Neo: new; Plasia: formation. A neoplasm is defined as an uncoordinated proliferation of tissue, the growth of which persists in a potentially unlimited.

Neo: new; Plasia: formation. A neoplasm is defined as an uncoordinated proliferation of tissue, the growth of which

persists in a potentially unlimited fashion, even after cessation of the stimulus which evoked the change.

CLASSIFICATIONCLASSIFICATION

BENIGN NEOPLASMSBENIGN NEOPLASMS

Odontogenic tumorsOdontogenic tumors Non-odontogenic tumorsNon-odontogenic tumorsA. Epithelial origin

1. Ameloblastoma2. Adenomatoid odontogenic tumor3. Calcifying epithelial odontogenic tumor4. Squamous odontogenic tumor

B Mixed origin 1. Ameloblastic fibroma

2. OdontomesC Mesodermal origin

1. Myxoma & Myxofibroma2. Odontogenic fibroma3. Cementifying fibroma4. Periapical cemental dysplasia5. Benign cementoblastoma6. Familial multiple cementoma

A. Epithelial origin1. Ameloblastoma2. Adenomatoid odontogenic tumor3. Calcifying epithelial odontogenic tumor4. Squamous odontogenic tumor

B Mixed origin 1. Ameloblastic fibroma

2. OdontomesC Mesodermal origin

1. Myxoma & Myxofibroma2. Odontogenic fibroma3. Cementifying fibroma4. Periapical cemental dysplasia5. Benign cementoblastoma6. Familial multiple cementoma

A. Hyperplastic lesions1. Polyp2. Epulis3. Giant cell granuloma

B. Epithelial origin1. Papilloma2. Adenoma3. Pigmented nevus4. Keratoacanthoma

C. Mesenchymal1. Connective tissue origina. Fibromab. Lipoma / Fibrolipomac. Haemangiomad. Lymphangiomae. Chondromaf. Osteoma




C. Mesenchymal2. Muscle tissue origina. Leiomyomab. Rhabdomyomac. Granular cell myoblastoma3. Nerve tissue origina. Neurofibromab. Neurilemmomac. Melanotic progonoma


Common Clinical Features


Age of occurrence: Varies with each tumorAge of occurrence: Varies with each tumor

Sex predilection: Varies with each tumor

Sex predilection: Varies with each tumor

Symptoms: Most of the tumors present as a painless, gradually / rapidly enlarging swelling. If infected, pain may be present. Other symptoms include facial deformity, mobility in teeth, numbness.

Symptoms: Most of the tumors present as a painless, gradually / rapidly enlarging swelling. If infected, pain may be present. Other symptoms include facial deformity, mobility in teeth, numbness.

ODONTOGENIC TUMORSODONTOGENIC TUMORS




Signs: The swelling has the following features:Inspection: usually single, round or oval, well-

defined boundaries, smooth or nodular surface, normal overlying skin or mucosa, expansion of jaw bone, obliteration of vestibule

Palpation: Normal temperature of the overlying skin or mucosa, non-tender, consistency is bony hard (if entirely within bone); ‘egg-shell crackling’ (if overlying bone is thin); firm (if no bone coverage), teeth mobility, paraesthesia

Additional features: missing tooth or normal dentition, displacement of teeth, pathological jaw fracture, signs of inflammation if tumor is infected

Signs: The swelling has the following features:Inspection: usually single, round or oval, well-

defined boundaries, smooth or nodular surface, normal overlying skin or mucosa, expansion of jaw bone, obliteration of vestibule

Palpation: Normal temperature of the overlying skin or mucosa, non-tender, consistency is bony hard (if entirely within bone); ‘egg-shell crackling’ (if overlying bone is thin); firm (if no bone coverage), teeth mobility, paraesthesia

Additional features: missing tooth or normal dentition, displacement of teeth, pathological jaw fracture, signs of inflammation if tumor is infected

Common Radiographic Features










Odontogenic tumorsOdontogenic tumorsA. Epithelial origin

1. Ameloblastoma2. Adenomatoid odontogenic tumor3. Calcifying epithelial odontogenic tumor4. Squamous odontogenic tumor5. Ameloblastic fibroma6. Odontomes

B. Mesodermal origin1. Myxoma & Myxofibroma2. Odontogenic fibroma3. Cementifying fibroma4. Periapical cemental dysplasia5. Benign cementoblastoma6. Familial multiple cementoma

A. Epithelial origin1. Ameloblastoma2. Adenomatoid odontogenic tumor3. Calcifying epithelial odontogenic tumor4. Squamous odontogenic tumor5. Ameloblastic fibroma6. Odontomes


Non-odontogenic tumorsNon-odontogenic tumors

Pathogenesis: Proliferation of tissues differentiated from dental lamina. Stimulus for this proliferation not known.



Age of occurrence: mostly between 20 to 50 years of age, peak frequency at 33 years of age

Age of occurrence: mostly between 20 to 50 years of age, peak frequency at 33 years of ageSex predilection: males slightly more commonly affected than females

Sex predilection: males slightly more commonly affected than females

Symptoms: Most of the tumors present as a painless, gradually / rapidly enlarging swelling. If infected, pain may be present. Other symptoms include facial deformity, mobility in teeth, numbness

Symptoms: Most of the tumors present as a painless, gradually / rapidly enlarging swelling. If infected, pain may be present. Other symptoms include facial deformity, mobility in teeth, numbness

Site: 80% of tumors in mandible, in mandible 3rd molar-ramus region more affected

Site: 80% of tumors in mandible, in mandible 3rd molar-ramus region more affected

Ameloblastoma(‘locally malignant’)


Clinical Features

Clinical Features

Signs: The swelling has the following features:

Inspection: single, round or oval, well-defined boundaries,

smooth or lobulated, normal overlying skin or mucosa

(ulcerated if large), expansion of jaw bone in all the 3

planes, obliteration of vestibule

Palpation: normal temperature of the overlying skin or

mucosa, non-tender, consistency is bony hard (if

entirely within bone); ‘egg-shell crackling’ (if overlying

bone is thin); firm (if no bone coverage) or soft (if

unicystic), teeth mobility, paraesthesia

Additional features: missing tooth or normal dentition,

displacement of teeth, pathological jaw fracture, thin

straw colored fluid on aspiration (unicystic variety)

signs of inflammation if tumor is infecte

Signs: The swelling has the following features:

Inspection: single, round or oval, well-defined boundaries,

smooth or lobulated, normal overlying skin or mucosa

(ulcerated if large), expansion of jaw bone in all the 3

planes, obliteration of vestibule

Palpation: normal temperature of the overlying skin or

mucosa, non-tender, consistency is bony hard (if

entirely within bone); ‘egg-shell crackling’ (if overlying

bone is thin); firm (if no bone coverage) or soft (if

unicystic), teeth mobility, paraesthesia

Additional features: missing tooth or normal dentition,

displacement of teeth, pathological jaw fracture, thin

straw colored fluid on aspiration (unicystic variety)

signs of inflammation if tumor is infecte




Clinical Features

Clinical Features

Image: Lucas’s Pathology of Tumors of the Oral Tissues, 5 th edition


Type of lesion: radiolucentSite: usually mandibular 3rd molar-ramus regionSize: large lesionShape: unilocular (round or oval), multilocular (‘soap

bubble’, ‘honeycomb’) with locules separated by bony septae

Number: singleOutline: regular or scallopedBorder: well-defined hyperostotic (‘partially hyperostotic’)Contents: homogenous radiolucencyAdditional features: impaction of tooth with displacement

deep in the jaw, expansion of jaw bone bucco-lingually, antero-posteriorly and vertically, displacement & resorption of roots, displacement of inferior alveolar canal, obliteration of maxillary antrum, thinning of cortical plates, thinning of inferior border of mandible, ‘cyst-in-cyst’ appearance, pathological jaw fracture

Type of lesion: radiolucentSite: usually mandibular 3rd molar-ramus regionSize: large lesionShape: unilocular (round or oval), multilocular (‘soap

bubble’, ‘honeycomb’) with locules separated by bony septae

Number: singleOutline: regular or scallopedBorder: well-defined hyperostotic (‘partially hyperostotic’)Contents: homogenous radiolucencyAdditional features: impaction of tooth with displacement

deep in the jaw, expansion of jaw bone bucco-lingually, antero-posteriorly and vertically, displacement & resorption of roots, displacement of inferior alveolar canal, obliteration of maxillary antrum, thinning of cortical plates, thinning of inferior border of mandible, ‘cyst-in-cyst’ appearance, pathological jaw fracture



Radiographic Features





Images: Atlas of Oral Diagnostic Imaging by Higashi

Differential Diagnosis:Unilocular - other odontogenic tumors (except

radiopaque) and cystsMultilocular - ameloblastic fibroma, myxoma,

haemangioma, central giant cell granuloma, early stages of fibro-osseous lesions, odontogenic keratocyst

Differential Diagnosis:Unilocular - other odontogenic tumors (except

radiopaque) and cystsMultilocular - ameloblastic fibroma, myxoma,

haemangioma, central giant cell granuloma, early stages of fibro-osseous lesions, odontogenic keratocyst




Management: wide surgical excision to avoid recurrence, bone grafts

Management: wide surgical excision to avoid recurrence, bone grafts










Adenomatoid Odontogenic Tumor(‘AOT’)


Clinical Features

Clinical Features

Signs: The swelling has the following features:Inspection: single, round or oval, well-defined

boundaries, smooth, normal overlying skin or mucosa, little expansion of jaw bone, obliteration of vestibule

Palpation: normal temperature of the overlying skin or mucosa, non-tender, consistency is bony hard (if entirely within bone); ‘egg-shell crackling’ (if overlying bone is thin); firm (if no bone coverage)

Additional features: normal dentition, displacement of teeth




Additional features: normal dentition, displacement of teeth

Age of occurrence: mostly in 2nd & 3rd decades of life

Age of occurrence: mostly in 2nd & 3rd decades of life

Sex predilection: females slightly more commonly affected than males

Sex predilection: females slightly more commonly affected than males

Symptoms: Most of the tumors present as a painless, gradually enlarging swelling. Sometimes asymptomatic, being discovered radiographically.

Symptoms: Most of the tumors present as a painless, gradually enlarging swelling. Sometimes asymptomatic, being discovered radiographically.

Site: almost all cases involve maxillary anterior teeth

Site: almost all cases involve maxillary anterior teeth

Type of lesion: predominantly radiolucent (‘mixed’)

Site: maxillary anterior regionSize: about 3 cms in diameterShape: unilocular (round or oval)Number: singleOutline: regularBorder: well-defined hyperostoticContents: homogenous radiolucency interspersed

with radiopaque foci (‘driven snow’ appearance)

Additional features: sometimes impaction of tooth, little expansion of jaw bone, displacement & resorption of roots, thinning of cortical plates


Site: maxillary anterior regionSize: about 3 cms in diameterShape: unilocular (round or oval)Number: singleOutline: regularBorder: well-defined hyperostoticContents: homogenous radiolucency interspersed

with radiopaque foci (‘driven snow’ appearance)

Additional features: sometimes impaction of tooth, little expansion of jaw bone, displacement & resorption of roots, thinning of cortical plates









Differential Diagnosis:No radiopaque foci – ameloblastoma,

ameloblastic fibroma, odontogenic fibroma, primordial cyst, lateral periodontal cyst

Radiopaque foci – CEOC, CEOT

Differential Diagnosis:No radiopaque foci – ameloblastoma,

ameloblastic fibroma, odontogenic fibroma, primordial cyst, lateral periodontal cyst

Radiopaque foci – CEOC, CEOT

Management: surgical enucleationManagement: surgical enucleation

Image: Atlas of Oral Diagnostic Imaging by Higashi

Age of occurrence: mostly in middle aged patients

Age of occurrence: mostly in middle aged patients

Sex predilection: females equally affected as males

Sex predilection: females equally affected as males

Symptoms: Most of the tumors present as a painless, gradually enlarging swelling. Sometimes non-eruption of tooth / asymptomatic, being discovered radiographically.

Symptoms: Most of the tumors present as a painless, gradually enlarging swelling. Sometimes non-eruption of tooth / asymptomatic, being discovered radiographically.

Site: majority in mandibular premolar-molar region

Site: majority in mandibular premolar-molar region


Calcifying Epithelial Odontogenic Tumor(‘CEOT’, Pindborg tumor)


Clinical Features

Clinical Features




Additional features: missing tooth, displacement of teeth




Additional features: missing tooth, displacement of teeth


Site: mandibular premolar-molar regionSize: about 3 cms in diameterShape: somewhat irregularNumber: singleOutline: somewhat irregularBorder: well-defined, at times diffuseContents: homogenous radiolucency interspersed

with diffuse radiopacitiesAdditional features: impaction of tooth is

common, little expansion of jaw bone, displacement & resorption of roots, thinning of cortical plates


Site: mandibular premolar-molar regionSize: about 3 cms in diameterShape: somewhat irregularNumber: singleOutline: somewhat irregularBorder: well-defined, at times diffuseContents: homogenous radiolucency interspersed

with diffuse radiopacitiesAdditional features: impaction of tooth is

common, little expansion of jaw bone, displacement & resorption of roots, thinning of cortical plates









Differential Diagnosis: CEOC, AOT, intermediate stages of fibro-osseous lesions

Differential Diagnosis: CEOC, AOT, intermediate stages of fibro-osseous lesions

Management: wide surgical excision to avoid recurrence

Management: wide surgical excision to avoid recurrence










Age of occurrence: mostly in young adultsAge of occurrence: mostly in young adults

Sex predilection: males more frequently affected

Sex predilection: males more frequently affected

Symptoms: mostly asymptomatic, being discovered radiographically for non-eruption of tooth, sometimes slowly enlarging swelling

Symptoms: mostly asymptomatic, being discovered radiographically for non-eruption of tooth, sometimes slowly enlarging swelling

Site: complex more common in mandibular premolar-molar region, compound more common in maxillary anterior region

Site: complex more common in mandibular premolar-molar region, compound more common in maxillary anterior region

Signs: If present, the swelling has the following features:

Inspection: single, round or oval, well-defined boundaries, smooth, normal overlying skin or mucosa, little expansion of jaw bone,

Palpation: normal temperature of the overlying skin or mucosa, non-tender, consistency is bony hard (if entirely within bone); firm or hard (if no bone coverage)

Additional features: missing tooth

Signs: If present, the swelling has the following features:

Inspection: single, round or oval, well-defined boundaries, smooth, normal overlying skin or mucosa, little expansion of jaw bone,

Palpation: normal temperature of the overlying skin or mucosa, non-tender, consistency is bony hard (if entirely within bone); firm or hard (if no bone coverage)

Additional features: missing tooth


Odontome(‘complex/compound composite odontome’, Odontoma)


Clinical Features

Clinical Features

Type of lesion: radiopaque mass surrounded by a radiolucent line and further by a radiopaque line, ‘mixed’ in early stages

Site: mandibular premolar-molar region / maxillary anterior region

Size: complex can be large, compound usually smallShape: round or ovalNumber: singleOutline: regularBorder: well-defined hyperostoticContents: radiopacities of varying densities interspersed

with tiny radiolucencies, radiopacities arranged in haphazard manner (‘complex’) or in anatomical relation forming several small teeth ‘denticles’ (‘compound’)

Additional features: associated with supernumerary tooth, impaction of tooth, little expansion of jaw bone, displacement & resorption of roots, thinning of cortical plates

Type of lesion: radiopaque mass surrounded by a radiolucent line and further by a radiopaque line, ‘mixed’ in early stages

Site: mandibular premolar-molar region / maxillary anterior region

Size: complex can be large, compound usually smallShape: round or ovalNumber: singleOutline: regularBorder: well-defined hyperostoticContents: radiopacities of varying densities interspersed

with tiny radiolucencies, radiopacities arranged in haphazard manner (‘complex’) or in anatomical relation forming several small teeth ‘denticles’ (‘compound’)

Additional features: associated with supernumerary tooth, impaction of tooth, little expansion of jaw bone, displacement & resorption of roots, thinning of cortical plates









Images: Atlas of Oral Diagnostic Imaging by Higashi

Differential Diagnosis:in the early stage: CEOC, AOT,

intermediate stage of fibro-osseous lesions

in the mature stage: mature stage of fibro-osseous lesions, osteoma

Differential Diagnosis:in the early stage: CEOC, AOT,

intermediate stage of fibro-osseous lesions

in the mature stage: mature stage of fibro-osseous lesions, osteoma

Management: surgical removal to allow eruption of impacted tooth and avoid cystic changes

Management: surgical removal to allow eruption of impacted tooth and avoid cystic changes











Fibro-osseous lesions

Fibro-osseous lesions



Odontogenic tumorsOdontogenic tumors Non-odontogenic tumorsNon-odontogenic tumorsA. Hyperplastic lesions

1. Polyp2. Epulis3. Giant cell granuloma







NON-ODONTOGENIC TUMORSNON-ODONTOGENIC TUMORS

Giant Cell Granuloma(‘central/peripheral’, reparative/hyperplastic giant cell lesion’ )


Pathogenesis: excessive reparative response to an irritant (trauma, infection)

Clinical Features

Age of occurrence: central variety occurs in young adults especially below 30 years of age, peripheral variety usually in adults

Sex predilection: both varieties more common in femalesSite: the region of the jaws anterior to molars involved by the central variety , the peripheral variety involves only gingiva / alveolar mucosa

Radiographic FeaturesType of lesion: radiolucentSite: usually anterior to mandibular 1st molarSize: medium sized lesionShape: unilocular (round or oval), multilocular

(‘soap bubble’) with locules separated by thin bony septae

Number: singleOutline: regular or scallopedBorder: well-defined hyperostoticContents: homogenous radiolucencyAdditional features: expansion of jaw bone bucco-

lingually and vertically, displacement of developing teeth, thinning of cortical plates, thinning of inferior border of mandible

Radiographic FeaturesType of lesion: radiolucentSite: usually anterior to mandibular 1st molarSize: medium sized lesionShape: unilocular (round or oval), multilocular

(‘soap bubble’) with locules separated by thin bony septae

Number: singleOutline: regular or scallopedBorder: well-defined hyperostoticContents: homogenous radiolucencyAdditional features: expansion of jaw bone bucco-

lingually and vertically, displacement of developing teeth, thinning of cortical plates, thinning of inferior border of mandible




Symptoms: mostly slowly enlarging swelling, sometimes mobility in teethSymptoms: mostly slowly enlarging swelling, sometimes mobility in teeth

Clinical FeaturesClinical Features

Signs: the swelling has the following features:Inspection: single, round or oval, well-defined boundaries, smooth, normal overlying mucosa, bluish discoloration of mucosa if cortex is perforated, expansion of jaw bone,Palpation: normal temperature of the overlying skin or mucosa, non-tender, consistency is bony hard (if entirely within bone); soft (if no bone coverage)Additional features: displacement / mobility in teeth

Signs: the swelling has the following features:Inspection: single, round or oval, well-defined boundaries, smooth, normal overlying mucosa, bluish discoloration of mucosa if cortex is perforated, expansion of jaw bone,Palpation: normal temperature of the overlying skin or mucosa, non-tender, consistency is bony hard (if entirely within bone); soft (if no bone coverage)Additional features: displacement / mobility in teeth






Differential Diagnosis: from other multilocular lesions like ameloblastoma, hemangioma, myxoma and early fibro-osseous lesions

Differential Diagnosis: from other multilocular lesions like ameloblastoma, hemangioma, myxoma and early fibro-osseous lesions


Management: surgical removal with adequate margins to avoid recurrence, screening for hyperparathyroidism

Management: surgical removal with adequate margins to avoid recurrence, screening for hyperparathyroidism



















OsteomasOsteomas


OsteomasOsteomas





Odontogenic tumorsOdontogenic tumors Non-odontogenic tumorsNon-odontogenic tumors


Thank you!!!!

Neo: new; Plasia: formation. A neoplasm is defined as an uncoordinated proliferation of tissue, the growth of which persists in a potentially unlimited.

Documents

odontogenic fibroma3

adenomatoid odontogenic

epithelial odontogenic

squamous odontogenic

expansion of jaw bone

overlying bone

bone coverage

odontomesmesodermal