Malignant Disease of The Jaws

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 carcinomaMetastatic: lesions from distant sitesSarcomas: lesions of mesenchymal origin Osteosarcoma Chondrosarcoma Ewings sarcoma FibrosarcomaMalignancies of the hematopoietic system: Multiple myeloma Non-hodgkins lymphoma Burkitts lymphoma leukemiaDisease mechanismClassified as (histopathologicly) :1.Primary tumors(de novo)2.Secondery/metastatic (distant primary tumors)Squamous cell carcinoma arising in soft tissue (epidermoid carcinoma)Most common oral malignancyOriginated from surface epitheliumEtiology : Appears to be multifactorial(chronic smoking , alcohol)

Most common in males older than 50 PainFoul smellTrismusGroosly loosened teethHemorrhagesoft tissue massindurated borders(hard borders)white or red irregular patchesinfiltration into adjacent muscles and boneregional lymphadenopathy(hard lymph node)Clinical featureImaging featuresLocation: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 cortical plate

Effect on the surrounding structures : Invasion of bone around the teeth appear as widening of PDL with loss of the adjacent lamina duraDefferential diagnosis1. Inflammatory lesions (osteomyelitis) 2. Osteoradionecrosis (patient has had prior malignancy > periosteal reaction is abcent)3. Periodontal diseasesManagement: 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 features:Imaging featuresLocation: 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:1. Periapical cysts/granuloma2. Odontogenic cysts/tumors3. Metastases 4. Multiple myeloma 5. Fibrosarcoma6. Scc arising in dental cysts 7. Scc arising in soft tissue 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:Imaging features Location:commonly occur in the mandible(can occur anywhere an odontogenic cyst is found)

Internal structure:Wholly radiolucentLacks any ability to produce bonePeriphery 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. Infected dental cyst 2. Multiple myeloma3. Metastatic diseases4. Scc arising in soft tissue 5. Scc arising in boneManagement: 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, 4-metals (nickel , chromium)Clinical features:

Imaging features:

Destruction of osseous structures bordering the maxillary sinusOpacification of the maxillary sinusTHANK YOU