Tumors and cysts of the mandible Flashcards
Describe odontogenesis
Development of a tooth
- Invagination of ectoderm into mesenchyme
- Focal thickenings=> Dental Lamina
- Condensation of mesenchyme=> Dental papilla
- Organ (papilla+lamina) grows via cap/bell stages
- Around papilla/lamina=>form dental follicle
- 3 structures critical - epithelial enamel, mesenchymal dental papilla, dental follicle
- Pre-ameloblasts stimulate odontoblast to develop
- Odontoblasts then stimulate Pre-A to place enamel on dentin
- Ameloblasts=>form enamel
- Odontoblasts=>form dentin
- remnants of dentla lamina =>rests of serres ->form many cysts and tumors
What is your management of pt presenting w mandible cyst/tumor
HISTORY
- Incidental?
- symptoms
- tooth loss, loose
- pathologic F#
PHYSICAL EXAM
- tender, gingival changes/swellings
- erupted/loose teeth
- cortical expansion
- paresthesia
INVESTIGATION
- panorex, periapicla views, CT - many appear similar
- BIOPSY - needle aspirate or incisional
What are treatment options
- Enucleation + curettage for most CYSTS and benign tumor except 4
- Resection + Recon for
- Ameloblastoma
- Calcified Epithelial odontogenic tumor
- Odonto-ameloblastoma
- Odontogenic myoxoma
- Malignant tumor (ie. odontogenic carcinoma)
WHat is expected f-u
- E&C curative in most cases
- for OKC and ameloblastoma, require 5 yr f/u b/c high recurrence
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What are common cysts/tumors to include in differential of mandible cyst/tumor
Odontogenic Cyst
Developmental
- Dentigerous/follicular cyst
- Odontogenic Keratocyst (OKC)
Inflammatory
- Radicular (periapical) cyst - most common
Non-Odontogenic cyst
- Aneurysmal bone cyst
Odontogenic Tumor
Epithelial Origin
- Ameloblastoma
- Calcified Epithelial Odontogenic tumor
Mixed Origin (epithelial/mesenchymal)
- Odonto-ameloblastoma
- Odontoma (compound/complex)
Mesenchymal Origin
- Odontogenic Myxoma
What is Gorlins syndrome
- AD
- Mandibular cysts (OKC)
- Skeletal (bifid/splayed ribs, spina bifida, syndactyly)
- CF (frontal bossing, CP, DD)
- Calcification Ectopic (falx cerebri)
- Palmar pits
- Multiple BCCs (and other tumors - medulloblastoma, rhabdomyoma, meningioma, ameloblastoma)
What is gardner syndrome
- AD
- Sebaceous/epithelial cysts
- Osteomas (frontal, sinuses, mandible)
- Desmoid fibromas
- Colon/rectum adenomatous polyps
What is a dentigerous cyst, presentation, management
- ass. w crown of unerupted tooth
- asymtomatic, incidental
- Tx w E&C
What is a OKC, presentation, management
- Odontogenic Keratocyst
- usually ass. w 3rd molar. May cause tooth loosening, resorption, cortical perforation
- HIGH recurrence rate
- Treat w E&C + chemical cautery (carnoy solution) +/- ostectomy
May be ass. w gorlins
What is a radicular cyst
- most common odontgenic cyst- ass. w caries
- asymptomatic/or painful
- treat w E&C +/- abx if infected
What is an ameloblastoma
- Benign mandibular tumor of epithelial origin- locally aggressive
- Ass. w ramus/posterior body
Imaging
- multiloculated lesion w soap bubble or honeycomb appearnace
- bony expansion
- tooth resorption
Treatment
- resection and recon, 1cm margin
- 5yr f/u 2’ to high reucrrence
What is an odontoma
Benign odontogenic tumor of mixed origin - hamartoma
- very common
- appears as mass of calcified miniature teeth
- Tx: E&C
What is cherubism
Non-odontogenic tumor of the mandible and maxilla
- Familial fibrous dysplasia
- Bilateral symmetric swelling of posterior mandible
- Bone is replaced wiht loose connectvie vascular tissue
- Tx: self limiting - may require curettage/excision if not resolved
What is fibrous dysplasia
Non-odontogenic tumor of the mandible/maxilla
- arrest of bone maturatio in woven phase
- most common in frontal, sphenoid, maxilla
Classifed as mono or polysostotic
Polyostotic can be syndromic or non
What is mcCune albright syndrome
Polyostotic fibrous dysplasia
- cafe au lait
- hyperthyriodism
- precocious puberty
Key becasue risk of malingnat degenraiton of FD into osteogenic sarcoma
