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OS II > sx management odontogenic tumors > Flashcards

sx management odontogenic tumors Flashcards

1
Q

Tumors of odontogenic epithelium

A

A. Ameloblastoma
1. Malignant ameloblastoma
2. Ameloblastic carcinoma
B. Clear cell odontogenic carcinoma
C. Adenomatoid odontogenic tumor
D. Calcifying epithelial odontogenic tumor
E. Squamous odontogenic tumor

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2
Q

Mixed odontogenic tumors

A

A. Ameloblastic fibroma
B. Ameloblastic fibro-odontoma
C. Ameloblastic fibrosarcoma
D. Odontoameloblastoma
E. Compound odontoma
F. Complex odontoma

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3
Q

Tumors of odontogenic ectomesenchyme

A

A. Odontogenic fibroma
B. Granular cell odontogenic tumor
C. Odontogenic myxoma
D. Cementoblastoma

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4
Q

BENIGN, NO RECURRENCE
POTENTIAL tumors

A
  • Adenomatoid odontogenic tumor
  • Squamous odontogenic tumor
  • Cementoblastoma
  • Periapical cemento-osseous dysplasia
  • Odontoma
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5
Q

BENIGN, SOME RECURRENCE
POTENTIAL tumors

A
  • Cystic ameloblastoma (unicystic)
  • Calcifying epithelial odontogenic tumor
  • Central odontogenic fibroma
  • Florid cementoosseous dysplasia
  • Ameloblastic fibroma and fibroodontoma
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6
Q

BENIGN AGGRESSIVE tumors

A

 Ameloblastoma(Multicystic/Solid)
 Clear cell odontogenic tumor (some consider this a carcinoma)
 Odontogenic ghost cell tumor (COC, solid type)
 Odontogenic myxoma
 Odontoameloblastoma

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7
Q

MALIGNANT

A

 Malignant ameloblastoma
 Ameloblastic carcinoma
 Primary intraosseous carcinoma
 Odontogenic ghost cell carcinoma
 Ameloblastic fibrosarcoma

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8
Q

Odontogenic Tumors - Diagnosis
* Detailed hx?
* Thorough Clinical examination?
* Conventional Radiographs?
* C.T Scan?

A
  • Detailed history – Pain, loose teeth, occlusion, swellings, Paresthesia, Dysesthesia,
    delayed tooth eruption, SPEED OF DEVELOPMENT
  • Thorough Clinical examination – Inspection, palpation, percussion
  • Conventional Radiographs – Panorex, dental radiographs
  • C.T Scan - for larger, aggressive lesions
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9
Q

cysts and tumors with nn’s

A

cysts will diplace nn, often no symptoms, tumors will compress nn leading to neurological symptoms

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10
Q

which imaging is used for sx planning/ is the gold standard?

A

CT

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11
Q

obtaining tissue for diagnosis with tumors

A

Obtain tissue: DONE AFTER CT SCAN DO NOT WNAT ANY INFLAMM FOR SCAN
– Aspiration – r/o vascular lesions, inflammatory, DONE FIRST
– Incisional biopsy – larger lesions prior to definitive therapy
– Excisional biopsy – smaller tumors
Establish Definitive Diagnosis !

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12
Q

Surgical Management of Odontogenic Tumors
Surgical Management includes:
* The type of surgical approach that is going to be employed is mainly dependant on?
* The type of reconstruction is mainly decided based on ?
*

A
  • “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 dependant on the type (Biologic behavior) of the tumor and it’s size.
  • The type of reconstruction is mainly decided based on the size and extent of the defect (Both Hard and Soft tissue)
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13
Q

Odontogenic Tumors - Surgical Treatment Options

A
  • Enucleation: smaller, low recurrence
  • Resection: larger, aggressive lesions
  • Marginal(Segmental) resection
  • Partial resection
  • Total resection
  • Composite resection
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14
Q

Enucleation of Odontogenic Tumors
types of lesions?
approach?

A
  • Local removal of tumor by appropriate instrumentation in direct contact with the lesion: used for** very benign types of lesions.**
  • intra oral approach can be used to reduce scarring
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15
Q

after tumor is removed via nucleation what is done with it

A

sent for histo exam

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16
Q

Surgical resection of odontogenic tumors

A
  • Removal of a tumor by incising through uninvolved tissues around the tumor, thus delivering the tumor without direct contact during instrumentation (also called as en bloc rection).
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17
Q

Marginal (Segmental) resection

A
  • Resection of a tumor without disruption of the continuity of the bone.
  • minimizes tumor spillage and reduces recurrence
  • 1-1.5cm surrounding tissue removed
18
Q

Partial Resection
thickness?
approach?

A
  • Resection of a tumor by removing full-thickness portion of the jaw.
  • Extra oral approach
  • In the mandible, this can vary from a small continuity defect to a hemimandibulectomy.
  • Jaw continuity is disrupted.
19
Q

total resection

A
  • Resection of a tumor by removal of the involved bone.
  • Eg., Hemi-Maxillectomy and Hemi-Mandibulectomy
20
Q

Composite Resection

A
  • Resection of tumor with bone, adjacent soft tissues and contiguous lymph node channels (This is an ablative procedure** used most commonly malignant tumors)**
21
Q

Rationale for Surgical Reconstruction of the Jaws
* To Restore the:

A
  • Form of the Maxilla and mandible
    – Maintain correct anatomical relation to the jaws
    – Important for dental rehabilitation (endosseous implant placement)
  • Function - Mastication and Speech
  • Aesthetics
22
Q

Types of Grafts Used for Reconstruction of the Jaws

A

free bone used with smaller defects, vacularized used with larger defects (has aa/vv attatched)

23
Q

Surgical Management of Common Tumors of Odontogenic Epithelium
* composed of?
* examples?

A

Epithelial odontogenic tumors are composed of odontogenic epithelium without participation of odontogenic ectomesenchyme.
- Ameloblastoma
- Adenomatoid Odontogenic tumor (AOT)

24
Q

Tumors of Odontogenic Epithelium: Ameloblastoma
* B/M?
* invasive?
* spread?
* Occasionally arise from?

A
  • Benign, but locally invasive (Except for the Malignant variant).
  • It is unencapsulated and infiltrates surrounding bone marrow.
  • Even though they are locally infiltrative, they do not metastasize (Except for the Malignant variant).
  • Occasionally arise from dentigerous cysts
25
Q

ameloblastoma most common locations?

A
26
Q

Ameloblastoma
* Clinical Subtypes – %
* It occurs chiefly in ?
* They may occur where?

A
  • Clinical Subtypes –
  • Multicystic or Solid (86%),
  • Unicystic (13%), and
  • Peripheral (extraosseous) and Malignant variant (1%)
  • It occurs chiefly in middle age people long after odontogenesis has ceased.
  • They may occur in any part of both jaws but most are in the middle and posterior regions of the mandible.
27
Q

Ameloblastoma: Radiographic findings

A
  • They 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 appearance” (Multicystic or Solid variant).
28
Q

Ameloblastoma: Treatment according to?

A
  • According to growth characteristics and type
29
Q

Unicystic Ameloblastoma tx?

A

– Complete removal (Enucleation)
– Peripheral ostectomies if extension through cyst wall

30
Q

Classic infiltrative (aggressive) – “Solid Ameloblastoma” tx
– Mandibular –
– Maxillary –

A

– Mandibular – adequate normal bone around margins of resection
– Maxillary – more aggressive surgery, 1.5 cm margins

31
Q

Ameloblastic carcinoma tx

A

– Radical surgical resection (like SCCa)
– Neck dissection

32
Q

Adenomatoid Odontogenic Tumor
* This is a tumor that is commonly found in?
* It occurs where?
* Commonly associated with?
* Two-thirds occur in? more common in?
*common teeth?
* chief complaint?

A
  • This is a tumor that is commonly found in teenagers.
  • It occurs in the middle and anterior portions of the jaws
  • Commonly associated with the crown of an impacted anterior tooth.
  • Two-thirds occur in the maxilla and it is more common in females.
  • The maxillary incisor-cuspids are common sites.
  • Painless expansion is often the chief complaint.
33
Q

AOT common sites

A
34
Q

Adenomatoid Odontogenic Tumor
Radiographic Findings

A

The radiographic appearance is a unilocular radiolucency, often around the crown of an unerupted tooth in which case they resemble a dentigerous cyst.

35
Q

Adenomatoid Odontogenic Tumor (AOT)
Treatment

A
  • Treatment is with simple surgical enucleation and recurrence is extremely rare.
36
Q

Compound and Complex Odontomas
* The tumors in which odontogenic differentiation is?
* In these tumors, the epithelium and ectomesenchyme?
* As a result, these tumors are mostly?
* commonality?

A
  • The tumors in which odontogenic differentiation is fully expressed are the odontomas.
  • In these tumors, the epithelium and ectomesenchyme realize their potential and make enamel and dentin respectively.
  • As a result, these tumors are mostly radiodense.
  • Odontomas are the most common type of odontogenic tumors seen in the oral surgery clinic.
37
Q

Complex Odontoma

A
  • In the complex odontoma, 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.
38
Q

Compound Odontoma

A

In the compound odontoma, multiple small and malformed tooth-like structures are formed creating a “bag of marbles” radiographic appearance.

39
Q

Complex and Compound Odontomas
* Both types of odontoma are found when?
* which types are more common where?
* Many are associated with?
* growth? pain? deformity?
* Treatment is?

A
  • Both types of odontoma are found in the early years, usually in the teens or early twenties.
  • Compound odontoma is more common in the anterior jaw segment whereas the complex type is found more commonly in the posterior jaws.
  • Many are associated with an unerupted tooth.
  • They have a limited growth potential and cause no pain or cosmetic deformity.
  • Treatment is elective surgery.
40
Q

Cementoblastoma
*neoplasm of?
* This tumor typically occurs where?
* Cortex?
* Involved tooth is?

A
  • True benign neoplasm of cementoblasts, tumor of odontogenic ectomesenchyme
  • This tumor typically occurs around the roots of the lower posterior teeth (First Mandibular molars)
  • Cortex expanded without pain
  • Involved tooth ankylosed.
41
Q

Cementoblastoma - Radiographic examination

A

Radiographically it appears as a ball of dense material attached to
the end of the root.

42
Q

Cementoblastoma - Treatment

A

Complete excision of the lesion along with extraction of the
involved tooth.

OS II (14 decks)

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