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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
Q

where are ameloblastomas most common

A

posterior mandible and 2nd - middle mandible

26
Q

what are the clinical subtypes of ameloblastoma and prevalance of each

A
  • multicystic or solid (86%)
  • unicystic (13%)
  • peripheral (extraosseous) and malignant variant (1%)
27
Q

ameloblastomas are most common in:

A

middle aged people long after odontogenesis has ceased
- any part of either jaws

28
Q

how does ameloblastoma appear radiographically

A
  • 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
Q

treatment of ameloblastoma is according to:

A

growth characteristics and type

30
Q

what is the tx for unicystic ameloblastoma

A
  • complete removal (enucleation)
  • peripheral ostectomies if extension through cyst wall
31
Q

what is the tx for classic infiltrative (aggressive) - Solid ameloblastoma

A
  • mandible- adequate normal bone around margins of resection
  • maxillary - more aggressive surgery - 1.5cm margins
32
Q

what is the tx for amelobastic carcinoma

A
  • radical surgical resection (like SCCs)
  • neck dissection
33
Q

adenomatoid odontogenic tumors are most commonly found in:

A
  • teenagers
  • in the middle and anterior portions of the jaws
34
Q

AOT is commonly associated with:

A

the crown of an impacted anterior tooth

35
Q

____ of AOT occur in the maxilla and is more common in what gender

A

2/3rds and females

36
Q

common sites of AOT are;

A

maxillary incisors- cuspids

37
Q

what is often the CC with AOTs

A

painless expansion

38
Q

is AOT more common in mandible or maxilla

A

maxilla

39
Q

what is the radiographic apperance of AOT

A
  • unilocular radiolucency often around the crown of an unerupted tooth in which case they resemble a dentigerous cyst
40
Q

what is the tx for AOT

A

simple surgical enucleation and recurrence is rare

41
Q

the tumors in which odontogenic differentiation is fully expressed are:

A

the odontomas

42
Q

in odontomas, the _____ realize their potential and make up the _____ respectively

A

epithelium and ectomesenchyme, enamel and dentin

43
Q

odontomas are mostly radio____-

A

dense

44
Q

what are the most common type of odontogenic tumors seen in the OS clinic

A

odontomas

45
Q

in complex odontomas:

A

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
Q

in the compound odontoma:

A

multiple small and malformed tooth- like structures are formed creating a bag of marbles radiographic appearance

47
Q

when are odontomas found

A

early years such as teens or early twenties

48
Q

where are compound odontomas found? complex?

A
  • compound: anterior jaw
  • Complex: posterior jaws
49
Q

many odontomas are associated with an:

A

unerupted tooth

50
Q

odontomas have a _____ growth potential and cause no:

A

limited; pain or cosmetic deformity

51
Q

what is the tx for odontomas

A

elective surgery

52
Q

describe a cementoblastoma

A
  • true benign neoplasm of cementoblasts
  • cortex expanded without pain
53
Q

cementoblastomas involve:

A

ankylosed tooth

54
Q

where do cementoblastomas occur

A

around the roots of the lower posterior teeth - first mandibular molars

55
Q

how does a cementoblastoma appear radiographically

A

as a ball of dense material attached to the end of the root

56
Q

what is the tx for a cementoblastoma

A
  • complete excision of the lesion along with extraction of the involved tooth
57
Q
A

Oral Surgery III (12 decks)

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