1. ODONTOGENIC TUMOURS OF ORAL CAVITY
DEFINITION
TUMOURS IN THE JAW THAT ARISE FROM ODONTOGENIC TISSUES ARE REFERRED TO AS ODONTOGENIC TUMOURS

2. CLASSIFICATION OF ODONTOGENIC TUMOURS (W.H.O CLASSIFICATION)
BENIGN
ODONTOGENIC EPITHELIUM WITHOUT ODONTOGENIC ECTOMESENCHYME
AMELOBLASTOMA
SQUAMOUS ODONTOGENIC TUMOUR
CALCIFYING EPITHELIAL ODONTOGENIC TUMOUR (PINDBORG)
ADENOMATOID ODONTOGENIC TUMOUR

3. 2. ODONTOGENIC EPITHELIUM WITH
ODONTOGENIC ECTOMESENCHYME
AMELOBLASTIC FIBROMA
AMELOBLASTIC FIBRODENTINOMA
AMELOBLASTIC FIBRO ODONTOMA
ODONTO AMELOBLASTOMA
CALCIFYING ODONTOGENIC CYST
COMPLEX ODONTOMA
COMPOUND ODONTOMA

4. 3.ODONTOGENIC ECTOMESENCHYME WITH OR
WITHOUT ODONTOGENIC EPITHELIUM
ODONTOGENIC FIBROMA
MYXOMA
CEMENTOBLASTOMA

5. ODONTOGENIC CARCINOMAS:
MALIGNANT
ODONTOGENIC CARCINOMAS:
MALIGNANT AMELOBLASTOMA
PRIMARY INTRAOSSEOUS CARCINOMA
CLEAR CELL ODONTOGENIC CARCINOMA
GHOST CELL ODONTOGENIC CARCINOMA
ODONTOGENIC SARCOMAS:
AMELOBLASTIC FIBROSARCOMA
AMELOBLASTIC FIBRO DENTINO SARCOMA
AMELOBLASTIC FIBRO ODONTO SARCOMA

6. BENIGN VS MALIGNANT TUMOUR
Depending upon their spread by invasion and metastasis, tumours are classified as benign or malignant. Benign tumors cannot spread by invasion or metastasis; hence, they only grow locally. Encapsulated, enlargement by peripheral expansion, pushes away the adjoining tissues and structures. Malignant tumors spread by invasion and metastasis. Rapidly infiltrates the surrounding tissue. By definition, the term "cancer" applies only to malignant tumors.

7. GENERAL PRINCIPLES OF DIAGNOSIS & MANAGEMENT OF JAW LESIONS
HISTORY OF LESION
DURATION
LONG HISTORY OF DURATION  CONGENITAL
LONG HISTORY OF DURATION (SLOW GROWTH) NO-PAIN  BENIGN
SHORT HISTORY OF DURATION, FAST GROWTH  MALIGNANT
Mode of onset & Progress-
E.g; history of trauma  Osteogenic Sarcoma
Rapid growth  Malignant
Slow growth  Benign
Size & Shape  To know the origin of the lesion.

8. Progression of the lesion:
Slowly growing and same size for long time  Benign
Same size for long time and the again growing  Malignant
transformation of Benign lesion.
Continuously growing  Malignant
Change in character of lesion
Ulceration, fluctuation, softening noticed by the patient. If
painless swelling has become painful, can be infection.

9. Associated symptoms Pain
Abnormal sensations like anesthesia, paresthesia
Nasal obstruction
Difficulty in breathing
Tenderness
Lymphadenopathy
Trismus
Similar swellings elsewhere in the body to rule out
metastasis
Loss of body weight
Any habits
Recurrence after previous surgery

10. CLINICAL EXAMINATION General physical examination
Examination of oral cavity, external face, regional lymph nodes.
Inspection
Palpation (Bimanual palpation)
Percussion
Auscultation

11. Imaging & biopsy PLAIN RADIOGRAPHS CT SCAN MRI
HISTO-PATHOLOGICAL EXAMINATION AFTER BIOPSY

12. PRINCIPLES OF SURGICAL MANAGEMENT OF JAW TUMOURS
ENUCLEATION
CURETTAGE
MARSUPIALIZATION
RESECTION WITHOUT CONTINUITY DEFECTS
RESECTION WITH CONTINUITY DEFECTS
DISARTICULATION

13. RESECTION WITHOUT CONTINUITY DEFECTS
MARGINAL RESECTION / EN-BLOCK RESECTION
RESECTION WITH CONTINUITY DEFECTS
INFERIOR BORDER OF MANDIBLE
PARTIAL RESECTION
HEMI-MANDIBULECTOMY
DISARTICULATION
TOTAL RESECTION
COMPOSITE RESECTION

15. AMELOBLASTOMA INCIDENCE - MOST COMMON ODONTOGENIC NEOPLASM
AGE-THIRD DECADE OF LIFE
SEX (M:F) - EQUAL
SITE: MANDIBLE - 80% (70% IN THE POSTERIOR
MOLAR REGION AND RAMUS REGION)
Recurrence is common

16. True neoplasm of enamel organ type tissue
Definition : ACCORDING to ROBINSON
“ usually uni-centric, non functional, intermittent in growth, anatomically benign and clinically persistent”.

17. Etiology Pathogenesis Cell rests of enamel organ
Epithelium of odonotogenic cysts – dentigerous cyst
Disturbances of developing enamel
Basal cells of surface epithelium
Presently – alteration or mutation in the genetic material of the cells that are programmed for tooth development
Etiology
Irritation:
Infection – ROBINSON – 1/3rd of cases- oral infections
Trauma:
Dietary deficiency – defect in development of tooth germ
Virus – polyoma virus

18. Classification
CENTRAL- INTRAOSSEOUS
PERIPHERAL- EXTRAOSSEOUS

19. CLINICAL FEATURES Usually asymptomatic at its early phase Late stage
Intra-oral & extra-oral jaw swelling
Disturbed normal occlusion and tooth eruption.
Teeth in the region are mobile
ill-fitting dentures
Ulcerations
Nasal obstructions
Nerve involvement, lower lip paresthesia
Egg shell cracking of bone

21. RADIOGRAPHIC FEATURES
Appears as Unilocular - Monocystic OR Multilocular - Multicystic radiolucency.
Honey - Comb / Soap Bubble Appearance.

22. TNM CLASSIFICATION OF CARCINOMAS OF ORAL CAVITY
T – PRIMARY TUMOUR
TX – Primary tumour can not be assessed
T0 – No evidence of primary tumour
TIS – Carcinoma in situ
T1 – Tumour 2cm or less in greatest dimention
T2 – Tumour more than 2cm but less than 4cm
T3 – More than 4cm
T4a – LIP (Tumour invades through cortical bone, inferior alveolar nerve,
floor of mouth, or skin )
T4a – ORAL CAVITY (Tumour invades through cortical bone, into
deep/extrinsic muscle of tongue (genioglossus,
hyoglossus, palatoglossus, and styloglossus), maxillary
sinus, or skin of face.
T4b – LIP & ORAL CAVITY ( Tumour invades masticator space, pterygoid
plates, or skull base; or encases internal carotid artery )

23. N – Regional lymph nodes metastasis
NX - Regional lymph nodes cannot be assessed
N0 - No regional lymph node metastasis
N1 - Metastasis in a single ipsilateral lymph node, 3 cm or less in
greatest dimension
N2 - Metastasis as specified in N2a, 2b, 2c below
N2a - Metastasis in a single ipsilateral lymph node, more than 3 cm
but not more than 6 cm in greatest dimension
N2b - Metastasis in multiple ipsilateral lymph nodes, none more than 6 cm in greatest dimension
N2c - Metastasis in bilateral or contralateral lymph nodes, none more
than 6 cm in greatest dimension
N3 - Metastasis in a lymph node more than 6 cm in greatest dimension

24. M – Distant metastasis
MX - Distant metastasis cannot be assessed
M0 - No distant metastasis
M1 - Distant metastasis

25. Stage grouping
Stage Tis N0 M0
Stage I T1 N0 M0
Stage II T2 N0 M0
Stage III - T1, T2 N1 M0
T3 N0, N1 M0
Stage IVA - T1, T2, T3 N2 M0
T4a N0, N1, N2 M0
Stage IVB - Any T N3 M0
T4b Any N M0
Stage IVC - Any T Any N M1