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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
Management of oral hemangiomas
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
What is an odontoma?
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
Clinical presentation of odontomas
Slow growing, expansile, painless Asymptomatic Max > mand Often associated with unerupted/impacted teeth Complex: posterior > anterior Compound: anterior > posterior
28
Radiographic presentation of odontomas
Well-defined mixed lesion with smooth but irregular periphery Encapsulated by RL rim Complex: amorphous RO Compound: multiple toothlets Mixed complex/compound: both
29
Histopathologic findings of odontomas
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
Management of odontomas
Surgical enucleation, no recurrence
31
What is a cementoblastoma
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
Clinical presentation of cementoblastomas
Pain Bony hard swelling and expansion of buccal and lingual cortical plates Mand > max Posterior > anterior Teeth are vital
33
Radiographic presentation of cementoblastomas
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
Histopathologic presentation of cementoblastomas
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
Management of cementoblastomas
Surgical enucleation of mass and exo of associated tooth Recurrence rate low
36
What is an ossifying fibroma aka cemento-ossifying fibroma
Benign neoplasm 30-40yo, female > male Juvenile OF aggressive, <20yo Significant growth potential
37
Clinical presentation of ossifying fibromas
Ranges from indolent to aggressive Asymptomatic Facial asymmetry, displacement/mobility of teeth Mand > max Posterior > anterior
38
Radiographic presentation of ossifying fibromas
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
Histopathologic findings of ossifying fibromas
Dense cellular fibrous CT stroma Abnormal mineralised spherules representing cementum-like material (cementicles) and ossicles (bone) Spherules have peripheral brush borders
40
Management of ossifying fibromas
Surgical enucleation/resection Recurrence unlikely
41
Malignant lesion typical features
Fast growing Indurated/firm Fixed to underlying tissues Irregular surface Mixed Sometimes ulcerates, bleeds easily
42
What is a biopsy
Removal of cells or tissues to be examined by a pathologist microscopically or via other tests
43
Indications for biopsy
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
Contraindications of biopsy
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
Types of biopsy
Excisional Incisional Intra-osseous Needle Punch Frozen section
46
Biopsy procedure
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
What is excisional biopsy
Surgical procedure in which an incision is made through the mucosa or skin to remove the entire lump
48
What is incisional biopsy
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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