Dillon-Cox-CPC-2-Feb..
Dillon-Cox-CPC-2-Feb..
Dillon-Cox-CPC-2-Feb..
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78 year old male with large<br />
lesion mandible. Refused surgery<br />
2 years ago now having difficulty<br />
breathing
Mandibular lesion<br />
MACHO<br />
• Myxoma<br />
• Ameloblastoma<br />
• Central Giant cell lesion<br />
• Hemangioma<br />
• Keratocystic odontogenic tumor (OKC)
PT: PD
Ameloblasts<br />
SR<br />
IEE<br />
EEE<br />
DP<br />
Odontoblasts<br />
PT: PD
Odontogenic tumors<br />
• Benign aggressive<br />
–Ameloblastoma<br />
–Odontogenic myxoma<br />
–Clear cell odontogenic tumor<br />
–Odontogenic ghost cell tumor<br />
–Odontoameloblastoma
Ameloblastoma<br />
• Benign but aggressive<br />
• Solid or multicystic<br />
• Broad age range<br />
• Mandibular molar – ramus commonly affected<br />
• Multi/unilocular radiolucency<br />
• Surgical excision or resection<br />
• Recurrence high with conservative treatment
56 year old dentist who noticed a swelling<br />
in the left body of the mandible
8 year old female with biopsy of<br />
left mandible confirming<br />
ameloblastoma
Odontogenic tumors<br />
• Benign – some recurrence potential<br />
–Calcifying epithelial odontogenic tumor<br />
–Central odontogenic fibroma<br />
–Florid cementoosseous dysplasia<br />
–Ameloblastic fibroma
Healthy 12 year old girl with<br />
roughly 1 year of increasing,<br />
asymptomatic R posterior<br />
mandibular swelling
Initial Pano 9/21/2010
Mandibular lesion<br />
MACHO<br />
• Myxoma<br />
• Ameloblastoma<br />
• Central Giant cell lesion<br />
• Hemangioma<br />
• Keratocystic odontogenic tumor (OKC)
Odontogenic Myxoma<br />
• Arises from permanent mesenchymal tissue<br />
• Either jaw<br />
• Ususally adults ( 10 -50 years)<br />
• No gender predilection<br />
• Recurrences<br />
• Pathology can be confused with dental follicle!
31 year old female with<br />
multilocular radiolucency right<br />
mandible
Odontogenic Cysts<br />
• Periapical (radicular cyst)<br />
• Lateral periodontal cyst<br />
• Gingival cyst of the newborn<br />
• Dentigerous cyst<br />
• Eruption cyst<br />
• Glandular odontogenic cyst<br />
• OKC/keratocystic odontogenic tumor<br />
• Calcifiying odontogenic cyst
Histogenesis of OKC<br />
• Basal layer of oral mucosa<br />
• Dental lamina or Rests of Serres (dental<br />
lamina rests)<br />
• “Daughter” cyst(s) from basal layer of the<br />
epithelial lining of the “mother” cyst<br />
• The WHO now classifies OKC as “odontogenic<br />
keratocystic tumor”
Odontogenic tumors<br />
• Benign – some recurrence potential<br />
–Calcifying epithelial odontogenic tumor<br />
–Central odontogenic fibroma<br />
–Florid cementoosseous dysplasia<br />
–Ameloblastic fibroma<br />
–OKC/keratocystic odontogenic tumor
63 year old female with KOT left<br />
mandible
37M numbness R V3<br />
No mobility or pain of his teeth<br />
Dentist: no abnormality<br />
Referred to oral surgeon and neurologist
Differential diagnosis<br />
• Primary intraosseous malignancy<br />
• Metastasis<br />
• Osteosarcoma<br />
• Osteomyelitis<br />
• Salivary gland neoplasm<br />
• Aggressive central giant cell tumor
Adenoid Cystic Carcinoma<br />
• submandibular> palate<br />
• 40-60 yrs<br />
• High local recurrence, distant metastasis.<br />
• Spread is to lungs and bones<br />
• 5 year survival 80-90%<br />
• 15 year survival 10%
Neutron Radiation<br />
• 3 centers in the USA<br />
• Seattle is one of them<br />
• Salivary gland malignancy<br />
• Tumors refractory to other treat<br />
• Last ditch effort
Neutron Radiation<br />
• Fractions from 1 -2 neutron Gy (nGy)<br />
• Median 19.2 (range is 10.7 – 19.95<br />
• Commonly 1.2 nGy over 4 weeks == 19.2 nGy<br />
• 19.2 nGy biologically equivalent to 154 Gy for<br />
ACC and 67 Gy for normal late reacting tissues
69 yo M with h/o inflammatory gingival<br />
lesions associated with teeth #17-#20.<br />
2005: two biopsies within months of<br />
each other with dx of nonspecific<br />
lichenoid reaction.
42 year old female with paresthesia<br />
right mental nerve distribution<br />
pain and swelling
Differential diagnosis<br />
• Primary intraosseous malignancy<br />
• Metastasis<br />
• Osteosarcoma<br />
• Osteomyelitis<br />
• Salivary gland neoplasm<br />
• Aggressive central giant cell tumor
Aggressive central giant cell tumor<br />
• Rapidly growing<br />
• Painful<br />
• Paresthesia<br />
• Perforate cortical plates<br />
• High recurrence
53 year old female with<br />
mandibular pain
The patient is a 55 year-old female<br />
with a mandibular mass diagnosed<br />
as ameloblastoma on fine needle<br />
aspiration. She presents for a second<br />
opinion. Initial recommendation is<br />
resection and reconstruction with a<br />
free fibular flap.
Differential diagnosis<br />
• Primary intraosseous malignancy<br />
• Metastasis<br />
• Osteosarcoma<br />
• Osteomyelitis<br />
• Salivary gland neoplasm<br />
• Aggressive central giant cell tumor
67 year old male with repeated infections<br />
left mandible<br />
Multiple I&D’s without it resolving