Benign tumors of

MODERATED BY:
jaw
DR. SUNITA GUPTA
DR. SHALINI
DR. DEEPMALA
DR. VIPUL
DR. ANSHUM
By:

VARUN

SURYA
1

The term " benign " implies

mild and non-progressive
A benign tumor is a tumor
that lacks all three of the
malignant properties of a
cancer.
Thus, by definition, a benign
tumor does not grow in an
unlimited , aggressive
manner, does not invade
2

Features

Benign tumor

Malignant tumor

Periphery

Smooth, well
defined,
Encapsulated,
corticated

Ill defined border,

lack of cortication ,
absence of
encapsulation

Surrounding tissue

Compressed

Invaded

Size

Usually small

Often larger

Growth rate

Slow

Rapid

Spread

Direct extension

Metastasis

Location

Specific anatomic
site

Anywhere

Internal structure

RO , RL , mixed

Radiolucent

Effect on surrounding Resorb teeth root ,

displace teeth in a
bodily fashion
without causing
loose teeth

Destroy supporting
alveolar bone so that
teeth may appear
floating in space

Benign

tumors represent a new

uncoordinated growth
Benign tumors are slow-growing and spread
by direct extension and not by metastases.
They tend to resemble the tissue of origin
histologically.
It is thought that benign tumors have
unlimited growth potential.
Often hamartomas are included in the
category of benign tumors.
However, hamartomas are overgrowths of
disorganized
normal tissue that have a limited growth
potential
For example, an odontoma is a hamartoma

Clinical Features

Benign tumors typically have an insidious

onset and
grow slowly.
These tumors usually are painless ,do not
metastasize, and are not life threatening
unless they
interfere with a vital organ by direct
extension.
Benign tumors are usually detected
clinically by
enlargement of the jaws or are found
during a
radiographic examination.
5

Radiologic features
LOCATION
Many tumors have a specific anatomic
predilection
odontogenic occur in the alveolar
lesions

processes
Above the inferior alveolar
nerve canal, where tooth
formation occurs

Vascular and
may originate inside the
neural lesions mandibular canal, arising
from the Neurovascular
tissues
Cartilaginous
tumors

occur in jaw locations where

residual cartilaginous cells lie,
such as around the mandibular
condyle.
6

PERIPHERY AND SHAPE

Benign tumors enlarge slowly by formation of
additional internal tissue.
Because of this, the radiographic borders of
benign tumors appear relatively smooth, well
defined, and sometimes corticated.
If the tumor produces a calcified product-for
example, abnormal tooth material or
abnormal bone-the
most mature part of the
tumor will be in the central region with the most
immature aspect at the periphery.
This sometimes results in a radiolucent band of
soft tissue or capsule at the periphery where the
calcified product has not yet formed; this band
separates the more mature internal
radiopaque portion from the surrounding
7
normal

INTERNAL STRUCTURE
It may be completely radiolucent or
radiopaque or maybe a mixture of
radiolucent and radiopaque tissues.
If the lesion contains radiopaque
elements, these structures usually
represent either residual bone or a
calcified material that is being
produced by the tumor.
For instance curved septa that are
characteristic in ameloblastoma represent
residual bone trapped inside the tumor
that has remodeled into curved septa.
The ameloblastoma does not produce
bone.
8
.

EFFECTS ON SURROUNDING STRUCTURES

a benign tumor exerts pressure on
neighboring structures, resulting in the

displacement of teeth or bony cortices.

If the growth is slow enough, there will be

adequate
time for the outer cortex to remodel in response
to the
pressure,resulting in an appearance that the
cortex has
been displaced by the tumor .
This is caused by simultaneous resorption of
bone along the inner surface (endosteal) of
the cortex and deposition of bone along the
outer cortical surface by the periosteum
Through this remodeling process, the cortex

maintains its integrity and resists

perforation.

The roots of teeth maybe resorbed by either

benign
or malignant tumors, but root resorption
more commonly is associated with benign
processes.
The benign tumors especially likely to
resorb roots are ameloblastomas, ossifying
fibromas, and central giant cell granulomas.
Benign tumors tend to resorb the adjacent
root Surfaces in a smooth fashion.
When root resorption is associated with
malignant tumors, the resorption is usually in
smaller quantities causing thinning of the
root into a "spiked" shape.
10

11

12

Benign tumors
The benign neoplasias are separated into
two major
groups: odontogenic tumors and nonodontogenic
tumors.
ODONTOGENIC
TUMORS
Odontogenic tumors arise from the tissues of
the odontogenic apparatus
According to (WHO),

13

1). Odontogenic epithelium

(i). Ameloblastoma
(ii). Squamous odontogenic tumor
(iii).Calcifying epithelial
odontogenic tumor (Pindborgs tumor)
(iv).Clear cell odontogenic tumor

2). Odontogenic epithelium with odontogenic

ectomesenchyme
(i). Ameloblastic fibroma
(ii). Ameloblastic fibro dentinoma and
ameloblastic fibro odontoma
(iii). Odontoameloblastoma
(iv). Adenomatoid OdontogenicTumor
(v). Calclifying odontogenic cyst
(vi). Complex odontoma
(vii). Compound odontoma
14

3). Odontogenic ectomesenchyme

(i). Odontogenic fibroma
(ii). Myxoma / Odontogenic myxofibroma
(iii).Benign cementoblastoma
( True Cementoblastoma)

15

Odontogenic
epithelial
tumors

16

AMELOBLASTOMA
Synonyms
Adamantinoma , adamantoblastoma, and
epithelial odontoma
Definition
A true neoplasm of enamel organ type which
doesnt undergo differentiation to the point of
enamel formation.
robinson Defined it as
A tumor that is -Unicentric,
non functional,
intermittent in growth,
anatomically benign
and clinically persistent
17

18

Clinical features
Age - 20 to 40yrs
Site - mandible > maxilla
slow growing, painless, bony expansion
initially Tennis ball like consistency
Egg shell like cracking
Jaw bone enlargement & parasthesia

19

Radiographic Features
Location. Most (80%) develop in the
molar-ramus region of the mandible, but
they may
extend to the symphyseal area.
Periphery. is usually well defined
and frequently delineated by a cortical
border. The
border is often curved and in small lesions
the border
and shape may be indistinguishable from a
cyst
The periphery of lesions in the maxilla is
usuallymore ill defined.

20

21

Internal structure. The internal structure

varies from totally radiolucent to mixed
with the presence of bony septa creating

internal compartments.
These septa are usually coarse and curved
and
originate from normal bone that has been
trapped
within the tumor.
Because this tumor frequently has internal
cystic components, these septa are often
remodeled into curved shapes providing a
honeycomb (numerous small compartments
or loculations) or soap bubble (larger
compartments of variable size)patterns .
22

23

Egg shell

24

Effects on surrounding structures.

There is pronounced tendency for
ameloblastomas to cause extensive root
resorption . Tooth displacement is common.
Because a common point of origin is occlusal
to a tooth, some teeth may be displaced
apically.
An occlusal radiograph may demonstrate
cyst like expansion and thinning of an adjacent cortical
plate, leaving
a thin "egg-shell" of bone .
Actual perforation of bone into the
surrounding soft tissues or anatomic spaces
is a late feature of ameloblastoma
Unicystic types of ameloblastoma may
25

Differential Diagnosis
The odontogenic keratocyst may contain
curved septa but usually the keratocyst
tends to grow along the bone without
marked expansion, which is Characteristic of
ameloblastomas.

26

Giant cell granulomas generally occur

anterior to the molars, occur in a younger
age group, and have more granular and ill
defined septa

27

Odontogenic myxomas may have similar

appearing septa; however , there are usually
one or two thin, sharp, straight septa,
characteristic of the myxoma.
Even the presence of one such septum may
indicate a myxoma. Also myxomas are not as
expansile as ameloblastomas and tend to

grow along the bone.

28

The septa in ossifying fibroma are

usually wide, granular, and ill defined.
Also, look for the presence of small
irregular trabeculae.

29

Treatment
The most common treatment is surgical
resection. If
the ameloblastoma is relatively small , it may
be removed
completely by an intraoral approach and
larger lesions
May require resection of the jaw.
The maxilla is usually treated more
aggressively because of the tendency of
ameloblastoma to invade adjacent vital
structures.
Radiation therapy may be used for inoperable
tumors,
Especially those in the posterior maxilla.
30

CALCIFYING EPITHELIUM ODONTOGENIC

TUMOR
( Pindborgs tumor )
Definition:
It is a locally aggressive tumor consist of sheets &
strands of polyhedral cells in fibrous stroma with
no inflammatory component & are often
accompanied by spherical calcifications & amyloid
staining hyaline deposits.
Origin -Rest of dental lamina
-Reduced enamel epithelium
1% of all odontogenic tumor

31

Clinical features

CEOT

Central
(intraosseous)
age - 40yrs
site - 2/3rd of
lesions in mandible
slow growing.
painless mass.

Peripheral
(extraosseous)
site - anterior gingiva
appears as superficial
soft tissue swelling
of gingiva in a tooth
bearing area or
edentulous area
of jaw

32

Radiographic features:

Location. mandible
most develop in the premolar-molar
area, with a
52% association with an unerupted or
impacted tooth.
Periphery. The border may have a welldefined cyst like
cortex. In some tumors the boundary maybe
irregular
and ill defined
Internal structure. The internal aspect
may appear unilocular or multilocular with
numerous scattered,
radiopaque foci of varying size and
33

34

most characteristic and diagnostic finding is the

appearance of radiopacities close to the crown of the
embedded tooth
35

36

Effects on surrounding structures. may

displace a developing tooth or prevent its
eruption.
Associated expansion of the jaw with
maintenance of a cortical boundary may also
occur.
Differential Diagnosis
Lesions with completely radiolucent internal
structure
may mimic dentigerous cysts or even
ameloblastomas
Other lesions with radiopaque foci,
including adenomatoid odontogenic tumor,
ameloblastic fibro37


Treatment
The treatment of the CEOT is more
conservative than
the ameloblastoma , with local resection

38

MIXED TUMORS
(OF ODONTOGENIC
EPITHELIUM
AND
ODONTOGENIC
ECTOMESENCHYME)

39

ODONTOMA
Most common type of odontogenic tumor
Definition:
a tumor that is radiographically and histologically
characterized by the production of mature
enamel, dentin, cementum,and pulp tissue.
Clinical features:
Age- 10 to 20yrs
Site - Maxilla > mandible
Slow growing , hard , painless mass

40

GARDNERS Syndrome is associated with it

(a). Multiple odontomas
(b). Multiple osteomas
(c ). Intestinal polyps
(d). Epidermoid cyst
(e). Dermoid tumor(fibrous)
2 Types
(1). Complex
(2). Compound

41

Features

Compound

complex

location

anterior maxilla in
association with the
crown of an
unerupted canine.

mandibular first
and second molar
area.

Internal

structure number of toothlike

structures or
denticles that look
like deformed teeth

irregular mass of
calcified tissue

Frequency

More

Less common

Sex predilection

M=F

More in female

42

Radiographic Features
Location.
compound odontomas (62%) occur in the
anterior maxilla in association with the crown
of an unerupted canine.
70%of complex odontomas are found in the
mandibular first and second molar area.

Periphery. The borders of odontomas

are well defined and may be smooth
or irregular. These lesions have a cortical
border and immediately inside and adjacent
to the cortical border is a soft tissue
capsule.
43

Internal structure. The contents of

these lesions are largely radiopaque.
Compound odontomas have a number of
toothlike structures or denticles that look
like deformed teeth
Complex odontomas contain an irregular
mass of calcified tissue
Effects on surrounding structures.
Odontomas ,can interfere with the normal
eruption of teeth. Most odontomas (70%)
are associated with abnormalities such as
impaction, malpositioning, diastema,
aplasia, malformation, and devitalization
of adjacent teeth.
Large complex odontomas may cause
44
expansion of the

Complex odontoma

45

Compound odontoma

46

treatment
Complex and compound odontomas are
usually
Removed by simple excision. They do not
recur and are
not locally invasive

47

AMELOBLASTIC FIBROMA
Synonyms
Soft odontoma, soft mixed odontoma, mixed
odonto genic tumor,
fibroadamantoblastoma,and granular cell
Ameloblasticfibroma
defination
Ameloblastic fibromas are benign, mixed
odontogenic
tumors. They are characterized by neoplastic
proliferation of maturing and early functional
ameloblasts,as
well as the primitive mesenchymal
48
components of the

Clinical features:
Age- 5 to 20yrs
Site - Maxilla > mandible
Sex- no sex predilection
They usually produce a painless,slow-growing
expansion, and displacement of the involved
teeth
Radiographic
Features
Location. in the premolar-molar area of the
mandible
Periphery. The borders of an ameloblasticfibroma are
well defined and often corticated in a
49

50

51

52

Internal structure. An ameloblastic

fibroma is more commonly unilocular
(totally radiolucent)
Effects on surrounding structures. If the
lesion is large,
there may be expansion with an intact
cortical plate.
The associated tooth or teeth may be
inhibited from
normal eruption or may be displaced in
an apical
direction.

53

Differential Diagnosis
Ameloblastomahowever ,the ameloblastic
fibroma occurs at an earlier age and the
septa in an ameloblastoma are more
defined and coarse. In fact the septa in
ameloblastic fibroma are infrequent and
often very fine.
Giant cell granulomas --may appear
multilocular, but these tumors usually have
an epicenter anterior to the first molar
and the septa are characteristically
granular and ill defined.
Odontogenic myxomas-- can appear
multilocular but usually a few sharp straight septa can
be identified, which are not characteristic of
54


Treatment. Ameloblastic fibromas are
benign, and the
rate of recurrence is low. A conservative
surgical
approach,including enucleation and
mechanical curet
tage of the surrounding bone,

55

AMELOBLASTIC FIBRO-ODONTOMA
Definition
An ameloblastic fibro-odontoma is a mixed
tumor with
all the elements of an ameloblastic fibroma
but with
Scattered collections of enamel and
dentine
Clinical Features.The clinical features
are similar
to odontomas, often associated with a
missing tooth
or tooth that has failed to erupt.
This tumor appears during the same age
as odontomas and ameloblastic fibromas 56

Radiographic Features
Location-posterior aspect of the mandible.
The epicenter of the lesion is usually
occlusal to a developing tooth or toward
the alveolar crest.
Periphery. This tumor is usually well defined
and sometimes corticated.
Internal structure. The internal
structure is mixed, with the majority of the
lesion being radiolucent. Small lesions may
appear as enlarged follicles with only one or
two small,discrete radiopacities. Larger
lesions may have a more extensive calcified
internal structure
57

Differential Diagnosis
Differentiation from a developing odontoma
may be difficult, but generally these tumors
have a greater soft tissue component
(radiolucent) than an odontoma
A complex odontoma, which shares a
common location, usually has one mass of
disorganized
tissue in the center, whereas the
ameloblastic fibroodontoma will usually have multiple
scattered mature
small pieces of dental hard tissue
Treatment
Usually conservative enucleation is used 58

59

ADENOMATOID ODONTOGENIC TUMOR

Synonyms
,
Adenoameloblastoma and ameloblastic
adenomatoid
tumor
Definition
Adenomatoid odontogenic tumors are
uncommon,
Nonaggressive tumors of odontogenic epithelium
Clinical features
Age - younger patient (10 to 19yrs).
Sex - female
Site - anterior portion of the jaw
maxilla > mandible
Asymptomatic, painless, slow growing.

60

Both central and peripheral tumors occur.

The central tumors are divided into the
follicular type (those associated with the
crown of an embedded tooth) and the extrafollicular type (those with no
embedded tooth).
Radiographic Features
Location. At least 75% occur in the

maxilla
The incisor canine-premolar region,
especially the canine region
Periphery. The usual radiographic
appearance is a welldefined corticated or sclerotic border.
Internal structure. Radiographically,

61

Effects on surrounding structures.

As the tumor enlarges, adjacent teeth are
displaced. Root resorption is rare. This
lesion also may inhibit eruption of an
involved tooth. Although some expansion of
the jaw may occur, the outer cortex is
maintained.
Differential Diagnosis
If the attachment of the radiolucent lesion
is more apical than the cementoenamel
junction, a follicular cyst can be
discounted.
The ameloblastic fibro-odontoma and the
calcifying epithelial odontogenic tumor
occur more commonly in the posterior
62
mandible.

Pebble like calcification

63

Treatment
Conservative surgical excision is adequate
because the
tumor is not locally invasive,is well
encapsulated,and
is separated easily from the bone

64

MESENCHYMAL TUMORS

(ODONTOGENIC

ECTOMESENCHYME)

65

ODONTOGENIC MYXOMA
Synonyms
Myxoma, myxofibroma, and fibromyxoma
Definition
Odontogenic myxomas are uncommon,
accounting
for only 3% to 6% of odontogenic tumors.
They are benign, intraosseous neoplasms
that arise from odontogenic ectomesenchyme and resemble the
mesenchymal portion of the dental papilla

66

Clinical features
Age - 10 to 30yrs.
Sex female
The tumor grows slowly and may or may
not cause pain.
Eventually it causes swelling and May
grow quite large if left untreated

67

Radiographic Features
Location- mandible , the premolar and molar
areas
Periphery--The lesion usually is well
defined, and it may
have a corticated margin but most often
is poorly
defined, especially in the maxilla
Internal structure. majority have a mixed
radiolucent-radiopaque internal pattern.
Residual bone trapped within the tumor
will remodel
into curved and straight, course or fine
septa.The pres68
ence of these septa gives the tumor a

69

70

The majority of the septa are curved and

course, but the finding of one or two of
these straight septa will help in the
identification of this tumor
Effects on surrounding structures. When
growing in a tooth-bearing area, it
displaces and loosens teeth,
but rarely causes resorption of teeth. The
lesional so frequently scallops between
the roots. of adjacent teeth similar to a
simple bone cyst. This tumor has a
tendency to grow along the involved bone
without the same amount of expansion
seen with other benign tumors.
71

Differential Diagnosis
Include ameloblastomas, central giant cell
granulomas, and central hemangiomas.
The finding of characteristic thin, straight
septa with less-than-expected bone
expansion is very useful in the differential.
Careful inspection of this area of expansion
will reveal a thin but intact outer cortex that
would not be seen in osteogenic sarcoma
Treatment
by resection with a generous amount of
surrounding bone to ensure removal of
myxomatous tumor that infiltrates the
adjacent marrow spaces.
72

BENIGN CEMENTOBLASTOMA
Synonyms
Cementoblastoma and true cementoma
Definition
Benign cementoblastomas are slow-growing ,
mesenchymal neoplasms composed
principally of cementum
Clinical
Features

Age - 12 to 65
Sex - females
The tumor usually is a solitary lesion that
is slow-growing but that may eventually
displace teeth.
The involved tooth is vital and often
painful.
The pain seems to
vary from patient to patient and can be

73

Radiographic Features
Location. mandible (78%) -premolar or first
molar(90%).
Periphery. The lesion is a well-defined
radiopacity with
a cortical border and then a well-defined
radiolucent
band just inside the cortical border
Internal structure. mixed radiolucentradiopaque lesions in which the majority
of the internal structure is radiopaque.
wheel spoke pattern
The density of the cemental mass usually
obscures the outline of the enveloped
root.
This central radiopaque mass as mentioned

74

75

Effects on surrounding structures.

If large enough, this tumor can cause
expansion of the mandible but with an
intact outer cortex.
Differential Diagnosis
the radiolucent band around the benign
cementoblastoma is usually better defined
and more uniform than with cemental
dysplasia.
Also, in the first molar region the
cementoblastoma has a more rounded
shape than cemental dysplasia.
Treatment
Benign cementoblastomas are apparently
self-limiting
and rarely recur after enucleation. Simple

76

CENTRAL ODONTOGENIC FIBROMA

Synonyms
Simple odontogenic fibroma and odontogenic
fibroma
(World Health Organization [WHO] type)
Definition
Central odontogenic fibromas are rare
neoplasms that
Sometimes are divided into two types
according to histologic appearance:
simple type contains mature fibrous tissue
with sparsely scattered odontogenic
epithelial rests;
77
WHO type, which is more cellular,

Clinical

Features

Age - 11 and 39 years

Sex females
patients may be asymptomatic or may have
swelling and mobility of the teeth.
Radiographic Features
Location. mandible, molar-premolar region.
They are also prevalent in the maxilla anterior
to the first molar.
Periphery. The periphery usually is well
defined,
Internal structure. Smaller lesions usually are
unilocular, and larger lesions have a multilocular
pattern. The
internal septa may be fine and straight, as in 78

Effects on surrounding structures. A

central odontogenic fibroma may cause
expansion with maintenance of a thin
cortical boundary or on occasion can grow
along the bone with minimum expansion
similar to an odontogenic myxoma.
Tooth displacement is common, and root
resorption has been reported.
Differential Diagnosis
Desmoplastic fibromas are more aggressive
and tend to break through the peripheral
cortex and invade surrounding soft tissue

79

NON
ODONTOGENIC
TUMORS
80

BENIGN TUMORS OF NEURAL ORIGIN

NEURILEMOMA
Synonym
Schwannoma
Definition
A central neurilemoma is a tumor of neuroectodermal
origin, arising from the Schwann cells that
make up the
inner layer covering the peripheral nerves.
Clinical
Features

Age second and third decades

Sex equal frequency
81

The usual complaint is a swelling.

Pain, when present, usually develops at the
Site of the tumor; if paresthesia occurs,it is
felt anterior
to the tumor.
Radiographic
Features
Location. mandible, most often located
within an expanded inferior alveolar nerve
canal posterior to the mental foramen
Periphery. In keeping with its slow growth
rate, the
margins of this tumor are well defined and
usually corticated as it expands the cortical walls of
82
the inferior

83

Internal structure. The internal structure

is uniformly
radiolucent. When lesions have a scalloping
outline,
this may give a false impression of a
multilocular
pattern.
Effects on surrounding structures. If the
tumor reaches either the mandibular
foramen or mental foramen, it can cause
enlargement of the foramen. Expansion of
the inferior alveolar canal is slow and thus
the outer cortex of the 'canal is maintained
and the expansion of the canal is usually
localized with a definite epicenter unless the
84
lesion is large.

Treatment
Excision is usually
choice

the

treatment

of

85

NEUROFIBROMA
Synonym
Neurinoma
Definition
Neurofibromas are moderately firm,
benign, wellcircumscribed tumors caused by
proliferation of
Schwann cells in a disorderly pattern that
includes
portions of nerve fibers, such as peripheral
nerves,
Axons ,and connective tissue of the sheath of
Schwann.
As neurofibromas grow, they incorporate 86

Clinical Features
The central lesion of a neurofibroma maybe
the same
as the multiple lesions that develop in von
Recklinghausen's disease.
Neurofibromas can occur at any age but
usually are found in young patients.
Neurofibromas associated with the
mandibular nerve may produce pain or
paresthesia.
Neurofibromas also may expand and
perforate the cortex; causing swelling that is
hard or firm to palpation.
87

Radiographic Features
Location. in the mandibular canal, in the
cancellous bone, and below the periosteum.
Periphery.. the margins of the radiolucency
in neurofibromas usually are sharply
defined and may be corticated.
However, despite the benign nature and
slow growth of the neurofibroma, some of
these lesions have indistinct margins.
Internal structure. The tumors usually
appear unilocular but on occasion may have a
multilocular appearance.
Effects on surrounding structures. A
neurofibroma of the inferior dental nerve
88

89

Differential Diagnosis
Differentiation from other types of neural
lesions may
not be possible.
This tumor can be differentiated from
Vascular lesions because the expansion of
the canal is
in a fusiform shape,'whereas vascular
lesions enlarge
the whole canal and alter its path.
Treatment
Solitary central lesions that have been
excised seldom
recur. However, it is wise to re-examine the
90
area peri-

NEUROFIBROMATOSIS
Synonym
von Reckling-hausen'sdisease
Definition
Neurofibromatosis
is a syndrome
consisting of cafe au-lait spots on the
skin, multiple peripheral nerve tumors,
and a variety of other dysplastic
abnormalities of the skin, nervous
system, bones, endocrine
organs, and
blood vessels
The two major classifications are
NF-1, a generalized form,
NF-2, a central form.
Oral lesion may occur as part of NF-1
or may be solitary and are called

91

Clinical Features
Neurofibromatosis is one of the most
common genetic
Diseases.
The peripheral nerve tumors are of two
types, schwannomas and neurofibromas.
Most manifestations are appear gradually
during childhood & adult life. Cafe-au-Iait
spots become larger and more numerous with age; most patients eventually
have more than six spots larger than
1.5 cm in diameter.

92

Radiographic features
The radiographic changes in the jaws with
neurofibroatosis
can be characteristic.
These changes include
1.enlargement
of the coronoid notch in
either or both the horizontal and
vertical dimensions
2. an obtuse angle between
the body
and the ramus
3. deformity
of the condylar head
4.lengthening of the condylar neck
5. lateral bowing
and thinning of the
ramus
6.enlargement
of the mandibular canal &
mental and mandibular foramina and an
93

94

Treatment
Most patients live a normal life with Jew or
no symp toms. Small cutaneous and
subcutaneous neurofibromas can be removed if they are painful,
but large
plexiform neurofibromas should be left
alone.
Malignant conversion of these lesions has
occurred in rare cases.

95

MESODERMAL TUMORS

OSTEOMA
Definition
Osteomas can form from membranous bones of
the
Skull and face.
The cause of the slowly growing osteoma is
obscure, but the tumor may arise from
cartilage or embryonal periosteum
It is not clearwhether osteomas are benign
neoplasms or hamartomas
Structurally, osteomas can be divided into
three- types: composed of compact bone (ivory),
composed of cancellous bone,
96
composed of a combination of compact and

97

98

Clinical

Features

Age above 40 years

Sex Cortical type = men
cancellous type= women
Radiographic
Features
Location. mandible -posterior aspect -lingual
side of the ramus or on the inferior
mandibular border below the molars
Internal structure. Osteomas composed
solely of
compact bone are uniformly radiopaque; those
containing cancellous bone show evidence of
internal trabecular structure.
Effects on surrounding structures. Large
lesions can dis99

Treatment
Unless the osteoma interferes with normal
function or
presents a cosmetic problem, this lesion
may not
require treatment. In such casesthe osteoma
should be
kept under observation.
Resection of osteoma sis possible and maybe
difficult if the osteoma is of the cortical
(ivory) type.

100

CENTRAL HEMANGIOMA
Definition
A hemangioma is a proliferation of blood vessels
creating a mass that resembles a neoplasm ,
although in many cases it is actually a
hamartoma
Clinical
Features

Age first decade

Sex female
Enlargement is slow , producing a non-tender
expansion of the jaw that occurs over several
months or years.
The swelling may or may not be painful, is
not tender, and usually is bony hard.
Pain, if present, usually of throbbing type
101

Some tumors may be compressible or

pulsate, and a bruit may be detected on
auscultation
Anesthesia of the skin supplied by the
mental nerve
May occur.
The lesion may cause loosening and
migration of teeth in the affected area.
Bleeding may occur from the gingiva around
the neck of the affected teeth.
These teeth may demonstrate rebound
mobility; that
is,when depressed into their sockets,they
rebound to
their original position within several
minutes because
102

Hemangioma are associated with following

Syndromefeatures
Syndrome
Rendu-oslerwebersyndrome

multiple telangi-ectasias ,occasional GI

tract & CNS involvement

Sturge-weberdimtri
syndrome

Port-wine stain, leptomeningeal angiomas

Kasabach
merritt
syndrome

Thrombocytopenic purpura associated with

hemangiomas , consumptive coagulpathy ,
microangiopathic hemolysis , intralesional
fibrinolysis

Maffucci
syndrome

Hemangiomas of mucous membrane ,

dyschondroplasia

Von hippellindau
syndrome

Hemangiomas of cerebellum , or retina,

cyst of viscera

Klippel

Port-wine stain & angiomas of extremities

103

Radiographic Features
Locotion. Mandible , posterior body and
ramus and within the inferior alveolar canal.
Periphery. In some instances the
periphery is well
defined and corticated, and in other cases it
maybe ill
defined and even simulate the appearance of
a malignant tumor
The formation of linear spicules of bone
emanating from the surface of the bone in a
sunray-like
104
appearance can occur when the

105

Internal structure. When there is

residual bone
trapped around the blood vessels ,the result
maybe a
multilocular appearance.
Small radiolucent locules may resemble
enlarged marrow spaces surrounded by
coarse, dense ,and well-defined trabeculae .
These internal trabeculae may produce a
honeycomb pattern composed of small
circular radiolucent spaces
that represent blood vessels oriented in the
same direction of the x-ray beam.
106

When the inferior alveolar canal

is involved, the whole canal is increased in
width and
often the normal path of the canal is
altered into a
serpiginous shape
Some lesions may be totally radiolucent.
When the hemangioma involves soft tissue
the formation of phleboliths (small areas of
calcification or concretions found in a
vein with slow blood
flow) may occur within surrounding soft
tissues
They develop from thrombi that become
organized and mineralized and consist of
107

108

Effects on surrounding structures. The

roots of teeth in the region of the vascular
lesion often are resorbed or displaced.
When the lesion involves the inferior
alveolar nerve canal, the canal can be
enlarged along its entire length and its
shape may be changed to a serpiginous
path. The mandibular and mental foramen
may be enlarged. Hemangiomas can
influence the growth of bone and teeth.
The involved bone may be enlarged and
have coarse, internal trabeculae.
Also, developing teeth may be larger and
erupt earlier when in an intimate
relationship with a hemangioma
109

110

Differential Diagnosis
Hemangiomas should be considered in the
differential
Diagnosis of multilocular lesions involving
the body of
the ramus and body of the mandible.
Demonstration
of involvement of the inferior alveolar
canal is an
important indicator of a vascular lesion.
Treatment should be treated without delay,
because trauma that disrupts the
integrity of the
Affected jaw may result in lethal
exsanguination .Specifically, embolization (introduction of inert 111

ARTERIOVENOUS FISTULA
Synonyms
A-V defect, A-V shunt, A-V aneurysm,
and A-V
malformation
Definition
An arteriovenous (A-V) fistula, an uncommon
lesion , is
a direct communication between an artery
and a vein
that bypasses the intervening capillary
bed.
It usually results from trauma .
The head and neck are the most
112
common sites.

Clinical Features
vary considerably, depending on the extent
of bone or soft tissue involvement.
The lesion may expand bone, and a mass
may be present in the Extraosseous soft
tissue.
The soft tissue swelling may have a purple
discoloration. Palpation or auscultation of
the swelling may reveal a pulse.
On the other hand,
neither the bone nor the soft tissue maybe
expanded,
and no pulse maybe clinically apparent.
Aspiration produces blood.
Recognition of the hemorrhagic nature of
these lesions is of utmost importance,

113

Radiographic Features
Location.- ramus and retromolar area of the
mandible and involve the mandibular canal.
Periphery.The margins usually are well
defined and
corticated.
Internal structure. A tortuous path of an
enlarged vessel in bone may give a
multilocular appearance.
Otherwise the lesion is radiolucent.
Effects on surrounding structures. Both
central lesions
and those in adjacent soft tissue can erode bone,
resulting in well-defined (cystlike) lesions in the
bone.
114

115

Treatment
An A-V aneurysmis treated surgically.

116

REFERENCES
1.SHAFERS

ORAL PATHOLOGY
2.NEVILLE ORAL PATHOLOGY
3. ORAL radiology white & pharoah
4. burkets ORAL medicine

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