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TABLE OF CONTENTS
Introduction ......................... 1
Objectives ........................... 1
Recommended Preparation .............. 2
I. Anatomy ........................ 3
II. Functions ..................... 4
III. Origin of Mandibular Tumors .... 4
IV. Pathology of Mandibular Tumors . 5
V. Functional Classification ...... 9
VI. Clinical Evaluation ............10
A. Physical Examination
B. Radiography
C. Biopsy
VII. Treatment ......................13
VIII. Operative Procedures ...........14
A. Extirpative
B. Reconstructive
IX. To Whom To Refer ...............16
References ...........................17
Post-test ............................19
Answers to Post-test .................24
Recommended Follow-up ................26
About the Author .....................26
Primary intended
medicine.
users -
Students of
INTRODUCTION
A
series of
self-instructional
programs has been designed to cover all
aspects in the management of patients
with mandibular tumors. This program is
the first part in the series.
It
discusses
the
generalities
and
principles related to diagnosis
and
treatment of mandibular tumors.
The
basic information given here provides
the
necessary
background
for
the
subsequent parts in the series.
OBJECTIVES
Upon completion of this program,
the user should be able to:
1. Identify the different parts of
the mandible.
2. Enumerate the functions of the
mandible.
3. List
the
elements
in
the
mandible which can be sources of tumor
formation.
4. Diagram a functional classification of mandibular tumors.
5. Compare the relative frequencies
between:
5.1 Benign and malignant mandibular tumors.
5.2 Benign odontogenic and nonodontogenic tumors.
5.3 Malignant odontogenic and
non-odontogenic tumors.
6. Name two diseases under each
category:
1
6.1
6.2
RECOMMENDED PREPARATION
A basic knowledge of anatomy and
pathology is necessary for the user to
obtain
maximum
benefit
from
this
program.
2
the
mandible
are
are
However,
in medical parlance,
nonodontogenic
tumors refer to
tumors
arising from the mandibular bone itself.
malignant
nonosteosarcoma and
Table
2. Classification of Odontogenic
Tumors
---------------------------------------Epithelial Odontogenic Tumors
Minimal
inductive
change
in
connective tissue
1. Ameloblastoma
2. Adenomatoid
odontogenic
tumor
3. Calcifying
epithelial
odontogenic tumor
Marked
inductive
change
in
connective tissue
1. Ameloblastic fibroma
2. Ameloblastic fibrosarcoma
3. Complex odontoma
4. Compound odontoma
Mesodermal Odontogenic Tumors
1. Myxoma
2. Odontogenic fibroma
3. Cementoma
a. Periapical
cemental
dysplasia
b. Benign cementoblastoma
c. Cementifying fibroma
d. Familial
multiple
(gigantiform) cementomas
---------------------------------------Source:
Based on classification
of
Pindborg and Clausen; modified by Gorlin
RJ, Goldman HM (eds): Thoma's
Oral
Pathology, 6th ed. St. Louis: The C.V.
Mosby Co., 1970.
Tissue
Tumors
of
Histiocytic
Fibrohistiocytic Origin
Malignant fibrous histiocytoma
Histiocytosis X
and
tumors
V.
FUNCTIONAL
CLASSIFICATIONS
MANDIBULAR TUMORS
OF
clinical
evaluation
tumors relies mainly on
of
the
1. Physical examination
2. Radiography
3. Biopsy
A. PHYSICAL EXAMINATION
The physical examination is the
first examination that will suggest that
a tumor on the face is mandibular in
origin.
A physician seeing a tumor in the
lower jaw area should right away think
of a possible mandibular tumor.
Upon
palpation, if the consistency is bony
hard, the said physician should all the
more suspect a mandibular tumor.
10
B. RADIOGRAPHY
To confirm the mandibular origin of
the tumor, radiography should be done.
There are two types of radiography that
can be done on the mandible. One is the
panorex
or panoramic view of
the
mandible.
The
other
is
the
anteroposterior
and
lateral-oblique
views of the mandible. Each type of
radiography is as good as the other with
all its inherent limitations.
Beside confirming the mandibular
origin of the tumor through the presence
of
some
abnormal changes
in
the
mandible, the radiograph can also give
suggestions as to the possible type of
tumor
based
on
the
radiographic
findings.
The tumor on X-rays may be radioopaque or radiolucent. Some tumors are
characteristically radio-opaque
while
some are radiolucent.
The tumor may be a unilocular or
multilocular radiolucency. It may be a
unilocular radiolucency located at the
apex of a tooth, in which case, a
radicular cyst is suspected. It may be
a radiolucency at the crown of
an
impacted
tooth, in which
case,
a
dentigerous cyst is suspected. It may
be a multilocular radiolucency
with
soap-bubble
appearance
without
any
definite relation to the teeth, in which
case, an ameloblastoma is suspected.
11
12
Currettage
Excision
Marginal mandibulectomy
Segmental mandibulectomy
14
15
16
REFERENCES
1. Browne GA: Odontogenic
tumors and
tumors of the bone. In McQuarrie DG,
Adams GL, Shons AR, Browne GA (eds):
Head
and
Neck
Cancer.
Clinical
Decisions and Management
Principles.
Chicago: Year Book Medical Publishers,
Inc. 1986, p. 334-346.
2. Ellis
E
III:
Management
of
odontogenic
cysts and
tumors.
In
Thawley
SE,
Panje
WR
(eds):
Comprehensive Management of Head and
Neck
Tumors.
Philadelphia:
W.B.
Saunders, Co. 1987, p. 1446-1483.
3. Gorlin RJ: Odontogenic tumors.
In
Gorlin RJ, Goldman HM (eds): Thoma's
Oral Pathology, 6th ed. St. Louis: The
C.V. Mosby Co., 1970.
4. Greer RO Jr, Rohrer MD, Young SK:
Clinical evaluation and pathology. Nonodontogenic tumors.
In Thawley
SE,
Panje WR (eds): Comprehensive Management
of Head and Neck Tumors.
Philadelphia:
W.B. Saunders, Co. 1987, p. 1510-1559.
5. Lawson W, Loscalzo LJ, Baek S, Biller
HF, Krespi YP: Experience with immediate
and delayed mandibular reconstruction.
Laryngoscope 1982, 92:5-10.
6. Lore JM Jr: An Atlas of Head and Neck
Surgery, 3rd ed. Philadelphia:
W.B.
Saunders, Co. 1988, p. 562-601.
17
18
POST-TEST
DIRECTION: Identify the different
of the mandible by filling in the
in the blanks provided.
19
parts
names
Mandibular Tumors
8.........l 9...........
l
Origin of tumor 10.......l 12.........
11.......l 13.........
Types of cancer
l
based on origin
l
14........
l
15........
DIRECTION:
Match
the
radiographic
findings on the mandible in Column A
with the interpretations in Column B.
Place the appropriate letter in the
blanks provided.
Column A
---16. Sunburst
appearance
---17. Unilocular
radiolucency
at apex of
tooth
---18. Soap-bubble
appearance
---19. Lytic
changes
---20. Radiolucency
at crown of
an impacted
tooth
---21. Reparative
changes
---22. Sequestrum
20
Column B
A. Malignant tumor
B. Ameloblastoma
C. Dentigerous
cyst
D. Radicular cyst
E. Osteosarcoma
F. Inflammatory
lesion
G. Osteomyelitis
Ameloblastoma
A. Operative
Small osteoma
B. Non-operative
Huge osteoma
Radicular cyst
Dentigerous cyst
Osteosarcoma
Chondrosarcoma
Osteomyelitis
Radicular cyst
Dentigerous cyst
Gingival cancer
(1 cm.)
___34. Osteosarcoma
___35. Chondrosarcoma
___36. Huge ameloblastoma
A. Currettage
B. Excision
C. Marginal
mandibulectomy
D. Segmental
mandibulectomy
DIRECTION:
Compare
the
relative
frequency of the following mandibular
tumors. Place the appropriate letter in
the blanks provided using the key below:
A
B
if
if
___37. A.
B.
___38. A.
B.
___39. A.
B.
A is more common
B is more common
Benign tumors
Malignant tumors
Benign odontogenic tumors
Benign non-odontogenic tumors
Malignant odontogenic tumors
Malignant
non-odontogenic
tumors
21
DIRECTION:
answers.
Supply
the
appropriate
functions
of
radiographic procedures
be done to study the
22
55.
56.
23
two
can
a
types
of
be
used
mandibular
Condyloid process
Coronoid process
Ascending ramus
Alveolar processes or ridges
Mentum
Body
Angle of the mandible
Benign
Malignant
Odontogenic or non-odontogenic
Non-odontogenic or odontogenic
Odontogenic
Non-odontogenic
Primary
Secondary
E
D
B
A
C
F
G
A
B
A
A
A
A
A
A
24
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
42.
43.
44.
45.
46.
47.
48.
49.
50.
51.
52.
53.
54.
55.
56.
57.
58.
59.
60.
B
B
C
D
D
D
A
A
B
Facial contour
Masticatory function
Bone
Tooth
Soft tissue (gingiva)
Dentigerous or radicular cyst
Ameloblastoma
Osteoma
Ossifying fibroma
Osteosarcoma
Chondrosarcoma
Inspection - tumor at lower jaw
area
Palpation - bony consistency of
the tumor
Panorex view
Anteroposterior
and
lateraloblique views
Need
for a more
definitive
diagnosis prior to a decision
on the treatment
Surgeons with a subspecialty in
head and neck surgery
Restoration of facial contour
Restoration
of
masticatory
function
Bone graft
Prosthesis
25
RECOMMENDED FOLLOW-UP
After
completing
this
selfinstructional
program, the user
is
advised to discuss this program with his
teachers as well as his peers.
He is
also strongly advised to proceed to Part
II, which presents illustrative cases.
If he
is interested and if he is a
surgeon or a surgeon-to-be,
he
can
proceed
to
Part III, which is on
surgical decision-making.
COPYRIGHT, 1992
26