
characteristic palisading pattern
98.
Treatment and Prognosis:
Include both radical and conservative surgical excision,
curettage, chemical and electrocautery, radiation.
Or a combination of surgery and radiation.
Curettage is least desirable - highest incidence of
recurrence
Radiation - highly radioresistant, so not preferred now
Surgical excision with 1mm of safety margins with chemical
cauterization with carnoy’s solution is treatment of choice.
carnoy’s solution:
60% ethanol, 30% chloroform and 10% glacial acetic
acid,1gm of ferric chloride
99.
Aka Pindborg tumor
Uncommon benign odontogenic tumor which is
exclusively epithelial in origin
Locally aggressive tumor, comprises 1% of all
odontogenic tumor.
Histogenesis:
Stratum intermedium and Strands of remnants of dental
lamina, as suggested by Pindborg
Amyloid depositions are believed to be immunological
response to the startum intermedium cells
Calcifying Epithelial
Odontogenic Tumor
100. Clinical Features:
• Affects populations over wide range of age group of 8-92
years with predilection for 4th to 6th decades.
• No specific gender predilection
• Mandible is affected twice more than maxilla
• Molar-ramus-angle region is most common sites, thrice
common than in premolars region.
• Asymptomatic, expansile, hard bony swellings, may be
associated with unerupted or impacted tooth.
• Tumor shows bucco-lingual extension with thining of cortical
plate, and egg-shell cracking
• Tipping of tooth, rotations, root resorption, mobility of tooth
in affected area is a common finding.
101. Radiographic features:
• Mixed radiolucent lesion
• Unilocular or multilocular radiolucency, with ill-
defined margins and flecks of calcifications giving
wind-driven snow appearance,
• Sometimes unerupted teeth is present inside lesion
mimicking dentigerous cyst.
102. Histology:
Proliferation of polyhedral epithelial cells in islands, strands,
cords or sheets which sometimes show cribiform
appearance.
Homogenous, amyloid depositions among the cells, and
calcifications in forms of “liesegang ring pattern”.
Apple green birefringence in polarized light
Treatment and prognosis:
Small lesions: excision or curettage
Larger, recurrent lesions: segmental resection
Atypical CEOT or Malignant ex CEOT radial resection+
radiotherapy+ chemotherapy
Recurrance rate: 10-20%
103.
Adenomatoid Odontogenic
Tumors
Uncommon tumor, mostly associated with
unerupted maxillary canine
Histogenesis
Unknown
Odontogenic; because arises in tooth areas, and
histologically resembles cells of dental lamina
104. Clinical Features:
• Younger patients with 69% occurring in second decade of life.
• Female : Male = 2: 1 (over 30 years, F:M = 1:2)
(Gingival lesions F:M= 14:1)
• Maxilla > mandible, anterior to canine
2/3rd tumor:
2/3rd occurs in maxilla
2/3rd in young patients
2/3rd in association with unerupted teeth
2/3rd of affected teeth are canines
• Asymptomatic, bony swelling, in maxillary anterior regions
mostly resulting into facial asymmetry and most commonly
missing canines or delayed eruption.
• When occurs in mandible, bucco-lingual extension can lead to
fractures of mandible.
105.
106. Radiographic Features:
• Unilocular to multilocular radiolucency with some foci
of calcification, smooth sclerotic or corticated borders.
• Erosions of cortical plates and displacement of tooth
more than resorption.
108.
Odontomas are hamartomas or malformations of dental tissues
and not neoplasms
Similar to teeth:
do not develop further once calcified
may erupt into the mouth
form during the period of odontogenesis
can become carious (if exposed to saliva)
Both epithelium and mesenchymal cells exibit complete
differentiation resulting in functional ameloblast and odontoblast
Organisation of odontogenic apparatus fails to reach normal state
of morphodifferentiation
Odontomas
109.
Two types:
a) Compound Odontoma : Moderately developed and
well arranged all tooth structures
b) Complex Odontomas: tooth like materials (enamel,
dentin) haphazardly arranged which don’t show
any resemblance to tooth.
110. Clinical Features:
Age: 10 and 19 years
Sex: No predilection
Site: Maxilla > Mandible
Anterior region ( maxilla)- Compound
Posterior Jaw- Complex
Hard painless masses, usually accidently recorded on
routine radiographic examination.
Associated problems:
Caries
Abscess formation
Prevent eruption
Displace teeth
Cyst formation
111. A. Compound Odontoma
Radiographic Features:
• Many separate, small denticles
• Structure of normal teeth; small and simpler gross morphology
112. Dense opacity
Radiolucent rimming (develop within a dental follicle)
If infected, the calcified tissues may be mistaken for a sequestrum
Radiographic Features:
B. Complex odontoma
113. Treatment:
A. Compound Odontoma
Enucleated surgically
Complications:
Dentigerous cyst
Gardner's syndrome of intestinal polyposis: multiple odontomas
Odontoameloblastoma
B. Complex Odontoma
Enucleated surgically
Complications:
potential obstructions to the eruption
focus of infection
cosmetic lesions