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TUMOR LIKE SWELLINGS OF JAWS

In olden time, tumor meant Lump or swelling due to any cause.

• In contemporary science, tumor means neoplasm that has formed lump/swelling in any part of body.
• In contemporary science, tumor means neoplasm
that has formed lump/swelling in
any part of body.

NEOPLASM….?

Abnormal Growth of

Cyst Tumor/Neoplasm • Odontogenic & Non Odontogenic • Odontogenic & Non Odontogenic • Metastatic Swellings of
Cyst
Tumor/Neoplasm
• Odontogenic & Non Odontogenic
• Odontogenic & Non Odontogenic
• Metastatic
Swellings of Jaws
Giant Cell Lesion
Fibro osseous Lesion
Studynama’s BDS Community is one of India’s Largest Community of Dental Students. About 19,232 Indian Dental
Studynama’s BDS Community is one of India’s Largest Community of Dental Students. About
19,232 Indian Dental Course students are members of this community and share FREE study
material, cases, projects, exam papers etc. to enable each other to do well in their semester exams.

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INTRODUCTION…

•As the name indicates, odontogenic tumors are derived from odontogenic tissues.
•As the name indicates, odontogenic tumors
are derived from odontogenic tissues.

Odontogenic tissues are those which take part in

tooth development.

Odontogenic Tumors are most common types of neoplasm of jaws.

Ameloblastoma Squamous Odontogenic Tumor Calcifying epithelial odontogenic tumor Adenomatoid odontogenic tumor Calcifying cystic tumor
Ameloblastoma
Squamous Odontogenic
Tumor
Calcifying epithelial
odontogenic tumor
Adenomatoid
odontogenic tumor
Calcifying cystic tumor

CLASSIFICATION

Epithelium Odontogenic fibroma Benign
Epithelium
Odontogenic fibroma
Benign
Mesenchymal
Mesenchymal
Odontogenic myxoma
Odontogenic myxoma
cementoblastoma Mixed of Both Ameloblastic Fibroma
cementoblastoma
Mixed of Both
Ameloblastic Fibroma
Odonto genic Tumors
Odonto genic Tumors
Odontogenic carcinoma Epithelium Clear cell odontogenic tumor Malignant Mesenchymal Odontogenic sarcoma
Odontogenic carcinoma
Epithelium
Clear cell odontogenic
tumor
Malignant
Mesenchymal
Odontogenic sarcoma

INTRODUCTION

Benign but locally invasive

neoplasm derived from one of the

following odontogenic epithelium;

Surface epithelium

Reduced enamel

Remnants of dental lamina

Rest cells of Malessez

Lining of dentigerous cyst

It is rare & accounts for 1% of all

tumors of oral cavity.

BUT, Ameloblastoma

is common in our

Society.

(PAKISTAN)

T YPES OF AMELOBLASTOMA

Multicystic Ameloblastoma Solid Ameloblastoma Conventional Ameloblastoma Follicular Ameloblastoma True Ameloblastoma
Multicystic Ameloblastoma
Solid Ameloblastoma
Conventional Ameloblastoma
Follicular Ameloblastoma
True Ameloblastoma
Unicystic
Unicystic
Central / Intra Osseous Peripheral / Extra Osseous Ameloblastoma On the basis of Clinical & Radiological
Central / Intra Osseous
Peripheral / Extra
Osseous
Ameloblastoma On the basis of Clinical & Radiological
Features.

GENERAL F EATURES

OF AMELOBLASTOMA

Most common neoplasm of

odontogenic origin.

Usually in 3 rd 5 th decade.

Rare in children & elderly

Mostly in posterior region of

mandible.

No specific gender prediction.

Locally invasive but does

not metastasize

That’s why called benign.

About 80% of

Ameloblastoma occur in

Mandible.

Studynama’s BDS Community is one of India’s Largest Community of Dental Students. About 19,232 Indian Dental
Studynama’s BDS Community is one of India’s Largest Community of Dental Students. About
19,232 Indian Dental Course students are members of this community and share FREE study
material, cases, projects, exam papers etc. to enable each other to do well in their semester exams.

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CLINICAL PRESENTAT ION

OF AMELOBLASTOMA

Characteristics of Jaw Expansion by

Usually asymptomatic & slow growing.

Bony hard, non tender, ovoid

Results in facial deformity & jaw

expansion.

or fusiform outline.

in advanced cases egg shell

In maxilla even large lesion of

Ameloblastoma produce very little

expansion because lesion can extend

into sinuses & beyond.

crackling due to thinning of

CLINICAL PRESENTAT ION OF AMELO <a href=BLASTOMA Characterist ics of Jaw Expansion by • Usually asymptomatic & slow growing. Ameloblasto ma Bony ha rd, non tender, ovoid • Results in facial defor mity & jaw expansion. or fusifo rm outline. in advan ced cases egg shell • In maxilla even large le sion of Ameloblastoma produ ce very little expansion because lesi on can extend into sinuses & beyond. crackling due to thinning of bone. " id="pdf-obj-11-52" src="pdf-obj-11-52.jpg">

A CLINICAL

PHOTOGRAPH OF

GRANULAR CELL

AMELOBLASTOMA IN

THE ORAL CAVITY

SHOWS AN

ENORMOUS MASS ON

THE RIGHT MANDIBLE.

http://www.nature.com/ijos/journal/v4/n1/full/ijos20129a.html

CLINICAL PRESENTAT ION

(LATE FEATURES) OF AMELOBLASTOMA

Pain

Paresthesia

Extension of

neoplasm into soft

tissue.

Perforation of bone

R A D I O G R A P H I C F E A T

R A D I O G R A P H I C

F E A T U R E S

O F

A M E L O B L A S T O M A

Typically form Rounded & Cyst like Radiolucency with moderately well defined margins and appear as multilocular

SOAP BUBBLE or HONEY COMB APPEARANCE.

Studynama’s BDS Community is one of India’s Largest Community of Dental Students. About 19,232 Indian Dental
Studynama’s BDS Community is one of India’s Largest Community of Dental Students. About
19,232 Indian Dental Course students are members of this community and share FREE study
material, cases, projects, exam papers etc. to enable each other to do well in their semester exams.

Links to Popular Study Material for BDS (Dental) students:

And 698 more free downloads for Dental Students.

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A panoramic radiograph displays a well defined multilocular

radiolucency with scalloped border (arrowheads) extending from the

right second mandibular premolar to the mandibular ramus. Extensive

root resorption of the right second mandibular premolar and thinning of the cortical plate is detected. Note that the inferior alveolar nerve canal has been displaced inferiorly to the inferior cortex of the mandible

(arrows).

A panoramic radiograph displays a well defined multilocular radiolucency with scalloped border (arrowheads) extending from thenferiorly to the inferior co rtex of the mandible (arrows). http://www.nature.com/ijos/journal/v4/n1/full/ijos20129a.html " id="pdf-obj-16-14" src="pdf-obj-16-14.jpg">

http://www.nature.com/ijos/journal/v4/n1/full/ijos20129a.html

HISTOPATHOLOGY

OF AMELOBLASTOMA

Conventional ameloblastoma are usually made of mixture of

solid neoplasm & cysts.

They have variety of patterns histologically but there are some features

which are common to all histological variety of ameloblastoma;

Presence of neoplastic ameloblasts

with Palisaded appearance & reverse

polarization (presence of nuclei away from basement membrane)

Ple xiform Ameloblastoma

Foll icula r Ameloblastoma

De smoplastic Ameloblastoma

Acanthoma tous Ameloblastoma

Gra nu <a href=lar Ameloblastoma Ple xiform Ameloblastoma Ba sal Ameloblastoma Foll icula r Ameloblastoma De smoplastic Ameloblastoma Acanthoma t ous Ameloblastoma " id="pdf-obj-18-17" src="pdf-obj-18-17.jpg">

FOLLICULAR AMELOBLASTOMA

Most common type of ameloblastoma.

Characterized by; islands of follicles of epithelial

cells in a connective tissue stroma.

Outer layer of these islands have well organized, tall

cells.

small cysts may be present within follicle or stoma

Here islands of epithelium are not interconnected.

FOLLICULAR AMELOBLASTOMA • Most common type of ameloblastoma. • Characterized by; isla <a href=nds of follicles of epithelial cells in a connective tissue stroma. – Outer layer of these islands have well organized, tall columnar ameloblas ts like cells with reverse polarity which are surroundi ng core of polyhedral or angular cells. – small cysts may be pr esent within follicle or stoma – Here islands of epithel ium are not interconnected. " id="pdf-obj-19-36" src="pdf-obj-19-36.jpg">
FOLLICULAR AMELOBLASTOMA • Most common type of ameloblastoma. • Characterized by; isla <a href=nds of follicles of epithelial cells in a connective tissue stroma. – Outer layer of these islands have well organized, tall columnar ameloblas ts like cells with reverse polarity which are surroundi ng core of polyhedral or angular cells. – small cysts may be pr esent within follicle or stoma – Here islands of epithel ium are not interconnected. " id="pdf-obj-19-38" src="pdf-obj-19-38.jpg">

FOLLICULAR AMELOBLASTOMA

FOLLICULAR AMELOBLASTOMA

PLEXIFORM AMELOBLASTOMA

Here epithelium forms cords or strands and

trabeculae of small, darkly stained epithelial

cells which may lack reverse polarization and

does not resemble any stage of ameloblasts

present in less cellular stroma.

This variant give Fish net appearance.

PLEXIFORM AMELOBLASTOMA • Here epithelium forms <a href=cords or strands and trabeculae of small, d arkly stained epithelial cells which may lack r everse polarization and does not resemble any stage of ameloblasts present in less cellular stroma. • This variant give Fish – net appearance. " id="pdf-obj-21-28" src="pdf-obj-21-28.jpg">

ACANTHOMATOUS

AMELOBLASTOMA

It has similar histological appearance to follicular

ameloblastoma, except difference in;

Squamous metaplasia of core cells (stellate &

angular cells) occurs producing prickle cells &

keratin in core.

this variant is sometimes confused with

squamous cell carcinoma.

BASAL

AMELOBLASTOMA

Rare type

Arranged as trabecular pattern

with peripheral cells cuboidal

rather than columnar.

Mistaken with basal cell carcinoma.

GRANULAR

AMELOBLASTOMA

In this appearance of epithelium & stroma is also

similar to follicular ameloblastoma but difference in

it is; central / core cells & some ameloblasts at

peripheral cells undergo degenerative changes &

form sheets of large PINK / eosinophilic granular

cells in the center of island.

GRANULAR AMELOBLAS <a href=TOMA • In this appearance of epith elium & stroma is also similar to follicular amelobl astoma but difference in it is; central / core cells & some ameloblasts at peripheral cells undergo degenerative changes & form sheets of large PIN K / eosinophilic granular cells in the center of isla nd. " id="pdf-obj-24-27" src="pdf-obj-24-27.jpg">

DESMOPLASTIC

AMELOBLASTOMA

In this epithelium,

odontogenic

epithelium is

arranged in small

islands or cords

in dense & highly

collagenised

stroma.

DESMOPLASTIC AMELOBLASTOMA • In this epitheliu <a href=m, odontogenic epithelium is arranged in sm all islands or cord s in dense & hig hly collagenised stroma. " id="pdf-obj-25-27" src="pdf-obj-25-27.jpg">

BEHAVIOR OF AMELOBLASTOMA

Although ameloblastoma is benign, but some cells of this

ameloblastoma may infiltrate the narrow spaces without

causing swelling and destruction of bone.

So that’s why simple curettage or enucleation of lesion cannot

be done due to high recurrence.

So surgical resection with small normal tissue is best treatment option. (wide excision)

MANAGEMENT OF MULTICYSTIC

AMELOBLASTOMA

Diagnosis is confirmed by biopsy.

Treatment of choice is wide excision taking upto 2 cm of

normal bone around margin of lesion.

Simple enucleation can cause Recurrence because of probability of

invasion in surrounding space.

Regular radiographic follow up for detecting any recurrence.

MANAGEMENT OF MULTICYSTIC

AMELOBLASTOMA

Maxillary Ameloblastoma are dangerous because;

Bone is thinner in mandible.

Neoplasm spread easily to following areas in maxilla.

Maxillary sinus

Pterygomaxillary fossa

Orbit Cranium Brain

INTRODUCTION

UNICYSTIC AMELOBLASTOMA

It is defined as ameloblastoma having single cyst or appear as single cyst.

However, ameloblastoma radiographically appearing as single cyst can be Multicystic

like mural ameloblastoma

Explanations for a Unicystic presentation of ameloblastoma radiologically. The two patterns on the left are true
Explanations for a Unicystic presentation of
ameloblastoma radiologically.
The two patterns on the left are true
Unicystic
ameloblastoma while that on the right is a
conventional ameloblastoma with one very
large cyst.
INTRODUCTION UNICYSTI <a href=C AMELOBLAS TOMA • It is defined as amelob lastoma having single cyst or ap pear as single cyst. • However, ameloblasto ma radiographically appearing a s single cyst can be Multicystic like mural ameloblasto ma Explanations for a Unicystic presentation of ameloblastoma radiologically. The two patterns on the left are true Unicystic ameloblastoma while that on the right is a conventional ameloblastoma with one very large cyst. " id="pdf-obj-30-23" src="pdf-obj-30-23.jpg">

FEATURES OF UNICYSTIC

AMELOBLASTOMA

Mostly b/w 10 20 years of age.

Mostly in posterior mandible.

Sometimes arises with

dentigerous cysts.

Radiological Features

Appear as unilocular radiolucency

Histology

Tumor cells forming cyst wall

are flattened & can be

mistaken for those or non

neoplastic cyst.

Treatment

Enucleation

PERIPHERAL AMELOBLASTOMA

In this type, ameloblastoma is present in gingival or alveolar soft tissues and does not

involve bone.

These lesion may arise from;

Basal cells of oral epithelium

Extra osseous rests of dental lamina.

Histologically similar to intra osseous ameloblastoma.

MALIGNANT OR METASTASIZING

AMELOBLASTOMA

It is distant or metastasized ameloblastoma.

Metastasis usually occur to lung.

Although it is benign and truly speaking does not metastasize

but in some conditions as described under they may move

from oral cavity to other places;

Aspiration of some cells of ameloblastoma into lungs during surgery. Surgically disrupting primary site Incomplete removal

AMELOBLASTIC CARCINOMA

It arises when dysplastic changes occur in the primary

benign ameloblastoma.

Rare

Histologically poorly differentiated and shows

dysplasia .

Metastasize to lymph nodes. If metastasis is present, prognosis is poor.

AMELOBLASTIC CARCINOMA

MALIGNANT AMELOBLASTOMA

Clinically primary &

secondary ameloblastoma

have same all clinical

histological & other

features.

Usually lungs.

AMELOBLASTIC CARCINOMA

Primary has features of

normal benign

ameloblastoma, while

secondary show dysplasia

& malignant .

Metastasize to lymph nodes.