Tumors of Jaw Volume VII Thursday, May 7, 1936 Number 27 r I' UNIVERSITY OF MIIDIESOTA HOSPITALS Volume VII Thursday, May 7, 1936 Number 27 r I. ABSTRACT. •••••••••..••• 315 - 329 I I. LAST WEEK •••••• • •.•••••••..• 329 I II. MOVIE . .. .. .... ... .. .. 329 C 0 U R T E S Y 0 F CIT I ZEN S A IDS 0 C lET Y r 315 I. ABSTRACT 2. Malignant: - Osteogenic Sarcoma a. Osteolytic osteogenic TUMORS OF JAW (myxochondral) b. Osteoblastic osteogenic E. J. Semansky (sclerosing) c. Telangiectatic osteogenic Classification D. Central Tumors in the Bone of Non­ osteogenic and Non-odontogenic Origin: The classification of the neoplasms 1. Central fibroblastoma of the jaw is extremely difficult. The a. Central fibroma Registry of Bone Sarcoma has adopted for b. Central fibrosarcoma all bone lesions a simplified classifica­ 2. Central angioma tion which has been used as a basis in 3. Ewing's tumor the treatment of jaw neoplasms: 4. Multiple myelooa 5. Intra-osseous mixed tumors Oral Neoplasms E. Tumors Derived from Epithelium: A. Peripheral Tumors of the Oral Tissues 1. Adenoma 1. HYPertrop~- or tumor-like 2. Precancerous overgrowths 3. Carcinoma t 2. Fibroblastoma: a. Epidermoid carcinoma a. Benign: - Peripheral Fibroma b. Basal-cell carcinoma Keloid c. Cylindrical-cell carcinoma Xanthoma d. Adeno-carcinoma b. Malignant: - Peripheral Fibrosarcoma F. Metastatic Tumors to Jaws: 3. Myxoblastoma - Myxoma 1. Carcinoma metaltatic to jaw 4. Lipoblastoma - Lipoma a. From lip 5. Neuroma - Amputation Neuroma b. from breast 6. Endothelioma c. from the prostate gland 7. AngiobIastoma d. from the stomach Vascular Nevus e. from the thyroid gland Haeluangioma f. from hypernephroma Lymphangioma 2. Sarcoma metastatic to jaw 8. Lymphoblastoma a. Melanosarcoma Lymphoma b. Lymphosarcoma Lym-.)ho sarcoma c. From various soft-tissue 9. Melanoblastoma sarcomata 10. Rhabdomyoma. 11. TeratoIJ.a Dental and benign osseous tumors B. Odontogenic Tumors: Radicular cysts 1. Adamantinoblastoma Follicular or dentigerous AdaIJJantinoma Adamantino-sarcoma Radicular or dentigerous cysts 2. Odontoma Giant cell epulis Central giant cell tumors C. Osteogenic Twnors 1. Benign: Hyperostosis Exostoses (Torus palatinus, The teeth are ectodermal and imbedded torus mandibulare) in the osseous substance of the upper and Osteoma lower jaws. The body of the tooth is Chondroma composed of dentine and the crown of 316 enamel. The enamel is a secretion of 4. Adamantinoma epithelial cells derived from the ecto­ True neoplasm arising from cells of derm and corresponds to elements of the one toot~germ layer (ameloblasts exoSkeleton found in other vertebrates. or dental debris). Solid, cystic, In both the dental lamina and itsderi­ differentiated or immature. vatives, the enamel organ may give rise to persistent strands of undiffer~ntiated 5. Odontomas basal-cells which may take part in tumor Malformations (or neoplasms?) in­ formation. From these cells, de~tal volving all the tooth elements root.cysts, follicular or dentige~bus producing nests of mature or cysts, adamantinomas may arise. The immature teeth. Mq be malignant. down-growing basal· cells nearest the primitive mucous membrane (known as' the 6. :Bone and soft tissue tumors epithelial debris of Malassez) may ,4if­ Variety and characteristics ferentiate to form a lining membrane. of generally as in other areas. squamous cells forming dental root Cysts. The cell le~ers of the enamel organs may expand about the non-erupted tooth Dental ~ Cysts to form a follicular or dentigerous Cyst. More primitive elements of the enamel Radicular cysts generally fonn at bUds may proliferate and differentiate the apex of the tooth but in rare in­ 1 in several directlons producing islands stances they may form at t he lateral of enameloblasts, squamous cells, basal surfaces of the root (paradental cysts). cells and epithelial elements character­ They derive their origin from chronic istic of adamantinomas. The enamel buds inflammatory changes of the paradental overly the dental papillae. From the membrane such as hemorrhage, infection, mesodermal papillae, the dentine is instrumentation or chemical. Radicular formed. The unossified portion of the cysts develop at any age. They occur dentine forms the tooth pulp. Prolifer­ on deciduous teeth, and must be carefully ation of these mesodermal elements occurs distinguished from extensive bone infec­ in odontomas. Eefore eruption of the tion. On permanent teeth, they are of permanent teeth, giant-cell odontoclasts frequent occurrence in the maxilla, as normally appear in the pericementum to well as in the mandible. If th~ are of loosen the temporary structures. These small size, they give no subjective or cells may give rise to giant-cell tumors objective symptoms. If'they assume larger of the alveolar ridge, known as giant­ proportions, they will at first expand cell epulides. between the cortical walls of the bone, but later resorption occurs on the inner side of the cortex and the thin wall ex­ Simplified Classification pands with a change in the outline of (Pathological Types) the jaw. In the mandible the expansion generally involves the external surface 1. Radicular cyst of the bones; while in the maxilla, these Simple cyst arising from paradental cysts expand both the outer surface and membrane. invade the maxillary sinu~palate or nasal fossa. The cys ts ma¥ ba found in 2. Dentigerous cyst edentulous parts of the jaws. Symptoms Simple cyst about crown of an of large cysts occur rather gradually. unerupted "normal" tooth. This is especially true of the change in contour of the oral surfaces. If the 3. Paradental cyst bony wall has become thin, palpation may Identical with either of apove two give a crepitating sensation. Occasion­ types but occurring around ally, paresthesia of the terminal supernumary teeth and fourth branches at the fifth nerve is produced. molars. In many old cases, the bone finally is 317 penetrated and an opening is formed into the mouth or Dose. The patient then complains of bad taste, sometimes salty Treatment of radicular cysts con­ in character, discharge or odor produced sists of extraction of the tooth, open­ by it. Maligna.."1t tumors and adamantinomas ing of the cavity and evacuation of its may arise from radicular cysts. contents, including removal of the epithelial lining and the cyst wall. The material removed should always be Pathology subjected to pathological examination. With such treatment, occurrences are In most radicular cysts, the sac can practically unknown. be removed in toto. The fluid, if aspirated, may be thick, mucous-like, watery, or thin. Generally, it has a Dentigerous Cysts yellowish and more often a brownish color• .Microscopic examination shows a fibrous Dentigerous cysts arise from the connective tissue wall of varying thick­ epithelium of the enamel orgarJ. during ness, covered by an epithelial lining, the development of the teeth. They are usually of the squamous type but rarely characterized by the presence of a non­ columnar. Inflammatory cells and choles­ erupted tooth, the ~st expanding about terin is present. the crown of the tooth rather than the root. Because of their relationship to Radicular cysts are generally single developing teeth the,y are usually found but may be multiple. They are falsely in young individuals. These lesions called multilocular cysts. They expand are frequently found in the regior. of the intervening bones but become con­ the third molar. There are no striking densed into a thin subste~ce. Cholesterin physical signs ex~ept failure of the crystals may become a very prominent fea­ tooth to erupt and expansion of the jaw .. ture and give the appearance of a choles­ at the tumor site. As the cyst expands, teatoma. the pressure exerted by the increasing contents of the cyst acts on the occlusal surface of the tooth, causing Diagnosis it to move apically, resulting in the extreme malpositions which are so fre­ Most radicular cysts are diagnosed quently observed. They show in the by routine roentgen examinations. The roentgenogram a non-erupted tooth cyst gives a shadow which has a char­ within a monolocular cyst. The tooth acteristic outline caused by the cortical is pushed ~- from the gum by the layer of bone lining the cavity. A cen­ growth of the cyst from the gum by the tral area of rarefaction with well-defined growth of the cyst which expands about outlines extends in semi-circular fashion the crown. Any of the various stages about the root of the devitalized tooth. of development, from a poorly This outline distinguishes the cyst from formed dense area of enamel to a co~ the ordi~ary root granuloma with hazy plete tooth may be found. Exploration margins. Expansion of the cyst about reveals a fibrous cyst wall lined by the apex rather than the crown of the stratified epithelium, containinG a tooth in the absence of a non-erupted serous or amber colored fluid. tooth distinguished these growths from dentigerous or follicular cysts. The cavity in the roentgenogram is usually Treatment monolocular but rarely multiple cysts / forming around several neighboring teeth Complete evacuation of the contents may give the impression of multilocularity. of the cyst, including the lining mem­ The involvement of neighboring structures, brane, and the non-erupted tooth. as well as the relation of the adjoining Recurrence is rare except in these cases teeth, must be studied if the cyst is which may be classified as cystic adaman­ large. tinomas with non-erupted teeth. 318 Simple Follicular Cysts of compact bone with evidence of osteoclastic resorption and new forma­ Follicular cysts are derived from tion in the peripheral marrow spaces. the epithelium of the enamel organ of the On the inner surface of the cyst sac, developing tooth. there is a lining of several rows o~ flattened squamous epithelium which in some cases becomes stratified. The Etiology of Follicular Cyst pressure of the cyst. besides causing bone resorption. may also cause the Bock and Jorgenson believe that resorption of the roots of the teeth.