Odontogenic tumours ii - Mesenchymal

Question 1

What benign odontogenic tumou will be focused on?

Answer 1

Mesenchymal

Question 2

Mesenchymal benign odontogenic tumours?

Answer 2

• Odontogenic fibroma
• Odontogenic myxoma
• Cementoblastoma
• Cemento-ossifying fibroma

Question 3

Clinical presentation of odontogenic fibroma?

Answer 3

• Rare.
• Slowly enlarging, painless, jaw swelling, often with cortical
  expansion.

Question 4

Radiographic appearance of odontogenic fibroma

Answer 4

• Unilocular radiolucency with a well-defined corticated outline.
• Calcified material may produce a mixed radiolucent and
  radiopaque appearance.
• Scalloped margins may be present and adjacent teeth may
  be displaced

Question 5

Histopathology of odontogenic fibroma?

Answer 5

• Cellular, fibroblastic, and collagenous connective tissue
  interwoven with less cellular vascular areas.
• Small islands or short strands of inactive odontogenic
  epithelium (epithelial- rich and poor- types).

Question 6

Manage to of odontogenic fibroma?

Answer 6

• Local enucleation and curettage.
• Recurrence is rare and is attributed to incomplete removal.
• Can reach large sizes causing facial deformity.

Question 7

Second most common tumour?

Answer 7

Odontogenic myxoma

First is ameloblastoma

Question 8

Clinical presentataion. Of odontogenic myxoma?

Answer 8

• Second most common odontogenic tumour after
  ameloblastoma.
• Children and young adults.
• Two- thirds are located in the mandible, mostly in the molar
  region.
• Intra- osseous that expands the jaw.
• Obliterates the maxillary sinus when affecting the maxilla.

Question 9

Radiographic appearance of odontogenic myxoma?

Answer 9

• Unilocular or multilocular
  radiolucency.
• Soap bubble appearance
  may be present.
• Fine trabeculae.
• Well defined and corticated
  borders but can be poorly
  demarcated or diffuse.
• Tooth displacement and
  root resorption may occur.

Question 10

Histopathology of odontogenic myxoma?

Answer 10

• Randomly oriented stellate and
  spindle- shaped cells
  embedded in a myxoid
  extracellular matrix.
• Rests of odontogenic
  epithelium may be present.
• Some odontogenic myxomas
  contain a collagenous fibrous
  component.
• Often permeates into the
  marrow spaces in an infiltrative
  pattern.

Question 11

Management of odontogenic myxoma?

Answer 11

• Small odontogenic myxomas are treated by curettage.
• Larger lesions require complete excision with free
  margins.
• Recurrence rates average about 25%.
• Metastasis does not occur and the prognosis is good.
• Maxillary lesions may extend into the cranial base.

Question 12

Clinical presentataion of cementoblastoma?

Answer 12

• Rare, benign.
• Age range 8-44 with the mean around 20 years.
• Molar or premolar area of the mandible (mostly
  lower 6).
• Attached to a root of a tooth. Involved tooth vital.
• Slowly growing swelling of the buccal and lingual
  aspects of the alveolus.
• Painful.

Question 13

Radiographic appearance of cementoblastoma?

Answer 13

• Well demarcated mottled or dense radiopaque
  mass.
• Radiolucent margin. Resorption of root involved.
• Obliteration of the periodontal space.

Question 14

Histopathology of cementoblastoma?

Answer 14

• Acellular cementum- like
  material in a fibrous stroma.
• Tumour merges with the
  root of the tooth.
• At the periphery, sheets of
  unmineralized tissue with
  *plump cementoblasts, often
  arranged in radiating
  columns.

Still forming cementum at periphery

Question 15

Management of cemetoblastoma?

Answer 15

• Conservative surgical removal is indicated.
• Recurrence is common and is usually a
  consequence of incomplete removal.