Malignant Diseases of the Jaw
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Transcript of Malignant Diseases of the Jaw
![Page 1: Malignant Diseases of the Jaw](https://reader030.fdocuments.in/reader030/viewer/2022032704/55cf9008550346703ba28a85/html5/thumbnails/1.jpg)
Central mucoepidermoid carcinoma.
Malignant ameloblastic & ameloblastic carcinoma.
Metastatic Tumors.
Osteosarcoma.
Presented by : an3’am a7mad abu 3’lyoun
20.11.2014
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Epithelial tumor arising in bone (arising from
odontogenic epithelium or cyst lining).
Intact cortical plate.
Typical histologic finding consistent
with mucoepidermoid
tumor
Radiographic evidence of
bone destruction.
![Page 3: Malignant Diseases of the Jaw](https://reader030.fdocuments.in/reader030/viewer/2022032704/55cf9008550346703ba28a85/html5/thumbnails/3.jpg)
More likely mimic a benign tumor or cyst .
Painless swelling > cause facial asymmetry.
Teeth have been moved.
Non-fitting denture.
Tenderness.
Paresthesia.
Spreading to regional lymph nodes.
Female (more).
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LOCATION
3-4 times in mandible > maxilla (PM & M ).
Commonly above the mandibular canal.
PERIPHERY & SHAPE:
Uni/multilocular expansile mass.
Well defined & well corticated border.
Thick peripheral cortication.
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INTERNAL STRUCTURE : Similar to benign odontogenic tumor (recurrent
ameloblastoma).
Multilocular/soap bubble/honeycomb.
Amorphous sclerotic bone .
EFFECTS ON SURROUNDING STRUCTURE:
Expansion of adjacent cortical plates.
Perforation /extension into surrounding soft tissue.
Mandibular canal may be depressed or pushed
laterally/medially.
Lost of lamina dura .
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Benign odontogenic tumor.
recurrent ameloblastoma.
odontogenic myxoma.
central giant cell granuloma (CGCG).
Surgery (en bloc resection).
Neck dissection & post operative radiation therapy
( to control the spread to lymph nodes ).
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Malignant ameloblastoma: Typical benign histologic features
+ malignant biologic behavior.
Ameloblastic carcinoma: malignant histologic Features +
malignant behavior.
Males (>59 yr)
hard expansile mass of the jaw + displaced/loosened teeth +
normal overlying mucosa.
Tenderness.
Metastatic.
Local extension.
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LOCATION
Mandible > maxilla (PM & M).
PERIPHERY & SHAPE:
well-defined border (+cortication).
scalloped border.
in malignant ameloblastoma loss + breaching of
cortical boundary ~> invading into soft tissue.
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INTERNAL STRUCTURE :
Unilocular/Multilocular (more common).
Honeycomb/soap bubble .
Robust & thick septa.
EFFECTS ON SURROUNDING STRUCTURE:
Teeth displacement.
Root resorption.
Breached bony borders.
Erode lamina dura.
Displace normal anatomic boundaries.
mandibular canal >> displaced // eroded.
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benign ameloblastoma.
Odontogenic keratocyst (OKC).
odontogenic myxoma.
central mucoepidermoid tumor.
central giant cell granuloma ( CGCG).
En bloc surgical resection.
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“Secondary Malignancy”.
New foci of malignant disease ( blood vessels).
Arise from sites that anatomically inferior to the
clavicle ( of jaw).
Carcinoma .
In children : neuroblastome ,retinoblastoma &
wilms tumor.
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Twice in women > men.
40-69 years .
Breast metastases.
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LOCATION Posterior areas of the jaw.
Mandible ( bilateral ) > maxilla > maxillary sinus >anterior hard palate > mandibular condyle.
PDL.
Papilla of developing tooth . PERIPHERY & SHAPE:
Moderately well demarcated.
No cortication /no encapsulation of margins .
Ill-defined invasive margins.
Polymorphous in shape .
Sclerotic bone formation of the adjacent bone. ( prostate &
breast lesion ).
Enlarged jaw.
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INTERNAL STRUCTURE :
Ragged Radiolucent.
Patchy sclerosis ( prostate & breast cancer).
Multi focal appearance with normal bone in between the foci .
General radiolucent appearance (similar to osteopenia).
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EFFECTS ON SURROUNDING STRUCTURE:
Periosteal reaction (speculated pattern) >> prostate & neuroblastome.
Effect the lamina dura.
Irregular increase in PDL width.
Totally or partially destroyed crypt cortices .
Teeth seems to be floating in soft tissue mass. .
Altered position of the tooth .
Failure in healing of extraction socket ( or increase in size).
Teeth resorption (rare) .
Destructed cortical bone of adjacent structures.
Breaches the outer cortical plate of the jaw > extending in the
surrounding ST / intraoral mass.
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Known primary malignancy.
Multiple myeloma.
Periapical inflammatory lesion.
Odontogenic cyst (2ry infected).
SCC
Metastatic tumor in the jaw ( poor prognosis).
Death in 1-2 years.
Chemotherapy / radiation therapy / surgery / immunotherapy / hormone treatment.
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“Osteogenic sarcoma”.
Malignant neoplasm of bone.
Unknown cause.
occur in association with: Paget's Disease / fibrous
dysplasia (after radiotherapy).
Rare in jaw (7%).
Males (30- 39 yrs).
swelling (rapid), pain, tenderness, erythema, ulceration,
loose teeth, Epistaxis, hemorrhage, nasal obstruction,
exophthalmos, trismus & blindness.
Hypoesthesia ( neurovascular canals involvement).
chondroblastic
osteoblastic
fibroblastic
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LOCATION Mandible > maxilla(posterior).
Mandible: tooth-bearing region, angle, vertical ramus.
Maxilla: alveolar ridge, antrum, palate.
May cross the midline.
PERIPHERY & SHAPE:
ill-defined border.
periosteum involvement > (sunray spicules)/”hair- on –end trabeculae).
Codman’s triangle at the periosteum edge.
Laminar periosteal bone (rarely).
Soft tissue mass emanating from the bone.
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INTERNAL STRUCTURE :
1. Radiolucent/Radiolucent-radiopaque/Radiopaque.
2. Granular(sclerotic bone)/Cotton balls/Wisps /honeycombed. +
destruction of the preexisting osseous architecture.
3. Lost of normal trabecular structure of the jaw.
EFFECTS ON SURROUNDING STRUCTURE:
Widening of PDL.
Maxillary lesion >> lost of antral/ nasal wall .
Mandibular lesion: destroy the cortex of the ID canal +
adjacent lamina dura.
ID canal may be symmetrically widened and enlarged.
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Fibrosarcoma.
metastatic carcinoma.
Chondrosarcoma.
prostate + breast metastases.
Ossifying fibroma .
fibrous dysplasia .
Ewing's sarcoma, solitary plasmacytoma, osteomyelitis.
Surgical resection (with large border of adjacent normal
bone).
Radiotherapy +chemotherapy.
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