odontgnic myxoma

is one type of odentogenic tumor , slow growing , and with a potential for aggressive
behavior .

what characterized it that there is no lining will show in the radiograph so it looks more
nastier , myxoma is a benign lesion , but what characterize it that it dont have will
delineated borders , so when doing surgery we have to be aggressive as we treated
ameloblastoma i.e. resection . because it can infiltrate where you can't see neither
radiographicaly nor clinically
occur commonly in the posterior mandible , rarely on posterior maxilla

May cause displacement or root resorption of teeth

one of the main characteristic feature of cancer that it always penetrate the
basement membrane , so when you see a lesion with no boundaries you will think
it's sinister and nasty

if you werent aggressive and did just curettage it might recurrence in a matter of fact
its consider as a persistent lesion because the lesion was not completely removed

 radiographic feature
- lesion of mixed density,
- multilocular or unilocular
- step leader pattern

treatment :- resection with 1 cm safety margin

calcified odontogenic tumor " Pindborg tumor"

it's a very rare tumor very unlikely to phase in your entire life , only 200 cases were
reported worldwide .

mixed radioobaque radio lucent lesion associated with an impacted tooth

ct scan coronal cut showing mid facial bone , obliterated left sinus with mixed lesion

treatment it resection with 1 cm margin

adenomatoid odontogenic tumor

it a hemartoma , it was previously called adeno amelo blastoma , in the anterior maxilla
asociated with a tooth " canine "

it resemble amelobalstoma histologicaly but it acts differently , the lesion will grow till
reach to a certain limit then stop growing so they classified it as hemartoma not a
tumor

treatment :- enculation with removing the associated tooth

fibro osseous disease

in the previous lectures we talked about a lot of lesions whats combine them that the
cell which form those lesions where odotognic in origin . Today we will be talking about
lesions found in the maxilla facial area but the cell which respond for there formation is
apparently not from an odentogenic source .

so if it's not from odentogenic source you can find it anywhere in the body , so its non
odontogenic can tumor that might come in the maxillofacial area

in this disease there will be some sort of abnormity resulting in replacement of the
ossteoblast with fibroblast ,That will start laying fibrous tissue . ossified cementum like
lesions can be found , and the lesion might ossifed completelly into complete hard
tissue not necessarily bone

there is three sub group for this diasese

fibro-osseous
disaeas

fibrous
dysplasia

cementosseous
dysplasia

Fibro-osseous
neoplasm

 fibrous dysplasia

Theres big controversy about it , some consider it as a tumor that should be excised
,while others consider it as hemartoma .
most likely it's hemartoatous
generally asymptomatic
maxilla appears to be affected more than mandible
and female seems to be affected more than males
period of activity and qusencse , it resemble cherabsum in this action

there is two type of it :-

- polystotic
-mono stotic

in case of maxillofacial area it's consider as monostotic if happens in mandible alone ,

or poly stotic if it happens in maxillofacial bone and anywhere else .

Albright syndrome characterized by

polyostatic fibrous dysplasia
if it was polystotic and associated with other findings
hyper pigmentations(caf-au-lait spots)
it is consider as a syndrome which is called
precocious puberty in female
Albright syndrome .
endocrine problem , and in male there
will be thyroid problem

In craniofacial fibrous dysplasia we are concerned about the vital structure in that area
i.e. optic nerve mainly ,in this case we must open surgically and do decompression
around the optic nerve

it has ground glass appearance radiographically

there is a type of imaging called bone scan to show the

activity of the bone over the body , the inject the patient
with a tracer in then take radionucluar image to see
where it's more absorbed the tracer name is
Technetium-99m .
in the jaw area of this patient theres three dark spots
meaning that
those are highly active .

theres two dark spots in the patient abdominal area

representing the
kidneys , because the kidney is a highly active organ
same goes for
brain and heart some in nuclear imaging those are
showed dark

 Treatment of this lesion whith such a behavior is to intervene in the quiescent phase ,
because this kind of lesion is highly vascularised so if we decided to do a surgery the
patient might lose high amount of blood resulting in his death !!
the treatment of choice is shaping or shaping or sculpting, same as cherabsim but if it caused
compression of the optic nerve we must open and decompress the nerve .

some says that the lesion might have sarcmatios changes we should remove it by excision
and some claims that this lesion from the beginning is a low grade ostosarcoma and should
be removed completely .

cemento osseuos dysplsia

has four types

:-

Periapical :- the lesion is most commonly found in the mandible anterior

mainly , like small target lesion around the apices of teeth , and teeth will
be vital so the lesion is not inflammatory in origin.
Florid :- if the patient was followed up then this lesion i.e. periapical may
ossified , or coherence with the lesion next door to become florid cemento
osseous dysplasia "

focal cemento osseos dysplsia:-

commonly founded in the

edantouls area e.g. when you extract a lower right six and you founded a
radiolucency and took a biopsy and turn out to be focla cemento osseos
dysplsia not a radicular cyst acoording to histology

Familial Gigantiform Cementoma : it's (familial) inherited ,autosomal

dominant , affect more than one quadrant of teeth , anterior mandible.

the etiology is unknown some theory says it's because of trauma happend to the
crrosponded teeth lead to the formation of the lesion around the apices of those teeth

 females
afro - american has the highest incident

treatment :- if it was asymptomatic then no treatment we just follow up

if the lesion was infected , we should give antibiotics and deal with it .

Florid cemento osseous dysplasia

Fibro-osseous neoplasm
ossifying fibroma :

the well known example of fibrosseous neoplasm , its tumor with well
demarcated bordered ,mixed radiolucency found mainly below the root of lower
first molar

Females > Male

It might be Peripheral(Outside bone) or Central (inside bone)

treatment is surgical to enculate the lesion

juvenile aggressive ossifying fibroma :

it happens in an earlier age below 15 years old

it's more aggressive it can easily expand and need to be dealt with aggressively
mainly happened in the rest of the body

osteoblastoma and osteoid lesion

osteoblastoma tumor happened in the rest of the body it maight happend in the
maxillofacial area but it's very unlikely

what is very piculiar about it is pain

if the lesion was > 2 cm it is called osteoblastoma , < 2cm it is called osteiod osteoma
they share the same histology
DD :- ossifying fibroma , fibrous dyspsia and osteo sarcoma
Tx :- conservative surgical excision

chondroma ,
benign tumor of cartilage it need to be dealt with very consciously
Painless slowly growing swelling which may result in mucosal ulceration
we need to deal with it as low grade chondro sarcoma like fibrous dysplsia
the patient should be closely foolwed up
treatment is localised surgical excision

osteoma
is a benign tumor of bone
asymptomatic radio opacity
periferal osteama or endoosteol osteoma

What's important to us in Osteoma is what is called Gardner's Syndrome,where there will be

multiple osteomas, Intestinal polyps, fibromas of skin,epidermal cyst ,impacted teeth, and
odontomas.
so we send him to a GI specialst to do tantheeer*********** to find multiple intestinal
polyps ,the findings in the maxillofacial won't harm him but what is consider fetal is the
intestinal polyps

synovial chondramatosis
happens in the capsule around the TMJ

small particles inside synovial membrane

 pain and swelling , and sounds

lose of occlusion& posterior open bite
treatment open the capsule and clean it

Osteochndroma

benign lesion conting bone and cartilage

on MRI it appears as extraneous appendages toward the TMJ.
It's usually more radiopaque than the surrounding mandible
very unlikely to see

general role in medicine we treat the biology not the histology ; so if a patient came to you
and he have growing a lesion with the histological report said nothing to worry you should
trust what you see and interfere.the lesion happens in children and start to eat the bone ,
when you take a biopsy and send to histopathology they will come back with very beigh
tumor they will say leave this tumor it's very benign and will do nothing ,so if you treat the
lesion as the histopatholgiest has recommended the patient will lose the mandible and the
maxilla , but if you treat the biology you need to be very aggressive to remove that lesion
before it's eat the whole maxilomandibuilar area.

vascular malformation

if the patient came to the clinic and we want to do an excisional biopsy the first thing to do is
aspiration to rule out any vascular mal formation .
vascular malformation is very unlikely to happens ,but if it happened once the patient might
lose his life

it's a developmental lesion it will happened while the patient is born and it will get
bigger and bigger as the patient is growing
it may affect soft tissue and bone
Central vascular malformation :- it happenes inside the bone
very rare but it's well documented intity
It's divided into :

High flow Vascular malformation

Low flow Vascular malformation

the High flow Vascular malformation is more dangerous

 Slowly growing expensile lesion of the jaw asymptomatic and if it's high it may be
assciated with brueeeeee "the sound of blood pumping " which mean that theres is
puls
Appears as irregular poor defined soap-bubble type lesion
Cause resorption of root of the teeth why because it's high flow , and it's illdefined
because it's inviding the area with presure

angiogram :- is an imiging modality for the blood vessele , the intervenisional radilogist will
inject all the blood vesele that might givesss ** that area ,in the maxillofacial aare the dr will
inject the facial blood vessele
it will give us that theres a large vessele due to empryolgical problem that supply the
radio lucent lesion
the treatment in high flow is embolization is to occlude the vessele that supplys the
area by special material and it's done by the intervenional radiolgist and it's very
dangours procedure
so the lesion that was supplied by the vessele be blood free , then the maxillofacialsurgen will
intervent and enculate and clean the area now why is this because although we occlude the
vessle and the area now is dry but the body has the ability to form colateral vesssels .
so one of the treament option is just to occlude the area while the better option is enculate
the lession after the embolization and to put a bone graft so that the space will be close so if
colateral vessele occured it will not have a room to cause vascular mal formation

paget diasese
ostitist for man it resamble fibrous dysplasia because it has stages
one of the clinical scenarios that the patient came to your clinic complying that his hat
wont fit his head anymore or as to dentist his denture, headache and symptoms due to
vascular and nerves compressions
panoramic radiograph you will find the cotton wool appearance

resorption of bone then period of high blood supply then the sclorsing phase
there will be vascular period

around the teeth there wil be hyper cementosis so when extracting the tooth it should
be made surgcally

how to diagnos the patient

he will have high serum alkaline phsphotase because of the bone resorption

 treatment of paget diasese

treatment to prevent bone resorption , the heromne that is in responabile of replacment of the
lost bone is calciotonine for inhbtion of bone resorption that occur in the first stage

or bisphisphonate to inhibt bone resorption

those patient will die manily because of left side heart faluire because the bone
resorption is taking place all over the body and it's being replaced by blood, so the
heart now is obligated to pump heart to the bone all over the body ending by having
heart failure
and the lesion might transform to cancer osteo sarcoma

one of the difficultiys that during the second stage there will be high blood supply in the
body,so if we tried to do surgery in this area we may face tremendous bleeding and the
patient may die !!