Tumors

1. Malignant

1.1. Mehod of Growth

1.1.1. 1-uncontrolled growth of tissue they are more locally invasive and have great degree of anaplasia with ability to metastasize regionally to lymph nodes or distally to other sites

1.2. 2- Radiographic location

1.2.1. 1-primary carcinomas: more commonly seen in tongue, floor of mouth, tonsillar area, lip, soft palate and gingiva, may invade jaw

1.2.2. 2- sarcomas: in mandible and posterior region of both jaws

1.2.3. 3- Metastatic tumors: common in posterior mandible and maxilla, some at apex of teeth, or in follicles of developing teeth

1.3. 3- Periphery and shape

1.3.1. 1. ill defined border shape is mainly irregular

1.3.2. 2. lack of cortication

1.3.3. 3. Lack of caspule

1.4. 4- Internal structures

1.4.1. 1. most malignancies don't produce bone or stimulate reactive bone formation, so internal aspect is radiolucent

1.4.2. 2. some metastatic lesions induce bone formation that appears as intraosseous architecture,

1.4.3. 3. other tumors as osteogenic sarcomas can cause frank sclerosis

1.5. 5- Effect

1.5.1. 1. rapidly growing

1.5.2. 2. resulting in destruction of of supporting alveolar bone so that teeth appear floating in space; internal trabecular bone and cortex as sinus floor inferior border of mandible and cortex of inferior alveolar canal are destroyed

1.5.3. 3. no periosteal reactions occur,  however sometimes unusual periosteal new bone formation is stimulated  as in osteosarcoma metastatic lesion

1.6. Examples

1.6.1. 1- squamous cell carcinoma in bone

1.6.1.1. 1. ill defined irregular sometimes rounded

1.6.1.2. 2. radiolucent i

1.6.1.3. 3. lesion capable of destruction of antranl or nasal floor and loss of cortical outline of mandible

1.6.1.4. 4. teeth appear to be floating due to loss of lamina dura and supporting bone

1.6.2. 2- central mucoepidermoid carcinoma

1.6.2.1. 1. well defined and corticated

1.6.2.2. 2. radiolucent,

1.6.2.3. 3. unilocular or multiolocular

1.6.2.3.1. multilocular lesion have soap bubble or honeycomb appearance

1.6.2.4. 4. expansile lesion

1.6.2.4.1. growth causes expansion of adjacent normal bony walls

1.6.2.5. 5. mandibular canal may be depressed or pushed laterally or medially

1.6.3. 3- Osteosarcoma

1.6.3.1. 1. ill-defined border.

1.6.3.2. 2. radiolucent lesion in some cases lesion may be mixed or quite radio opaque

1.6.3.3. 3. when the lesion involves periosteum directly by extension, the characteristic hair on end or sunray appearance occurs

1.6.4. 4- General metastatic tumors

1.6.4.1. 1. , but mostly shows ill defined invasive marins with no cortication

1.6.4.2. 2. generally radiolucent lesion sclerotic metastases may occur from breast and prosate

1.6.4.3. 3. causes destruction of jaw bone

1.6.4.4. 4. loss of lamina dura and widening of pdl space resultng in floating appearance of teeth

1.6.4.5. 5. lesion may be multifocal if metastasis occured to more than one site of the jaw

2. Benign

2.1. 1. Mehod of Growth

2.1.1. 1- new growth resembling tissue of origin and true neoplasms. they continue to grow until treated

2.2. 2. Radiographic location

2.2.1. 1. odontogenic: in alveolar process above inf. alveolar nerve canal

2.2.2. 2. vascular and neural inside mandibular canal

2.2.3. 3. cartilagenous tumor in jaw locations where residual cartilagenous cells lie as around the condyle

2.3. 3. Periphery and shape

2.3.1. 1. have smooth, round or oval peripheries

2.3.2. 2. bony margin is usually regular, corticated, well defined

2.3.3. 3. encapsulated in connective tissue capsule and show radiolucent band seperating lesion from surrounding bone

2.4. 4. Internal structure

2.4.1. 1. radiolucent or radio opaque or mixed

2.4.2. 2. lesions with internal calcifications as septa, calcified flecks or patterned compartments are usually benign because time is required for residual trabeculae to remodel into septa a

2.4.3. 3. nd some produce calcified tissue due to presence of bone ( osteoma or odontoma )

2.5. 5. Effect on surrounding

2.5.1. 1. the movement produced is slow

2.5.2. 2. benign tumor exert pressure on neighboring structures resulting in displacement of tooth or bone cortex

2.5.3. 3. roots of teeth may be resorbed and is more common in benign

2.6. 6. Examples

2.6.1. 1.Ameloblastoma

2.6.1.1. 1. well defined well corticated margin

2.6.1.2. 2. may be multilocular

2.6.1.3. 3. may cause root resorption

2.6.2. 2.Adenomatoid odontogenic tumor

2.6.2.1. 1. well defined, corticated or sclerotic

2.6.2.2. 2. radiolucent or radiolucent with radio opaque foci or dense clusters of radio opacities

2.6.2.3. 3. causes displacement of teeth and may cause jaw expansion

2.6.3. 3.Calcifying epithelial odontogenic ( Pindborg)

2.6.3.1. 1. well defined or diffuse lesion

2.6.3.2. 2. unilocular or multilocular

2.6.3.3. 3. radiolucent with numerous radio opaque foci of different size and density

2.6.3.4. 4. may cause displacement of developing tooth preventing its eruption

2.6.3.5. 5. may cause jaw expansion

2.6.4. 4.central hemangioma

2.6.4.1. 1. well defined corticated periphery sometimes maybe illdefined

2.6.4.2. 2. radiolucent and may contain enclosed trabecular spaces giving soap bubble or honeycomb appearance

2.6.4.3. 3. causes root resorption

2.6.4.4. 4. may cause enlargement of inferior alveolar canal or enlargement of mental foramen

2.6.4.5. 5. related developing teeth usually erupt earlier and are larger in size

2.6.5. 5. Cementoblastoma

2.6.5.1. 1. radio opaque lesion, well defined by a radiolucent halo

2.6.5.2. 2. lesion may contain radiolucencies mixed

2.6.5.3. 3. causes external root resorption

2.6.5.4. 4. causes expansion of mandibular cortex

2.6.6. 6. odontoma

2.6.6.1. 1. well defined radio opaque lesion may be smooth or irregular

2.6.6.2. 2. types: compound: appear as tooth or tooth like structure complex: a mass of irrgular dental tissue

2.6.6.3. 3. causes diplacement devitalizing or diastoma

2.6.6.4. 4. may cause jaw expansion

2.6.7. 7. osteoma

2.6.7.1. 1. radio opaque lesion: compact bone with well defined borders

2.6.7.2. 2. internal trabeculation are found in lesions containing cancellous bone

2.6.7.3. 3. large lesions cause displacement of adjacent soft tissue muscles resulting in disfunction