27.01.2015 Views

Dillon-Cox-CPC-2-Feb..

Dillon-Cox-CPC-2-Feb..

Dillon-Cox-CPC-2-Feb..

SHOW MORE
SHOW LESS

Create successful ePaper yourself

Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.

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

Hooray! Your file is uploaded and ready to be published.

Saved successfully!

Ooh no, something went wrong!