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Oral Surgery III > Surgical Management of Odontogenic Tumors > Flashcards

Surgical Management of Odontogenic Tumors Flashcards

1
Q

what are the tumors of odontogenic epithelium

A
  • ameloblastoma
  • adenomatoid odontogenic tumor
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2
Q

what are the mixed odontogenic tumors

A
  • compound odontoma
  • complex odontoma
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3
Q

what are the tumors of odontogenic ectomesenchyme

A
  • cementoblastoma
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4
Q

what are the benign, no recurrence potential odontogenic tumors

A
  • adenomatoid odontogenic tumor
  • cementoblastoma
  • odontoma
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5
Q

what are the benign, aggressive tumors

A
  • ameloblastoma (multicystic/solid)
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6
Q

what are the benign, some recurrence potential odontogenic tumors

A
  • cystic ameloblastoma (unicystic)
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7
Q

what is included in the diagnosis of odontogenic tumors

A
  • detailed history: pain, loose teeth, occlusion, swellings, paresthesia, dysthesia, delayed tooth eruption
  • thorough clinical exam: inspection, palpation, percussion
  • conventional radiographs: panorex, dental radiographs
  • CT scan: for larger, aggressive lesions
  • obtain tissue
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8
Q

what are the ways to obtain tissue and which lesions are they for

A
  • aspiration: r/o vascular lesions, inflammatory
  • incisional biopsy- larger lesions prior to definitive therapy
  • excisional biopsy- smaller tumors
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9
Q

surgical management includes:

A
  • surgical removal of the odontogenic tumor followed by appropriate method for reconstruction of the defect
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10
Q

the type of surgical approach that is going to be employed is mainly dependent on:

A

the type (biologic behavior) of the tumor and its size

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11
Q

the type of reconstruction is mainly decided based on:

A

the size and extent of the defect on both hard and soft tissue

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12
Q

what are the surgical treatment options for odontogenic tumors

A
  • enucleation
  • resection
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13
Q

what are the types of resection

A
  • marginal (segmental) resection
  • partial resection
  • total resection
  • composite resection
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14
Q

what is enucleation of odontogenic tumors

A

local removal of tumor by appropriate instrumentation in direct contact with the lesion: used for very benign types of lesions

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15
Q

what is surgical resection of odontogenic tumors and what is it also called

A
  • removal of tumor by incising through uninvolved tissues around the tumor, thus delivering the tumor without direct contact during instrumentation
  • AKA en bloc resection
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16
Q

what is marginal (segmental) resection

A
  • resection of a tumor without disruption of the continuity of the bone
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17
Q

what is partial resection

A
  • resection of a tumor by removing full thickness portion of the jaw
  • can vary from small continuity to a hemimandibulectomy
  • jaw continuity is disrupted
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18
Q

what is total resection

A
  • resection of a tumor by removal of the involved bone
  • hemi-maxillectomy and hemi-mandibulectomy
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19
Q

what is a composite resection and when is it used

A
  • resection of tumor with bone, adjacent soft tissues and contiguous lymph node channels
  • an ablative procedure
  • most commonly used in malignant tumors
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20
Q

what is the rationale for surgical reconstruction of the jaws

A
  • to restore the:
  • form of the maxilla and mandible to maintain correct anatomical relation to the jaws and important for dental rehab such as endosseous implant placement
  • function: for mastication and speech
  • esthetics
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21
Q

what are the types of grafts used for reconstruction of the jaws

A
  • free bone grafts (non vascularized): cortical bone grafts and cancellous bone grafts
  • vascularized bone grafts: osteomyocutaneous- microvascular free flap
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22
Q

epitheial odontogenic tumors are composed of:

A

odontogenic epithelium without participation of odontogenic ectomesenchyme

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23
Q

what are the common tumors of odontogenic epithelium

A
  • ameloblastoma
  • adenomatoid odontogenic tumor (AOT)
24
Q

describe ameloblastoma

A
  • benign but locally invasive
  • encapsulated and infiltrates surrounding bone marrow
  • even though they are locally infiltrative, they do not metastasize
  • occasionally arise from dentigerous cysts
25
where are ameloblastomas most common
posterior mandible and 2nd - middle mandible
26
what are the clinical subtypes of ameloblastoma and prevalance of each
- multicystic or solid (86%) - unicystic (13%) - peripheral (extraosseous) and malignant variant (1%)
27
ameloblastomas are most common in:
middle aged people long after odontogenesis has ceased - any part of either jaws
28
how does ameloblastoma appear radiographically
- may be unilocular but frequently become multilocular as they increase in size - the unilocular lesion is indistinguishable from an odontogenic cyst - well-circumscribed, soap bubble apperance (multicystic or solid variant)
29
treatment of ameloblastoma is according to:
growth characteristics and type
30
what is the tx for unicystic ameloblastoma
- complete removal (enucleation) - peripheral ostectomies if extension through cyst wall
31
what is the tx for classic infiltrative (aggressive) - Solid ameloblastoma
- mandible- adequate normal bone around margins of resection - maxillary - more aggressive surgery - 1.5cm margins
32
what is the tx for amelobastic carcinoma
- radical surgical resection (like SCCs) - neck dissection
33
adenomatoid odontogenic tumors are most commonly found in:
- teenagers - in the middle and anterior portions of the jaws
34
AOT is commonly associated with:
the crown of an impacted anterior tooth
35
____ of AOT occur in the maxilla and is more common in what gender
2/3rds and females
36
common sites of AOT are;
maxillary incisors- cuspids
37
what is often the CC with AOTs
painless expansion
38
is AOT more common in mandible or maxilla
maxilla
39
what is the radiographic apperance of AOT
- unilocular radiolucency often around the crown of an unerupted tooth in which case they resemble a dentigerous cyst
40
what is the tx for AOT
simple surgical enucleation and recurrence is rare
41
the tumors in which odontogenic differentiation is fully expressed are:
the odontomas
42
in odontomas, the _____ realize their potential and make up the _____ respectively
epithelium and ectomesenchyme, enamel and dentin
43
odontomas are mostly radio____-
dense
44
what are the most common type of odontogenic tumors seen in the OS clinic
odontomas
45
in complex odontomas:
there is little or no tendency to form tooth like structures - the dentin and enamel are entwined in a mass that bears no resemblance to teeth
46
in the compound odontoma:
multiple small and malformed tooth- like structures are formed creating a bag of marbles radiographic appearance
47
when are odontomas found
early years such as teens or early twenties
48
where are compound odontomas found? complex?
- compound: anterior jaw - Complex: posterior jaws
49
many odontomas are associated with an:
unerupted tooth
50
odontomas have a _____ growth potential and cause no:
limited; pain or cosmetic deformity
51
what is the tx for odontomas
elective surgery
52
describe a cementoblastoma
- true benign neoplasm of cementoblasts - cortex expanded without pain
53
cementoblastomas involve:
ankylosed tooth
54
where do cementoblastomas occur
around the roots of the lower posterior teeth - first mandibular molars
55
how does a cementoblastoma appear radiographically
as a ball of dense material attached to the end of the root
56
what is the tx for a cementoblastoma
- complete excision of the lesion along with extraction of the involved tooth
57

Oral Surgery III (12 decks)

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