DEPARTMENT OF ORAL AND

MAXILLOFACIAL SURGERY

ODONTOGENIC TUMORS
COMMON TO THE MANDIBLE

Presented by
IRENGBAM VIDYA
LAKSHMI
Introduction
 Varietyof cysts and tumors
 Uniquely derived from tissues of
developing teeth
 May present to otolaryngologist
Diagnosis
 Complete history
 Pain,loose teeth, occlusion, swellings,
dysthesias, delayed tooth eruption
 Thorough physical examination
 Inspection, palpation, percussion,
auscultation
 Plain radiographs
 Panorex, dental radiographs
 CT for larger, aggressive lesions
Differential Diagnosis
 Obtain tissue
 FNA – r/o vascular lesions, inflammatory
 Excisional biopsy – smaller cysts,
unilocular tumors
 Incisional biopsy – larger lesions prior to
definitive therapy
Odontogenic Tumors

 Ameloblastoma
 Calcifying Epithelial Odontogenic Tumor
 Adenomatoid Odontogenic Tumor
 Squamous Odontogenic Tumor
 Ameloblastoma
 Most common odontogenic tumor
 Benign, but locally invasive
 Clinically and histologically similar to BCCa
 4th and 5th decades
 Occasionally arise from dentigerous cysts
 Subtypes – multicystic (86%), unicystic
(13%), and peripheral (extraosseous – 1%)
Ameloblastoma
 Radiographic findings
 Classic – multilocular radiolucency of
posterior mandible
 Well-circumscribed, soap-bubble

 Unilocular – often confused with

odontogenic cysts
 Root resorption – associated with
malignancy
Ameloblastoma
Treatment of Ameloblastoma
 According to growth characteristics and type
 Unicystic
 Complete removal
 Peripheral ostectomies if extension through cyst
wall
 Classic infiltrative (aggressive)
 Mandibular – adequate normal bone around
margins of resection
 Maxillary – more aggressive surgery, 1.5 cm
margins
 Ameloblastic carcinoma
 Radical surgical resection (like SCCa)
 Neck dissection.
Case Report
 A 60-year-old male presented at the out patient
department with complaints of swelling of the right side of
the face of 2 years duration. A history of progressive
increase in size, not associated with pain was elicited. He
had under gone dental extraction of right lower jaw 1.5
years back for carious/loose tooth at some private setup.
There was no history of ulceration, discharge, bleeding, or
difficulty opening mouth.
 On examination there was an irregular swelling of 8 x 8
cm over lower jaw, extending from zygomatic arch to
angle of mandible vertically and preauricular region to just
short of symphysis. It was nontender, bony hard in
consistency, nonpulsatile and neither compressible. There
was no sensory or motor deficit on right side of face.
There was no cervical lymphadenopathy.
 Examination of oral cavity revealed poor orodental
hygiene with right lower third molar missing and
ulceration present over right buccal area. There was
mild right lateral bulge in floor of mouth that was
again bony hard.
 Routine biochemical and hematological investigations
were within normal limits.
 The panoramic view of the jaw revealed expanding
multiseptate lesion in the vertical ramus of the right
mandible extending up to the horizontal ramus with
evidence of break in the cortex and marked soft
tissue swelling.
 CECT [Figure - 1] showed a multilobulated massive
cosmetically deforming right suprahyoid swelling
replacing mandible, predominantly right entire ramus,
coronoid process.
 FNAC of the mass revealed fluid with smears showing
polymorphs and macrophages.
 Biopsy of the mass suggested the diagnosis of benign
odontogenic tumor with ameloblastic differentiation.
 The patient was taken up for surgical resection and
primary stage mandibular reconstruction with iliac crest
graft under general anesthesia. Right lower mandibular
margin incision was made with lower lip split in midline.
Soft tissue with periosteum cut open and periosteum
overlying cystic bony expansion raised both externally
and internally along with attached muscles. Oral
mucosa incised from lower gingivo-floor of mouth
junction. Whole of right hemimandible exposed till
condyle and coronoid process above. Right lower first
premolar removed, mandible cut with giglis saw. Right
tympanomandibular joint disarticulated. The expansile
swelling was removed in toto and sent for
histopathology.
 The right iliac crest was exposed; template marked
from left healthy mandible using X-ray plate was
placed on inner table of exposed iliac after raising
periosteum with muscles. The template was placed in
such a way so that lower border of graft matches with
crest. Drill, burr was used to excise the inner table of
iliac bone along with inner half of crest. Harvested
iliac graft [Figure - 2] was placed in such a way so
that condyle like process rests in right
tympanomastoid joint capsule and anterior free end
opposes left mandible. After making holes graft was
fastened with mandible anteriorly using titanium
plates and screws and condyle fastened with joint
capsule with prolene suture. Both the wounds were
closed in two layers over romovac suction drain.
Ryles tube was inserted and intermaxillary -
mandibular fixation done on left side using K wire.
 The gross appearance [Figure - 3] of the mass was a
smooth, nodular, capsulated and cystic which
measured 7.5 x 7.5 x 4 cm.
 Histopathological examination revealed
ameloblastoma showing granular cell change.
 Ryles tube was removed on seventh day and patient
was allowed fluids orally, and after 3 weeks
intermaxillary - mandibular fixation was also removed
and semisolids was allowed. Patient was advised
complete bed rest fo3 weeks to avoid stress fracture
of iliac crest outer table.
 Postoperative patient had no complaints in chewing,
swallowing or speech articulation. Also mouth
opening was normal and jaw was midline with no
recurrent swelling in 1-year follow up.
Calcifying Epithelial
Odontogenic Tumor
 a.k.a.Pindborg tumor
 Aggressive tumor of epithelial derivation
 Impacted tooth, mandible body/ramus
 Chief sign – cortical expansion
 Pain not normally a complaint
Calcifying Epithelial
Odontogenic Tumor
 Radiographic findings
 Expanded cortices in all dimensions
 Radiolucent; poorly defined, noncorticated
borders
 Unilocular, multilocular, or “moth-eaten”

 “Driven-snow” appearance from multiple

radiopaque foci
 Root divergence/resorption; impacted tooth
Calcifying Epithelial
Odontogenic Tumor
Treatment of CEOT
 Behaves like ameloblastoma
 Smaller recurrence rates
 En bloc resection, hemimandibulectomy
partial maxillectomy suggested
Adenomatoid Odontogenic
Tumor
 Associated with the crown of an impacted
anterior tooth
 Painless expansion
 Radiographic findings
 Well-defined expansile radiolucency
 Root divergence, calcified flecks (“target”)
 Treatment – enucleation, recurrence is rare
Adenomatoid Odontogenic
Tumor
Squamous Odontogenic Tumor
 Hamartomatous proliferation
 Maxillary incisor-canine and mandibular
molar
 Tooth mobility common complaint
 Radiology – triangular, localized radiolucency
between contiguous teeth
 Treatment – extraction of involved tooth and
thorough curettage; maxillary – more
extensive resection; recurrences – treat with
aggressive resection
Squamous Odontogenic
Tumor
Mesenchymal Odontogenic
Tumors
 OdontogenicMyxoma
 Cementoblastoma
Odontogenic Myxoma
 Originates from dental papilla or
follicular mesenchyme
 Slow growing, aggressively invasive
 Multilocular, expansile; impacted teeth?
 Radiology – radiolucency with septae
 Treatment – en bloc resection,
curettage may be attempted if fibrotic
Cementoblastoma
 True neoplasm of cementoblasts
 First mandibular molars
 Cortex expanded without pain
 Involved tooth ankylosed, percussion
 Radiology – apical mass; lucent or solid,
radiolucent halo with dense lesions
 Treatment – complete excision and tooth
sacrifice
Cementoblastoma
 Mixed Odontogenic Tumors
 Ameloblastic fibroma, ameloblastic
fibrodentinoma, ameloblastic fibro-
odontoma, odontoma
 Both epithelial and mesenchymal cells
 Mimic differentiation of developing tooth
 Treatment – enucleation, thorough
curettage with extraction of impacted tooth
 Ameloblastic fibrosarcomas – malignant,
treat with aggressive en bloc resection
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