Odontogenic tumors

Odontogenic tumors are tumors that arise in the jaws of forming teeth tissues. These include rare tumors: adamantinoma (from cells that make up the enamel of the tooth), odontoma (from various dental tissues) and cementum (by type of cement teeth), and a tooth cyst (see).
Odontogenic tumours grow in thicker jaw, often lower. This appears deformation jaw as bulging or her face asymmetry, especially when adamantinoma, which usually develops in the lower jaw in her corner and bulge outwards. The mucous membrane of the long-term remains unchanged. In some cases, may be offset dentition, rarely loosening of teeth. Possibly malignant transformation adamantina that is more rapid growth and spread to the surrounding tissue. Metastases are rare.
Odontogenic tumors grow slowly, but when they reach large sizes, becomes difficult when you open your mouth and swallowing; they thinner jaw, can develop fistulas and be pathological fractures of the jaw. With the feeling of the tumor is sometimes a crunch like parchment paper that indicates the thinning of bone tissue. Pain is usually not.
To odontogenic tumors close epulis (see) - fibrous education on the mucous membrane of the jaw. On enamel cover teeth sometimes seen bulging in the form of one or more nodules - adamantane (malformation of the tooth, but not odontogenic tumor).
Treatment of odontogenic tumors, the surgical; the patient with suspected s.r.o should be directed to the dentist.

Odontogenic tumors (gr. odous, odontos - tooth; genesis - emergence and development) - tumors of the jaws, the occurrence of which is connected with the development of the dental system. To odontogenic tumors include follicular cysts of jaws, adamantinoma, odontogenic fibroids, cementary, odontoma.
Adamantinoma (synonym: adamantopoulos, ameloblastoma is a relatively rare slow-growing benign epithelial tumor growing mainly in the region of large molars, angle and branches of the lower jaw. Observed in most cases among people over the age of 20-25 years, slightly more often in women. I believe that adamantinoma can develop from the epithelium of the rudiment of the tooth, enamel organ or ingrown gingival epithelium in the underlying tissues.
Macroscopically adamantinoma divided into dense (adamantinoma solidum) and cystic (adamantinoma cysticum). The former are education elastic consistence, on the incision have views of the spongy dirty-gray or reddish-brown fabric with small cavities in some areas. Cystic adamantinoma consist of several cavities of various sizes; sometimes, there is one large cavity. In most cases, oral tumors are made transparent yellowish liquid, sometimes smetanopodobnogo whitish or brownish mass containing a small amount of cholesterol crystals. Microscopic examination (Fig. 1) find a kind of expansion branching fibers epithelium, founded in fibrous stroma, on the periphery of which are cells of cylindrical epithelium, reminiscent adamantanes (cells early tooth development, forming enamel). In the Central parts of the cell tumor cells have stellate and elongated form, resemble the structure of the pulp enamel organ. In a few cases described malignant transformation and the development of metastases of adamantinoma.
Clinical symptoms of adamantinoma largely resemble symptoms jaw cysts. Progression of adamantinoma in thicker jaw leads to a uniform thickening of its plot or to the emergence of merging with each other vbuhanii. Thinning bone, located in the area of the tumor, springs with pressure-sometimes there is a parchment crunch. You can observe the displacement of the teeth in the area of the tumor. Sometimes on the surface of the tumor arises prints teeth-antagonists, rare - ulcers.
After ineradicable made operative intervention adamantinoma recurs. The most effective treatment resection of the jaw region in healthy tissues. To preserve the continuity of the lower jaw is advisable to leave in the area formed by the surgical intervention defect bridge from the bone. At impossibility of radical intervention may be carried operation type of cystectomy carefully scraping and drilling boron all small growths, penetrating into the wall of bone cavity.
Odontogenic fibroma is a peculiar kind of intraosseous fibroids jaws. It very rarely, in people young and middle aged, mostly in the area of the body, sometimes angle of the mandible. I believe that odontogenic fibroids are genetically connected with the tissues of the tooth Bud; in adults, the tumor can develop from pariament. Macroscopically odontogenic fibroma is a education rounded shapes of grayish-white in color, well separated from the surrounding bone. Microscopic examination detect poor fibrous tissue cells, among which are the bands or the Islands of the cells taboobrother epithelium. Separate sections of the tumor may have a loose structure and contain a considerable quantity of cells. Sometimes Muco rebirth areas of the tumor.
Slowly growing in size, without causing any abnormal sensations, fibroma leads to thickening of the boundary area of the jaw. See misalignment of teeth, and resorption of their roots. During germination on the outside or the inside of the jaw tumor is palpated in the form of rounded vbuhanii solid elastic consistence.
Treatment - removal of the tumor.
Cementum (cementoma) - the original, not common connective tissue tumor with cementoplasty properties is observed mainly in the lower jaw, usually in persons at the age of about 20 years, mostly women. Macroscopically cementum is the formation of bone consistency, located in the area of the roots of one or more teeth, limited capsule. Sometimes cementum is moderately thick, whitish on the cut and contains only some calcified areas. Microscopic examination discover
(in varying proportions) the so-called semanticly integrated into the bone tissue. Notes resorption of teeth roots and deposition in place rezorbirovanny sections of the masses of cement.
Clinical symptoms are not typical, some patients seek thickening plot jaw, and sometimes painful when pressed. The tumor grows slowly, in most cases find it accidentally in radiography produced about any disease of the teeth or jaw. In some cases, in circumference cementary due to caries or damage covering the alveolar soft tissue may develop inflammation.
If there cementary, increasing in size or causing pain and complicated inflammatory phenomena, it is shown surgery - removing and carefully scraping bone cavity.
Odontoma (odontoma) develops complex subaortalny tissues epithelial and mesenchymal nature. Depending on the degree of differentiation they are composed of tissues distinguish odontoma soft (ameloblastoma) and solid. The first consists of undifferentiated, randomly located tissues enamel organ and dental papilla, the second - from conglomerate highly differentiated Mature tissues of the tooth.
Soft odontoma is rare, develops mainly at a young age, in the period of formation and growth of permanent teeth. Macroscopically represents a generation of solid elastic consistence, the cut-light-gray color with a separate lighter areas. Microscopically, the parenchyma of the tumor presents epithelial complexes and strands (similar to that observed in tissue adamantinoma), between which are tissue elements stromal tumor, which resembles the structure of papilla early tooth development. Clinical manifestations are similar to symptoms of other benign tumors strata jaw, sometimes soft odontoma similar course with a malignant tumour. Recurs when non-radical surgical intervention. Sometimes there is a malignancy. Treatment resection of the affected area of the jaw.
Solid odontoma equally often found in the upper and lower jaw in both sexes, in most cases after the age of 20 years. Macroscopically there are complex solid odontoma (which include elements of several teeth) and simple (having a form of more or less deformed teeth; these also include parodontale). Usually odontoma surrounded by a fibrous capsule. There is also cystic odontoma (in the wall cyst find hard tooth tissues or in the lumen cysts juts out plot solid odontoma). Microscopically in solid odontoma can find all the tissues of the tooth (enamel, dentin, cement, pulp), as well as pariament and bone. Often prevails dentin (normal or modified). Often enamel is located inside odontoma.
With solid odontoma considerable size see thickening plot alveolar process or jaw. Sometimes there inflammation, especially in violation piece of soft tissues, covering the tumor. In some cases there is a so-called eruption of odontoma. Usually this tumor is diagnosed by chance, when I have problems during surgery tooth extraction or root, which is part of odontoma. Odontoma often find randomly and in radiography jaw.
The removal of solid TomTom conducted by type of operation vydalblivanija tooth, you need to carefully scrape the sharp spoon and the capsule surrounding the tumor. Cm. also Jaw (tumors).


X-ray diagnostics. X-ray picture follicular cysts, odontoma and adamantinoma different. Follicular cyst causes in the alveolar ridge and in the body of the jaw clearly expressed enlightenment shadow of bone substance in the form of various sizes (from 1 to more than 5 cm) area with smooth contours. With larger tumors see bloating thinning of the cortical layer of the jaw. As a rule, in the cavity cystic enlightenment facing the crown of the detainee and incorrectly located tooth (Fig. 2). In rare cases, follicular cyst may develop in the absence of the detainee of the tooth. In this case it acquires the similarity with radicular cyst, but, unlike the latter, is large and is not associated with the tip of the root caries.
Odontoma is characterized by the presence of the hearth rarefaction of bone of the alveolar process and body jaw, surrounded by a well-defined stripe sklerozirovanie bones. On the background of this center of depression, having correctly rounded shape, visible high randomly formed the beginnings of detainees and additional undeveloped teeth. According to position of odontoma teeth in the alveolar series are unavailable. The root tips neighboring odontology teeth partially rezorbiruetsa (Fig. 3).
X-ray picture of adamantinoma is expressed by the presence of multichamber cystic depression, usually occupying the body of the mandible and the ascending branch. Adamantinoma detainees teeth or their germs does not contain. Picture of multichambers create bone beams, jutting out from the walls cysts in her cavity. Thinning of the cortical layer of bone swollen (Fig. 4). X-ray picture of adamantinoma requires differentiation with giant cell tumor and local manifestation giperparatireoidizm osteodystrophies. In the first case, when a single ray study of differential diagnosis is based on the biopsy, in the second case the diagnosis precise x-ray study of other bones. When giperparatireoidizm osteodystrophies defeat multiple bones, adamantinoma always a single disease. In rare cases adamantinoma can undergo malignant transformation that radiographically establish the violation of the integrity of the cortical layer and other signs of a malignant tumor of the bone (fan-shaped periosteal overlay, the destruction of bone bars inside the cyst).

Fig. 1. Adamantinoma - one of the cells of the tumor (schematically).
Fig. 2. Follicular cyst of the left half of the lower jaw. Pronounced swelling thinning of the cortical layer of the body and the ascending line of the lower jaw. The detainee and incorrectly set the third molar tooth, facing the crown in the center of the cyst.
Fig. 3. Odontoma lower jaw on the left in the area of the missing 8-th tooth and root region 7-th tooth. Large plot of depression, surrounded by clear boundaries compacted bone. On the background of depression is a separate dense areas - the beginnings of immature teeth. Swelling of the lower edge of the jaw.
Fig. 4. Adamantinoma body and the ascending line of the lower jaw bone substance which replaced multiple sites vacuum - multichamber cystic depression.