Tumors and cysts of the mandible Flashcards

1
Q

Describe odontogenesis

A

Development of a tooth

  • Invagination of ectoderm into mesenchyme
  • Focal thickenings=> Dental Lamina
  • Condensation of mesenchyme=> Dental papilla
  • Organ (papilla+lamina) grows via cap/bell stages
  • Around papilla/lamina=>form dental follicle
  • 3 structures critical - epithelial enamel, mesenchymal dental papilla, dental follicle
  • Pre-ameloblasts stimulate odontoblast to develop
  • Odontoblasts then stimulate Pre-A to place enamel on dentin
  • Ameloblasts=>form enamel
  • Odontoblasts=>form dentin
  • remnants of dentla lamina =>rests of serres ->form many cysts and tumors
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2
Q

What is your management of pt presenting w mandible cyst/tumor

A

HISTORY

  • Incidental?
  • symptoms
  • tooth loss, loose
  • pathologic F#

PHYSICAL EXAM

  • tender, gingival changes/swellings
  • erupted/loose teeth
  • cortical expansion
  • paresthesia

INVESTIGATION

  • panorex, periapicla views, CT - many appear similar
  • BIOPSY - needle aspirate or incisional
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3
Q

What are treatment options

A
  • Enucleation + curettage for most CYSTS and benign tumor except 4
  • Resection + Recon for
    • Ameloblastoma
    • Calcified Epithelial odontogenic tumor
    • Odonto-ameloblastoma
    • Odontogenic myoxoma
    • Malignant tumor (ie. odontogenic carcinoma)
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4
Q

WHat is expected f-u

A
  • E&C curative in most cases
  • for OKC and ameloblastoma, require 5 yr f/u b/c high recurrence
    *
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5
Q

What are common cysts/tumors to include in differential of mandible cyst/tumor

A

Odontogenic Cyst

Developmental

  • Dentigerous/follicular cyst
  • Odontogenic Keratocyst (OKC)

Inflammatory

  • Radicular (periapical) cyst - most common

Non-Odontogenic cyst

  • Aneurysmal bone cyst

Odontogenic Tumor

Epithelial Origin

  • Ameloblastoma
  • Calcified Epithelial Odontogenic tumor

Mixed Origin (epithelial/mesenchymal)

  • Odonto-ameloblastoma
  • Odontoma (compound/complex)

Mesenchymal Origin

  • Odontogenic Myxoma
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6
Q

What is Gorlins syndrome

A
  • AD
  • Mandibular cysts (OKC)
  • Skeletal (bifid/splayed ribs, spina bifida, syndactyly)
  • CF (frontal bossing, CP, DD)
  • Calcification Ectopic (falx cerebri)
  • Palmar pits
  • Multiple BCCs (and other tumors - medulloblastoma, rhabdomyoma, meningioma, ameloblastoma)
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7
Q

What is gardner syndrome

A
  • AD
  • Sebaceous/epithelial cysts
  • Osteomas (frontal, sinuses, mandible)
  • Desmoid fibromas
  • Colon/rectum adenomatous polyps
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8
Q

What is a dentigerous cyst, presentation, management

A
  • ass. w crown of unerupted tooth
  • asymtomatic, incidental
  • Tx w E&C
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9
Q

What is a OKC, presentation, management

A
  • Odontogenic Keratocyst
  • usually ass. w 3rd molar. May cause tooth loosening, resorption, cortical perforation
  • HIGH recurrence rate
  • Treat w E&C + chemical cautery (carnoy solution) +/- ostectomy

May be ass. w gorlins

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10
Q

What is a radicular cyst

A
  • most common odontgenic cyst- ass. w caries
  • asymptomatic/or painful
  • treat w E&C +/- abx if infected
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11
Q

What is an ameloblastoma

A
  • Benign mandibular tumor of epithelial origin- locally aggressive
  • Ass. w ramus/posterior body

Imaging

  • multiloculated lesion w soap bubble or honeycomb appearnace
  • bony expansion
  • tooth resorption

Treatment

  • resection and recon, 1cm margin
  • 5yr f/u 2’ to high reucrrence
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12
Q

What is an odontoma

A

Benign odontogenic tumor of mixed origin - hamartoma

  • very common
  • appears as mass of calcified miniature teeth
  • Tx: E&C
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13
Q

What is cherubism

A

Non-odontogenic tumor of the mandible and maxilla

  • Familial fibrous dysplasia
  • Bilateral symmetric swelling of posterior mandible
  • Bone is replaced wiht loose connectvie vascular tissue
  • Tx: self limiting - may require curettage/excision if not resolved
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14
Q

What is fibrous dysplasia

A

Non-odontogenic tumor of the mandible/maxilla

  • arrest of bone maturatio in woven phase
  • most common in frontal, sphenoid, maxilla

Classifed as mono or polysostotic

Polyostotic can be syndromic or non

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15
Q

What is mcCune albright syndrome

A

Polyostotic fibrous dysplasia

  • cafe au lait
  • hyperthyriodism
  • precocious puberty

Key becasue risk of malingnat degenraiton of FD into osteogenic sarcoma

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16
Q
A