Benign Tumors of the Oral Cavity

1. Benign Tumors of the Oral Cavity

2. Benign Tumors of the Oral Cavity The dentist has a vital role in the diagnosis and treatment of these lesions. Although the dentist might not see all the types of benign oral tumors, it is important to be familiar about them so as to manage them whenever necessary.

3. What is a tumor? The tumor, by definition is simply a swelling of the tissue; in the strict sense, the word does not imply a neoplastic process. Many of the lesions to be discussed now are called tumors only because they are manifested as swellings; they are in no way actually related to true neoplasms.

4. Benign Tumor It is a locally controlled growth or lesion, generally encapsulated, which does not produce metastases, and therefore not endangering life. Malignant Tumor It is an independent uncoordinated new growth of tissue which is potentially capable of unlimited proliferation and which does not regress after removal of the stimulus which produced the lesion. Difference between a Benign and malignant tumor?

5. Benign tumors of the Oral Cavity - Classification • Tumors of Epithelial Tissue origin. • Tumors of Connective Tissue origin. • Tumors of Muscle Tissue origin. • Tumors of Nerve Tissue origin.

6. Benign Tumors of Epithelial Tissue origin Papilloma

7. Benign Tumors of Epithelial Tissue origin Papilloma • It is an exophytic growth made up of numerous,small finger like projections which result in a roughened surface. • It is well circumscribed pedunculated tumor. • It is found in the tongue, lips, buccal mucosa, gingiva and palate and are mainly few millimeters in diameter.

8. Benign Tumors of Epithelial Tissue origin Papilloma • It is seen at any age and probably caused by the Human Papilloma Virus. • The common skin wart (verruca vulgaris) is a frequent tumor of the skin analogous to the oral papilloma. • Treatment includes excision including the base of the mucosa into which the pedicle inserts.

9. Benign Tumors of Epithelial Tissue origin Pigmented cellular Nevus

10. Benign Tumors of Epithelial Tissue origin Pigmented cellular Nevus • A nevus is defined as a congenital, developmental tumor like malformation of the skin or mucous membrane that contains melanin pigment. • In the skin it is called as the “common mole”. • This lesion is composed of so-called nevus cells.

11. Benign Tumors of Epithelial Tissue originPigmented cellular Nevus • The following are the different types of nevi that are recognized now, • Intradermal nevus • Junctional nevus • Compound nevus • Juvenile melanoma • Blue nevus

12. Benign Tumors of Epithelial Tissue originPigmented cellular Nevus • Pigmented nevi of all types, except the juvenile melanoma, occasionally occur on the oral mucosa. • They are well circumscribed lesions and may occur at any site intra-orally but are more commonly seen in the anterior gingiva, lips and palate. • Treatment is surgical excision.

13. Benign Tumors of Connective Tissue origin Fibroma

14. Benign Tumors of Connective Tissue origin - Fibroma • It is the most common benign soft tissue tumor occurring in the oral cavity. • It is intimately related to fibrous hyperplasia. • It appears as an elevated lesion of normal color with a smooth surface and a sessile or pedunculated base. • The tumor maybe small or in some cases up to several centimeters in diameter.

15. Benign Tumors of Connective Tissue origin -Fibroma • It is always a well defined, slow growing lesion that occurs in any age , but is more common in the third, fourth or fifth decade of life. • It is most frequenly seen in the buccal mucosa, gingiva, tongue, lips and palate and is firm on palpation. • Treatment is surgical excision.

16. Benign Tumors of Connective Tissue origin Central Ossifying Fibroma of Bone

17. Benign Tumors of Connective Tissue origin -Central Ossifying Fibroma of Bone • This tumor occurs as a central tumor of bone and is a separate entity from the fibrous dysplasia and other fibro-osseous lesions of the bone. • It occurs at any age, but is more common in young adults. • Either jaw may be involved, but more common in the mandible.

18. Benign Tumors of Connective Tissue origin -Central Ossifying Fibroma of Bone • The lesion is slow growing, and generally asymptomatic until the growth produces a noticeable swelling and mild deformity. • Displacement of teeth may be an early feature. • X-ray examination presents an extremely variable appearance depending upon it’s stage of development.

19. Benign Tumors of Connective Tissue origin -Central Ossifying Fibroma of Bone • In the early stages the lesion appears as a radiolucent area with no internal radiopacities and as the tumor matures there is increasing calcification and the radiolucent area becomes a uniform radiopaque mass.

20. Benign Tumors of Connective Tissue origin -Central Ossifying Fibroma of Bone • However in all the stages the X-ray shows that the lesion is always well demarcated from surrounding bone, in contrast to the fibrous dysplasia. • The lesion should be excised conservatively and recurrence is rare.

21. Benign Tumors of Connective Tissue origin Peripheral Giant Cell Granuloma

22. Benign Tumors of Connective Tissue origin -Peripheral Giant Cell Granuloma • This tumor is similar to the central giant cell granuloma of bone, because of the presence of multinucleated giant cells in the lesion, however it occurs peripherally in the oral cavity. • The role of trauma as in tooth extraction, calculus deposits, ill fitting dentures and poor restorations may be a source of etiology of this lesion.

23. Benign Tumors of Connective Tissue origin -Peripheral Giant Cell Granuloma • It always occurs on the gingiva or alveolar process, most frequently anterior to the molars. • Thus it seems to originate from either the periodontal ligament or mucoperiosteum. • The lesion is usually between 0.5 to 1.5 cm in diameter.

24. Benign Tumors of Connective Tissue origin -Peripheral Giant Cell Granuloma • The lesions typically present with a bluish – purple color. • Females are affected twice as much as males. • It is more commonly seen between the age of 30 to 50 years. • Treatment is surgical excision.

25. Benign Tumors of Connective Tissue origin Central Giant cell tumor of the bone.

26. Benign Tumors of Connective Tissue origin -Central Giant cell tumor of the bone. • There is a longstanding controversy regarding the relationship between giant cell tumors of the axial skeleton and giant cell granulomas of the jaws.

27. Benign Tumors of Connective Tissue origin –Central Giant cell tumor of the bone. • Currently there are two schools of thought regarding the existence of giant cell tumors in the facial skeleton. • Some like Jaffe, firmly believe that true giant cell tumors either do not exist or occur very rarely in the maxillofacial region. • However other pathologists and clinicians remain convinced that giant cell tumors do occur within the jaws.

28. Benign Tumors of Connective Tissue origin –Central Giant cell tumor of the bone. • Abrams and shear in 1974, consolidated these two positions, and suggested that certain jaw lesions may be true giant cell tumors and certain giant cell lesions outside the jaws maybe giant cell granulomas.

29. Benign Tumors of Connective Tissue origin –Central Giant cell tumor of the bone. • These lesions occurs between the age of 2 to 81 years, but the average age is within the second decade of life. • Sex: 2:1 female predilection. • The mandible is clearly the preferred site.

30. Benign Tumors of Connective Tissue origin –Central Giant cell tumor of the bone. • These lesions mainly occur in the anterior portion of the maxilla and mandible. • Posterior maxilla or mandible is rarely involved. • A painless local swelling is the most commonest presenting symptom although some patients may have pain or anesthesia.

31. Benign Tumors of Connective Tissue origin –Central Giant cell tumor of the bone. • The X-ray feature is a radiolucency within bone and can either have an multilocular or unilocular configuration. • Resorption of teeth very common. • V-shaped bony ridges separating the locules.

32. Benign Tumors of Connective Tissue origin –Central Giant cell tumor of the bone. • Small, slow growing, asymptomatic mass responds well to curettage. • However, the large and aggressive mass produces recurs frequently, especially in younger patients. • Surgical curettage is the most commonest procedure. • Large aggressive lesions of the maxilla and mandible may require an en-bloc resection.

33. Benign Tumors of Connective Tissue origin –Central Giant cell tumor of the bone. • Some lesions both the overlying mucosa and periosteum must be removed. • Non surgical modalities of treatment include systemic calcitionin administration, anti-angiogenic therapy with interferon, and intra-lesional corticosteroids.

34. Benign Tumors of Connective Tissue origin Aneurysmal bone cyst

35. Benign Tumors of Connective Tissue origin –Aneurysmal bone cyst There is controversy regarding the etiology of this lesion. • For the moment there are no strong evidences to prove that these lesions develop primarily, or to say that they develop secondarily due to another underlying disease process.

36. Benign Tumors of Connective Tissue origin– Aneurysmal bone cyst • Lichenstein indicates that this lesion results from a localized vascular disturbance such as a venous thrombosis or arteriovenous malformation. • Others believe that this lesion can either be a separate reactive process, arising from another primary bone lesion such as fibrous dyplasia, central giant cell granuloma, or pagets disease.

37. Benign Tumors of Connective Tissue origin– Aneurysmal bone cyst • This lesion occurs in younger patients usually below 20 years of age. • The mandible appears to be more commonly affected than the maxilla. • The posterior molar-bearing segments of the maxilla and mandible seem to be more commonly affected region. • Clinically these lesions are characterized by a non-pulsatile swelling of variable duration.

38. Benign Tumors of Connective Tissue origin– Aneurysmal bone cyst • 50% of patients present with pain in the affected region. • Tooth displacement and external root resorption may also be seen. • There is a slight female predilection in both the long bones and jaw lesions.

39. Benign Tumors of Connective Tissue origin– Aneurysmal bone cyst • This lesion is classically described as an expanded, cystically transformed, eccentric ballooning of the bone. • Fine bony trabeculations in the lesion give a “soap bubble appearance”.

40. Benign Tumors of Connective Tissue origin– Aneurysmal bone cyst • The recurrence rate of these lesions in the jaws is about 19%. • Despite the recurrence rates, a thorough curettage is the most commonest treatment modality for this lesion.

41. Benign Tumors of Connective Tissue origin– Aneurysmal bone cyst • In some lesions with associated vascular malformations, preoperative super-selective embolization of the feeding vessels to the lesion is mandatory before surgery. • Following embolization either curettage or en-bloc resection can be performed.

42. Benign Tumors of Connective Tissue origin Lipoma

43. Benign Tumors of Connective Tissue origin - Lipoma • It is a relatively rare intraoral tumor, although it occurs more frequently in the subcutaneous tissues of the neck. • It is a benign, slow growing tumor composed of mature fat cells. • The cells of lipoma differ metabolically from normal fat cells though they are histologically similar.

44. Benign Tumors of Connective Tissue origin - Lipoma • The tumor occurs in the tongue, floor of the mouth, buccal mucosa, gingiva, and mucobuccal folds. • It appears as a single or lobulated, painless lesion attached by either a sessile or a pedunculated base. • The lipoma is yellowish and soft on palpation.

45. Benign Tumors of Connective Tissue origin - Lipoma • Lipomas can be of the superficial or deep type. • Those that are deep produce only a slight surface elevation. • Treatment of lipoma is surgical excision.

46. Benign Tumors of Connective Tissue origin Hemangioma

47. Benign Tumors of Connective Tissue origin - Hemangioma • It is a common tumor characterized by the proliferation of blood vessels. • It is often congenital in nature and is not a true neoplasm but a developmental anomaly i.e an abnormal proliferation of tissues of structures native to the part.

48. Benign Tumors of Connective Tissue origin - Hemangioma Classification • Capillary • Cavernous • Angiobastic • Racemose • Diffuse systemic • Port-wine stain • Hereditary hemorrhagic telangiectasia

49. Benign Tumors of Connective Tissue origin - Hemangioma • Most cases of hemangioma are present at birth or arise at an early age. • Intraorally they appear as a flat or raised lesion of the mucosa, usually deep red or bluish red and seldom well circumscribed. • It commonly occurs in the tongue, lips, buccal mucosa and palate.

50. Benign Tumors of Connective Tissue origin - Hemangioma • Central hemangiomas of the maxilla and mandible occur and have to be carefully diagnosed and managed. • In the bone, the tumor is destructive lesion. • Some of them present a honeycombed appearance in the X-rays.