ML Chindia School of Dental Sciences UNIVERSITY OF NAIROBI Presentation Objectives To provide an appraisal of some common and rare jaw lesions To provide a review of the existing nomenclature ID: 614217
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LESIONS OF THE JAWS
M.L. Chindia
School of Dental Sciences
UNIVERSITY OF NAIROBISlide2
Presentation Objectives:
To provide an appraisal of some common and rare jaw lesions.
To provide a review of the existing nomenclature
To stimulate some discussion on management approachesSlide3
Compound Odontoma
Tiny teeth varying in number:
Only afew to numerous
Do not resemble normal teeth
Usually cone-shaped
Histologically:
Normal arrangement of a centrally placed fibrovascular pulp
Tissue surrounded by dentine
Crown area covered by enamel
Cementum covers the root part.Slide4Slide5
Complex Odontoma
Haphazard arrangement of a usually well, delineated mass of dental hard tissues
Bulk of the lesion consists of dentine
Enamel plays a minor role
Stroma consists of a mature fibrous connective tissue:
Sometimes contains areas identical to the Calcifying Odontogenic cyst
Ghost cells maybe includedSlide6
Complex OdontomaSlide7
Osseous Dysplasia (OD)
A pathologic process of unknown aetiology
Located in the tooth bearing jaw areas
Proliferation of periodontal ligament fibroblasts
Bone and cementum deposition
Occurs in various clinical formsSlide8
Radiographic presentation of ODSlide9Slide10
Histomorphology of OD
Cellular fibrous tissue
Trabeculae
of woven and lamellar bone
Spherules of
cementum
-like material
Lacks encapsulation or demarcation
Merges with cortical or
medullary
boneSlide11
Tissue Variation in OD
Reflected in radiographic appearance thus:
Predominantly radiolucent
Predominantly radiodense
MixedSlide12
Subtypes of OD
Distinguished by clinical and radiological features:
Periapical
O
sseous Dysplasia
Focal Cemento-Osseous Dysplasia
occurs in the Posterior jaw quadrant
is a limited lesionSlide13
Focal ODSlide14
Florid Osseous Dysplasia
Occurs bilaterally in the mandible or may involve all four quadrants
Non-
expansile
Occurs in middle-aged black femalesSlide15
FODSlide16Slide17
Familial Gigantiform CementomaMay involve two or more quadrantsIs expansible
Occurs at a young age
Shows an autosomal dominant inheritance
Sporadic cases reportedSlide18
FGCSlide19
CementoblastomaSlide20
Ossifying Fibroma (OF)
A well-demacated lesion
Composed of:
Fibrocellular tissue
Mineralized material of varying appearances
Most commonly occurs in the 2
nd
to 4
th
decates
Shows a preponderance for females
Varied mean age of histological sub-typesSlide21
Histological Subtypes of OF
Juvenile Trabecular Ossifying Fibroma (JTOF)
Maxilla the site of predilection
Occurs at an older age
Mitoses present at histology
Less typical features: multinucleated giant cells,pseudocystic stroma degeneration,haemorrhageSlide22
Juvenile Psammomatoid Ossifying Fibroma (JPOF)Mainly occurs in the bony walls of the paranasal sinuses
Occurs at a much younger age
Histology shows small ossicles resembling psammoma bodies
Loose and fibrocellular to intensely cellular
Minimal intervening collagen
Spherical or curved ossicles
Differential diagnosis: Intra – cranial meningioma with psammoma bodies.
The psammoma bodies in JPOF are clearly different from the a cellular spherical true psammoma bodiesSlide23
Clinical appearance of OFSlide24
Radiographic appearance of OFSlide25
Fibrous Dysplasia
A genetically – based sporadic disease of bone
May affect a single (monostotic) or multiple (polyostotic) bones
FD occuring in multiple adjacent craniofacial bones is regarded as monostotic (craniofacial FD)
FD may be part of the Mc Cune – Albright sydrome (MAS).Slide26
FDSlide27
FDSlide28
Radiographic appearance of FDSlide29
Ground glass appearance of FD Slide30
Radiographic appearance of FDSlide31
Epeclemiology of FD
The monostotic (MFD) is equally distributed in both genders and ethnic groups
The polystotic(PFD) is more frequent in females (F/M ratio;3:1)
Both entities are mainly diagnosed in childhood and young adults
MAS constitutes 3% of all PFD cases which may manifest at infancySlide32
Aetiology of FD
Proliferation and differentiation of preosteoblasts affected by:
Mutation in the gene (GNAS1) which encodes for the a-submit
a signal transduction G-protein (Gs-alpha)
Leads to increased C-AMP productionSlide33
Clinical Features of FD
Occurs more often in the maxilla than in the mandible
May involve adjacent bones like the zygoma,sphenoid and temporal plates
Base of skull and ribs are the most frequently affected sites in the skeleton
Painless swelling leading to facial asymmetry
Occasionally café,
au lait
pigmentation is manifestSlide34
Gardener’s Syndrome (GS)
Multiple polyposis of the large intestine (premalignant)
Osteomas of the bones: long bones, skull and jaws
Multiple epidermoid or sebeceous cysts of the skin scalp and back
Occasional occurrence of desmoid tumours
Impacted supernumerary and permanent teethSlide35
Clinico-radiographic presentationSlide36
Aetiology of GS
Due to a single phenotypic gene
Autosommal pattern of inheritance
With complete penetrance and variable expressionSlide37
Osteoma
A benign neoplasm
Characterized by the proliferation of either compact or cancellous bone
Usually in an endosteal or periosteal locationSlide38
Clinical Features of Osteoma
Is an uncommon oral lesion
May occur at any age but more common in the young adult
Is slow growing
The periosteal form of the disease manifests as a sclerotic, circumscribed mass
At histology it is composed either of extremely dense compact bone or course cancellous bone.Slide39
Clinico-radiographic presentationSlide40
Ameloblastic Fibroma (AF)
Displays soft tissues similar to those found in an immature tooth germ
Lacks a hard tissue component
Epithelial strands lie in a myxoid cell-rich mesenchyme
Mitotic figures are extremely rare
May contain granular cells: Granula cell AF or Granular Cell Odontogenic fibroma
Epithelial component closely resembles that of ameloblastoma
The stromal component is, however, different
Stroma in AF: immature,embryonic,cell rich myxoid tissueSlide41
Clinico-radiologic Features of AF
Painless swelling
Centrally placed: a radiolucent lesion
Peripherally located: swelling in the gingivae
Bone saucerization in peripheral locationSlide42
Clinical presentationSlide43
Intra-operative appearanceSlide44
Surgical defectSlide45
Hyperplasia of the Mandibular Condyle (HPMC)
A rare unilateral enlargement of the condyle
Should not be confused with neoplasia
May superficially resemble osteoma or chondroma
Aetiology remains obscure
Mild chronic inflammation has been suggested:
Proliferative osteomyelitis
Unilateral occurrence suggests a local phenomenonSlide46
Clinical Features of HPMC
Unilateral slowly progressive elongation of the face
Deviation of the chin away from the affected side
Enlarged condyle may be clinically evident
Striking radiographic features in all views
Affected condyle may be painful or not
A severe malocclusion is the sequelaSlide47
Clinico- radiographic presentation Slide48
Treatment of HPMC
Resection