1. TUMORS OF JAW BONES
TUMOR / NEOPLASM –
Abnormal new growth which results from
Excessive, Autonomous, Uncoordinated ,Purposeless
Proliferation of Cells which continues its growth even after
cessation of stimuli.

2. TUMORS OF JAW BONES
BENIGN TUMOR
Grows slowly
Encapsulated
MALIGNANT TUMOR
Rapid growth
Poorly circumscribed, Irregular
Adjoining structures Compressed
Invasion of adjoining structures
Not Fixed
No Tendency
Fixed to sorrounding structures
Tendency towards Ulceration
& Hemorrhage
Metastasis present
Exhibits no Metastasis

3. TUMORS OF JAW BONES
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All Tumors - 2 components
Parenchyma - Proliferating Tumor Cells - Nature & Evolution
Supportive Stroma – Fibrous Connective Tissue & Blood Vessels –
Provide Framework on which Parenchymal
Tumor Cells Grow
Suffix ‘ oma’ - Benign Tumor
Malignant tumors of Epithelial Origin - CARCINOMAS
Malignant tumors of Mesenchymal Origin - SARCOMAS
BENIGN JAW TUMORS – 2 TYPES
ODONTOGENIC TUMORS
NONODONTOGENIC TUMORS

4. BENIGN JAW TUMORS

CLASSIFICATION OF ODONTOGENIC TUMORS
( KRAMER, PINDBORG , SHEAR – 1992)
A. ODONTOGENIC EPITHELIUM
1. Ameloblastoma
2. CEOT / Pindborg’s Tumor
3. Clear Cell Odontogenic Tumor
4. Squamous Odontogenic Tumor
B. Odontogenic Epithelium with Odontogenic Ectomesenchyme
With / Without Dental Hard Tissue Formation
1. Ameloblastic Fibroma
2. Ameloblastic Fibrodentinoma
5. Compound Odontome
3. OdontoAmeloblastoma
6. Complex Odontome
4. Adenomatoid Odontogenic Tumor ( AOT)

5. CLASSIFICATION OF ODONTOGENIC TUMORS
C. Odontogenic Ectomesenchyme with / without Odontogenic epithelium
1. Odontogenic Fibroma
2. Myxoma
3. Benign Cementoblastoma
NON ODONTOGENIC TUMORS (WHO Classification)
A . OSTEOGENIC NEOPLASMS
Cemento Ossifying Fibroma
B. NON NEOPLASTIC BONE LESIONS
Fibrous Dysplasia
Cemento Osseous Dysplasia
- Periapical Cemento Osseous Dysplasia
- Focal Cemento Osseous Dysplasia
- Florid Cemento Osseous Dysplasia

6. Classification Of Non Odontogenic Tumors
C. CEMENTO OSSEOUS DYSPLASIAS
Cherubism
Central Giant Cell Granuloma

7. General Principles in Management of Jaw Lesions

HISTORY OF LESION
Duration – Long without Pain – Benign Neoplasm
Short , Rapid Growth – Malignant Lesion
Mode of Onset - H/o Trauma - Osteogenic Sarcomas
Rapid growth – Benign
Slow growth - Malignant
Site & Shape
Progress of Lesion – Stationary, Continous, Intermittent
Change in Character of Lesion – Ulcerations, Fluctuation
Associated Symptoms – Pain , Paresthetia, Tenderness,
Lymphadenopathy, Difficulty in breathing
Trismus
Recurrence
Loss of Body weight
Habits

8. General Principles in Management of Jaw Lesions
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INSPECTION
Number
Size
Shape
Skin Over Swelling
PALPATION
Consistency
Pulsations
IMAGING
Plain Radiographs
CT Scans
MRI
Angiographic Studies
Bone Scans / Scintigraphy
Color Surface
Pedunculated / Sessile
Fixity
Lymph Node Examination

9. BIOPSY

EXFOLIATIVE CYTOLOGY
FNAC
INCISIONAL BIOPSY
ASPIRATION BIOPSY
EXCISIONAL BIOPSY
Exfoliative Cytology - Malignancy ,Scrapings are transfered to slide ,
stained & examined under microscope
Aspiration Biopsy – Nature of lesion
FNAC - Deep seated lesions ( salivary glands, neck, )
Excisional Biopsy
Incisional Biopsy

10. General Principles in Management of Jaw Lesions
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
Goal of Treatment
Complete Eradication of lesion
Preservation of normal tissue
Excision with least morbidity
Restoration of tissue loss, form , function
Long term follow up
Gold ,Upton, & Marx 1991 – Terminology for Surgical Excisions
Enucleation
Curettage
Marsupialization
Recontouring
Resection with Continuity Defect
Resection without Continuity Defect
Disarticulation

11. General Principles in Management of Jaw
Lesions
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-
ENUCLEATION With / Without CURETTAGE INDICATIONS
Small Benign Tumors , Non Aggressive
Tumors which tend to grow by Expansion rather than Infiltration
Distinct seperation between sorrounding bone & Lesion
Cortical margin of bone that separates Tumor / Cyst from bone
Indicated in Following Tumors
a) Odontogenic Tumors
Odontoma
Ameloblastic Fibroma
Fibroodontoma
AOT
Cementoblastoma
Ameloblastic

12. General Principles in Management of Jaw
Lesions
B) Non Odontogenic Tumors
Ossifying Fibroma
Cherubism
Central Giant Cell Granuloma
C) Other Lesions
Hemangioma Neurofibroma
Eosinophilic Granuloma
Osteoblastoma
Neurilemmoma

13. General Principles in Management of Jaw
Lesions
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MARGINAL RESECTION / PERIPHERAL OSTEOTOMY
RESECTION WITHOUT CONTINUITY DEFECT
EN – BLOC RESECTION
INDICATIONS
- Benign lesions with known H/O Recurrence
- Lesions that are incompletely Encapsulated
- Recurrent Lesions previously treated by Enucleation
- Ameloblastoma, CEOT, Myxoma, Ameloblastic Odontoma,
Squamous Odontogenic Tumor
Benign Chondroblastoma , Hemangiomas
Allows for complete Excision of Tumor ,Continuity of Jaw Bone is
maintained – Need for Secondary Cosmetic Surgery not required

14. General Principles in Management of Jaw
Lesions

SEGMENTAL RESECTION OF JAW
- Infiltrative Lesions that have tendency to recur
- Lesions which are close to Lower border, Posterior border of
mandible,
- Lesions that extend to Maxillary sinus / Nasal cavity
- Malignant Lesions with high recurrence potential
- Maxillary Ameloblastomas with high Recurrence rate

15. MAXILLECTOMY

23. AMELOBLASTOMA
History
- Cuzack – 1827
- Robinson – Unicentric , NonFunctional , Intermittent in Growth,
Anatomically Benign , Clinically Persisitent
- WHO – True Neoplasm of Enamel Organ which does not undergo
differentiation to the point of Enamel Formation
- Benign but locally invasive Epithelial Odontogenic Neoplasm with
strong tendency to recur
Origin Late Development Source
Cell Rests of Enamel Organ
Remnants of Dental Lamina
Cell Rests of Malassez
Follicular Sacs

24. AMELOBLASTOMA
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-
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Early Embryonic Sources –
Disturbances of Developing Enamel organ
Dental Lamina
Tooth Buds
Basal Cells of Surface Epithelium
Epithelium of Primordial , Dentigerous , Lateral Periodontal Cyst
Heterotropic Epithelium from Pituitary Gland
Incidence 18% of all Odontogenic Tumors
3 – 4 th decade of life
Site
Mandible : Maxilla - 5:1
Mandible – Posterior molar - 60 %
Blacks – Anterior Maxilla

25. AMELOBLASTOMA
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Clinical Features
Early Stages – Asymptomatic
Slow growing, Painless, Hard , NonTender, Ovoid Swelling
Mobile Teeth, Ill Fitting Denture, Malocclusion, Exfoliation
Nasal Obstruction
Paresthetia
Egg shell crackling
Non Encapsulated – invades by destroying rather than pushing
Transform in to Malignant form ( 2 – 4 %)

26. AMELOBLASTOMA

Radiological Features
Unilocular Radiolucency - 6%
Multilocular Radiolucency - 15%
Honeycomb Appereance – Multilocular radiolucency with
compartmentalized appearance due to Bony Septa – Giant cell lesions
Fibro Myxoma
Root Resorption ( 30%)
Tooth Displacement
Buccolingual cortical Expansion - 80%
Neurovascular bundle – displaced
Desmoplastic Ameloblastoma – Radioopaque – Dense Connectivetissue
Anterior Maxilla / Mandible

27. AMELOBLASTOMA

Differential Diagnosis
Multilocular lesions - Dentigerous Cyst
Cherubism
Giant cell granuloma
OKC
Odontogenic Myxoma
ABC

28. AMELOBLASTOMA

TREATMENT
Curettage – Should never be considered
Unicystic Lesions – Recurrence Rate (18% – 25%)
Multicystic Lesions - Recurrence Rate ( 55% - 100%)
Microscopically infiltrates Bone beyond Tumor Interface
Safe Margin of uninvolved bone of 2 cm should be removed
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Multicystic Ameloblastoma –
En Bloc Resection without Continuity Defect
Segmental Resection with Continuity Defect - Cortical Bone perforated

29. AMELOBLASTOMA

RECONTRUCTION
Immediate Reconstruction –
Autogenous Free Bone Graft - Iliac / Rib Graft
Autogenous Bone Marrow + Reconstruction Plate
Bank Allogenic Bone Crib
Reconstruction Plate with / without condylar process
Vascularized Composite Pedicled Graft of Bone + Myocutaneos tissue

53. AMELOBLASTOMA
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Tumor confined to Maxilla without Orbital Floor involvement
Partial Maxillectomy
Tumor involving Orbital Floor – Total Maxillectomy
Tumor involving Orbital Contents – Total Maxillectomy + Orbit
Exonteration
Tumor involving Skull Base – Neurosurgical Procedure
Prognosis
Multicystic Ameloblastoma – 50% Recurrence rate – 5 yrs Post op
Long Term Follow up Must

54. CALCIFYING EPITHELIAL ODONTOGENIC
TUMOR
-
CEOT / Pindborg’s Tumor
Origin – Epithelial remnants of Enamel organ
1% of all Odontogenic Tumors
30 – 50 yrs
Mandible – molar
50% associated with unerupted / embedded tooth
Painless slow growing , Nasal obstruction, Epistaxis
Uni / Multi locular radiolucency with circumscribed / diffuse border
Honey comb appereance
Driven Snow Appereance – scattered flakes of calcification seen
around crown of embedded tooth
Recurrence – 15%

55. ADENOMATOID ODONTOGENIC TUMOR
AOT
3 – 7% of all Odontogenic Tumors
10 – 20 yrs
Females
Maxilla ( 65%) – Anterior region
Associated with Impacted Canine – 74%
Painless swelling
Unilocular Radiolucency around crown of impacted tooth - well defined
margins. Radiolucency shows Fine Calcifications – Snow Flakes
DD – Pindborg’s tumor , CEOC, Amelobastoma
Treatment
Enucleation – encapsulated
- Recurrence rare
-

65. ODONTOMA
- Growth in which both Epithelial & Ectomesenchymal cells exhibit
coplete / incomplete differentiation in to tooth formation
1 – 2 decade
Complex - Mandible – 67% , Posterior Jaw
Compound - Maxilla , Anterior Jaw
Hamartomatous malformation
Composite lesion
COMPOUND – consist of calcified toothlike structures / miniatured
Dwarfed tooth
COMPLEX COMPOSITE ODONTOMA
Disorderly & Haphazard arrangement of Calcified Dental Structures
R/FCompound – Radioopaque Mass with anatomic similarity to normal
tooth
Complex – Radioopaqe not resembling tooth
- Treatment - Enucleation

66. CEMENTOBLASTOMA / TRUE CEMENTOMA
-
Tumor of connective tissue forming cementum like calcification fused to
tooth root
10 – 20 yrs Premolar – Molar region
Mandibular lesions – attached to single tooth
Maxillary lesions – fused to 2 / more teeth
Slow growing lesion ,vital tooth , Resorption of cortical bone
R / F – Oval radioopaque mass with radiolucent periphery fused to
single / multiple roots
DD – Condensing Osteitis, Cementifying Fibroma,Osteoblastoma
Treatment – Enucleation, Large lesions can be cut in to smaller pieces

67. CEMENTO OSSIFYING FIBROMA
-
Benign lesion arising from undifferentiated cells of Periodontal
Ligament
3 – 4 decade Females – 5:1 Mandible – Premolar molar
Painless slow persistent growth – Facial asymmetry
R/F – Early – Radiolucent
Late – Radioopaque
Tr - Enucleation

68. OSTEOMA
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-
Benign tumors consist if Mature compact / cancellous bone
Peripheral – surface of jaw bone as Polypoid / sessile mass
Endosteal – develop centrally within medullary bone
Slow growing asymptomatic bony hard masses
R / F – Radioopaque mass
Tr – surgical excision

69. BENIGN OSTEOBLASTOMA
-
Central Bone tumor – actively proliferating Osteoblasts,
multinucleated Giant cells in Osteoid tissue
Males , < 25yrs Post aspect of jaws
R / F – Sun ray appereance - Central opacity with thin rim of
radiolucency
Tr – surgical excision

70. ODONTOGENIC FIBROMA
Central Benign Odontogenic Tumor
Contains Fibrous CT stroma & inactive Odontogenic Epithelium
Intraosseous – Central
Gingiva – Peripheral
Slow persistent growth, asymptomatic cortical expansion, Mandible
Males, Mean age 37yrs
R / F – Multiloculated radiolucency,well / ill defined sclerotic margin
Root divergence / resorption
- Tr – Enucleation & Curettage
-

71. ODONTOGENIC MYXOMA
-
Central benign slow growing , infiltrative tumor of jaws which cause
destruction of cortex
Found in Tooth bearing areas of jaws
Mandible
Females
Children
R / F – Multilocular / soapbubble / honeycomb
Recurrence rate – 33%
Tr – Resection with / wthout continuity defect