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BDS4-oral Surgery > Odontogenic Tumours > Flashcards

Odontogenic Tumours Flashcards

1
Q

Are they rare

A

Yes

1% of oral & maxillofacial lesions sent for histopathological assessment in UK

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2
Q

What non-cystic radiolucent lesions are there

A

Odontogenic tumours
-Amrloblastoma
-Ameloblastic fibroma
-Malignant ameloblastoma
-Odontogenic fibroma and myxoma

Giant cell lesions
-Peripherla and central giant cell granuloma
-Brown tumours of hyperparathyroid
-Cherubism

Fibro cemento osseous lesions

Radiolucent non-odontogenic tumours
-Chondroma
-Osteosarcoma
-Squamous cell carcinoma

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3
Q

Are they more bengin or malignant

A

Benign&raquo_space; malignant (100:1)

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4
Q

What are the symptoms

A

Majority asymptomatic and discovered due to late eruption of teeth, late stage bony expansion or imaging for ther reasons

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5
Q

Where do they arrise

A

Mostly within bone of jaws

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6
Q

Whatare the classifications

A

Grouped based on there tissue of origin

-Epithelial

-Mesenchymal

-Mixed (only tumour to have dentine/enamel formation)

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7
Q

What are the odontogenic sources of epithelium of odontogenic tumours

A

Rests of Malassez
-Remnants of Hertwig’s epithelial root sheath

Rests of Serres
-Remnants of the dental lamina

Reduced enamel epithelium
-Remnants of the enamel organ

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8
Q

What is meant by the concept of induction

A

cannot have enamel without dentine

Odontoblasts forms dentine (mesenchymal origin) ameloblasts only start to form enamel once dentine is layed down, So the presence of dentine is important for induction of maturation of ameloblasts and then formation of enamel

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9
Q

What forms hertwigs epithelial root sheath

A

inner and outer odontogenic epithelium (on histology side its the bits forming the roots)

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10
Q

What forms the tooth germ

A

Dental lamina

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11
Q

Give examples of epithelial, mesenchymal and mixed tomours

A

Epithelial
-Ameloblastoma
-Adenomatoid odontogenic tumour
-Calcifying epithelial odontogenic tumour

Mesenchymal
-Odontogenic myxoma

Mixed
-odontoma

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12
Q

What are the radiographic features of a odontogenic tomour

A

Highly variable

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13
Q

> 50% of cases are either what

A

ameloblastoma or odontoma

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14
Q

What is a ameloblastoma and what is the incidence

A

Benign epithelial tumour
-Locally destructive but slow-growing
-Typically painless

inidence
-1% of oral & maxillofacial tumours
-Most common in 4th-6
the decades
-80% occur in posterior mandible
-M > F

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15
Q

What are the radiologically types of ameloblastomas

A

Multicystic (85-90%)

Unicystic

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16
Q

What are the histological types of ameloblastomas

A

Follicular

Plexiform

Desmoplastic

17
Q

What are the radiograhpic features of a ameloblastoma

A

Margins
-Well-defined, corticated
-Potentially scalloped

Multicystic type
-May have thick, curved septa → “soap bubble” appearance

Primarily radiolucent

Adjacent structures
-Displacement
-Thinning of bony cortices
-“Knife edge” external root resorption

18
Q

What is the histology of a follicular ameloblastoma

A

Islands with ameloblast like cells lining them with a fibrous tissue background

Ameloblast-like cells

Stellate reticulum like tissue, in the inside of the islands

Fibrous tissue

Cystic changes in the island

19
Q

What is the histology of plxiform ameloblastoma

A

Ameloblast-like cells arranged in strands sometimes with stellate reticulum like tissue inbetween

Stellate reticulum like tissue

Fibrous tissue

20
Q

What is the key thing about ameloblastomas and what does it result in

A

No Connective tissue capsule

Cells wont be stopped gorwing and infiltrating into jaw bone resulting in the high recurrence rate

21
Q

What is the mangement of ameloblastomas

A

Surgical resection with margin

Recurrence relatively common, Up to 15% of cases

22
Q

Risk of malignant transformation of ameloblastoma

A

<1% of cases

Ameloblastic carcinoma

23
Q

What is a Adenomatoid odontogenic tumour (AOT) and what is its incidence

A

Benign epithelial tumour

Incidence
-3% of odontogenic tumours
- 2nd decade
-F > M
-Majority occur in anterior maxilla

24
Q

What is the presentation of AOT

A

75% associated with an unerupted toothCommonly a maxillary canine
-Similar to dentigerous cyst but typically attached apical to cemento-enamel junction
-Impedes eruption

Unilocular radiolucency

Majority have internal calcifications/radiopacities

Margins well-defined & corticated/sclerotic

May displace adjacent structures but external root resorption is rare

asymmetrical

25
Q

What is the histology of a AOT

A

Epithelial cells can present as a duct like structure or have a rosette apperance

Some calcification leading to distinctive patches

Well developed fibrous tissue capsule

26
Q

What is a Calcifying epithelial odontogenic
tumour (CEOT) and what is its incidence

A

A benign epithelial tumour (Pindborg tumour)

Incidence
-1% of odontogenic tumours
-5th decade
-M > F
-Posterior mandible is most common site

27
Q

What is the prsentation of CEOT

A

Slow-growing but can become large

Half associated with unerupted tooth

Radiolucency often with internal radiopacities

Calcifications of varying sizes

Variable radiographic presentation otherwise
-Unilocular/multilocular
-Margins: well-defined/ poorly-defined
-Internal septa: none/fine/coarse

28
Q

What is a Odontogenic myxoma and its incidence

A

Benign mesenchymal tumour

Incidence
-3-6% of odontogenic tumours
-3rd decade
-F = M
-Mandible > maxilla

29
Q

What is the presentation of odontogenix myxoma

A

Well-defined radiolucency +/- thin corticated margin

Smaller lesions unilocular

Larger lesions multilocular with scalloped margins
-“Soap bubble” appearance

Slow growth along bone before causing notable
bucco-lingual expansion

Scallops between teeth but larger lesions may
cause displacement

External root resorption rare

30
Q

What is the histology of a odontogenic myxoma

A

Loose myxoid tissue with stellate cells

May have smalls groups of odontogenic epithelium

May contain islands of inactive odontogenic epithelium

No capsule → locally invasive into adjacent bone

31
Q

What is the management of odontogenic myxoma

A

Curettage or resection

High recurrence rate: 25%
-Follow-up important
-Lower recurrence rate if unilocular

32
Q

What is a odontoma and what is its incidence

A

Benign mixed “tumour”
-Technically a hamartoma

Malformation of dental tissue
-Enamel, dentine, cementum & pulp

Similarities to teeth
-Mature to a certain stage
-Can be associated with other odontogenic lesions (e.g. dentigerous cysts)
-Surrounded by dental follicle

Lie above inferior alveolar canal

Incidence
-1/5 to 2/3’s of all odontogenic tumours
-2nd decade
-F = M

33
Q

What are the types of odontoma

A

Compound odontoma
-Ordered dental structures
-May appear as multiple “mini teeth” (i.e. denticles)
-More common in anterior maxilla

Complex odontoma
-Disorganised mass of dental tissues
-More common in posterior body of mandible

Compound > complex (2:1)

34
Q

What is the histology of a odontoma

A

Will have dental hard tissues
-Dentine and enamel space(as enamel inorganic so it get dissolved in prep)

35
Q

What is mainly used for treating ameloblastoma and sarcoma and what ha[[ens

A

Segmental resection:

-Removal of cyst with margin of ‘normal’ bone

-Normally require secondary procedure for reconstruction of defect

BDS4-oral Surgery (13 decks)

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