M

O
.C
A
M
A
N
Y
D
U
T
S
TUMOR LIKE SWELLINGS OF JAWS

M cause.
• In olden time, tumor meant Lump or swelling due to any
O

• In contemporary science, tumor means neoplasm

M
A
.C

that has formed lump/swelling in

A
N
Y
D

any part of body. S

T
U
NEOPLASM….?

Abnormal Growth of
M
O
.C
A
M

Tissues.
A
N
Y
D
U
T
S
Cyst Tumor/Neoplasm

• Odontogenic & Non Odontogenic • Odontogenic & Non Odontogenic

M
• Metastatic
O
.C
A
Swellings
Mof Jaws
A
N
Y
D
Giant Cell Lesion U Fibro osseous Lesion
T
S
Studynama’s BDS Community is one of India’s Largest Community of Dental Students. About
19,232 Indian Dental Course students are members of this community and share FREE study
material, cases, projects, exam papers etc. to enable each other to do well in their semester exams.

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 Orthodontic Fixed Appliances - BDS Lecture Notes PDF Download
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 COMPLEX NON-SKELETAL PROBLEMS IN PREADOLESCENT CHILDREN - BDS Lecture Notes
 Anatomy of Scalp - BDS Lecture Notes PDF Download
 Cerebrospinal Fluid (CSF) - BDS Lecture Notes PDF Download
 Cementum - BDS Lecture Notes PDF Download
 Recent Advances in Instrumentation Techniques - BDS Lecture Notes PDF Download
 Ameloblastoma - BDS Lecture Notes PDF Download
 Prevention of Odontogenic Infection - Principles of Management - BDS Lecture Notes
 Therapeutic Dentistry Histology of Teeth Dental Charting - BDS Lecture Notes PDF Download
 Maxillofacial Trauma and Management - BDS Lecture Notes PDF
 Technical Endodontics - BDS Lecture Notes PDF Download
And 698 more free downloads for Dental Students.
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 BDS University Previous Year Exam Question Papers & Solutions FREE PDF Download
INTRODUCTION…
• As the name indicates, odontogenic tumors
M
are derived from odontogenic
. C
O tissues.
–Odontogenic tissues areMthose
A
which take part in
tooth development. NA
Y
D
U
T
• Odontogenic Tumors
S
are most common types
of neoplasm of jaws.
 Ameloblastoma

CLASSIFICATION Squamous Odontogenic

Tumor

Calcifying epithelial
Epithelium
odontogenic tumor

Adenomatoid
odontogenic tumor

M
O Calcifying cystic tumor

.C Odontogenic fibroma
Benign A
M
Odontogenic Tumors

Odontogenic myxoma
Mesenchymal A
N
Y cementoblastoma

D
U
T Mixed of Both Ameloblastic Fibroma
S
Odontogenic carcinoma

Epithelium
Clear cell odontogenic
Malignant tumor

Mesenchymal Odontogenic sarcoma

INTRODUCTION

M
• Benign but locally invasive • It is rare & accounts for
1% of all
O
neoplasm derived from one of the .tumors
C of oral cavity.
following odontogenic epithelium; A

– Surface epithelium A
M • BUT, Ameloblastoma
– Reduced enamel
D
Y
N
is common in our
– Remnants of dental lamina
T
– Rest cells of Malessez
S
U
Society.
– Lining of dentigerous cyst (PAKISTAN)
T Y P E S OF AMELOBLASTOMA
Multicystic Ameloblastoma
Solid Ameloblastoma
Conventional Ameloblastoma Unicystic
M
Follicular Ameloblastoma
O
True Ameloblastoma
.C
A
M
A Peripheral / Extra
Central / Intra Osseous
Y
N
D Osseous
U
T
S
Ameloblastoma On the basis of Clinical & Radiological
Features.
G E N E R A L F E AT U R E S
OF AMELOBLASTOMA
M
• Most common neoplasm of • Locally
O invasive but does
odontogenic origin. .not
C metastasize
A
M – That’s why called benign.
A
• Usually in 3rd – 5th decade.YN
– Rare in children & elderly
D • About 80% of
U
– Mostly in posteriorSregion
T of Ameloblastoma occur in
mandible. Mandible.

• No specific gender
prediction.
Studynama’s BDS Community is one of India’s Largest Community of Dental Students. About
19,232 Indian Dental Course students are members of this community and share FREE study
material, cases, projects, exam papers etc. to enable each other to do well in their semester exams.

Links to Popular Study Material for BDS (Dental) students:

 Orthodontic Fixed Appliances - BDS Lecture Notes PDF Download
 Amalgam Restoration - BDS Lecture Notes PDF Download
 COMPLEX NON-SKELETAL PROBLEMS IN PREADOLESCENT CHILDREN - BDS Lecture Notes
 Anatomy of Scalp - BDS Lecture Notes PDF Download
 Cerebrospinal Fluid (CSF) - BDS Lecture Notes PDF Download
 Cementum - BDS Lecture Notes PDF Download
 Recent Advances in Instrumentation Techniques - BDS Lecture Notes PDF Download
 Ameloblastoma - BDS Lecture Notes PDF Download
 Prevention of Odontogenic Infection - Principles of Management - BDS Lecture Notes
 Therapeutic Dentistry Histology of Teeth Dental Charting - BDS Lecture Notes PDF Download
 Maxillofacial Trauma and Management - BDS Lecture Notes PDF
 Technical Endodontics - BDS Lecture Notes PDF Download
And 698 more free downloads for Dental Students.
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C L I N I C A L P R E S E N TAT I O N
OF AMELOBLASTOMA
• Characteristics of Jaw Expansion by
• Usually asymptomatic & slow growing.Ameloblastoma
M
O
– Bony.Chard, non tender, ovoid
A
• Results in facial deformity & jaw
Mor fusiform outline.
expansion. A
N – in advanced cases egg shell
Y
• In maxilla even large lesion of D crackling due to thinning of
U
Ameloblastoma produce very
S
Tlittle bone.
expansion because lesion can extend
into sinuses & beyond.
A CLINICAL
PHOTOGRAPH OF
GRANULAR CELL
AMELOBLASTOMA IN
THE ORAL CAVITY
M
O
.C
SHOWS AN A
ENORMOUS MASS ONAM
THE RIGHT MANDIBLE.
Y
N
D
U
T
S

http://www.nature.com/ijos/journal/v4/n1/full/ijos20129a.html
C L I N I C A L P R E S E N TAT I O N
(LATE FEATURES) OF AMELOBLASTOMA
M
• Pain .C
O

Extension of
A
M
A
•
• Paresthesia Y
N
neoplasm into soft
D
T
U
tissue.
S

• Perforation of bone
 RADIOGRAPHIC
F E A T U R E S OF
AMELOBLASTOMA

Typically form
O Rounded & Cyst like
M

.C
A Radiolucency with
A
M moderately well
Y
N defined margins and
U
D
appear as multilocular
T
S – SOAP BUBBLE or
HONEY COMB
APPEARANCE.
Studynama’s BDS Community is one of India’s Largest Community of Dental Students. About
19,232 Indian Dental Course students are members of this community and share FREE study
material, cases, projects, exam papers etc. to enable each other to do well in their semester exams.

Links to Popular Study Material for BDS (Dental) students:

 Orthodontic Fixed Appliances - BDS Lecture Notes PDF Download
 Amalgam Restoration - BDS Lecture Notes PDF Download
 COMPLEX NON-SKELETAL PROBLEMS IN PREADOLESCENT CHILDREN - BDS Lecture Notes
 Anatomy of Scalp - BDS Lecture Notes PDF Download
 Cerebrospinal Fluid (CSF) - BDS Lecture Notes PDF Download
 Cementum - BDS Lecture Notes PDF Download
 Recent Advances in Instrumentation Techniques - BDS Lecture Notes PDF Download
 Ameloblastoma - BDS Lecture Notes PDF Download
 Prevention of Odontogenic Infection - Principles of Management - BDS Lecture Notes
 Therapeutic Dentistry Histology of Teeth Dental Charting - BDS Lecture Notes PDF Download
 Maxillofacial Trauma and Management - BDS Lecture Notes PDF
 Technical Endodontics - BDS Lecture Notes PDF Download
And 698 more free downloads for Dental Students.
Other Popular Links for Law Study Material:
 BDS Lecture Notes, eBooks, Guides, Projects and Case Papers FREE PDF Download
 BDS Lecture Notes, eBooks, Guides & Handouts FREE PDF Download
 BDS University Previous Year Exam Question Papers & Solutions FREE PDF Download
A pa n o ra m ic ra dio gr a p h dis p la y s a w ell defin ed m u lt ilo c u la r
radio lu cen cy w it h s callo ped bo rder (arro w h eads ) ex t en din g fro m t h e
r igh t s eco n d m a n dib u lar p r em o la r t o t h e m a n dib ula r r a m u s . Ex t en s iv e
r o o t res o rpt io n o f t h e r igh t s ec o n d m a n dib u la r p r em o la r a n d t h in n in g o f
t h e co rt ica l pla t e is det ec t ed. N o t e t h a t t h e in fer io r a lv eo la r n er v e c a n a l
h a s been dis pla c ed in fer io r ly t o t h e in fer io r c o r t ex o f t h e m a n dib le
(a rro w s ).
M
O
.C
A
M
A
N
Y
D
U
T
S

http://www.nature.com/ijos/journal/v4/n1/full/ijos20129a.html
H I S T O PAT H O L O G Y
OF AMELOBLASTOMA
• Conventional ameloblastoma are usually made of mixture of
M
O
solid neoplasm & cysts. A
.C

• They have variety of patterns histologically

A
M but there are some features
which are common to all histological
N variety of ameloblastoma;
Y
–Presence of neoplastic
U
D ameloblasts
with Palisaded appearance & reverse
T
S

polarization (presence of nuclei away from

basement membrane)
 Follicular Ameloblastoma

Plexiform Ameloblastoma

S
T
U

Basal Ameloblastoma
D
Y
N
A

Granular Ameloblastoma
M
A
.C
O

Acanthomatous Ameloblastoma
M

Desmoplastic Ameloblastoma
FOLLICULAR AMELOBLASTOMA
• Most common type of ameloblastoma.
• Characterized by; islands of follicles of epithelial
cells in a connective tissue stroma.
– Outer layer of these islands have well organized, tall M
columnar ameloblasts like cells with reverse polarityO
which are surrounding core of polyhedral or angular
cells. .C
A
– small cysts may be present within follicle or stoma
M
– Here islands of epithelium are not interconnected.
A
N
Y
D
U
T
S
FOLLICULAR AMELOBLASTOMA

M
O
.C
A
M
A
N
Y
D
U
T
S
PLEXIFORM AMELOBLASTOMA

• Here epithelium forms cords or strands and M

O
trabeculae of small, darkly stained epithelial .C
cells which may lack reverse polarization and
A
does not resemble any stage of ameloblasts
M
A
present in less cellular stroma. N
Y
D
• This variant give Fish – net appearance.
U
T
S
ACANTHOMATOUS
AMELOBLASTOMA
• It has similar histological appearance to follicular M
O
ameloblastoma, except difference in; .C
– Squamous metaplasia of core cells (stellate & A
M
angular cells) occurs producing prickle cells &
A
keratin in core.
N
Y
D
• this variant is sometimes confused U with
T
squamous cell carcinoma. S
BASAL
AMELOBLASTOMA
M
• Rare type O
.C
A
M
• Arranged as trabecular pattern A
N
with peripheral cells cuboidal
Y
D
rather than columnar. U
T
S

• Mistaken with basal cell carcinoma.

GRANULAR
AMELOBLASTOMA
M
• In this appearance of epithelium & stroma is also O
C
similar to follicular ameloblastoma but difference in .
A
it is; central / core cells & some ameloblasts at
M
peripheral cells undergo degenerative changes
A &
form sheets of large PINK / eosinophilicNgranular
Y
cells in the center of island. D
U
T
S
DESMOPLASTIC
AMELOBLASTOMA
M
• In this epithelium, O
.C
odontogenic A
epithelium is A
M

arranged in small Y
N

islands or cords D
U
in dense & highlyST
collagenised
stroma.
BEHAVIOR OF AMELOBLASTOMA
• Although ameloblastoma is benign, but some cells of this
ameloblastoma may infiltrate the narrow
O
M
spaces without
causing swelling and destructionAof.Cbone.
M
A
N
• So that’s why simple curettage
Y or enucleation of lesion cannot
D
be done due to high recurrence.
U
T
S

• So surgical resection with small normal tissue is best

treatment option. (wide excision)
MANAGEMENT OF MULTICYSTIC
AMELOBLASTOMA
M
• Diagnosis is confirmed by biopsy. O
.C
A
M
• Treatment of choice is wide excision
A – taking upto 2 cm of
N
normal bone around marginY of lesion.
D
– Simple enucleation can Ucause Recurrence because of probability of
T
invasion in surrounding
S space.

• Regular radiographic follow up for detecting any recurrence.

MANAGEMENT OF MULTICYSTIC
AMELOBLASTOMA
• Maxillary Ameloblastoma are dangerous
O
M because;
.C
– Bone is thinner in mandible. A
M
– Neoplasm spread easily toAfollowing areas in maxilla.
N
• Maxillary sinus Y
D
• Pterygomaxillary
T
Ufossa
S
• Orbit
• Cranium
• Brain
 M
O
.C
A

UNICYSTIC Y
N
A
M

A M E LO B L A S T O M A
S
T
U
D
 INTRODUCTION
UNICYSTIC AMELOBLASTOMA
M as single cyst.
• It is defined as ameloblastoma having single cyst or appear
O
.C
A
• However, ameloblastoma radiographically appearing as single cyst can be Multicystic
M
like mural ameloblastoma A
N
Y
Explanations for a Unicystic presentationD
of
U
ameloblastoma radiologically. T
S
The two patterns on the left are true
Unicystic
ameloblastoma while that on the right is a
conventional ameloblastoma with one very
large cyst.
FEATURES OF UNICYSTIC
AMELOBLASTOMA
M
• Mostly b/w 10 – 20 years of age. • Histology
O
• Mostly in posterior mandible. .C
A – Tumor cells forming cyst wall
• Sometimes arises with M are flattened & can be
A
dentigerous cysts. N mistaken for those or non –
Y
D neoplastic cyst.
U
• Radiological FeaturesST
– Appear as unilocular radiolucency • Treatment
– Enucleation
PERIPHERAL AMELOBLASTOMA

M
• In this type, ameloblastoma is present in gingival or alveolar soft tissues and does not
O
involve bone. .C
A
M
• These lesion may arise from; A
N
– Basal cells of oral epithelium Y
D
– Extra osseous rests of dental lamina.
U
T
S
• Histologically similar to intra osseous ameloblastoma.
MALIGNANT OR METASTASIZING
AMELOBLASTOMA
M
• It is distant or metastasized ameloblastoma.
O
.C
• Metastasis usually occur to lung. A
M
• Although it is benign and truly A speaking does not metastasize
N
but in some conditions asYdescribed under they may move
D
from oral cavity to otherU places;
T
– Aspiration of someScells of ameloblastoma into lungs during surgery.
– Surgically disrupting primary site
– Incomplete removal
AMELOBLASTIC CARCINOMA

M
• It arises when dysplastic changesOoccur in the primary
.C
benign ameloblastoma. A
M
• Rare N
A
Y
• Histologically poorlyDdifferentiated and shows
U
dysplasia . S
T

• Metastasize to lymph nodes.

• If metastasis is present, prognosis is poor.
AMELOBLASTIC CARCINOMA

M
MALIGNANT AMELOBLASTOMA A M EO
LOBLASTIC CARCINOMA
.C
• Clinically primary & • Primary has features of
A
M
secondary ameloblastoma A normal benign
N
have same all clinical Y ameloblastoma, while
D
histological & other U secondary show dysplasia
T
features. S & malignant .

• Usually lungs. • Metastasize to lymph

nodes.