ODONTOGENIC TUMOURS OF ORAL
CAVITY
DEFINITION
• TUMOURS IN THE JAW THAT ARISE FROM
ODONTOGENIC TISSUES ARE REFERRED
TO AS ODONTOGENIC TUMOURS
CLASSIFICATION OF ODONTOGENIC
TUMOURS (W.H.O CLASSIFICATION)
BENIGN
1. ODONTOGENIC EPITHELIUM WITHOUT
ODONTOGENIC ECTOMESENCHYME
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AMELOBLASTOMA
SQUAMOUS ODONTOGENIC TUMOUR
CALCIFYING EPITHELIAL ODONTOGENIC
TUMOUR (PINDBORG)
ADENOMATOID ODONTOGENIC TUMOUR
2. ODONTOGENIC EPITHELIUM WITH
ODONTOGENIC ECTOMESENCHYME
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AMELOBLASTIC FIBROMA
AMELOBLASTIC FIBRODENTINOMA
AMELOBLASTIC FIBRO ODONTOMA
ODONTO AMELOBLASTOMA
CALCIFYING ODONTOGENIC CYST
COMPLEX ODONTOMA
COMPOUND ODONTOMA
3.ODONTOGENIC ECTOMESENCHYME WITH OR
WITHOUT ODONTOGENIC EPITHELIUM
• ODONTOGENIC FIBROMA
• MYXOMA
• CEMENTOBLASTOMA
MALIGNANT
1. ODONTOGENIC CARCINOMAS:
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MALIGNANT AMELOBLASTOMA
PRIMARY INTRAOSSEOUS CARCINOMA
CLEAR CELL ODONTOGENIC CARCINOMA
GHOST CELL ODONTOGENIC CARCINOMA
2. ODONTOGENIC SARCOMAS:
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AMELOBLASTIC FIBROSARCOMA
AMELOBLASTIC FIBRO DENTINO SARCOMA
AMELOBLASTIC FIBRO ODONTO SARCOMA
BENIGN VS MALIGNANT TUMOUR
Depending upon their spread by invasion and
metastasis, tumours are classified as benign or
malignant.
Benign tumors cannot spread by invasion or
metastasis; hence, they only grow locally.
Encapsulated, enlargement by peripheral expansion,
pushes away the adjoining tissues and structures.
Malignant tumors spread by invasion and
metastasis. Rapidly infiltrates the surrounding tissue.
By definition, the term "cancer" applies
only to malignant tumors.
GENERAL PRINCIPLES OF DIAGNOSIS
& MANAGEMENT OF JAW LESIONS
HISTORY OF LESION
• DURATION
LONG HISTORY OF DURATION  CONGENITAL
LONG HISTORY OF DURATION (SLOW GROWTH) NO-PAIN  BENIGN
SHORT HISTORY OF DURATION, FAST GROWTH  MALIGNANT
• Mode of onset & ProgressE.g; history of trauma  Osteogenic Sarcoma
Rapid growth  Malignant
Slow growth  Benign
• Size & Shape  To know the origin of the lesion.
• Progression of the lesion:
Slowly growing and same size for long time  Benign
Same size for long time and the again growing  Malignant
transformation of Benign lesion.
Continuously growing  Malignant
• Change in character of lesion
Ulceration, fluctuation, softening noticed by the patient. If
painless swelling has become painful, can be infection.
• Associated symptoms
Pain
Abnormal sensations like anesthesia, paresthesia
Nasal obstruction
Difficulty in breathing
Tenderness
Lymphadenopathy
Trismus
Similar swellings elsewhere in the body to rule out
metastasis
Loss of body weight
Any habits
Recurrence after previous surgery
CLINICAL EXAMINATION
• General physical examination
• Examination of oral cavity, external face, regional lymph
nodes.
• Inspection
• Palpation (Bimanual palpation)
• Percussion
• Auscultation
Imaging & biopsy
• PLAIN RADIOGRAPHS
• CT SCAN
• MRI
• HISTO-PATHOLOGICAL EXAMINATION
AFTER BIOPSY
PRINCIPLES OF SURGICAL
MANAGEMENT OF JAW TUMOURS
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ENUCLEATION
CURETTAGE
MARSUPIALIZATION
RESECTION WITHOUT CONTINUITY DEFECTS
RESECTION WITH CONTINUITY DEFECTS
DISARTICULATION
RESECTION WITHOUT CONTINUITY DEFECTS
• MARGINAL RESECTION / EN-BLOCK RESECTION
RESECTION WITH CONTINUITY DEFECTS
• INFERIOR BORDER OF MANDIBLE
• PARTIAL RESECTION
• HEMI-MANDIBULECTOMY
• DISARTICULATION
• TOTAL RESECTION
• COMPOSITE RESECTION
AMELOBLASTOMA
INCIDENCE - MOST COMMON ODONTOGENIC
NEOPLASM
AGE-THIRD DECADE OF LIFE
SEX (M:F) - EQUAL
SITE: MANDIBLE - 80% (70% IN THE POSTERIOR
MOLAR REGION AND RAMUS REGION)
Recurrence is common
• True neoplasm of enamel organ type tissue
• Definition : ACCORDING to ROBINSON
“ usually uni-centric, non functional, intermittent in
growth, anatomically benign and clinically
persistent”.
Pathogenesis
Cell rests of enamel organ
Epithelium of odonotogenic cysts – dentigerous cyst
Disturbances of developing enamel
Basal cells of surface epithelium
 Presently – alteration or mutation in the genetic material of
the cells that are programmed for tooth development
Etiology
 Irritation:
 Infection – ROBINSON – 1/3rd of cases- oral infections
 Trauma:
 Dietary deficiency – defect in development of tooth germ
 Virus – polyoma virus
Classification
• CENTRAL- INTRAOSSEOUS
• PERIPHERAL- EXTRAOSSEOUS
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CLINICAL FEATURES
Usually asymptomatic at its early phase
Late stage
Intra-oral & extra-oral jaw swelling
Disturbed normal occlusion and tooth eruption.
Teeth in the region are mobile
ill-fitting dentures
Ulcerations
Nasal obstructions
Nerve involvement, lower lip paresthesia
Egg shell cracking of bone
RADIOGRAPHIC FEATURES
• Appears as Unilocular - Monocystic OR
Multilocular - Multicystic radiolucency.
• Honey - Comb / Soap Bubble Appearance.
TNM CLASSIFICATION OF CARCINOMAS OF
ORAL CAVITY
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T – PRIMARY TUMOUR
TX – Primary tumour can not be assessed
T0 – No evidence of primary tumour
TIS – Carcinoma in situ
T1 – Tumour 2cm or less in greatest dimention
T2 – Tumour more than 2cm but less than 4cm
T3 – More than 4cm
T4a – LIP (Tumour invades through cortical bone, inferior alveolar nerve,
floor of mouth, or skin )
T4a – ORAL CAVITY (Tumour invades through cortical bone, into
deep/extrinsic muscle of tongue (genioglossus,
hyoglossus, palatoglossus, and styloglossus), maxillary
sinus, or skin of face.
T4b – LIP & ORAL CAVITY ( Tumour invades masticator space, pterygoid
plates, or skull base; or encases internal carotid artery )
N – Regional lymph nodes metastasis
• NX - Regional lymph nodes cannot be assessed
• N0 - No regional lymph node metastasis
• N1 - Metastasis in a single ipsilateral lymph node, 3 cm or less in
greatest dimension
• N2 - Metastasis as specified in N2a, 2b, 2c below
• N2a - Metastasis in a single ipsilateral lymph node, more than 3 cm
but not more than 6 cm in greatest dimension
• N2b - Metastasis in multiple ipsilateral lymph nodes, none more than
6 cm in greatest dimension
• N2c - Metastasis in bilateral or contralateral lymph nodes, none more
than 6 cm in greatest dimension
• N3 - Metastasis in a lymph node more than 6 cm in greatest dimension
M – Distant metastasis
• MX - Distant metastasis cannot be assessed
• M0 - No distant metastasis
• M1 - Distant metastasis
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Stage grouping
Stage 0 - Tis N0 M0
Stage I - T1 N0 M0
Stage II - T2 N0 M0
Stage III - T1, T2 N1 M0
T3 N0, N1 M0
Stage IVA - T1, T2, T3 N2 M0
T4a N0, N1, N2 M0
Stage IVB - Any T N3 M0
T4b Any N M0
Stage IVC - Any T Any N M1