sx management odontogenic tumors Flashcards by Caleb Houghton

Tumors of odontogenic epithelium

A. Ameloblastoma
1. Malignant ameloblastoma
2. Ameloblastic carcinoma
B. Clear cell odontogenic carcinoma
C. Adenomatoid odontogenic tumor
D. Calcifying epithelial odontogenic tumor
E. Squamous odontogenic tumor

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Mixed odontogenic tumors

A. Ameloblastic fibroma
B. Ameloblastic fibro-odontoma
C. Ameloblastic fibrosarcoma
D. Odontoameloblastoma
E. Compound odontoma
F. Complex odontoma

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Tumors of odontogenic ectomesenchyme

A. Odontogenic fibroma
B. Granular cell odontogenic tumor
C. Odontogenic myxoma
D. Cementoblastoma

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BENIGN, NO RECURRENCE
POTENTIAL tumors

Adenomatoid odontogenic tumor
Squamous odontogenic tumor
Cementoblastoma
Periapical cemento-osseous dysplasia
Odontoma

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BENIGN, SOME RECURRENCE
POTENTIAL tumors

Cystic ameloblastoma (unicystic)
Calcifying epithelial odontogenic tumor
Central odontogenic fibroma
Florid cementoosseous dysplasia
Ameloblastic fibroma and fibroodontoma

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BENIGN AGGRESSIVE tumors

 Ameloblastoma(Multicystic/Solid)
 Clear cell odontogenic tumor (some consider this a carcinoma)
 Odontogenic ghost cell tumor (COC, solid type)
 Odontogenic myxoma
 Odontoameloblastoma

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MALIGNANT

 Malignant ameloblastoma
 Ameloblastic carcinoma
 Primary intraosseous carcinoma
 Odontogenic ghost cell carcinoma
 Ameloblastic fibrosarcoma

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Odontogenic Tumors - Diagnosis
* Detailed hx?
* Thorough Clinical examination?
* Conventional Radiographs?
* C.T Scan?

Detailed history – Pain, loose teeth, occlusion, swellings, Paresthesia, Dysesthesia,
delayed tooth eruption, SPEED OF DEVELOPMENT
Thorough Clinical examination – Inspection, palpation, percussion
Conventional Radiographs – Panorex, dental radiographs
C.T Scan - for larger, aggressive lesions

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cysts and tumors with nn’s

cysts will diplace nn, often no symptoms, tumors will compress nn leading to neurological symptoms

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which imaging is used for sx planning/ is the gold standard?

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obtaining tissue for diagnosis with tumors

Obtain tissue: DONE AFTER CT SCAN DO NOT WNAT ANY INFLAMM FOR SCAN
– Aspiration – r/o vascular lesions, inflammatory, DONE FIRST
– Incisional biopsy – larger lesions prior to definitive therapy
– Excisional biopsy – smaller tumors
Establish Definitive Diagnosis !

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Surgical Management of Odontogenic Tumors
Surgical Management includes:
* The type of surgical approach that is going to be employed is mainly dependant on?
* The type of reconstruction is mainly decided based on ?
*

“Surgical removal” of the odontogenic tumor followed by appropriate method for reconstruction of the defect.
The type of surgical approach that is going to be employed is mainly dependant on the type (Biologic behavior) of the tumor and it’s size.
The type of reconstruction is mainly decided based on the size and extent of the defect (Both Hard and Soft tissue)

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Odontogenic Tumors - Surgical Treatment Options

Enucleation: smaller, low recurrence
Resection: larger, aggressive lesions
Marginal(Segmental) resection
Partial resection
Total resection
Composite resection

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Enucleation of Odontogenic Tumors
types of lesions?
approach?

Local removal of tumor by appropriate instrumentation in direct contact with the lesion: used for** very benign types of lesions.**
intra oral approach can be used to reduce scarring

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after tumor is removed via nucleation what is done with it

sent for histo exam

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Surgical resection of odontogenic tumors

Removal of a tumor by incising through uninvolved tissues around the tumor, thus delivering the tumor without direct contact during instrumentation (also called as en bloc rection).

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Marginal (Segmental) resection

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Resection of a tumor without disruption of the continuity of the bone.
minimizes tumor spillage and reduces recurrence
1-1.5cm surrounding tissue removed

Partial Resection
thickness?
approach?

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

total resection

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Resection of a tumor by removal of the involved bone.
Eg., Hemi-Maxillectomy and Hemi-Mandibulectomy

Composite Resection

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

Rationale for Surgical Reconstruction of the Jaws
* To Restore the:

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Form of the Maxilla and mandible
– Maintain correct anatomical relation to the jaws
– Important for dental rehabilitation (endosseous implant placement)
Function - Mastication and Speech
Aesthetics

Types of Grafts Used for Reconstruction of the Jaws

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free bone used with smaller defects, vacularized used with larger defects (has aa/vv attatched)

Surgical Management of Common Tumors of Odontogenic Epithelium
* composed of?
* examples?

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Epithelial odontogenic tumors are composed of odontogenic epithelium without participation of odontogenic ectomesenchyme.
- Ameloblastoma
- Adenomatoid Odontogenic tumor (AOT)

Tumors of Odontogenic Epithelium: Ameloblastoma
* B/M?
* invasive?
* spread?
* Occasionally arise from?

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Benign, but locally invasive (Except for the Malignant variant).
It is unencapsulated and infiltrates surrounding bone marrow.
Even though they are locally infiltrative, they do not metastasize (Except for the Malignant variant).
Occasionally arise from dentigerous cysts

ameloblastoma most common locations?

Ameloblastoma * Clinical Subtypes – % * It occurs chiefly in ? * They may occur where?

* Clinical Subtypes – - **Multicystic or Solid (86%),** - Unicystic (13%), and - Peripheral (extraosseous) and Malignant variant (1%) * It occurs chiefly in middle age people long after odontogenesis has ceased. * They may occur in any part of both jaws but most are in the middle and posterior regions of the mandible.

Ameloblastoma: Radiographic findings

* They may be unilocular but frequently become multilocular as they increase in size. * The unilocular lesion is indistinguishable from an odontogenic cyst. * Well-circumscribed, “soap- bubble appearance” (Multicystic or Solid variant).

Ameloblastoma: Treatment according to?

* According to growth characteristics and type

Unicystic Ameloblastoma tx?

– Complete removal (Enucleation) – Peripheral ostectomies if extension through cyst wall

Classic infiltrative (aggressive) – “Solid Ameloblastoma” tx – Mandibular – – Maxillary –

– Mandibular – adequate normal bone around margins of resection – Maxillary – more aggressive surgery, 1.5 cm margins

Ameloblastic carcinoma tx

– Radical surgical resection (like SCCa) – Neck dissection

Adenomatoid Odontogenic Tumor * This is a tumor that is commonly found in? * It occurs where? * Commonly associated with? * Two-thirds occur in? more common in? *common teeth? * chief complaint?

* This is a tumor that is commonly found in teenagers. * It occurs in the middle and anterior portions of the jaws * Commonly associated with the crown of an impacted anterior tooth. * Two-thirds occur in the maxilla and it is more common in females. * The maxillary incisor-cuspids are common sites. * Painless expansion is often the chief complaint.

# AOT common sites

Adenomatoid Odontogenic Tumor Radiographic Findings

The radiographic appearance is a unilocular radiolucency, often around the crown of an unerupted tooth in which case they resemble a dentigerous cyst.

Adenomatoid Odontogenic Tumor (AOT) Treatment

* Treatment is with simple surgical enucleation and recurrence is extremely rare.

Compound and Complex Odontomas * The tumors in which odontogenic differentiation is? * In these tumors, the epithelium and ectomesenchyme? * As a result, these tumors are mostly? * commonality?

* The tumors in which odontogenic differentiation is fully expressed are the odontomas. * In these tumors, the epithelium and ectomesenchyme realize their potential and make enamel and dentin respectively. * As a result, these tumors are mostly radiodense. * Odontomas are the most common type of odontogenic tumors seen in the oral surgery clinic.

Complex Odontoma

* In the complex odontoma, there is little or no tendency to form tooth-like structures. * The dentin and enamel are entwined in a mass that bears no resemblance to teeth.

Compound Odontoma

In the compound odontoma, multiple small and malformed tooth-like structures are formed creating a “bag of marbles” radiographic appearance.

Complex and Compound Odontomas * Both types of odontoma are found when? * which types are more common where? * Many are associated with? * growth? pain? deformity? * Treatment is?

* Both types of odontoma are found in the early years, usually in the teens or early twenties. * Compound odontoma is more common in the anterior jaw segment whereas the complex type is found more commonly in the posterior jaws. * Many are associated with an unerupted tooth. * They have a limited growth potential and cause no pain or cosmetic deformity. * Treatment is elective surgery.

Cementoblastoma *neoplasm of? * This tumor typically occurs where? * Cortex? * Involved tooth is?

* True benign neoplasm of cementoblasts, tumor of odontogenic ectomesenchyme * This tumor typically occurs around the roots of the lower posterior teeth (First Mandibular molars) * Cortex expanded without pain * Involved tooth ankylosed.

Cementoblastoma - Radiographic examination

Radiographically it appears as a ball of dense material attached to the end of the root.

Cementoblastoma - Treatment

Complete excision of the lesion along with extraction of the involved tooth.

sx management odontogenic tumors Flashcards

(42 cards)