Tumour

Epithelial tumors of oral

mucosa
Etiological factors
Smoking
Chewing habits
Alcohol
Industrial hazards
Dental factors
Epithelial tumors of oral
mucosa
Etiological factors
Actinic radiation
Epithelial atrophy
Viruses
Immunosuppression
Candida infection
Smoking

There is undoubtedly evidence relating

pipe and cigar smoking to oral carcinoma,
particularly on the lip
Chewing habits

 Pan chewing induces leukoplakia where the pan is

held in the mouth and malignant transformation is
usually evidenced clinically by the development of a
papilliferous, ulcerated mass.
 (basically a pan consists of betel nut and lime wrapped
in a betel leaf, and tobacco, catechu, and other spices
are often added )
 (pan is normally chewed after meals, its effects being
to satisfy the hunger sensation, to aid digestion, to
produce a slight euphoric effect)
alcohol

The risk of developing oral carcinoma is

10-15 times greater in heavy than in
minimal alcohol drinkers
alcohol drinking and tobacco smoking
appear to have a synergistic effect in the
development of oral carcinoma
Industrial hazards

Independent studies have indicated a high

incidence of oral carcinoma in textile
workers, particularly in those exposed to
the dust from raw cotton and wool.
Dental factors

Poor oral hygiene, faulty restorations,

sharp edges of teeth and ill-fitting dentures
have all been incriminated in the etiology
of oral cancer
Actinic radiation

Sunlight is probably a factor in causing lip

carcinomas.
Epithelial atrophy

This may enhance the absorption of

carcinogens through the oral epithelium
and explain the reported association
between oral carcinoma and syphilis, iron,
and vitamin deficiencies, and lichen planus
viruses

Laboratory experiments have shown that herpes

simplex viruses(HSV) can be carcinogenic or
cocarcinogenic under certain circumstances
There is evidence that human papilloma virus, as
well as being associated with some oral squamous
cell papillomas, may be associated with oral
carcinoma
Immunosuppression

Reports have been published of carcinoma

of the lip developing in patients with renal
transplants
Candida infection

Keratotic lesions associated with chronic

candidal infection such as chronic
hyperplastic candidosis are particularly
prone to undergo malignant transformation
Ameloblastoma

 Potential epithelial
sources include enamel
organ,odontogenic
rests(rests of
malassez,rests of
serres)reduced enamel
epithlium and the
epithelial lining of
odontogenic
cyst,especially the
dentigerous cyst
Ameloblastoma

 Swelling of cheek and

alveolar ridge
 Loosening of
mandibular teeth
Ameloblastoma

The tumors are appreciated for their

locally aggressive behavior,recurrence rate
and slight metastatic potential.
Ameloblastoma

 Clinical features
 There appears to be no gender predilection
 It occurs predominantly in the fourth and fifth decades
 The mandibular molar-ramus area is the most favored
site
 Ameloblastomas are usually asymptomatic
 Tooth movement or malocclusion may be the initial
presenting sign
Ameloblastoma

 Clinical features
 Rarely,extraosseous peripheral ameloblastomas
are found in the gingiva
 They arise from dental lamina and often are
associated with impacted teeth in young patients
 Radiographically,it appears as osteolytic
processes,may exhibits a unilocular or
multilocular appearance,root resorption may
appear
Ameloblastoma

 Treatment and prognosis

 The solid-multicystic lesions require at least
surgical excision,since recurrence follows curettage
in 50 to 90% of cases
 Block excision or resection should be reserved for
larger lesions
 Unicystic lesions and peripheral ameloblastomas
require only enucleation
 Resection of the entire lesion with a margin of bone
to prevent local recurrence
Ameloblastoma

 Radiograph
unilocular appearance
root resorption
Benign mixed
tumor(pleomorphic adenoma)
It is the most common tumor of major and
minor salivary glands
The parotid gland accounts for
approximately 85% of these tumors
Of those tumors arising within the oral
cavity, the majority are noted in the hard
and soft palates
Benign mixed
tumor(pleomorphic adenoma)
The histogenesis of this lesion relates to a
simultaneous proliferation of variable
numbers of cells with ductal and
myoepithelial features
The risk of recurrence
It is difficult to distinguish from enlarged
lymph nodes within the submandibular
triangle
Benign mixed
tumor(pleomorphic adenoma)
Clinical features
They appear as firm,painless swellings and, in
the vast majority of cases, do not cause
ulceration of the overlying mucosa
When they arise within the parotid gland,
mixed tumors are generally painless, non-
tender, and slow growing, located below the
ear and posterior to the mandible
Benign mixed
tumor(pleomorphic adenoma)
 Clinical features
 The tumors may present below the angle of the
mandible and anterior to the sternocleidomastoid
muscle when they are situated within the inferior
pole or tail of the parotid
 they generally range from a few millimeters to
several centimeters in diameter and are capable
of reaching giant proportions ,especially in the
parotid
Benign mixed
tumor(pleomorphic adenoma)
It is clinically impossible to distinguish
these from malignant salivary gland
tumors during early stages of growth
pleomorphic adenoma

 Pleomorphic adenoma
of 19 years’
duration.despite its
large size, it did not
affect facial nerve
function,and the
patient concealed it
beneath her hair.
Malignant tumor of parotid
gland
Benign mixed
tumor(pleomorphic adenoma)
Malignant mixed tumor
Benign mixed
tumor(pleomorphic adenoma
Treatment
Enucleation of parotid mixed tumors is not
advisable because of risk of recurrence.
In most cases, superficial parotidectomy
with preservation of the facial nerve is the
most appropriate management for mixed
tumors arising within the parotid
 Hemangiomas and vascular
malformations
 Introduction
 Vascular birthmarks,in the past named
“strawberry”or“capillary” hemangioma, “port-wine
stains,” “cavernous hemangiomas,”and “cystic
hygromas,”
 Accurate description is crucial,since the prognosis and
management of vascular birthmarks depend on their
correct classification as hemangiomas or malformations
Hemangiomas and vascular
malformations
 Introduction
 Their distinctions have been clarified on the basis of cellular
and clinical characteristics.
 Hemangiomas have an increased mitotic activity and as such
may be considered true neoplasms. they are typically absent
at birth or as a faint vascular blush.during the first several
months of life they may undergo a rapid proliferative phase,
during which they sometimes grow to large size. The
majority of Hemangiomas undergo spontaneous involution
by the age of seven
 Hemangiomas and vascular
malformations
 Introduction
 vascular malformations have a normal rate of
endothelial cell turnover. They result from congenital
errors in vascular morphogenesis and are classified by
their vessel of involvement–
capillary,venous,arterial,lymphatic, or combined. They
normally grow proportionally with the child and do not
regress spontaneously, unlike Hemangiomas
 Lymphatic malformations(cystic hygromas) classically
occur in the neck or the floor of the mouth.
Hemangiomas and vascular
malformations
surgical resection
Photodynamic laser therapy
Intralesional steroid injections or
sclerosing agents
Systemic dexamethasone therapy, or the
intravenous administration of interferon-a
Hemangiomas
cheek
Hemangiomas
tongue
Hemangiomas
the lower lip
Cystic hygroma

 Very large cystic

hygroma in a 12-
month-old child.this
present at birth.
Cystic hygroma
Treatment of Hemangiomas

surgical resection
Indications for early surgical resection
include ulceration and bleeding,
obstruction of the eye with subsequent
amblyopia, nasal airway obstruction
Treatment of Hemangiomas

Photodynamic laser therapy

May be helpful in preventing the onset of
the proliferative phase of Hemangiomas
Treatment of Hemangiomas

Intralesional steroid injections or

sclerosing agents
May be successful in achieving temporary
control of smaller Hemangiomas in certain
locations such as the lip or eyelid
Treatment of Hemangiomas

Systemic dexamethasone therapy, or the

intravenous administration of
interferon-a
For a short course has been found to arrest
the growth of large lesions during their
proliferative phase
Hemangiomas and vascular
malformations
Treatment of malformations
The management of malformations often
is surgical
Indications for early surgical resection
include recurrent infections, obstructive
symptoms(e.g.,respiratory distress),
hemorrhage,and significant aesthetic
deformities.
Odontogenic tumors

Epithelial tumors
Ameloblastoma
Squamous odontogenic tumor
Calcifying Epithelial Odontogenic tumor
Clear cell Odontogenic tumor
Odontogenic tumors

 Mesenchymal tumors
 Odontogenic Myxoma
 Central Odontogenic Fibroma
 Cementoblastoma
 Periapical Emental Dysplasia
 Mixed tumors(Epithelial and Mesenchymal)
 Odontoma
 Ameloblastic fibroma and Ameloblastic fibroodontoma
Malignant tumors

Malignant tumors which may arise in the

mouth are epidermoid carcinomas and
adenocarcinomas
Malignant tumors

 Introduction
 Malignant neoplasms that arise in the head and
neck area or upper aerodigestive tract share the
general behavior of most solid tumors:local
growth, locoregional spread, and distant
metastasis.
 Unlike most other solid tumors, 60 percent of
patients with a fatal head and neck malignancy
die without clinical evidence of metastasis
beyond the local (regional) disease.
Malignant tumors

 Introduction
 Central nervous system invasion, rupture of the
great vessels,airway obstruction, and invasive
local infection are common causes of death on
these patients
 Because of the predominant local and
locoregional natural history of this disease,
significant attention must be paid to local
diagnosis and therapy
Squamous cell carcinoma

 Introduction
 Accounts for about 90 percent of all oral
malignancies
 Over 90 percent of cases occur in patients over
the age of 40 years
 Oral carcinoma may occur on any part of the oral
mucosa(lip, tongue, the floor of the mouth, the
buccal mucosa, the alveolar ridge, and the palate)
Squamous cell carcinoma

Clinical presentation
Early lesions are usually asymptomatic and
have a variable appearance
Common modes of presentation are a
white patch, a small exophytic growth(no
ulceration or erythema), a small indolent
ulcer, or an area of erythroplakia
Pain is seldom present
Squamous cell carcinoma

 Clinical presentation
 Persistent ulceration, induration and fixation of
affected tissue to underlying structures, and
underlying bone destruction in the case of
alveolar lesions
 An advanced lesion may present as a broad
based, exophytic mass with a rough nodular,
warty, hemorrhagic or necrotic surface, or as a
deeply destructive and crater-like ulcer with
raised,rolled everted edges
Squamous cell carcinoma

 Clinical presentation
 Pain may be a feature of an advanced lesion.
 Bone invasion may be detected on radiographs
but may be suggested clinically by mobility of
teeth and in the case of mandible by altered
sensation over the distribution of the mental
nerve, or pathological fracture
Squamous cell carcinoma

It is important to note that the size of the

surface lesion does not indicate the extent
of underlying invasion
Premalignant lesions and
condition
A lesion may be said to be premalignant if
it precedes or coexists with a tumor more
frequently than would be expected by
chance alone
The following may be described as
Premalignant lesions :
(1)leukoplakia and erythroplakia
diagnosis

Clinical symptoms
X-ray examination
biopsy
Squamous carcinoma

 A pipe smoker for many

years.
 The “C”is a well-
differentiated
Squamous carcinoma
and removed by wedge
resection of the lip.
 The “L”is leukoplakia
which proved to be a
carcinoma-in-situ
Posterior of tongue

 Tobacco,alcohol, chronic
irritation from jagged teeth or
dental appliances are the most
common factors
 Occurs at the midportion of
the lateral tongue
 Exophytic growth with
nodular surface
 Cervical metastases is present
in 40 to 61 percent of patients
Squamous cell carcinoma
Floor of mouth
 13 to 17 percent of oral
lesions arise in this area
 Crater-liked ulcer with
raised, rolled, everted
edges
 Cervical metastases are
frequent
Squamous cell carcinoma
Floor of mouth
Maxillary sinuses

 Late-stage disease
 Nasal obstruction
 Local pain
 Epistaxis
 Cheek swelling
 Loosening of maxillary
teeth
 Paresthesias
 Double vision
Maxillary sinuses
(CT scan)
Treatment

 Survival obviously is of first concern and depends

on adequate surgical or radiotherapeutic ablation
and possibly adjuvant chemotherapy or
immunotherapy
 Freedom from pain is accomplished in most cases
of successful ablative therapy
 Preservation or restoration of function as well as
appearance is the next consideration
 Efficiency is most practically important to the
patient
Fibrous epulis

 A benign fibrous
tissue tumor arising
from the periodontal
membrane or
nearby periosteum
 A smooth, firm,
slowly growing
lump,covered with
normal gingiva
Fibrous epulis

 Usually emerges
between two teeth,
which may be pushed
apart by pressure
 Treatment:local
excision with curettage
of the origin.otherwise,
it may recur