Classification of bone tumors According to the WHO classification ICG (series №6) primary bone tumors and tumor-like lesions are divided into the following groups and individual species. 1.Kosteobrazuyuschie tumors: benign - osteoma, osteoid osteoma, malignant, osteogenic sarcoma, osteosarcoma parostalnaya. 2.Hryascheobrazuyuschie tumors: benign -hondroma, osteochondroma, hondrroblastoma, hondromiksoidnaya fibroma, malignant - chondrosarcoma, yukstakortikalnaya chondrosarcoma, mesenchymal chondrosarcoma. 3.Gigantokletochnaya tumor (osteoclastoma) 4.Kostnomozgovye tumors (all malignant) - Ewing's sarcoma, clasmocytoma bones, lymph bone sarcoma, myeloma. 5.Sosudistye bone tumors: benign hemangioma, Lim fangioma, intermediate or indeterminate (aggressive with signs of malignancy) - hemangioendothelioma, hemangiopericytoma, zloka-tative - angiosarcoma. 6. Other connective tissue bone tumors: benign, desmoplastic fibroma, fibrosarcoma, malignant, liposarcoma, malignant mezenhimoma, undifferentiated sarcoma. 7.Prochie bone tumors: benign, chordoma, adamantinoma of long bones, nevrilemmoma (shvanoma, neuroma), neurofibroma. 8.Neklassifitsiruemye tumor. 9.Opuholepodobnye bone disease - a solitary bone cyst, aneurysmal bone cyst, periarticular bone cyst, neossifitsiruyuschaya fibroma, eosinophilic granuloma, fibrous dysplasia, "myositis ossificans", "brown tumor" hyperparathyroidism. The WHO classification is based only on the principle of differentiation histological tumor cells with regard to the nature of the intercellular substance. Classification has shortcomings when applied in clinical practice the dentist. Therefore we use in clinical practice classification of primary tumors and tumorlike formations on the bones of the face A.A.Kolesovu, which includes primary benign and malignant bone formation, as well as a number of tumor lesions. Tumors benign osteogenic group chondroma Osteoblastoklastoma osteoma Neosteogennaya group Myxoma fibroma Hemangioma Neurofibroma Nevrilemmona Cholesteatoma odontogenic group Adamantinoma odontoma soft tumor-like formations malignant chondrosarcoma Osteoblastoklastoma osteosarcoma Fibr.displaziya (single bone, a lot of bone). deforming ostoz Miksosarkoma fibrosarcoma Hemangiosarcoma Hemangioendothelioma Ewing's sarcoma reticular sarcoma Myeloma Eosinophilic granuloma. radicular cyst follicular cyst odontoma solid Cementoma FEATURES diagnosis of tumors jawbone The main difficulties in the diagnosis of bone tumors of the jaws due not only to a variety of different kinds of diseases and malformations of the facial bones, but the lack of specific initial symptoms. Sometimes feel that pain symptom, dominant at some swelling caused by inflammatory diseases of the maxillofacial area and prescribe treatment, leading to increased tumor growth (tooth extraction, antiinflammatory, restorative therapy and physiotherapy). Often the disease is detected only in developing stage. The child, unlike the adult is not always able to assess and build their complaints in the clinical diagnosis of tumors of the jaw bones play a significant role first patient complaints, medical history, the duration of the disease and its comparison with the size of the bone formation, visual inspection, the overall condition of the patient, his age, localization of education. Anamnesis. At the beginning of the disease, children and their parents often pay attention to the trauma, pain, swelling, tooth mobility, limited mobility of the lower jaw, which occur in pathological processes of the maxillofacial region. The sequence of occurrence of these symptoms can help in the differentiation of pathological processes. When malignancy pain, swelling and dysfunction appear after some time. A osteogenic tumor, unlike malignant tumors and indolent first attracted attention deformation of the jaws. Examination of the child. When osteogenic tumors of the jaws general condition of the child is not getting worse. Affected jaw bone tumors increased in volume. The tumor is detected early by the child or parent in the case where the developing or periosteum located directly underneath the coating layer of the bone. Later revealed swelling in the localization of education in the thickness of the jaw bone, especially in the upper jaw. Osteogenic tumors are characterized by a solid consistency, bumpy surface and quite clear boundaries. In the bulging tumor should pay attention to the color of the skin and mucous membranes of the mouth, the mobility of the soft tissue over the tumor, expanding the network of veins, pulsing possible. When osteogenic tumors, facial skin over the tumor moves freely. Malignant tumors of the skin, first movable gradually becomes thinner, and in the future is firmly soldered to the tumor. Subcutaneous veins usually dilate, the surrounding soft tissues of the face swollen, sometimes becoming cyanotic color. In the diagnosis of tumor disease duration is of particular importance. Malignant tumors of the jaws for 1-2 months of the disease, with clinical and radiographic changes. Some osteogenic tumors (myxoma, lytic giant cell tumor) in children are developing very quickly, destroying the jaw sprout in the soft tissue, resembling a picture of malignant growth. X-ray examinations allow to specify the location of the tumor in the bones of the face, its location, the direction of the growth of tumors, the boundaries with the surrounding tissues. In a study of osteogenic tumors kompyutertomografiey have the opportunity to assess the condition of the bone tissue in three-dimensional spatial location of the tumor. A high-resolution level has a magnetic resonance imaging. This research is important in the propagation of the tumor beyond the jawbone. Both methods are very important in the study of tumor location in the upper jaw, are important for the differential diagnosis with other tumors, tumorlike lesions of bone. These modern techniques allow for a clear plan for the amount of surgical treatment. In some types of bone tumors highly informative method of research is angiography, which allows us to determine vascular connection tumor and treatment planning is used to perform pre-stage rentgenangiooklyuzii to reduce blood loss during removal of such tumors. Clinical and radiological findings must be confirmed by morphological study. The final diagnosis is established after analyzing the results of the clinical, radiological, morphological and other types of research. Osteoma - benign tumor of bone. The tumor can be located centrally and peripherally. They are spongy, compact and mixed. Clinical signs osteoma, the following 1) extremely slow painless tumor growth. 2) Developing of the jaw bone, causing thickening of the corresponding region. 3) This leads to a deformation of the jaw, cosmetic and functional disorders. The clinical course of the tumor depends on the location, size and direction of growth. Squeezing the neurovascular bundle in the lower jaw, swelling can cause neurological symptoms. Development of osteoma in the upper jaw leads to exophthalmos, difficulty in nasal breathing (propagation on sinuses). With the defeat of the TMJ marked limitation of lowering and increasing difficulties lateral movements of the mandible. Central osteoma radiographically detected in the form of intense focus seal of round shape with smooth contours and peripheral osteoma is defined as a single bone growth, a projection jutting out into the surrounding soft tissue. Differential diagnosis of osteoma should be made with fibrous dysplasia, reactive hyperostosis, myositis ossificans and ossified hematoma. Treatment. Removal of the tumor within the healthy bone. The indications for surgery are 1) Pain 2) Large tumor size 3) Cosmetic and functional disorders. Chondroma - a benign tumor made up of cartilage. Is a rare tumor of the jaw bones. Distinguish chondroma, protruding beyond the normal limits of bone growing ekzhofitno-ekhondromy (peripheral) and growing inside the bone enchondroma (central). Ekhondromy - occur in the maxilla and nasal cavity. Clinical signs: 1) markedopen lips by raising the upper lip tissue growing tumor 2) tumor can displace teeth and bite to break, but do not cause tooth mobility. 3) the mucous membrane covering the tumor has not changed. 4) chondroma initially deforms the upper jaw to the side of the hard palate 5) is determined by palpation dense painless nodular fixed tumor. Upon germination ekhondromy into the nasal cavity is marked "snub" of its front, which has a saddle shape. Nasal breathing is often difficult. The mucous membrane covering the tumor more anemic. If the tumor extends to the hard palate, nasal bone, the maxillary sinus, orbit, it may appear neurological syndromes, functional and trophic disorders. Enchondroma unlike ekhondromy localized in both the upper and the lower jaw. Tumor growth occurs within the bone very slowly. Observed following clinical signs. ), Tenderness, or mobility shift tooth located at the tumor site. 2) Appears swelling of the bone and tumor fixed, dense, often painful on palpation, in which sometimes defined symptom parchment crunch. 3) Skin and mucous membrane swelling over unchanged. When chondroma visible on the radiograph plotnovata shadow neoplasms, the roots of the teeth not resorbed, the tumor has a structureless shadow uneven density. Differentiate chondroma accounts from fibrous dysplasia, chondrosarcoma, as well as odontogenic cysts. Chondroma surgical treatment. Surgery for ekhondromah enchondroma and can only be reliable if completely remove neoplastic tissue. Osteoblastoklastoma (giant cell tumor). On the basis of clinical and radiological data should distinguish between two forms of osteoblastoklastomy: lytic and mesh. Each of these different clinical features. Clinical signs of political forms osteoblastoklastomy, which occurs in children 4-12 years: 1) grows quickly and can be a pain, 2) in severe swelling of the tumor observed. Swelling and warming the skin at the location of the tumor. 3) The venous network of vessels of the mucous membrane covering the tumor extended. 4) Upon germination of the tumor beyond the cortical bone oral mucosa becomes bluish-bagrovuyu color. Under her palpable soft-woven education. 5) The teeth are sometimes shifted and become mobile and in pathological lesions may be mandibular fractures. Lytic form osteoblastoklastomy differentiated with osteosarcoma of the jaw. At the cellular form of the tumor is more common in the age of 8-15 years and the beginning of developing symptoms. Inherent to form cellular osteoblastoklastomy following: 1) Swelling developed on one portion of the upper or lower jaw. 2) The tumor is painless, with a bumpy surface, diffusely thickened. 3) has a spindle-shaped jaw. 4) The mucous membrane of the alveolar bone covering the tumor, a few anemic and brilliant 5) palpation slightly painful and thus can be detected symptom parchment hrusta.6) Teeth that are in the area of the tumor, rarely change their position and are movable. Cellular form osteoblastoklastomy differentiated with fibrous dysplasia, odontogenic cysts. Radiograph. During lytic form osteoblastoklastomy hearth destruction structureless. If the process is limited to a part of the jaw bone, this defect is marginal. If the bone is destroyed around the diameter, on the background of the tumor determined by the free ends of the jaw fragments with jagged edges blurred. Cortex drastically thinned or not detected. When the honeycomb form in the lesion reveals numerous small cavities or larger honeycomb formations which are separated from each other by partitions with different bone thicknesses. Treatment of children with osteoblastoklastomoy surgery. Given that it is prone to relapse, and shows the radical surgery. Hemangioma. Bone hemangioma with the localization of the field with the upper or lower jaw - a vascular malformations, occur infrequently and is very difficult to diagnose and treat. They are observed in patients from the moment of birth, but their clinical manifestations are more likely to occur after 7-11 years on the background of hormonal changes. The reason progression is vice hemodynamic alteration, often associated with regional hypertension affecting the surrounding tissues, including bone structures, with the formation of intraosseous cavities. The most characteristic features of hemangiomas of bone in the jaw are in the early stages of the emergence of mild soft tissue swelling cheeks, teleangiektatsii on the skin, eventually increasing the mobility of the teeth and gingival margin hyperemia of these teeth, bleeding. Bleeding occurs either by removing the abnormal mobility of teeth, either spontaneously from the subgingival region, as well as during the eruption of permanent teeth. With the defeat of the upper jaw are often marked nosebleeds. Determined by clinical examination of the jaw body increase, due to the asymmetry of facial swelling and presence of arteriovenous fistulas in the soft tissues, vascular pattern of varying intensity on the skin or oral mucosa, and skin temperature rise above the mucosal lesion. Auscultation auscultated diastolosistolichesky rough noise in the carotid artery on the affected side and pulsation in the soft tissues of the affected person. Radiologically marked areas pulping bone petlistogo large structure, combined with areas of cellular degradation of character. Defined pathological roots resorption milk teeth, which leads to their pronounced mobility. Rudiments of permanent teeth are displaced, there is a delay of their formation. Treatment: hemangioma before a radical surgery. But lately, the most effective treatment is a combination of endovascular embolization with intraosseous administration of a liquid biopolymer glue. This method is based on the restriction of blood flow and hemodynamics restructuring in conjunction with the closing of bone cavities and subsequent repair, which makes it resistant therapeutic effect