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LESIONS OF THE JAWS

LESIONS OF THE JAWS. M.L. 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 To stimulate some discussion on management approaches.

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LESIONS OF THE JAWS

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  1. LESIONS OF THE JAWS M.L. Chindia School of Dental Sciences UNIVERSITY OF NAIROBI

  2. 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 approaches

  3. 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.

  4. 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 included

  5. Complex Odontoma

  6. 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 forms

  7. Radiographic presentation of OD

  8. 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 bone

  9. Tissue Variation in OD • Reflected in radiographic appearance thus: • Predominantly radiolucent • Predominantly radiodense • Mixed

  10. Subtypes of OD Distinguished by clinical and radiological features: • Periapical Osseous Dysplasia • Focal Cemento-Osseous Dysplasia • occurs in the Posterior jaw quadrant • is a limited lesion

  11. Focal OD

  12. Florid Osseous Dysplasia • Occurs bilaterally in the mandible or may involve all four quadrants • Non-expansile • Occurs in middle-aged black females

  13. FOD

  14. Familial Gigantiform Cementoma • May involve two or more quadrants • Is expansible • Occurs at a young age • Shows an autosomal dominant inheritance • Sporadic cases reported

  15. FGC

  16. Cementoblastoma

  17. Ossifying Fibroma (OF) • A well-demacated lesion • Composed of: • Fibrocellular tissue • Mineralized material of varying appearances • Most commonly occurs in the 2nd to 4th decates • Shows a preponderance for females • Varied mean age of histological sub-types

  18. 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,haemorrhage

  19. 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 bodies

  20. Clinical appearance of OF

  21. Radiographic appearance of OF

  22. 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).

  23. FD

  24. FD

  25. Radiographic appearance of FD

  26. Ground glass appearance of FD

  27. Radiographic appearance of FD

  28. 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 infancy

  29. 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 production

  30. 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 manifest

  31. 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 teeth

  32. Clinico-radiographic presentation

  33. Aetiology of GS • Due to a single phenotypic gene • Autosommal pattern of inheritance • With complete penetrance and variable expression

  34. Osteoma • A benign neoplasm • Characterized by the proliferation of either compact or cancellous bone • Usually in an endosteal or periosteal location

  35. 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.

  36. Clinico-radiographic presentation

  37. 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 tissue

  38. Clinico-radiologic Features of AF • Painless swelling • Centrally placed: a radiolucent lesion • Peripherally located: swelling in the gingivae • Bone saucerization in peripheral location

  39. Clinical presentation

  40. Intra-operative appearance

  41. Surgical defect

  42. 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 phenomenon

  43. 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 sequela

  44. Clinico- radiographic presentation

  45. Treatment of HPMC • Resection

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