JAW TUMORS

Dr.Sudipta Bera
PDT 1st Year
Plastic and Reconstructive Surgery
SSKM & IPGMER
 Tumors include cystic,
inflammatory,developmental, and
posttraumatic masses.
 Radiologic evaluation: radiopaque,
radiolucent or combinations of varying
densities.
 The final diagnosis usually requires
histologic interpretation.
 Jaw masses
Cysts Tumors
A.TUMORS OF ODONTOGENIC
A.ODONTOGENIC CYSTS(ARISE FROM EPITHELIUM
AN ALTERATION OF THE ENAMEL 1. Ameloblastoma
ORGAN) B.TUMORS OF ODONTOGENIC
1. Periapical (radicular) cysts EPITHELIUM AND MESENCHYME
2. Dentigerous cysts 1. Complex, compound, and mix Odontomas
2. Cementoma
3. Primordial (follicular) cysts
C. TUMORS OF NONODONTOGENIC
B.NONODONTOGENIC ORIGIN
DEVELOPMENTAL CYSTS(DERIVED 1. Bony exostoses (TORI)
FROM EPITHELIUM ENTRAPPED IN THE
2. Osteomas
LINES OF FUSION OF THE BODY PROCESS)
3. Giant cell reparative granuloma
1. Nasopalatine (incisive canal) cysts
4. Hemangioma
2. Globulomaxillary cysts
5. Osteogenic sarcoma
C.NONODONTOGENIC AND 6. Multiple myeloma
NONDEVELOPMENTAL CYSTS 7. Metastatic tumors
1. Aneurysmal bone cysts 8. Fibrous dysplasia
2. Traumatic bone cysts 9. Paget disease (Osteitis deformans)
10. Familial fibrous dysplasia (Cherubism)
PERIAPICAL (RADICULAR) CYSTS

 M/C cyst of jawbone

 Occurs at the apex of non vital tooth as a result
of chronic inflammation, a/w degeneration of pulp
tissue
 Well circumscribed peri apical radiolucency,
Cholesterol crystal
 Rx: small cyst->conservative, non surgical RCT.
 >2cm->apical curretage,extensive root resection.
 If restoration of dentition not possible,tooth
extraction
DENTIGEROUS CYSTS

 Arise as a result of reduction in enamel forming

epithelium after crown is formed
 Seen surrounding crown of an unerupted tooth
 Posterior mandible M/c site,3rd Molar most
friquent
 Sign/Symptoms:delayederuption,swelling,asymmet
ry
 Rx:smaller cyst->enucleation+primary closure,
Large cyst->decompression,mersupialisation
PRIMORDIAL (FOLLICULAR) CYSTS

 Develops before calcified enamel or

dentition formed, d/t abnormal formation
of enamel organ
 Found in place of a tooth, c/b absence of
dentition with in cyst, epithelial lining
 Well circumscribed,
radiolucent,multiloculer
 Rx: enucleation, curretage
 High recurrence-post surgical X-Ray
follow up
NASOPALATINE (INCISIVE CANAL)
CYSTS
 Trapping tissue during fusion of palatine
process with pre maxilla
 Anterior:Sratified squmous epithelium,
Posterior:cuboidal
 S/S:painless buldging in the roof of mouth
 Rx:Surgical excision with mucoperiosteal
flap elevation
GLOBULOMAXILLARY CYSTS

 Fissural cyst at junction of globular

portion of median nasal process and
maxillary process
 Usually at between maxillary lateral
incisor and canine
 Radiolucency between roots,inverted tear
appearance
 Rx; Surgical excision
ANEURYSMAL BONE CYSTS

 Numerous capillaries intermixed with

with prominent vasculer space
 Multineucleated giant cell, no epithelial
lining
 Irreguler destruction of cortical
plate,scalloping
 Rx:Aspiration f/b surgical curratage
TRAUMATIC BONE CYST

 Devoid of lining
 Mandible seldom involved,uncommon
over 25yrs age
 Rx: Surgical exploration, enucleation and
curratage
AMELOBLASTOMA

 Ectodermal epithelium origin differentiation

into enamel forming cell
 Closely resembles dentigerous cyst, or
multiloculer, Honey comb appearance
 Onset 20-40 yrs, posterior mandible M/c site
 Histological type:Acanthometous(aggressive,
metastatic), folliculer, flexiform
 Destruction of cortex and tooth apex
usually, high recurrence
 Rx: Radical approach (wide block resection
and bone grafting) most effective
ODONTOMAS

 Composed of aberrant tissue of dental

element
 Complex: aberrant all dental element,
Compound:normal composition of tooth
like element independent of tooth follicle,
mixed
 Radio opeque
 M/c in maxilla(incisor-canine region)
Cementoma
 Originates from peri odontal ligament of
unerupted tooth
 Benign fibrosseus lesion replacing the
bone
 M/c mandibuler premolar and molar
 Rx: excision curratage
BONY EXOSTOSES (TORI)

 M/c benign bone tumor,slow growing

bony protrusion
 Palate,mandible,buccal surface of
mandibular or maxillary dentition
 Hereditary
 Cause mechanical and oral problem
 Rx:surgical removal
OSTEOMA

 Derived from osteoblastic activity

 Single or multiple(Gardner syndrome)
 Very opaque ireguler masses
GIANT CELL REPARATIVE GRANULOMA

 Slowly expanding mass usually anterior to

2nd mandibular molar
 Irreguler osteolytic lesion with migration
of tooth
 D/D obscured d/t similarity between
benign cyst and ameloblastoma
HEMANGIOMA

 Congenital or traumatic
 Thin wall vessel scattered with in bony
trabeculae
 C/f:Firm painless mass increasing in size,
loosening of dentition,gingival bleeding
 Dx.angiography,Rx:Sclerotherapy,Surgery
or both
OSTEOGENIC SARCOMA

 Highly malignant mass of bone or osteoid

originating from connective tissue
 Young age(10-40yrs)
 Sunray appearance
 Rx: Resection and Radiation
MULTIPLE MYELOMA

 Often involve jaw with plasmalike cells in

the marrow
 Multiple osteolytic lucent area
 Hyperglobulinemia, Bence Jones protein
,altered A:G ratio
 Rx: Alkylating agent, systemic steroid
METASTATIC TUMORS

 M/c from Squmous cell Ca. from

surrounding oral tissue, Others: primary
tumor of breast, uterus, lung and thyroid
 Mandible m/c site
FIBROUS DYSPLASIA

 Membrenous facial bone of young

individual
 Commonly single Fibroosseous mass, M/c
in maxilla
 Surge of growth during hormonal changes
 CT Scan evaluation necessary to r/o
orbital or base of skull involvement
 Rx: conservative surgical curratage
through intra oral route
PAGET DISEASE (OSTEITIS
DEFORMANS)
 Resembles ossifying fibroma
 Older age group
 Maxilla M/c site,commonly multiple
 ↑ serum PO4
FAMILIAL FIBROUS DYSPLASIA
(CHERUBISM)
 Multiple areas of fibrous dysplasia in
mandible and maxilla
 Occurs as early as 1 year
 Inherited genetic disorder
 Rx:multiple curratage spaced over a
number of years
THANK YOU