Malignant diseases of the jaws / dental courses

MALIGNANT DISEASES
OF THE JAWS
INDIAN DENTAL ACADEMY
Leader in continuing Dental Education
www.indiandentalacademy.com

• Neoplasm:
A neoplasm can be defined as an abnormal mass of tissue
, the growth of which exceeds and is uncoordinated with that
of the normal tissues and persists in the same excessive manner
after cessation of stimuli which evoked the change.(willis
1952).

• Tumours are classified as a:
Benign
Malignant

• Benign tumours :
A slow growing self contained tumour that is not
seriously harmful.
They are:
Slow growing
Usually painless
Do not metastasise
Spread by direct extension

• Malignant tumours:
• A usually fast growing often fatal tumour that invades
surrounding tissues and sheds cells that spreads through
out the body creating new tumours.
Represents an uncontrolled growth of tissue.
They are:
Fast growing
More locally invasive
Greater degree of cellular anaplasia
Have the ability to metastasize to regional
lymph nodes or distantly to other sites.

Benign tumours Malignant tumours
o Well differentiated
o Slow growth
o Well circumscribed and
encapsulated
o Localised- Usually
spread by direct
extension
o Less differentiated
o Rapid growth
o Invasion into adjacent
structures
o Spread by metastasis.
sarcomas- blood
stream
Carcinomas- Lymph

Classification: According to origin they classified into
Primary
Secondary
Primary tumours:
Malignant tumours that arise denavo
is called as primary tumours.
Secondary tumours:
Those that originate from distant
primary tumours are called as secondary or metastatic
malignancy.

• Malignant odontogenic tumours( WHO in 1992);
• A. Odontogenic carcinoma
• Malignant ameloblastoma
• Primary intraosseous carcinoma
• Malignant changes in odontogenic cyst
• Malignant variants in the odontogenic epithelial
tumours
• B.Odontogenic sarcoma:
• Ameloblastic fibrosarcoma
• Ameloblastic dentino sarcoma

• Non odontogenic malignant tumours:
• A. epithelial:
• SCC
• Metastatic carcinoma
• Basal cell carcinoma
• Transitional cell carcinoma
• Malignant melanoma
• Verrucous carcinoma
• Spindle cell carcinoma
• Primary intraosseous carcinoma
• Intraepidermoid carcinoma
•

• B.Fibrous connective tissue
• Fibrosarcoma
• Malignant fibrous histocytomas
• C.Adipose tissue
• Lipo sarcoma
• D. cartilage
• Chondrosarcoma
• E. bone
• Osteosarcoma
• Osteochondrosarcoma
• Ewing’s sarcoma

• F. Vascular origin:
• Hemangio endothelioma
• Hemangio pericytoma
• Angiosarcoma
• G.Neural tissue:
• Neurosarcoma
• Neurofibrosarcoma
• Neuroblastoma
• H. Muscle
• Leomyosarcoma
• Rhabdomyosarcoma

• I. lymphoid tissue:
• Hodgkins lymphoa
• NON hodgkins lymphoma
• Burkitts lymphoma
• Leukemia
• Primary reticular cell carcinoma
• myeloma:
• Multiple myeloma
• plasmacytoma
• Tumours of salivary glands:
• Mucoepidermoid crcinoma
• Adenocystic carcinoma, malignant changes in
pleomorphic adenoma

According to histopathological characteristics they
classified into 4 categories :
Carcinoma- Lesions of Epithelial origin
Sarcoma- Lesions of mesenchymal origin
Metastatic lesions- from distinct sites
Malignancy of hematopoietic system

• Carcinoma’s are:
• Squamous cell carcinoma
Sarcoma’ s are:
Osteosarcoma
Chondrosarcoma
Ewing’s sarcoma
Fibro sarcoma
Secondary malignancy's are:
Metastatic tumours
Hematopoietic system lesions include:
Multiple myeloma
Non-hodgkin’s lymphoma
Burkitt’s lymphoma
Leukemia

Etiology of malignancies are :
Viruses
Significant radiation exposure
Genetic factors
Exposure to carcinogenic
chemicals
Tobacco-strongly associated with:
oral carcinoma

• C/F: Clinical signs and symptoms that suggestive that a
lesion may be malignant:
• Displaced tooth
• Loosened tooth over a short period of time
• Foul smell
• Ulceration
• Presence of indurated or rolled border
• Exposure of underlying bone
• Sensory or motor neural deficits
• Lymphadenopathy ,weight loss, dysgeusia ,
dysphonia ,dysphasia, haemorrhage, lack of normal
healing
• Pain ,rapid swelling with no demonstrable dental cause

Radiographic examination: R/s may aid in the initial
diagnosis of tumour.
 R/g investigation has the potential to determine the
osseous involvement from soft tissue tumours .
 R/g examination may aid role in the management of
cancer.
 Commonly used imaging techniques are:
IOPA
OPG
CT
MRI

oCommon r/g features: Following features may suggest
that presence of malignant tumour.
o LOCATION:
o Primary and metastatic tumours- Any where in oral
region
o Primary carcinoma- Tongue, floor of the mouth, lip
, soft palate, gingiva and may invade the jaws from any
of these sites.
o Sarcomas: mandible and post regions of jaws.
o Metastatic tumours: post regions of maxilla and
mandible.

• PERIPHERY AND SHAPE: ill-defined border with
lack of cortication and absence of encapsulation(soft
tissue or r/l periphery).
oThis infiltrative border has uneven extensions of bone
destruction.
oFinger-like extensions of the tumour occurs in many
directions ,followed by osseous destruction producing
a zone of R/L.
o The shape of malignant tumour is commonly
irregular.

• INTERNAL STRUCTURE: Because malignancies do
not produce bone nor they do not stimulate the
formation of reactive bone internal aspect is always
R/L.
• But metastatic tumours of breast and prostate lesions
, can induce bone formation-appears as internal
sclerotic osseous architecture.

• EFFECTS ON SURROUNDING STRUCTURES:
• Benign tumours and cysts are slow growing may resorb
the roots and displace the tooth in bodily fashion with out
causing loose tooth.
• Malignant tumours :rapidly growing, destroy surrounding
alveolar bone so that tooth may appear to be floating in a
space.
• Fast growing, they invade through easiest ways such as
maxillary antrum and PDL space causing irregular
widening of PDL space.

Ill defined invasive border followed by bone destruction

Destruction of cortical boundary (maxillary sinus )with
an adjacent soft tissue mass

Tumour invasion along the PDL space causing
irregular widening

Multifocal lesions located at root apices and papillae of
developing tooth destroying the crypt cortex

Four types of effects on cortical bone and periosteal
reaction
• A) cortical bone destruction
with out periosteal reaction.
• B) Laminated periosteal
reaction with destruction of
cortical bone and new
periosteal bone.
• C) Destruction of cortical bone
with periosteal reaction at the
periphery forming the
CODMAN’S triangle.
• D) Spiculated or sun ray
appearance type of periosteal
reaction.

Bone destruction around existing tooth ,producing a
appearance of teeth floating in a space.

• CARCINOMAS:
• Squamous cell carcinoma arising in soft tissue:
• Also called epidermoid carcinoma.
• Most common oral malignancy , which originating from
surface epithelium
• Initially by invasion of malignant cells into underlying
CT with subsequent spread into deeper structures and
adjacent bone and regional lymph nodes.
o C/F :
o Males are affected than females.
o Appears initially as white or red irregular patchy lesion.
o Later exhibit central ulceration with indurated border .
o Regional lymphadenopathy and hard lymph nodes.
o Soft tissue mass, paraesthesia, foul smell , weight loss.
o most squamous cell carcinoma occurs in 50 yrs.

Clinical picture of squamous cell carcinoma

R/G findings:
Location: commonly involves the lateral border of tongue.
 common site for bony invasion is post lingual aspect of
mandible.
 Also seen on gingiva, soft palate, buccal vestibule, less
commonly hard palate.
Periphery and shape:
 producing a R/L that is polymorphous , irregular, ill-
defined ,non-corticated border.
 The border may appears as smooth indicates erosion
rather than invasion.
 Bone involvement is extensive ,the periphery appears to
have finger like extensions .

Internal structure: Totally radiolucent, sometimes small
islands of normal trabecular bone are visible.
Effects on surrounding structures:
 Invasion of bone around the tooth may 1st appears
as widening of PDL space with loss lamina dura.
 Teeth may appears to float in R/L mass, grossly
displaced from their position
 Tumours may grow along the neurovascular canal,
mental foramen resulting in inc in the width and loss
of cortical boundary.
 The inferior border of mandible is thinned.

R/G picture of squamous cell carcinoma

Squamous cell carcinoma arising from
soft tissue

SCC arising from soft tissue

Differential diagnosis::
Osteomyelitis- Produces some periosteal bone
reaction , where scc does not.
Periodontal disease
Osteoradionecrosis
Management:
Usually combination of chemotherapy and
radiotherapy.

Squamous cell carcinoma originating in bone:
Also called primary intra osseous carcinoma, intra
alveolar carcinoma, central squamous cell carcinoma,
primary odontogenic carcinoma .
It is a SCC arises with in the bone and has no
original connection with the surface epithelium.
Etiology:
Remnants of odontogenic epithelium
Carcinoma from surface epithelium
Odontogenic cysts.

• Clinical findings: More common in males, 4th -8th decade.
• Rare neoplasms and may remain silent until they have
reached large size.
pain, pathological fracture, paraesthesia,
lymphadenopathy.
R/G FINDINGS::
Location: Mandibular molar region is mostly involved.
B/c these lesion associated with remnants of dental
lamina , it originates tooth bearing portions of jaw.
Periphery and shape: Ill-defined R/L and have a border
demonstrates osseous destruction, and varying degrees of
extensions.
Internal structure: completely radiolucent.

Effects on surrounding structures: capable of
destruction of antral and nasal floors.
Sometimes loss of lamina dura.
Differential diagnosis
If the lesions are not aggressive –
periapical granuloma
periapical cysts
If lesion is aggressive :
multiple myeloma
Fibrosarcoma
Management:
tumours are excised with surrounding normal
bone.

R/g picture of intra alveolar carcinoma:

Squamous cell carcinoma originating in a cyst:
• Also called epidermoid cell carcinoma and carcinoma existing
odontogenic cyst.
• May arise from inflammatory periapical ,residual ,dentigerous and
OKC.
Clinical findings :
Pain-dull pain of several months duration.
Regional lymphadenopathy
R/G findings:
Location:
Most commonly mandibular tooth bearing portions
Initial lesion: Well-defined round to oval ,even corticated.
Advanced lesions : Ill-defined and lacks cortication.

Internal structure:
completely R/L.
Thinning and destroying the lamina dura of adjacent
tooth lamina dura and adjacent cortical boundaries.
Differential diagnosis:
Infected dental cyst- Usually show a reactive peripheral
peripheral sclerosis.
Multiple myeloma
Metastatic disease- It is commonly multifocal.
Management:
Surgical excision of tumour with surrounding normal bone.

Carcinoma arising from pre existing dentigerous
cyst

Central muco epidermoid carcinoma:
o Also called mucoepidermoid carcinoma.
o It is epithelial tumour arising from bone likely originating
from pluripotent odontogenic epithelium .
Clinical findings:
More likely to mimic benign tumour or cyst.
Painless swelling, facial asymmetry.
Tenderness, paraesthesia.
More common in females.
R/G findings:
Location:
Mandibular premolar and molar region.
Occurs above the mandibular canal.

unilocular or multilocular.
Border is well-defined and well-corticated.
Internal structure:
Being multilocular or honey coomb or soap bubble
appearance. compartments separated by thin or thick
cortical septa
Effects on surrounding structure:
Expansion of adjacent bony walls. Buccal and
lingual cortical plates , inferior border of mandible,
usually intact or may be thinned and grossly displaced.

Central muco epidermoid carcinoma producing a multi
locular appearance

Other conditions which producing soap-bubble
pattern:
Ameloblastoma
Aneurysmal bone cyst
Central haemangioma
Other conditions which produce honey-coomb
pattern:
CEOC
Haemangioma
Central giant cell granuloma

• D/D:
Ameloblastoma
Odontogenic myxoma
Glandular odontogenic tumour
CGCG
Management:
Surgical treatment with en bloc resection.

• Malignant ameloblastoma and ameloblastic
carcinoma:
It is ameloblastoma with typical benign histologic
features ,it is malignant b/c of biologic behaviour
,metastasis.
Ameloblastic carcinoma is an ameloblastoma exhibiting
the histologic criteria of malignant neoplasm such as
incrased and abnormal mitosis.
Clinical findings:
1st to 6th decades of life.
• More common in males.
• Exhibit a hard expansile mass with displaced or
loosened tooth.
• Tenderness
• Metastatic spread into lymph nodes, lungs and other
viscera.

• R/G findings:
• Most common in man premolar and molar area
• A well define border with cortication .
• May show sub sequent breaching into adjacent tissue.
• Unilocular or multilocular (honey coomb or soap
bubble appearance)
• Septa are robust and thick.
• Root resorption .
• May erode lamina dura .
• Displace maxillary sinus, floor of the nose.

R/G appearance of ameloblastoma

Benign ameloblastoma
Odontogenic keratocyst
Odontogenic myxoma
Centrl muco epidermoid tumour
CGCG- if patient is young and lesion is located
anterior to 2nd molar.
Management:
Enbloc surgical resection.

Metastatic tumours: (secondary malignancy)
o Establishment of new foci of malignant disease from
distinct malignant tumour usually by the way of blood
vessels.
o metastatic lesions of jaw usually arise from sites
inferior to clavicle.
o most frequently tumour is type of carcinoma.
o most common primary sites are breast, kidney, lung,
prostate, testes ,ovary ,cervix .
Clinical findings:
5th to 7th decades of life.
Dental pain, numbness ,paraesthesia.
Haemorrhage from tumour site.

R/G findings:
Location:
posterior mandible is most commonly affected
maxillary sinus
anterior hard palate
mandibular condyle
some of located in PDL space mimicking periapical
conditions or papilla of developing tooth.
ill-defined margins with lack of cortication.
prostate and breast cancers may stimulate bone
formation of adjacent bone- appears sclerotic.

Internal structure:
normally total R/L.
Breast and prostate cancers- area of patchy
sclerosis b/c of new bone formation.
irregular widening of PDL space.
may stimulate periosteal reaction that usually takes
the form of speculated pattern(prostate and
neuroblastoma).

• Multiple myeloma:
• Border is usually
circumscribed
• Periapical
inflammatory disease:
• PDL space widening is
greatest and centred over
apex of the tooth
• Malignant tumour:
Irregular widening may
extend into side of root.

Metastatic tumours of maxillary anterior
region

Metastatic tumours in posterior man
region

Management:
it indicates poor prognosis.
treatment may be in the form of:
chemotherapy
radiotherapy
surgery

Sarcomas:
Osteosarcoma:
Also called osteogenic sarcoma.
it is a malignant neoplasm of bone which osteoid is
produced directly by malignant stroma as adjacent
reactive bone formation.
major histologic types are;
chondroblastic
osteoblastic
fibroblastic
cause is unknown, but gene mutation and viral cause
may suggested.

• C/F:
• is more in males, most common symptom is swelling
which is rapid.
• -There may be pain, tenderness, erythema of overlying
mucosa, ulceration, loose teeth, epistaxis and trismus.
• -Peak age incidence is between 30-40 years .
• -Posterior part of mandible is most commonly affected
followed by posterior part of maxilla.
• -It is the most common intra-osseous malignant jaw
tumour.

• R/G findings:
• Location;
• Mandibular posterior tooth bearing areas and ramus,
angle region.
• The lesion may cross the midline.
• Periphery and shape:
• Ill defined border with no peripheral border and
encapsulation.
• If periosteum is involved- typical sun ray or hair on end
appearance.
• If periosteum is elevated and breaches in center a
codman’s triangle is formed at the edges.

• Internal structure:
• Radiolucent , radiopaque, or mixed.
• Effects on surrounding structures:
• Symmetric widening of PDL space- GARRINGTON’S
SIGN(early effect)
• May destroy the walls of neurovascular canal, loss of
adjacent lamina dura

• R/G types:
• Osteolytic: no neoplastic bone formation
• Osteosclerotic: neoplastic bone is formed
• Mixed lytic and sclerotic: Patches of neoplastic bone.
• Later features:
• Osteolytic lesion:
• Monolocular ragged area of R/L,
• Poorly defined moth-eaten appearance.
• So called spicking resorption , and loosening of
associated tooth
• Osteosclerotic and mixed types:
• Poorly defined R/L area.
• Distortion of alveolar ridge.

R/G pictures of osteosarcoma

R/G picture of osteosarcoma(irregular
bone destruction)

Osteo sclerotic type of osteosarcoma

Osteosacoma showing sunray
appearance

Fibrosarcoma
metastatic carcinoma
chondrosarcoma
Ewing sarcoma
Osteomyelitis
Fibrosarcoma
Management:
Surgical excision with adjacent normal bone

Chondrosarcoma:
chondrogenic sarcoma
Malignant tumour of cartilagenous origin.
It occurs centrally with in the bone ,peripheral to bone rarely with
in the soft tissue.:
• C/F:
• Affects any age mean age is 47 yrs.
• They affect males & females equally.
• The patient may have a firm or hard mass of relatively long
duration(Starts as a painless hard or firm swelling of the bone
which later produces extensive bone destruction).
• Enlargement of these lesions may cause pain, headache, and
deformity
.

R/G findings:
Location;
Oral lesions affects only 10% of cases.
• Occurs equally in both jaws.
• In maxilla it affects the cartilagenous area which is the anterior
maxilla,while in the mandible it affects the condylar head and neck
as well as the coronoid processes.
• Periphery and shape:
slow growing-misleading to benign tumours.
well-defined , round, oval, sometimes lobulated with corticated
border.
sometimes peri osteal new bone formation occurs- sunray or
hair on end appearance.
uncommonly ill defined, non corticated border.

• Some form of calcification in center – mixed R/L and R/O.
• Rarely completely R/L.
• The central R/L structure has been described as flocculent
implying snowlike features.
• The diffuse calcification may superimposed on bony back
ground that resembles granular or ground glass appearance.

• Being, often expands normal cortical boundaries
rather than rapidly destroying them.
• The inferior border of mandible or alveolar process
may be grossly expanded while still maintaining its
cortical integrity.
• Similar to benign tumors,if lesions occur near teeth,
root resorption and tooth displacement may occur, as
may widening of the PDL space.

Chondrosarcoma of ant maxilla with
irregular calcifications

osteosarcoma-
Typical calcifications are absent in osteosarcoma.
fibrous dysplasia:
Both are similar internal pattern.
The R/O portion of fibrous dysplasia is abnormal bone not
calcification, The calcification in chondrosarcoma is calcified cartilage.
Management:
may be surgical , radiotherapy and chemotherapy.

Ewings sarcoma:
Epithelial myeloma or round cell sarcoma
Tumour of long bones rare in jaws, arises in medullary portion of
bone.
C/F:
males are most commonly affected, 2nd decade of life(5 and 30 yrs).
swelling ,pain , loose tooth, paraesthesia, epistaxis, ulceration ,
trismus.
cervical lymphadenopathy

R/G findings:
Location:
mandibular and maxillary posterior areas are mostly
affected.(very rare in jaws)
periphery and space:
solitary, poorly defined , ragged border.
Internal structure:
usually total radiolucent.
Effect on surrounding structures:
it stimulates periosteum to produce new bone takes the form of
ONION SKIN appearance .Osteophytic formation may also be
visible may be similar to sunray appearance.

R/G of ewing’s sarcoma

osteomyelitis
Eosinophilic granuloma
management:
surgery, chemotherapy ,radiotherapy combination or alone.

Fibrosarcoma:
Neoplasm composed of malignant fibroblasts that produce
collagen and elastin.
C/F:
males and females affected equally, 4th decade.
A slowly to rapidly enlaring mass
The mass may be inside bone causing pain, or peripheral
causing a bulky swelling.
If enlarges in size,it may cause pathological fracture.

R/G findings:
Location:
mostly mandibular premolar and molar region.
periphery and shape:
• They have ragged, ill-defined borders, poorly demarcated,
noncorticated and tend to be elongated through the marrow
space.
If soft tissue lesions occur adjacent to bone, they may cause a
saucer-like depression in the underlying bone or invade it as would
a squamous cell carcinoma.
•
Sclerosis may occur in the adjacent normal bone whether the
sarcoma is peripheral or central

Internal structure:
Totally radiolucent
Effect on surrounding structures:
It is characterized by destroying adjacent structures. In the
mandible, inferior border, alveolar processes and corticesof IAC
are lost.
In the maxilla, floor of sinus and nasal floor can be destroyed.
Lamina dura are lost, teeth are grossly displaced and appear
floating in place.

Fibrosarcoma of mandible with ill defined
bone destruction

D/D:
metastatic carcinoma
multiple myeloma
Ewings sarcoma
primary and secondary intra osseous carcinoma
squamous cell carcinoma
Management:
surgical treatment

Malignancies of hematopoietic system:
Multiple myeloma:
plasma cell myeloma, plasmscytoma
It is a malignant neoplasm of plasma cells.
Most common malignancy of bone in adults.
Single lesions are called- plasmacytoma
Multiple lesions are called- multiple myeloma
C/F:
3rd to 7th decades of life.
Fatigue, weight loss, fever, bone pain, anemia.
Typical feature is low back pain.
Secondary signs: Amyloidosis, hypercalcemia
Bence-jones proteins may appear in urine.

Intra oral c/f:
Dental pain, swelling, paraesthesia, dysesthesia
R/g findings:
Location:
more common in mandible posterior region.
Incidence of jaw involvement 2 to 78%
Periphery and shape;
It has a well-defined border but not corticated with no signs of
bone reaction. It appears "punched-out". Many tumors appear ragged
and infiltrative, some lesions have an oval or cystic shape.

• No internal structure is radiographically visible,it is radiolucent.
Occasionally islands of residual bone within the mass may be
detected.
• Effect on Surrounding Structures:
• If enough mineral is lost, teeth appear to be "too opaque". Lamina
dura and follicles of impacted teeth may lose their typical corticated
surrounding bone.
• Mandibular lesions may cause thinning of the lower border of the
mandible or endosteal scalloping .
• All these features may be profound if there is renal failure
accompanying the case.

D/D:
metastatic diseases
Eosinophilic granuloma
osteomyelitis
Hyperparathyroidism
Gauchers disease
Management:
chemotherapy with or without bone marrow transplantation.

Other conditions where generalised rarefaction of jaw bones
are seen:
Hyperparathyroidism
Multiple myeloma
Osteoporosis
Leukemia
Rickets
Sickle cell anaemia

Multiple myeloma of ramus(multiple R/L
S)

Multiple myeloma typical punched out
radiolucency

Non- hodgkins lymphoma:
Malignant lymphoma and lymphosarcoma.
• It is a malignant tumor of cells normally resident in the lymphatic
system.(Malignant lymphomas are a group of immunologic
neoplasms which arise in lymphoid tissue).Most non-Hodgkin's
lymphomas of the head and neck occur in the lymph nodes.
• In general, all lymphomas occur within lymphnodes, however,
extranodal sites such as bone, skin and tonsils can be involved.
• Based on histologic appearance divided into:
• low- grade
• Intermediate grade
• High grade

C/F:
• It occurs in all age groups specially middle and older age groups,
but rare in patients in the first decade.
• The maxillary sinus, palate, tonsillar area, and bone may be sites of
primary or secondary lymphoma spread.
• Patients may experience night sweats ,fever, pruritus ,painless
enlargement, weight loss ,anaemia, anorexia and generalizes
weakness.
• Isolated lesions of the jaws may be accompanied by palpable
painless swelling and lymphadenopathy.
• Teeth resident in a lymphoma may become mobile as the
supporting bone is lost
•

R/G findings:
Location:
Those that are extranodal affects maxillary sinus, post mandible.
initially shape of host bone
Later it is ill defined ,invasive , ill defined and lack of corticated
border.
it is generally invasive.

Internal structure:
Entirely radiolucent.
Destroy the cortex and neurovascular canal .
Tumour has potentially grow along the PDL space of mature
tooth.
Tooth may displaced from their former positions.
D/D:
Multiple myeloma
Metastatic carcinoma
Osteolytic osteosarcoma
Leukemia

Non hodgkins lymphoma of maxilla with
loss of anterior part of maxillary antrum

Non hodgkins lymphoma (ill defined bone
destruction)

Management:
Depends on location and extent of disease.
Radiation therapy with or without chemotherapy.

Burkitts lymphoma:
African jaw lymphoma
It is a high grade b-cell lymphoma.
Two forms:
African jaw lymphoma- affects young children
American form- affects young adults
C/F:
It affects males more than females , maxilla more than mandible
Very rapid in growth.
Very young ages are affected ;a disease of childhood &
occasionally young adults.
Jaw tumour are rapidly growing and cause facial deformity very
early in their course.
They are capable of blocking nasal passages, displacing orbital
contents, causing gross facial swelling, and eroding through skin.

Teeth may become loosened rapidly, grossly-displaced and
alveolar bone grossly distended.
Paraesthesia of the inferior alveolar nerve or other facial
nerves is common.
R/G findings:
Location:
African type: may involve one jaw or both the jaws and
affects the posterior parts of jaws.
American type: not involve the facial bones but are more
likely to involve abdominal viscera and testes.

may begin as multiple ill defined radiolucencies that later
coalesce into larger ill-defined radiolucencies with an expansile
periphery.
This expansion breaches its outer cortical plates ,causing gross
balloon like expansion with thinning of adjacent structure and
production of a soft tissue tumour mass adjacent to osseous lesion.
Internal structure:
Does not produce new bone formation, totally radiolucent.
Particularly in children.

Erupted teeth in the area of tumour are grossly displaced.
Tumour cells with in the tooth crypt may displace the developing
tooth bud to one side of crypt.
A tumour that is located apical to a developing tooth may cause
it to be displaced such that it appears to be erupt with little if any
root formation.
Lamina dura is destroyed, maxillary sinus, inferior border of
mandible, nasal floor, orbital floors may be thinned.
If periosteum is involved may show sunray spiculation , this is
rare.

Burkitt lymohoma of maxilla (almost all
anatomical landmarks are lost)

D/D:
cherubism
Metastatic neuroblastoma
Ewing sarcoma
Osteolytic osteosarcoma
Non- hodgkins lymphoma
Management:
Chemo therapeutic agents

Leukaemia:
It is a malignant tumour of hematopoietic stem cells.
Types:
Acute and chronic
Acute: affects the very young patients and very old patients are most
commonly affected.
Associated with chromosomal abnormalities.
c/f:
chronic cases may have no presenting symptoms.
Acute type:
weak ness, bone pain , pallor
Spontaneous haemorrhage
hepatomegaly , splenomegaly, fever, lymphadenopathy

Oral symptoms:
loose teeth, petechiae , ulcerations.
Enlarged gingiva
R/G findings:
Location:
Affects the entire body b/c malignancy of bone marrow , which
discharges malignant cells into circulating blood.
May be localized around the periapical region.
Radiological features may be bilateral as ill-defined radiolucent
areas.
with tine these patchy areas may coalesce to form larger areas
of ill-defined radiolucent regions of bone.

Internal structure:
Patchy radiolucency and generalised radiolucencies of
bone.(generalised rerefaction of jaw bones)
occasionally foci of leukemic cells may be present as a mass that
behave like a malignant tumour, these lesions are called
chloromas, rare in jaws.
Effects on surrounding structures;
The lamina dura and cortical outlines of follicles may be
effaced.
Developing tooth may be displaced in occlusal direction.

R/G of leukemia- loss of lamina dura

D/D:
Metabolic disorders
Rarefying osteitis
Lymphoma and neuroblastoma(occassionally)
Management:
combination of chemotherapy with or without autologous bone
marrow transplantation.

• REFERENCES:
• STUART C. WHITE , MICHAEL J.PHAROAH – ORAL
RADIOLOGY principles and interpretation
• SHAFER’S oral pathology- 5th edition
• ERIC WHAITES- Essentials of dental radiography and
radiology , 3rd edition

Malignant diseases of the jaws / dental courses

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