Oral & Maxillofacial Surgery Fifth Year

1. Mixed Odontogenic
Tumors
This group of tumors
is composed of
proliferating
odontogenic
epithelium in a
cellular
ectomesenchyme
resembling the dental
papilla.
Clinical features
Histopathology


Posterior mandible 70%.

Small (asymptomatic) – Large
(Local swelling / failure of
eruption).
Well defined RL with sclerotic
borders.

50% assoc. with unerupted teeth.
Encapsulated.

.has general features of

ameloblastic fibroma but containing
enamel and dentin.


5-12 yrs.

Premolar/molar region of both jaws

Well defined unilocular RL with
calcified radiopaque material
(mixed).

The most common odontogenic
tumor.

Developmental anomaly
(hamartoma).
Treatment
Males.

2-Ameloblastic Fibroodontoma.
1st & 2nd decade.

1-Ameloblastic
Fibroma.

types
3-Odontoma

2nd decade.

Maxilla.
Conservative
surgical excision.
20% recurrence
(some surgeons
recommend
more aggressive
approach).
Conservative
curettage.
Foci of enamel & dentin
in epithelial structure.
Prognosis is
excellent


Compound: enamel,
dentin, & cementum
arranged in recognizable
tooth forms.
Complex: enamel,
dentin, & cementum
arranged in a random
manner (no resemblance
to tooth).
-Compound odontoma:
Multiple small & malformed
tooth-like structures are
formed creating a “bag of
marbles” radiographic
appearance.
-complex odontoma:
Conglomerate mass of ename
& dentin, which bears no
Simple local
excision.
Prognosis is
Excellent.

2. 
Compound (anterior maxilla).

Complex (posterior of both jaws).

Assoc. with unerupted tooth / block
eruption.

Odontogenic differentiation is fully
expressed.

Mostly radiodense.

RL with well defined, smooth
contours / later a well defined
radiopaque appearance.

Compound shows apparent tooth
shapes while complex appears as a
uniform opaque mass.

Asymptomatic.

Arise from altered fibroblast or
myofibroblast that produce excess
of mucopolysaccharides &
incapable of producing mature
collagen.
4-odontogenic
myxoma.

Benign, locally aggressive in bone
or soft tissues.

20-40 yrs.

Female.

Posterior mandible 28%

Unencapsulated, locally
infiltrating tumor.

Small (unilocular)
anatomic resemblance of tooth.


Stellate, spindle-shaped
& round cells in myxoid
stroma with few collagen
bundles.
It might be confused with
chondromyxoid fibroma
or with myxoid change in
an enlarged dental
follicle or papilla.
Small:
Curettage.
Large:
Surgical excision.
25% recurrence.
Prognosis is
good

3. 

Purely RL.

Well circumscribed, expanding,
detructive lesion.

Maxillary lesion may extend to
sinus, nasal cavity, orbit, or cranial
cavity.

5-Cementoblastoma
(true cementum)
Large (multilocular).
Teeth displacement / root
resorption.

2nd & 3rd decades.

Roots of mandibular posterior teeth.

Slow growing / local expansion.

Asymptomatic (may be pain).

Radiographically: ball of dense
material attached to the end of root.
(opaque lesion). Opaque spicules
radiate from the central mass.



Mineralized materials.
Multinucleated giant
cells.
This lesion resemble
Osteoblastoma.
Done by/ Mahdi 207 for ever
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
Surgical removal
(of tooth together
with mass).
Prognosis is
excellent