Malignant

Disease of
The Jaws
Suzan Raheb Elmansour
Co-ordinator: DR. Mustafa
Al-Khader

Outline

Carcinomas: lesions of epithelial origin (most commonly

encountered in dental practice)
Squamous cell carcinoma arising in soft tissue
Squamous cell carcinoma originating in bone
Squamous cell carcinoma originating in a cyst
Squamous cell carcinoma originating in the maxillary sinus
Central mucoepidermoid carcinoma
Malignant ameloblastoma and ameloblastic carcinoma

Metastatic: lesions from distant sites

Sarcomas: lesions of mesenchymal origin
Osteosarcoma
Chondrosarcoma
Ewings sarcoma
Fibrosarcoma

Malignancies of the hematopoietic system:

Multiple myeloma
Non-hodgkins lymphoma
Burkitts lymphoma
leukemia

Disease mechanism
Uncontrolled
tissue growth

Destructiv
e

Rapidely
growing

Cellular
anaplasia

Classified as (histopathologicly) :
1.Primary tumors(de novo)
2.Secondery/metastatic (distant
primary tumors)

Metastasize
regionally to
lymph node

Squamous cell carcinoma arising in

soft tissue (epidermoid carcinoma)
Most common oral malignancy
Originated from surface epithelium
Etiology : Appears to be
multifactorial(chronic
( smoking , alcohol

Clinical
feature

Most common in males

older than 50

soft tissue mass

regional
lymphadenopat
hy(hard lymph
node)

indurated borders(hard
borders)

Pain
Foul smell
Trismus
Groosly
loosened
teeth
Hemorrhage

white or red
irregular patches

infiltration into
adjacent muscles
and bone

Imaging features
Location:
Commonly involves the lateral border of the
tongue
Lesions of the lip and FOM invade the anterior
mandible

 Periphry and shape :

Erode into underlying bone from any direction
producing a radiolucency (polymorphous&irregular)
Invasion (50%) ill-defined&noncorticated
borders.

Internal structures:
Totally radiolucent

Destruction of the anterior

floor of the nasal fossa

Destruction of the lateral

ect on the surrounding structures :

Invasion of
bone around
the teeth
appear as
widening of
PDL with loss
of the
adjacent
lamina dura

Defferential diagnosis

Inflammatory lesions (osteomyelitis) .1

Osteoradionecrosis (patient has had prior malignancy .2
> periosteal reaction is abcent)
Periodontal diseases .3

:Management
Combination of surgery and radiotheraby
Adequate margin of normal tissue can be
obtained : surgery then radiotherapy
Chemotheraby as an adjunct

Squamous cell carcinoma originating

in bone(primary intraosseous
carcinoma)
Arising from intraosseous remmnants of
odontogenic epithelium (no original connection with surface
epithelium of the oral mucosa)

Clinical
:featuresPain

pathologic
fracture
sensory
nerve
abnormalities
(lip
parasthesia),l
ymphoadeno
pathy

common
in men
(30-79 in
age)

silent until
reach
large size

Imaging features
Location:

More common in the mandible in the molar

region
Originates only in tooth-bearing parts of the jaw

:Internal structure
Wholly radiolucent
(no bone production)

Periphery and shape:

Most lesions are ill-defined
Rounded/irregular shape and have border that
demonstrates osseous destruction
If sufficient in size pathologic fracture occurs >
thinned cortical borders + soft tissue mass

Effect on surrounding structures:

Destruction of antral or nasal floors
Loss of the cortical outline of the mandibular
neurovascular canal
Loss of lamina dura+supporting bone(teeth are
floating)

:Differential diagnosis
Periapical cysts/granuloma. 1
Odontogenic cysts/tumors. 2
Metastases. 3
Multiple myeloma. 4
Fibrosarcoma. 5
Scc arising in dental cysts . 6
Scc arising in soft tissue. 7

:Management
Excision with the surrounding osseous structures in
an en bloc resection
Radiation and chemotherapy as adjunct

Squamous cell carcinoma

originating in a cyst
Arising in preexisting dental cyst
Arise from inflammatory periapical , residual ,
dentigerous and keratocytic odontogenic tumors
The lining squamous epithelium of the cyst
gives rise to the malignant neoplasm
(Histologically)

Clinical
features:
fistul
a

lymp
hoad
enop
athy

Path
ologi
cal
fract
ure
PAIN(
dull&s
everal
month
s
durati
on
Sinu
s
swel
ling

swell
ing

Sinus
pain

Imaging features
Location:
commonly occur in the mandible(can occur anywhere
an odontogenic cyst is found)

Internal
:structure
Wholly
radiolucent
Lacks
any
ability to
produce
bone

Periphery and shape:

Round/ ovoid(because it arises from a cyst)
small lesion > well defined&even corticated
malignant tissue replaces cyst lining > the
smooth border become ill-defined
advanced lesions(ill-defined, infiltrative, lacks
cortication > it is shape(less hydraulic&more
diffuse)

Effects on surrounding
structures:
Thinning&destroying the lamina dura of the
adjacent Teeth/adjacent cortical
bounderies(inferior border of the mandible,floor of
the nose)
complete destruction of the alveolar process

Defferential diagnosis :
1.
2.
3.
4.
5.

Infected dental cyst

Multiple myeloma
Metastatic diseases
Scc arising in soft tissue
Scc arising in bone

Management:
Excision in an en bloc resection
Radiation and chemotherapy as adjunct

Squamous cell carcinoma originating in the

maxillary sinus
Risk factors for developing SSC include:
1-chronic sinusitis, 2-chemicals(volatile
hydrocarbones , isopropyl oils), 3-wood dust, 4metals (nickel , chromium)

Clinical features:
Common in patients of African&
Asians
Men are more affected

Imaging features:
Opacification of the maxillary
sinus

Destruction of osseous
structures bordering the
maxillary sinus

THANK YOU