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16.12 Tumours and Tumour-Like Conditions of Oral Cavity and Facial Region

Table of Contents

16.12.1 Benign odontogenic tumors

Each tumor presents with different cardinal features radiologically and on histopathological diagnosis.

Ameloblastoma:

  • Recognized between ages of 30 and 50 years
  • 80% form in the mandible and 70% develop in the posterior molar region and often involve the ramus
  • Painless, slow growing tumor that may be solid or cystic
  • Looseness of teeth, with roots resorption
  • Gradual facial asymmetry due to enlargement and destruction of bone
  • Continuous sheet of paper thin bone covering the tumor
  • Radiographically the tumor presents with the following features:
    Multilocular radiolucency, honeycomb or soap bubble appearance

NOTE: Diagnostic confirmation of this tumor is through histopathology. Complete excision e.g. total resection of the jaw, segmental resection plus bone grafting is the treatment of choice. Hence refer the patient to a centre where there is Oral and Maxillofacial surgeon and Histopathology Unit.

Calcifying odontogenic tumors

  • Most often found in the mandibular molar/premolar region, but 33% of cases are found in the maxilla
  • It is associated with an unerupted or impacted tooth in 50% of cases
  • Radiographically these lesions can be radiolucent, but more characteristically are mixed lucent and opaque masses, exhibiting a snowdriven appearance

Non-Pharmacological Treatment

Complete excision of the tumour with border of normal lobe should be curative, but recurrence follows incomplete excision.

Amelobastic fibroma

  • Slower growing tumor than the simple ameloblastoma and does not infiltrate between bone trabeculae
  • 75% of ameloblastic fibromas are found in the posterior mandible in the area of a developing tooth. It is benign and expansile, growing as a pushing front rather than invading surrounding tissues
  • Radiographically: This lesion appears as a uniocular or bilocular radiolucency, most often in the posterior mandible. The radiographic appearance is identical to that of unicystic ameloblastoma, and both lesions should be differential diagnoses because they affect similar age groups and have similar clinical and radiographic appearances. Histologic examination differentiates the two.
  • Conservative resection is effective, but if incomplete, recurrence follows

Adenomatoid tumors (Adenoameloblastoma)

  • Two thirds of the cases occur in the anterior maxilla, one third occur in the anterior mandible, and it is never found posterior to the premolars
  • Two thirds of the cases are associated with an impacted tooth (usually the cuspid)
  • Present with mild swelling or in association with a clinically missing tooth
  • Radiographically: This lesion generally appears as a well-demarcated radiolucency. In 75% of cases, it is associated with an unerupted tooth, usually the canine. It may contain radiopaque flecks, which represent calcified material. If associated with a tooth, it generally attaches to the tooth further apical on the root than the typical dentigerous cyst.

Non-Pharmacological Treatment

Enucleation is curative and recurrence is almost unknown.

Odontogenic myxoma

  • Clinically indistinguishable from ameloblastoma
  • The radiographic appearance of this lesion is not distinctive. It appears quite similar to ameloblastoma (eg, multilocular radiolucency)  Confirmation is through Histopathology

Non-Pharmacological treatment Wide excision is required.

Other tumors of which needed to be diagnosed through histopathogy are; Odonto ameloblastoma, Complex odontoma, Compound odontoma, Odontogenic fibroma, Cementoma and Cementifying fibroma.

16.12.2 Non odontogenic benign tumors (benign osteogenic tumors, arise from bone)

Ewing’s tumor

Diagnostic criteria:

  • Painful swelling accompanied with fever
  • It is characterized by extraordinarily fast growth
  • Radiographically: Poorly defined solitary osteolytic lesion, irregular moth– eaten appearance which may be undetectable in serial images for a long period. Histological diagnosis is needed

Pharmacological Treatment

The initial treatment is wide excision, if not possible radiation should be considered. Combination chemotherapy should be given.

Pregnancy tumors

Diagnostic criteria:

  • They most commonly appear after first trimester, grow rapidly, and typically regress after delivery
  • Found on the gingiva and arise predominantly
  • They are exophytic, lobulated, or smooth surfaced lesion with a red to purplish color and a soft, spongy texture.

Non-Pharmacological Treatment

Surgical intervention is often not required. However, pregnancy tumors can be removed during the second trimester if they interfere with occlusion, are painful, bleed excessively, or are excessively large. Lesions excised during pregnancy often recur. After delivery, pregnancy tumors typically recede spontaneously but excision may be necessary for those cases which persist. Other non-odontogenic tumors are Osteomas, Myxomas, Chondromas, Central giant cell and Fibro-osteoma.

16.12.3 Benign Soft Tissues Non-odontogenic Tumors

Diagnostic criteria

Haemangioma

  • Enlarged, vascular hamartoma appears as a painless, soft, smooth or lobulated, sessile or pedunculated mass but may ulcerate and possibly hemorrhage if traumatized
  • The lesions present with deep red or bluish red in color and moderately firm to palpation.
  • May occur on tongue, lips, buccal mucosa, gingiva, palatal mucosa, salivary glands, alveolar ridge, and jaw bone
  • They occur early in life and may enlarge rapidly or progressively as the patient grows

Non-Pharmacological Treatment

Most true hemangiomas require no intervention as some congenital lesions may undergo spontaneous regression at an early age. However, 10–20% require treatment because of the size, exact location, stages of growth or regeneration and functional compromise. The potential for severe hemorrhage caused by the vascular nature of the lesion must be considered. Hence, refer the patient to a centre where there is Oral and Maxillofacial surgeon.

Other soft tissue non-odontogenic tumors are Papilloma, Fibroma, Fibrous Epulis, Peripheral Giant Cells, Lymphangioma, Lipoma and Pigmented nerves.

General non-pharmacological treatment of benign tumors

  • Enucleation or excision is the treatment of choice depending on the type. Can be hemimandibulectomy, total mandibulectomy, hemimaxillectomy or total maxillectomy.
  • Treatment of most of these conditions needs the expertise of an oral and maxillofacial surgeon and patients should be referred

16.12.4 Malignant soft and bone tumors

Squamous cell carcinoma Diagnostic criteria

  • A sore in the mouth that does not heal (most common symptom)  Pain in the mouth
  • Persistent lump or thickening of mucosa in the cheek
  • Persistent white or red patch on the tongue, gums, tonsils, or lining of the mouth
  • Difficult moving jaw or tongue
  • Difficult chewing or swallowing
  • Enlarged cervical lymph nodes may be present

NOTE: Take tissue biopsy of the lesion and send for histopathology investigation or refer the patient as early as possible to a centre where there is Oral and Maxillofacial surgeon and Histopathology unit.

Other malignant soft and bone tumors are Lymphosarcoma, Myosarcoma, Chondrosarcoma, Fibrosarcoma, Adenosarcoma, Adenocystic carcinoma and epidermoid carcinoma.

Treatment

Palliative – but this depends on stage of the tumor: stage I and II surgical excision (squamous cell carcinoma) with wide margin then curative radiotherapy. Others, surgical excision, radiotherapy followed by chemotherapy.

Lymphomas

These are group of neoplasms of varying degrees of malignancy which are derived from B-cells of lymphoid tissues, the lymphocytes and histiocytes in any of their developmental stages.

Burkitt’s Lymphoma (African Jaw Lymphoma)

Diagnostic criteria.

  • It shows close association and infection with the Epstein Barr virus. Confined almost exclusively to children between 2–14 years of age
  • Rapidly growing tumor mass of the jaws, destroying the bone and causing teeth loosening with extension the maxillary, ethmoid and sphenoid sinuses as well as the orbit.
  • Visceral organ involvement also occurs.
  • NB: Diagnostic confirmation is through histopathology, hence, it is emphasized to do early detection and referral since Burkitt’s lymphoma responds very quickly on chemotherapy. (For detailed management of malignant tumors please refer to the malignancy on chapter twenty two)

The codes will be shown below

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