Oral Facial & Bone Neoplasms

Question 1

What is neoplasia?

Answer 1

New growth

Question 2

What is a neoplasm?

Answer 2

An abnormal growth that exceeds normal tissue
It is uncoordinated & persists after the cessation of the stimulus that caused it.

Question 3

How do we differentiate neoplasia?

Answer 3

Into benign and malignant.

Question 4

How do benign and malignant neoplasms look?

Answer 4

In benign neoplasms they are:
-well-differentiated, looks like tissue of origin with organised structure.
-the rate of growth is usually slow
-normally well-circumscribed with no invasion
-no metastasis

In malignant neoplasms they are:
-un-differentiated, looks different to the tissue of origin with a disorganised structure
-rate of division of cells is very high so it outstrips its blood supply.
This causes starvation of blood = Necrosis
-Invasive with poorly defined margin
-metastasis is common

Question 5

What are some examples of benign oral neoplasia?

Answer 5

Haemangioma
Lipoma
Fibroepithelial polyp
Papilloma
Naevus
Pyogenic granuloma
Ameloblastoma
Pleomorphic adenoma
Bony exostosis

Most of these have the word ‘oma’ at the end. So ‘Oma’ usually indicates benign neoplasia

Question 6

Haemangioma is a benign vasoformative neoplasm. What does this mean?

Answer 6

-It’s formed from either capillaries or blood vessels.

-So can either be described as a capillary or cavernous haemangioma

Question 7

What is characteristic of a haemangioma?

Answer 7

Blanches on pressure

Question 8

What can a haemangioma cause?

Answer 8

Troublesome bleeding or oral cosmetic defects e.g on the lip

Question 9

How do you treat a haemangioma?

Answer 9

Cryotherapy/sclerotherapy (inject irritant into vascular space causing scaring) /excision.

Question 10

What is a lipoma and where can it occur?

Answer 10

-It’s a benign neoplasm of adipose tissue

-can occur anywhere where there is subcutaneous/dermal fat (fatty tissue eg neck, oral cavity ,face.

Question 11

What does a lipoma look like and how is it treated?

Answer 11

Soft yellow or pink with overlying mucosa/skin

Treat with surgical excision

Question 12

What is a fibroepithelial polyp (FEP) and what does it look like?

Answer 12

It’s the most common benign epithelial tumour of the oral cavity (although uncommon before the age of 30)

& it’s a painless flat or pedunculate lesion

Question 13

How can a FEP be caused and how do you treat it?

Answer 13

Inflammatory hyperplasia due to chronic irritation e.g. cheek biting

Treat by local surgical excision if troublesome

Question 14

What is a papilloma?

Answer 14

-Benign proliferating lesion caused by human papilloma virus (HPV-not oral cancer)

-is most common between age 30 - 50

Question 15

What is a papilloma caused by?

Answer 15

HPV strains 6 & 11, not the cancer inducing type 16 & 18

Question 16

Where are papillomas most common and how do you treat them?

Answer 16

-Soft palate and tongue

-Local surgical excision or cryotherapy if troublesome

Question 17

What is a melanocytic naevi and how is it causes also how do you treat it?

Answer 17

-Pigmented mole that develops in childhood & early adult life (30-40)

-Runs in families (sun exposure/sun burn)

-Remove by local surgical excision if troublesome or of concern

Question 18

What is a pyogenic granuloma and what causes it?

Answer 18

-It’s a reactive hyperplasia of connective tissue (no pus & not a granuloma)

-Usually due to low grade irritation, trauma, poor oral hygiene, hormonal change (so it’s more common in females than in males)

Question 19

Where are pyogenic granulomas most commonly found?

Answer 19

Gingiva, buccal mucosa, tongue & lips

Question 20

How do you treat pyogenic granulomas?

Answer 20

Local surgical excision (including base) plus improved Oral hygien

Question 21

What is an ameloblastoma and where does it commonly occur?

Answer 21

Benign tumour of odontogenic epithelium - usually found in x-rays

80% of these occur in the mandible, most commonly in the posterior region

Question 22

What can ameloblastomas cause?

Answer 22

Expansion of the bone & resorption of adjacent tooth roots

Question 23

Are ameloblastomas invasive?

Answer 23

Yes, they are actually locally invasive (very rarely metastatic spread to lung)

Question 24

How do you treat ameloblastomas?

Answer 24

Surgical excision with margin/enucleation possible

Must be monitored - could re-occur

Question 25

What are pleomorphic adenomas and what/who does it affect?

Answer 25

Most common salivary gland tumour (accounting for 80% of them)

Parotid gland more commonly affected

F>M 2:1

it can occur at any age but it’s most frequent in 30-60 year olds

Question 26

How are pleomorphic adenomas treated?

Answer 26

Careful surgical excision required

Can get bigger overtime and risk of malignancy.

Question 27

What is a bony exostosis/ torus and where is it most common?

Answer 27

Benign localised peripheral overgrowth of bone.

Most common in palate and lingual aspect of mandible.

Question 28

Why are bony exostoses frequently traumatised?

Answer 28

Due to location & thin mucosa

Question 29

How do you treat a bony exostosis/torus?

Answer 29

Surgical reduction if functionally/cosmetically problematic