Oncostomatology: statistics, Oncostomatology: statistics, organization of medical service, organization of medical service,

centre system of health. centre system of health. Classification of tumors of Classification of tumors of

maxillofacial area. High qualities maxillofacial area. High qualities tumors and tumor-like formations of tumors and tumor-like formations of

soft tissue of maxillofacial area soft tissue of maxillofacial area (papilloma, fibroma, (papilloma, fibroma, lіpomalіpoma, ,

hhemangіomaemangіoma, , ateromaateroma, , neyrofіbromatozneyrofіbromatozis, cysts of soft is, cysts of soft tissue): etiology, pathogenesis, tissue): etiology, pathogenesis, histological structure, clinic, histological structure, clinic,

differential diagnostics, treatment differential diagnostics, treatment and prophylaxis of complications.and prophylaxis of complications.

Traumatic fibromaTraumatic fibroma

Traumatic (Irritation) Traumatic (Irritation) Fibroma: Clinical FeaturesFibroma: Clinical Features

Traumatic fibromas appear as firm, Traumatic fibromas appear as firm, asymptomatic nodules covered by asymptomatic nodules covered by epithelium unless secondarily traumatized.epithelium unless secondarily traumatized.

They usually occur along the line of They usually occur along the line of occlusion in the lower lip or buccal occlusion in the lower lip or buccal mucosa; they may, however, be found mucosa; they may, however, be found anywhere in the oral cavity.anywhere in the oral cavity.

These lesions, which are reactive These lesions, which are reactive hyperplasias rather than true neoplasms hyperplasias rather than true neoplasms as suggested by the term fibroma, are very as suggested by the term fibroma, are very common oral lesions.common oral lesions.

Traumatic (Irritation) Traumatic (Irritation) Fibroma: CauseFibroma: Cause

It is a reactive lesion to trauma or It is a reactive lesion to trauma or chronic irritation.chronic irritation.

Although rare according to research Although rare according to research studies, clinically similar lesions may studies, clinically similar lesions may be true neoplasms (fibromas).be true neoplasms (fibromas).

Traumatic (Irritation) Traumatic (Irritation) Fibroma: TreatmentFibroma: Treatment

Surgical excision is the treatment of Surgical excision is the treatment of choice.choice.

Traumatic (Irritation) Traumatic (Irritation) Fibroma: SignificanceFibroma: Significance

This lesion is a reactive one which This lesion is a reactive one which has limited growth potential.has limited growth potential.

No malignant transformation has No malignant transformation has been reported.been reported.

Epulis Epulis FissuratumFissuratumDenture Injury TumorDenture Injury Tumor

Inflammatory Fibrous Inflammatory Fibrous HyperplasiaHyperplasia

Denture EpulisDenture Epulis

Epulis Fissuratum: Clinical Epulis Fissuratum: Clinical FeaturesFeatures

Tumor-like hyperplasia of fibrous connective Tumor-like hyperplasia of fibrous connective tissue associated with denture flange.tissue associated with denture flange.

Presents as fold (s), usually two, with flange Presents as fold (s), usually two, with flange fitting in between.fitting in between.

The lesion is usually firm and fibrous but may The lesion is usually firm and fibrous but may show erythema and ulceration.show erythema and ulceration.

Most common on facial aspect in the anterior Most common on facial aspect in the anterior of either jaw.of either jaw.

It is more common in middle-aged and older It is more common in middle-aged and older females females

(two-thirds to three-fourths of the cases are in (two-thirds to three-fourths of the cases are in females).females).

Epulis Fissuratum: Epulis Fissuratum: CauseCause

Chronic irritation or trauma from Chronic irritation or trauma from denture flange making the lesion a denture flange making the lesion a reactive hyperplasia.reactive hyperplasia.

The denture is typically ill-fitting.The denture is typically ill-fitting.

Epulis Fissuratum: Epulis Fissuratum: TreatmentTreatment

Treatment consists of surgical Treatment consists of surgical removal of excess tissue with removal of excess tissue with microscopic examination and….microscopic examination and….

The poorly fitting denture should be The poorly fitting denture should be remade or relined.remade or relined.

Epulis Fissuratum: Epulis Fissuratum: SignificanceSignificance

Lesion will recur (or remain) if ill-Lesion will recur (or remain) if ill-fitting denture is not remade or fitting denture is not remade or relined.relined.

Papillary Papillary HyperplasiaHyperplasiaInflammatory Papillary Inflammatory Papillary

HyperplasiaHyperplasia

Palatal PapillomatosisPalatal Papillomatosis

Denture PapillomatosisDenture Papillomatosis

(Inflammatory) Papillary (Inflammatory) Papillary Hyperplasia: Clinical Hyperplasia: Clinical

FeaturesFeatures Papillary hyperplasia is a reactive tissue Papillary hyperplasia is a reactive tissue

growth that usually, but not always, develops growth that usually, but not always, develops beneath a denture.beneath a denture.

It typically appears as a painless, It typically appears as a painless, papillomatous, “cobblestone” lesion of hard papillomatous, “cobblestone” lesion of hard palate although occasionally it occurs on the palate although occasionally it occurs on the edentulous mandibular ridge or in association edentulous mandibular ridge or in association with epulis fissuratum.with epulis fissuratum.

The lesion is usually asymptomatic and red The lesion is usually asymptomatic and red because of inflammation.because of inflammation.

It is a common lesion in denture wearers. It is a common lesion in denture wearers.

Papillary Hyperplasia: Papillary Hyperplasia: CauseCause

Soft tissue reaction to ill-fitting Soft tissue reaction to ill-fitting denture and probable fungal denture and probable fungal overgrowth. overgrowth.

Patients generally have poor Patients generally have poor oral/denture hygiene.oral/denture hygiene.

One study indicated approximately One study indicated approximately 20 % of the patients wore their 20 % of the patients wore their dentures 24 hours per day.dentures 24 hours per day.

Papillary Hyperplasia: Papillary Hyperplasia: TreatmentTreatment

In cases of very early inflammatory papillary In cases of very early inflammatory papillary hyperplasia, removal of the denture may allow hyperplasia, removal of the denture may allow the erythema and edema to subside and the the erythema and edema to subside and the tissues may resume a more normal tissues may resume a more normal appearance.appearance.

Lesions may show some improvement after Lesions may show some improvement after topical or systemic antifungal therapy.topical or systemic antifungal therapy.

For advanced cases, excision of the lesion is For advanced cases, excision of the lesion is treatment of choice prior to the fabrication of treatment of choice prior to the fabrication of a new denture.a new denture.

Partial and full-thickness surgical blade Partial and full-thickness surgical blade excision, curettage, electrosurgery and excision, curettage, electrosurgery and cryrosurgery have all been used with success cryrosurgery have all been used with success in particular cases. in particular cases.

Papillary Hyperplasia: Papillary Hyperplasia: SignificanceSignificance

The lesion is not premalignant.The lesion is not premalignant. Following surgery the old denture Following surgery the old denture

can be lined with a temporary tissue can be lined with a temporary tissue conditioner that acts as a dressing conditioner that acts as a dressing and promotes healing.and promotes healing.

After healing, the patient should be After healing, the patient should be encouraged to leave the new encouraged to leave the new denture out at night and to practice denture out at night and to practice good denture hygiene.good denture hygiene.

Peripheral Giant Peripheral Giant Cell GranulomaCell Granuloma

Giant Cell EpulisGiant Cell Epulis

Peripheral Giant Cell Peripheral Giant Cell Granuloma: CauseGranuloma: Cause

This is a reactive lesion associated This is a reactive lesion associated with chronic trauma or irritation.with chronic trauma or irritation.

Peripheral Giant Cell Peripheral Giant Cell Granuloma: TreatmentGranuloma: Treatment

Excision is the treatment of choice Excision is the treatment of choice down to the underlying bone. down to the underlying bone.

Adjacent teeth should be carefully Adjacent teeth should be carefully scaled to remove any source of scaled to remove any source of irritation thus minimizing the risk of irritation thus minimizing the risk of recurrence.recurrence.

Peripheral Giant Cell Peripheral Giant Cell Granuloma:Granuloma:SignificanceSignificance

These lesions will remain indefinitely These lesions will remain indefinitely if not treated.if not treated.

Remember, it is a reactive lesion Remember, it is a reactive lesion similar in clinical appearance to the similar in clinical appearance to the pyogenic granuloma.pyogenic granuloma.

Peripheral Peripheral Ossifying Ossifying FibromaFibroma

Ossifying Fibroid EpulisOssifying Fibroid Epulis

Peripheral Fibroma with Peripheral Fibroma with CalcificationCalcification

Calcifying Fibroblastic Calcifying Fibroblastic GranulomaGranuloma

Peripheral Ossifying Peripheral Ossifying Fibroma (POF)Fibroma (POF)

The POF is a common reactive gingival The POF is a common reactive gingival growth.growth.

Its pathogenesis is best describe as Its pathogenesis is best describe as uncertain; some POFs have been suggested uncertain; some POFs have been suggested to develop from pyogenic granulomas.to develop from pyogenic granulomas.

It should be noted that POFs are It should be noted that POFs are notnot the the same as peripheral same as peripheral odontogenic odontogenic fibromas fibromas and they are and they are notnot the soft tissue counterpart the soft tissue counterpart of the central ossifying fibroma.of the central ossifying fibroma.

Peripheral Ossifying Peripheral Ossifying Fibroma (POF): Clinical Fibroma (POF): Clinical

FeaturesFeatures This lesion occurs exclusively on the This lesion occurs exclusively on the

gingiva.gingiva. It appears as a nodular mass usually It appears as a nodular mass usually

arising from the interdental papilla area.arising from the interdental papilla area. It is red to pink in color and the surface is It is red to pink in color and the surface is

often ulcerated.often ulcerated. POFs are more common in young adults POFs are more common in young adults

and females.and females. There is a slight predilection for the There is a slight predilection for the

maxilla and the anterior region of the maxilla and the anterior region of the jaws.jaws.

Peripheral Ossifying Peripheral Ossifying Fibroma: Treatment and Fibroma: Treatment and

PrognosisPrognosis The treatment of choice is local The treatment of choice is local

surgical excision down to the surgical excision down to the periosteum to prevent recurrence.periosteum to prevent recurrence.

The adjacent teeth should be scaled The adjacent teeth should be scaled to eliminate irritants such as to eliminate irritants such as calculus.calculus.

A recurrence rate of 16 % has been A recurrence rate of 16 % has been reported in the literature.reported in the literature.

Hemangioma and Hemangioma and Vascular Vascular

MalformationsMalformations

Hemangioma and Vascular Hemangioma and Vascular MalformationsMalformations

The term hemangioma has traditionally been used The term hemangioma has traditionally been used to describe a variety of developmental vascular to describe a variety of developmental vascular anomalies.anomalies.

Currently, hemangiomas are considered to be Currently, hemangiomas are considered to be benign tumors of infancy that are characterized by benign tumors of infancy that are characterized by a rapid growth phase with endothelial cell a rapid growth phase with endothelial cell proliferation, followed by a gradual involution. proliferation, followed by a gradual involution. Most cannot be recognized at birth but make their Most cannot be recognized at birth but make their appearance in most instances during the first 8 appearance in most instances during the first 8 weeks of life.weeks of life.

Vascular malformations are structural anomalies of Vascular malformations are structural anomalies of blood vessels without endothelial proliferation and blood vessels without endothelial proliferation and are present at birth and persist throughout life.are present at birth and persist throughout life.

HemangiomaHemangioma

Hemangiomas are the most common tumors Hemangiomas are the most common tumors of infancy.of infancy.

They have a female gender predilection (3:1) They have a female gender predilection (3:1) and are most common in the White and are most common in the White population.population.

60% of the hemangiomas occur in the head 60% of the hemangiomas occur in the head and neck region with 80% of them occurring and neck region with 80% of them occurring as single lesions. Multiple lesions may be as single lesions. Multiple lesions may be part of a syndrome.part of a syndrome.

About 50 % of all hemangiomas will show About 50 % of all hemangiomas will show complete resolution by 5 years of age.complete resolution by 5 years of age.

Vascular MalformationsVascular Malformations These lesions are present from birth and These lesions are present from birth and

persist throughout life.persist throughout life. As with hemangiomas, these lesions tend to As with hemangiomas, these lesions tend to

darken with age.darken with age. Low-flow venous malformations typically Low-flow venous malformations typically

have a blue color and are easily have a blue color and are easily compressible.compressible.

Arteriovenous malformations are high-flow Arteriovenous malformations are high-flow lesions that result from persistent direct lesions that result from persistent direct arterial and venous communications. A arterial and venous communications. A palpable thrill or bruit is often noticeable palpable thrill or bruit is often noticeable and the overlying skin typically feels and the overlying skin typically feels warmer to the touch.warmer to the touch.

Hemangioma and Vascular Hemangioma and Vascular MalformationsMalformations

Because most hemangiomas undergo involution, Because most hemangiomas undergo involution, management often consists of “watchful neglect”. For management often consists of “watchful neglect”. For problematic hemangiomas, surgical resection or problematic hemangiomas, surgical resection or pharmacologic therapy may be indicated (systemic pharmacologic therapy may be indicated (systemic steroids or interferon-steroids or interferon-αα-2a). Flashlamp-pulsed dye -2a). Flashlamp-pulsed dye lasers can be effective in treating port wine stains.lasers can be effective in treating port wine stains.

Management of vascular malformations depends on Management of vascular malformations depends on their size, location and associated complications. their size, location and associated complications. Sclerotherapy and surgical excision are the mainstays.Sclerotherapy and surgical excision are the mainstays.

Treatment of arteriovenous malformations is more Treatment of arteriovenous malformations is more challenging and may involve surgical resection or challenging and may involve surgical resection or embolization.embolization.

Central vascular malformations of the jaws are Central vascular malformations of the jaws are potentially dangerous lesions because of severe potentially dangerous lesions because of severe bleeding. Needle aspiration of any undiagnosed bleeding. Needle aspiration of any undiagnosed intrabony lesion before biopsy is a wise precaution to intrabony lesion before biopsy is a wise precaution to rule out these lesions. rule out these lesions.

LymphangiomaLymphangioma Lymphangiomas are benign, hamartomatous Lymphangiomas are benign, hamartomatous

tumors of lymphatic vessels.tumors of lymphatic vessels. There are three types of lymphangiomas:There are three types of lymphangiomas: 1) lymphangioma simplex (capillary size 1) lymphangioma simplex (capillary size

vessels)vessels) 2) cavernous lymphangioma (larger vessels)2) cavernous lymphangioma (larger vessels) 3) cystic lymphangioma (cystic hygroma) with 3) cystic lymphangioma (cystic hygroma) with

large macroscopic cystic spaceslarge macroscopic cystic spaces Lymphangiomas have a predilection for the Lymphangiomas have a predilection for the

head and neck with about half of all lesions head and neck with about half of all lesions present at birth.present at birth.

Lymphangioma: Clinical Lymphangioma: Clinical FeaturesFeatures

Oral lymphangiomas occur most frequent on Oral lymphangiomas occur most frequent on the anterior 2/3 of the tongue where they the anterior 2/3 of the tongue where they may produce macroglossia.may produce macroglossia.

They appear as a spongy, diffuse, painless They appear as a spongy, diffuse, painless mass which usually has a pebbly surface. mass which usually has a pebbly surface. Their appearance is one of a cluster of Their appearance is one of a cluster of translucent vesicles having a red-blue hue.translucent vesicles having a red-blue hue.

Small lymphangiomas may appear on the Small lymphangiomas may appear on the alveolar ridges of neonates and are more alveolar ridges of neonates and are more common in African-Americans. These often common in African-Americans. These often occur bilaterally, have a male gender occur bilaterally, have a male gender predilection and spontaneously resolve. predilection and spontaneously resolve.

Lymphangioma: Treatment Lymphangioma: Treatment and Prognosisand Prognosis

Treatment usually consists of surgical Treatment usually consists of surgical excision although total removal may not excision although total removal may not be possible in all cases.be possible in all cases.

Lymphangiomas generally do not Lymphangiomas generally do not respond to sclerosing agents although respond to sclerosing agents although recent studies indicate some success recent studies indicate some success with OK-432.with OK-432.

The prognosis is good for most patients The prognosis is good for most patients although large tumors (cystic hygromas) although large tumors (cystic hygromas) may cause airway obstruction.may cause airway obstruction.

Giant Cell FibromaGiant Cell Fibroma

Giant Cell Fibroma: Giant Cell Fibroma: Clinical FeaturesClinical Features

Giant cell fibromas usually present as Giant cell fibromas usually present as asymptomatic, sessile or pedunculated asymptomatic, sessile or pedunculated nodules less than one centimeter in size.nodules less than one centimeter in size.

While they may have a smooth surface, they While they may have a smooth surface, they often have a papillary surface.often have a papillary surface.

Sixty percent are diagnosed during the first Sixty percent are diagnosed during the first three decades with a slight female gender three decades with a slight female gender predilection.predilection.

Fifty percent occur on the gingiva and the Fifty percent occur on the gingiva and the mandible is more commonly site of this lesion mandible is more commonly site of this lesion (2:1).(2:1).

Giant Cell Fibroma: Giant Cell Fibroma: Histological FeaturesHistological Features

The mass is composed of vascular, loosely The mass is composed of vascular, loosely arranged fibrous connective tissue.arranged fibrous connective tissue.

The hallmark of the lesion is the presence of The hallmark of the lesion is the presence of large, stellate fibroblasts, which may contain large, stellate fibroblasts, which may contain several nuclei, within the fibrous connective several nuclei, within the fibrous connective tissue.tissue.

The covering epithelium is often thin and The covering epithelium is often thin and atropic and the rete ridges may be elongated atropic and the rete ridges may be elongated and narrow.and narrow.

Lesions with a similar histological Lesions with a similar histological appearance found on the lingual mandibular appearance found on the lingual mandibular gingiva in the region of the mandibular gingiva in the region of the mandibular canine, have been called retrocuspid papillae.canine, have been called retrocuspid papillae.

Giant Cell Fibroma: Giant Cell Fibroma: Treatment and PrognosisTreatment and Prognosis

Treatment consists of conservative Treatment consists of conservative surgical excision.surgical excision.

If properly excised, the lesion rarely If properly excised, the lesion rarely recurs.recurs.

LipomaLipoma

Lipoma: Clinical Features Lipoma: Clinical Features and Causeand Cause

Clinical Features: Lipomas appear Clinical Features: Lipomas appear as asymptomatic, slow-growing, as asymptomatic, slow-growing, well-circumscribed, yellow to yellow-well-circumscribed, yellow to yellow-white benign neoplasms of fat.white benign neoplasms of fat.

While common elsewhere in the While common elsewhere in the body, lipomas are uncommon body, lipomas are uncommon intraorally.intraorally.

The cause of lipomas is unknown.The cause of lipomas is unknown.

Lipoma: Treatment and Lipoma: Treatment and PrognosisPrognosis

Excision is the treatment of choice Excision is the treatment of choice for the oral lipoma.for the oral lipoma.

Oral lipomas seem to have a limited Oral lipomas seem to have a limited growth potential and recurrence is growth potential and recurrence is not expected after removal.not expected after removal.

Traumatic Traumatic NeuromaNeuroma

Amputation NeuromaAmputation Neuroma

Traumatic NeuromaTraumatic Neuroma(Amputation Neuroma)(Amputation Neuroma)

This lesion is a reactive proliferation This lesion is a reactive proliferation of neural tissue following transection of neural tissue following transection or damage to the nerve bundle.or damage to the nerve bundle.

Traumatic Neuroma: Traumatic Neuroma: Clinical FeaturesClinical Features

These lesions generally present as These lesions generally present as smooth, non-ulcerated nodules.smooth, non-ulcerated nodules.

Predilection sites include: mental Predilection sites include: mental foramen, tongue and lip.foramen, tongue and lip.

There is often a history of trauma.There is often a history of trauma. They may produce a RL defect if They may produce a RL defect if

bone is involved.bone is involved.

Traumatic Neuroma: Traumatic Neuroma: Clinical Features ContinuedClinical Features Continued They may occur at any age but most They may occur at any age but most

cases occur in middle-aged adults and cases occur in middle-aged adults and there is a slight female gender there is a slight female gender predilection.predilection.

Only 25-33% are reported to be painful. Only 25-33% are reported to be painful. If painful, the pain can be constant or If painful, the pain can be constant or intermittent and mild to severe.intermittent and mild to severe.

Lesions involving the mental foramen Lesions involving the mental foramen are most often painful especially if are most often painful especially if there is contact by a denture.there is contact by a denture.

Traumatic Neuroma: Traumatic Neuroma: Histological FeaturesHistological Features

Presents as a haphazard Presents as a haphazard proliferation of mature, myelinated proliferation of mature, myelinated nerve bundles within a fibrous nerve bundles within a fibrous connective tissue stoma.connective tissue stoma.

The lesion may have an associated The lesion may have an associated chronic inflammatory cell infiltrate.chronic inflammatory cell infiltrate.

Traumatic Neuroma: Traumatic Neuroma: Treatment and PrognosisTreatment and Prognosis

Surgical excision is the treatment of Surgical excision is the treatment of choice with the excision to include a choice with the excision to include a small portion of the involved nerve small portion of the involved nerve bundle.bundle.

Most lesions do not recur.Most lesions do not recur.

Traumatic NeuromaTraumatic Neuroma

Palisaded Palisaded Encapsulated Encapsulated

NeuromaNeuroma

Palisaded Encapsulated Palisaded Encapsulated Neuroma: Clinical FeaturesNeuroma: Clinical Features The etiology of this lesion is unknown but The etiology of this lesion is unknown but

trauma has been suggested as a cause.trauma has been suggested as a cause. The lesion usually appears as a solitary, The lesion usually appears as a solitary,

smooth, painless, dome-shaped papule or smooth, painless, dome-shaped papule or nodule.nodule.

It occurs more commonly in adults and It occurs more commonly in adults and there is no gender predilection.there is no gender predilection.

Common sites include the face, palate Common sites include the face, palate and lip.and lip.

Palisaded Encapsulated Palisaded Encapsulated Neuroma: Histological Neuroma: Histological

FeaturesFeatures As the name suggests the lesion is As the name suggests the lesion is

typically well-circumscribed and often typically well-circumscribed and often encapsulated.encapsulated.

The tumor consists of interlacing The tumor consists of interlacing fascicles of spindle cells, which are fascicles of spindle cells, which are probably Schwann cells.probably Schwann cells.

The nuclei are wavy and pointed.The nuclei are wavy and pointed. While there is palisading there are While there is palisading there are no no

Verocay bodies of Antoni A tissue.Verocay bodies of Antoni A tissue.

Palisaded Encapsulated Palisaded Encapsulated Neuroma: Treatment and Neuroma: Treatment and

PrognosisPrognosis Treatment consists of conservative Treatment consists of conservative

local excision and recurrence is rare.local excision and recurrence is rare. This lesions is This lesions is notnot associated with associated with

neurofibromatosis, multiple neurofibromatosis, multiple endocrine neoplasia syndrome and it endocrine neoplasia syndrome and it does does notnot undergo malignant change. undergo malignant change.

Palisaded Encapsulated Palisaded Encapsulated NeuromaNeuroma

PEN VS SchwannomaPEN VS Schwannoma

NeurilemomaNeurilemoma

SchwannomaSchwannoma

Neurilemoma Neurilemoma (Schwannoma)(Schwannoma)

This lesion is a benign neural This lesion is a benign neural neoplasm of Schwann cell origin.neoplasm of Schwann cell origin.

It is a relatively uncommon lesion, It is a relatively uncommon lesion, although 25-48 % of all cases occur although 25-48 % of all cases occur in the head and neck region.in the head and neck region.

Neurilemoma: Clinical Neurilemoma: Clinical FeaturesFeatures

The neurilemoma is a slow-growing, The neurilemoma is a slow-growing, encapsulated tumor associated with the encapsulated tumor associated with the nerve trunk.nerve trunk.

It is usually asymptomatic but pain may It is usually asymptomatic but pain may occur.occur.

Most lesions occur in young to middle-Most lesions occur in young to middle-aged adults.aged adults.

The tongue is the most common oral site. The tongue is the most common oral site. The lesion may occur in bone where it The lesion may occur in bone where it may cause expansion, radiolucency, pain may cause expansion, radiolucency, pain or paresthesia.or paresthesia.

Neurilemoma: Histological Neurilemoma: Histological FeaturesFeatures

The neurilemoma is an encapsulated The neurilemoma is an encapsulated tumor composed of varying amounts tumor composed of varying amounts of Antoni A and Antoni B tissue.of Antoni A and Antoni B tissue.

Antoni A tissue appears as streaming Antoni A tissue appears as streaming fascicles of spindle-shaped Schwann fascicles of spindle-shaped Schwann cells. These cells often form a cells. These cells often form a palisaded arrangement around an palisaded arrangement around an acellular eosinophilic area known as acellular eosinophilic area known as a Verocay body.a Verocay body.

Neurilemoma: Histological Neurilemoma: Histological Features ContinuedFeatures Continued

Verocay bodies represent Verocay bodies represent reduplicated basement membrane reduplicated basement membrane and cytoplasmic processes.and cytoplasmic processes.

Antoni B tissue is less cellular and Antoni B tissue is less cellular and less well organized.less well organized.

Neurites can Neurites can notnot be demonstrated be demonstrated within the mass.within the mass.

Ancient neurilemomasAncient neurilemomas

Neurilemoma: Treatment Neurilemoma: Treatment and Prognosisand Prognosis

Surgical excision is the treatment of Surgical excision is the treatment of choice and the lesion should not choice and the lesion should not recur.recur.

Extremely rare malignant Extremely rare malignant transformation.transformation.

Neurofibroma/Neuro-Neurofibroma/Neuro-fibromatosisfibromatosis

Neurofibroma/Neuro-Neurofibroma/Neuro-fibromatosis: Clinical fibromatosis: Clinical

FeaturesFeatures These lesions are soft, single or multiple, These lesions are soft, single or multiple,

asymptomatic nodules covered by asymptomatic nodules covered by epithelium.epithelium.

Intraorally, they may appear as the same Intraorally, they may appear as the same color as or lighter in color than the color as or lighter in color than the surrounding mucosa.surrounding mucosa.

Most frequently they are found on the Most frequently they are found on the tongue, buccal mucosa and vestibule but tongue, buccal mucosa and vestibule but may occur anywhere.may occur anywhere.

They may occur at any age and there is They may occur at any age and there is no gender predilection.no gender predilection.

Neurofibroma/Neurofibroma/Neurofibromatosis:Neurofibromatosis:

CauseCause Unknown for the solitary Unknown for the solitary

neurofibromas while neurofibromas while neurofibromatosis is an autosomal neurofibromatosis is an autosomal dominant disease entity.dominant disease entity.

Approximately 50 % of cases of Approximately 50 % of cases of neurofibromatosis present no family neurofibromatosis present no family history and are considered the result history and are considered the result of spontaneous mutation.of spontaneous mutation.

Neurofibromatosis is associated with Neurofibromatosis is associated with NF1 and NF2 genes.NF1 and NF2 genes.

Neurofibroma/Neurofibroma/Neurofibromatosis:Neurofibromatosis:

Treatment and PrognosisTreatment and Prognosis The treatment of solitary neurofibromas The treatment of solitary neurofibromas

is excision and recurrence is not is excision and recurrence is not expected.expected.

Multiple neurofibromas should suggest Multiple neurofibromas should suggest neurofibromatosis (von Recklinghausen neurofibromatosis (von Recklinghausen disease), which consists of multiple disease), which consists of multiple neurofibromas with malignant potential, neurofibromas with malignant potential, cafè au lait spots, optic gliomas, Lisch cafè au lait spots, optic gliomas, Lisch nodules (iris hamartomas) and bony nodules (iris hamartomas) and bony lesions as outlined in the next slide.lesions as outlined in the next slide.

Box 12-1 Box 12-1 Diagnostic Criteria for Diagnostic Criteria for Neurofibromatosis Type INeurofibromatosis Type I

The diagnostic criteria are met if a patient has two or more of The diagnostic criteria are met if a patient has two or more of the following features: the following features:

1.1. Six or more Six or more café au laitcafé au lait macules macules over 5 mm in greatest over 5 mm in greatest diameter in prepubertal persons diameter in prepubertal persons and over 15 mm in greatest and over 15 mm in greatest diameter in postpubertal diameter in postpubertal personspersons

2.2. Two or more neurofibromas of any Two or more neurofibromas of any type or one plexiform type or one plexiform neurofibromaneurofibroma

3.3. Freckling in the axillary or inguinal Freckling in the axillary or inguinal regionsregions

4.4. Optic gliomaOptic glioma 5.5. Two or more Lisch nodules (iris Two or more Lisch nodules (iris

hamartomas)hamartomas) 6.6. A distinctive osseous lesion such as A distinctive osseous lesion such as

sphenoid dysplasia or sphenoid dysplasia or thinning of long bone cortex with or thinning of long bone cortex with or without without pseudoarthrosispseudoarthrosis

7.7. A first-degree relative (parent, A first-degree relative (parent, sibling, or offspring) with sibling, or offspring) with neurofibromatosis type I, neurofibromatosis type I, based on the above criteriabased on the above criteria

Neural Tumors: Neural Tumors: Comparative FeaturesComparative Features

Granular Cell TumorGranular Cell Tumor

Granular Cell Tumor: Granular Cell Tumor: Clinical FeaturesClinical Features

These lesion typically appear as painless, These lesion typically appear as painless, elevated tumescences covered by an elevated tumescences covered by an intact epithelium. intact epithelium.

Their color may be the same as or lighter Their color may be the same as or lighter than the surrounding tissue.than the surrounding tissue.

There is a strong predilection for the There is a strong predilection for the dorsum of the tongue but may be found dorsum of the tongue but may be found anywhere.anywhere.

Granular cell tumors are rare in children Granular cell tumors are rare in children and there is a 2:1 female gender and there is a 2:1 female gender predilection.predilection.

Granular Cell TumorGranular Cell Tumor The cause of the granular cell tumor is The cause of the granular cell tumor is

unknown and the cell of origin is unknown and the cell of origin is undetermined.undetermined.

Originally, it was considered to be of skeletal Originally, it was considered to be of skeletal muscle origin but current research suggests muscle origin but current research suggests origin from Schwann cells or neuorendocrine origin from Schwann cells or neuorendocrine cells.cells.

Treatment consists of surgical excision and Treatment consists of surgical excision and the lesion does not recur.the lesion does not recur.

The lesion must be differentiated from other The lesion must be differentiated from other lesions of the tongue particularly squamous lesions of the tongue particularly squamous cell carcinoma as a superficial biopsy of a cell carcinoma as a superficial biopsy of a granular cell tumor with PEH may be granular cell tumor with PEH may be confused with this cancer.confused with this cancer.

Congenital Congenital EpulisEpulis

Congenital Epulis of the Congenital Epulis of the NewbornNewborn

Congenital Granular Cell Congenital Granular Cell LesionLesion

Soft Tissue Soft Tissue SarcomasSarcomas

Soft tissue sarcomas are rare Soft tissue sarcomas are rare malignant tumors of the oral and malignant tumors of the oral and maxillofacial region accounting maxillofacial region accounting

for less than 1% of the cancers in for less than 1% of the cancers in this area.this area.

FibrosarcomaFibrosarcoma

Fibrosarcomas are malignant tumors Fibrosarcomas are malignant tumors of fibroblasts.of fibroblasts.

They were once considered the most They were once considered the most common soft tissue sarcoma but are common soft tissue sarcoma but are considered uncommon today (and considered uncommon today (and only 10% of them occur in the head only 10% of them occur in the head and neck region).and neck region).

Fibrosarcoma: Clinical Fibrosarcoma: Clinical FeaturesFeatures

Fibrosarcomas most often present as Fibrosarcomas most often present as slow-growing masses which may reach slow-growing masses which may reach considerable size before producing pain.considerable size before producing pain.

They can occur anywhere in the oral They can occur anywhere in the oral region. A number of cases have been region. A number of cases have been reported in the nose and paranasal reported in the nose and paranasal sinuses where obstructive symptoms are sinuses where obstructive symptoms are the chief complaint.the chief complaint.

They can occur at any age but are more They can occur at any age but are more common in children and young adults.common in children and young adults.

Fibrosarcoma: Treatment Fibrosarcoma: Treatment and Prognosisand Prognosis

Surgical excision with wide margins Surgical excision with wide margins is the treatment of choice.is the treatment of choice.

The 5-year survival rates range from The 5-year survival rates range from 40-70 %.40-70 %.

Malignant Fibrous Malignant Fibrous HistiocytomaHistiocytoma

This sarcoma, which has both This sarcoma, which has both fibroblastic and histiocytic features, fibroblastic and histiocytic features, is now considered to be the most is now considered to be the most common soft tissue sarcoma in common soft tissue sarcoma in adults.adults.

Malignant Fibrous Malignant Fibrous Histiocytoma: Clinical Histiocytoma: Clinical

FeaturesFeatures This is primarily a tumor of older This is primarily a tumor of older

age groups.age groups. The most common complaint is an The most common complaint is an

expanding mass that may or may not expanding mass that may or may not be ulcerated or painful.be ulcerated or painful.

Tumors of the nasal cavity or Tumors of the nasal cavity or paranasal sinuses usually produce paranasal sinuses usually produce obstructive symptoms.obstructive symptoms.

Malignant Fibrous Malignant Fibrous Histiocytoma: Treatment Histiocytoma: Treatment

and Prognosisand Prognosis This is an aggressive tumor that typically This is an aggressive tumor that typically

requires radical surgical resection.requires radical surgical resection. Approximately 40 % of patients have Approximately 40 % of patients have

local recurrences with a similar number local recurrences with a similar number developing metastases within 2 years of developing metastases within 2 years of initial diagnosis.initial diagnosis.

The survival rate for patients with oral The survival rate for patients with oral tumors seems to be worse that for those tumors seems to be worse that for those with the tumor at other body sites.with the tumor at other body sites.