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OMS x OMOPOR > Growths of the Jaw > Flashcards

Growths of the Jaw Flashcards

1
Q

Etiology of squamous papilloma

A

HPV 6, 11

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2
Q

Clinical presentation of squamous papilloma

A

Mainly in 30-50yo adults
Solitary
Exophytic nodule (0.5-3mm)
Finger-like surface projections, cauliflower or wart-like appearance
Painless, pedunculated, soft
White/red/normal in colour depending on amount of surface keratinization

Can be anywhere in mouth but its the most common soft tissue mass on the soft palate

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3
Q

Histopathologic findings of squamous papilloma

A

Proliferation of keratinized squamous epithelium arranged in finger-like projections with fibrovascular CT cores
Koliocytes (viral-altered epithelial cells) present in spinous cell layer

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4
Q

Management of squamous papilloma

A

Conservative surgical excision
CO2 laser
Cryotherapy
Electrosurgery
Chemical tx

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5
Q

What are tori/exostosis

A

Bony protuberances from cortical plate
Usually in adults
Common in asians
Male > female

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6
Q

Clinical presentation of tori

A

Exophytic nodular growth of dense cortical bone
Round smooth surface
Asymptomatic unless traumatized
Frequently lobulated and symmetrical/bilateral

Torus palatinus: midline hard palate
Torus mandibularis: cuspid/PM area of lingual surface of mand
Buccal exostoses: buccal aspect of alveolar ridge

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7
Q

Radiographic presentation of tori

A

Well-defined RO, may be superimposed over teeth

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8
Q

Histopathologic findings of tori

A

Dense lamellar bone with small amounts of fibrofatty marrow
May have inner zone of trabecular bone

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9
Q

Management of tori

A

No treatment needed
May be removed as part of preprosthetic surgery for dentures
May interfere with speech, tongue movement, dentures and OH maintenance, may have traumatic ulcers

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10
Q

What is denture-induced fibrous hyperplasia/epulis fissuratum

A

Hyperplasia of fibrous CT due to flange of ill-fitting denture
Flange tends to be overextended or rough
Usually in middle-aged to older adults
Female > male

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11
Q

Clinical presentation of epulis fissuratum

A

Single/multiple folds of hyperplastic tissue in alveolar vestibule, usually 2 folds w flange fitting into the fissure between the folds
Redundant tissue firm and fibrous, can be erythematous and ulcerated

Max or mand
Anterior > posterior
Usually labial aspect of ridge but can be lingual to mand alveolar ridge

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12
Q

Histopathologic findings of epulis fissuratum

A

Hyperplasia of fibrous CT
Overlying hyperkeratotic epithelium with irregular hyperplasia or rete ridges
Variable chronic inflammatory infiltrate
Focal areas of ulceration esp at base of grooves
If minor salivary glands included, usually shows chronic sialadenitis

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13
Q

Management of epulis fissuratum

A

Surgical removal
Ill-fitting denture remade/relined to prevent recurrence

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14
Q

What is a fibroma?

A

Reactive hyperplasia of fibrous CT in response to local irritation/trauma
Not a true neoplasm
Usually in 40-60yo, female > male

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15
Q

Clinical presentation of fibromas

A

Smooth-surfaced gingiva-colored nodule
May be white due to hyperkeratosis
Sessile or pedunculated
Mostly <1.5cm
Asymptomatic unless ulcerated due to trauma
May appear as a frenal tag on max labial frenum, small exophytic growth

Buccal mucosa, along occlusal plane
Labial mucosa, tongue, gingiva

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16
Q

Histopathologic findings of fibromas

A

Nodular mass of fibrous CT covered by SSE
Dense and collagenised CT, fibrous tissue blends in CT, not encapsulated
Atrophy of rete ridges
Scattered chronic inflammation may be present (lymphocytes and plasma cells) under epithelial surface

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17
Q

Management of fibromas

A

Conservative surgical excision, recurrence rare
Biopsy

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18
Q

What is a mucocele

A

Trauma to salivary gland causing rupture of duct, mucous extravasation into CT, stimulating inflammatory response
Lacks epithelial lining
Usually in children and young adults

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19
Q

Clinical presentation of mucoceles

A

Usually single, 1-2mm, sessile, fluctuant well-circumscribed nodule
Variable in colour: blue/pink/white if traumatized
May be compressible, fluctuates in size
Hx of recurrent swelling and rupture
Rapid onset, days to years in duration
Asymptomatic
Increases in size during mealtimes

Any sites of minor salivary gland tissues, esp lower lip, but can be in anterior ventral tongue, buccal mucosa

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20
Q

Histopathologic findings of mucoceles

A

Area of spilled mucin surrounded by granulation tissue response
Inflammation includes many foamy histiocytes
Adjacent minor salivary glands have chronic inflammatory cell infiltrate and dilated ducts
May have ruptured salivary duct feeding into area
No epithelial lining

21
Q

Management of mucoceles

A

If it doesnt affect function or aesthetics monitor
Otherwise surgical excision of lesion and affected salivary gland to prevent recurrence

22
Q

What is an oral hemangioma

A

Benign neoplasm of infancy/childhood
Proliferates for 6-12 months
Then grows proportionally with child, slowly involutes
Female > male
True neoplasm of endothelial cells

23
Q

Clinical presentation of oral hemangiomas

A

Usually single dark reddish/purplish flat/raised smooth soft lesion that blanches on pressure
Asymptomatic
Larger lesions can compress vital structures or ulcerate and bleed, can detect phleboliths radiographically

Lips > tongue > buccal mucosa > palate

24
Q

Histopathologic findings of oral hemangiomas

A

Endothelial cell hyperplasia

25
Q

Management of oral hemangiomas

A

No treatment
Self limited, involutes by 5-9yo, just monitor
Intervene if life threatening, like blocks airway or bleeding, ulcerates or impacts function etc by surgical excision/laser/sclerotherapy

26
Q

What is an odontoma?

A

Most common odontogenic tumour
Non-neoplastic, developmental anomaly containing enamel, dentine, pulp, cementum
10-20yo
Arises from epithelium, mesenchyme
Unknown etiology

Complex: mass of disorganised odontogenic tissues
Compound: multiple well-organised small tooth-like structures

27
Q

Clinical presentation of odontomas

A

Slow growing, expansile, painless
Asymptomatic

Max > mand
Often associated with unerupted/impacted teeth

Complex: posterior > anterior
Compound: anterior > posterior

28
Q

Radiographic presentation of odontomas

A

Well-defined mixed lesion with smooth but irregular periphery
Encapsulated by RL rim

Complex: amorphous RO
Compound: multiple toothlets
Mixed complex/compound: both

29
Q

Histopathologic findings of odontomas

A

Empty spaces and clefts = enamel
Dentine with dentinal tubules are the bulk of the lesion
Pulp-like tissue: dentine lined by odontoblast-like cells

Complex: disorganised hard tissue mass surrounded by soft tissue capsule, disorderly arranged but well-formed enamel, dentine, pulp and cementum

Compound: multiple toothlets within soft tissue capsule, well-organised and well-formed enamel, dentine, pulp and cementum

30
Q

Management of odontomas

A

Surgical enucleation, no recurrence

31
Q

What is a cementoblastoma

A

Benign neoplasm of cementoblast
Unknown etiology
Mass of cementum-like tissue in continuity with apical epithelium layer of molar/premolar
20-30yo
Arises from ectomesenchymal cells of periodontium

32
Q

Clinical presentation of cementoblastomas

A

Pain
Bony hard swelling and expansion of buccal and lingual cortical plates

Mand > max
Posterior > anterior
Teeth are vital

33
Q

Radiographic presentation of cementoblastomas

A

Well-defined RO lesion with corticated border and thin well-defined RL rim
When mature its a more dense RO mass
Fused to apex of associated tooth

May cause external root resorption, bony expansion and cortical erosion

34
Q

Histopathologic presentation of cementoblastomas

A

Dense mass of mineralised cementum-like material with many basophilic reversal lines
Cemental trabeculae lined by plump and hyperchromatic cementoblasts
Peripheral radiating/perpendicular trabeculae extending towards surrounding fibrous capsule

35
Q

Management of cementoblastomas

A

Surgical enucleation of mass and exo of associated tooth
Recurrence rate low

36
Q

What is an ossifying fibroma aka cemento-ossifying fibroma

A

Benign neoplasm
30-40yo, female > male
Juvenile OF aggressive, <20yo

Significant growth potential

37
Q

Clinical presentation of ossifying fibromas

A

Ranges from indolent to aggressive
Asymptomatic
Facial asymmetry, displacement/mobility of teeth

Mand > max
Posterior > anterior

38
Q

Radiographic presentation of ossifying fibromas

A

Epicenter apical to teeth, above IDN
Well defined, may have corticated border
Encapsulated by RL rim
May have surrounding sclerosis

RL/mixed/RO
Wispy
Snowflake like
Granular

Concentric expansion with thinning of cortical plates
Superior displacement of max sinus
Inferior displacement of IDN
Loss of lamina dura
Teeth displacement
Possible root resorption

39
Q

Histopathologic findings of ossifying fibromas

A

Dense cellular fibrous CT stroma
Abnormal mineralised spherules representing cementum-like material (cementicles) and ossicles (bone)
Spherules have peripheral brush borders

40
Q

Management of ossifying fibromas

A

Surgical enucleation/resection
Recurrence unlikely

41
Q

Malignant lesion typical features

A

Fast growing
Indurated/firm
Fixed to underlying tissues
Irregular surface
Mixed
Sometimes ulcerates, bleeds easily

42
Q

What is a biopsy

A

Removal of cells or tissues to be examined by a pathologist microscopically or via other tests

43
Q

Indications for biopsy

A

Enlarging mass suspicious of malignancy
New or enlarging pigmented lesion, esp if have irregular border, mixed color etc
Entities that appear to be clinically benign, excised then submitted for histological analysis

44
Q

Contraindications of biopsy

A

Vascular lesions which would cause hemorrhage
Areas that would cause damage to anatomical structures like floor of mouth area which may damage lingual nerve and submand duct
Areas where its difficult to get hemostasis like tonsillar area

45
Q

Types of biopsy

A

Excisional
Incisional
Intra-osseous
Needle
Punch
Frozen section

46
Q

Biopsy procedure

A

Select area
Prepare instruments and environment
LA
Make a wedge shaped incision
Remove and transfer specimen into a container w formalin
Obtain hemostasis and wound closure
Provide post-op instructions

47
Q

What is excisional biopsy

A

Surgical procedure in which an incision is made through the mucosa or skin to remove the entire lump

48
Q

What is incisional biopsy

A

Surgical procedure in which incisions are made through the lesion to remove a section of the growth

Often used when malignancy or aggressive benign tumour is suspected

OMS x OMOPOR (8 decks)

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