Surgical Management of Odontogenic Tumors Flashcards
what are the tumors of odontogenic epithelium
- ameloblastoma
- adenomatoid odontogenic tumor
what are the mixed odontogenic tumors
- compound odontoma
- complex odontoma
what are the tumors of odontogenic ectomesenchyme
- cementoblastoma
what are the benign, no recurrence potential odontogenic tumors
- adenomatoid odontogenic tumor
- cementoblastoma
- odontoma
what are the benign, aggressive tumors
- ameloblastoma (multicystic/solid)
what are the benign, some recurrence potential odontogenic tumors
- cystic ameloblastoma (unicystic)
what is included in the diagnosis of odontogenic tumors
- 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
what are the ways to obtain tissue and which lesions are they for
- aspiration: r/o vascular lesions, inflammatory
- incisional biopsy- larger lesions prior to definitive therapy
- excisional biopsy- smaller tumors
surgical management includes:
- surgical removal of the odontogenic tumor followed by appropriate method for reconstruction of the defect
the type of surgical approach that is going to be employed is mainly dependent on:
the type (biologic behavior) of the tumor and its size
the type of reconstruction is mainly decided based on:
the size and extent of the defect on both hard and soft tissue
what are the surgical treatment options for odontogenic tumors
- enucleation
- resection
what are the types of resection
- marginal (segmental) resection
- partial resection
- total resection
- composite resection
what is enucleation of odontogenic tumors
local removal of tumor by appropriate instrumentation in direct contact with the lesion: used for very benign types of lesions
what is surgical resection of odontogenic tumors and what is it also called
- removal of tumor by incising through uninvolved tissues around the tumor, thus delivering the tumor without direct contact during instrumentation
- AKA en bloc resection
what is marginal (segmental) resection
- resection of a tumor without disruption of the continuity of the bone
what is partial resection
- resection of a tumor by removing full thickness portion of the jaw
- can vary from small continuity to a hemimandibulectomy
- jaw continuity is disrupted
what is total resection
- resection of a tumor by removal of the involved bone
- hemi-maxillectomy and hemi-mandibulectomy
what is a composite resection and when is it used
- resection of tumor with bone, adjacent soft tissues and contiguous lymph node channels
- an ablative procedure
- most commonly used in malignant tumors
what is the rationale for surgical reconstruction of the jaws
- 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
what are the types of grafts used for reconstruction of the jaws
- free bone grafts (non vascularized): cortical bone grafts and cancellous bone grafts
- vascularized bone grafts: osteomyocutaneous- microvascular free flap
epitheial odontogenic tumors are composed of:
odontogenic epithelium without participation of odontogenic ectomesenchyme
what are the common tumors of odontogenic epithelium
- ameloblastoma
- adenomatoid odontogenic tumor (AOT)
describe ameloblastoma
- 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
where are ameloblastomas most common
posterior mandible and 2nd - middle mandible
what are the clinical subtypes of ameloblastoma and prevalance of each
- multicystic or solid (86%)
- unicystic (13%)
- peripheral (extraosseous) and malignant variant (1%)
ameloblastomas are most common in:
middle aged people long after odontogenesis has ceased
- any part of either jaws
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)
treatment of ameloblastoma is according to:
growth characteristics and type
what is the tx for unicystic ameloblastoma
- complete removal (enucleation)
- peripheral ostectomies if extension through cyst wall
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
what is the tx for amelobastic carcinoma
- radical surgical resection (like SCCs)
- neck dissection
adenomatoid odontogenic tumors are most commonly found in:
- teenagers
- in the middle and anterior portions of the jaws
AOT is commonly associated with:
the crown of an impacted anterior tooth
____ of AOT occur in the maxilla and is more common in what gender
2/3rds and females
common sites of AOT are;
maxillary incisors- cuspids
what is often the CC with AOTs
painless expansion
is AOT more common in mandible or maxilla
maxilla
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
what is the tx for AOT
simple surgical enucleation and recurrence is rare
the tumors in which odontogenic differentiation is fully expressed are:
the odontomas
in odontomas, the _____ realize their potential and make up the _____ respectively
epithelium and ectomesenchyme, enamel and dentin
odontomas are mostly radio____-
dense
what are the most common type of odontogenic tumors seen in the OS clinic
odontomas
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
in the compound odontoma:
multiple small and malformed tooth- like structures are formed creating a bag of marbles radiographic appearance
when are odontomas found
early years such as teens or early twenties
where are compound odontomas found? complex?
- compound: anterior jaw
- Complex: posterior jaws
many odontomas are associated with an:
unerupted tooth
odontomas have a _____ growth potential and cause no:
limited; pain or cosmetic deformity
what is the tx for odontomas
elective surgery
describe a cementoblastoma
- true benign neoplasm of cementoblasts
- cortex expanded without pain
cementoblastomas involve:
ankylosed tooth
where do cementoblastomas occur
around the roots of the lower posterior teeth - first mandibular molars
how does a cementoblastoma appear radiographically
as a ball of dense material attached to the end of the root
what is the tx for a cementoblastoma
- complete excision of the lesion along with extraction of the involved tooth
