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Ministry of Health of Ukraine Ukrainian Medical Stomatolgical Academy Ministry of Health of Ukraine Ukrainian Medical Stomatolgical Academy Methodical Instructions for independent work of students during the training for the practical studies Academic discipline Surgical stomatology Моdule № 6 The topic of the stadies Benign tumors and tumor-like formations of soft № 11 tissue of maxillofacial area (papilloma, fibroma, lipoma, hemangioma, atheroma, neurofibromatosis, epidermal and dermoid cyst, medial and lateral cyst and fistula of neck): etiology, pathogenesis, classification, histological structure. Clinic, differential diagnosis, treatment and prevention of complications. Course V Faculty Foreign Students Training, Stomatological Poltava -2020 1. Relevance of the topic: Connective tissue lesions comprise a large and diverse number of entities ranging from reactive conditions to neoplasms. Reactive conditions arederived from mesenchymal cells and are represented by fibrous hyperplasias or exuberant proliferations of granulation tissue. Tumors of connective tissue elements are heterogeneous and form a complex collection of diseases. Prediction of biological behavior from histology alone is problematic and is reflected in the difficulties in grading individual tumors. Periapical disease presents with swellings and radiographic changes (osteolytic or osteosclerotic). It is therefore, essential for dentists to be aware of any non- endodontic lesions that may mimic periapical pathosis. The problem is that presentations of many diseases can have overlapping features when the full spectrum of disease presentation is taken into account; the overlap is greater for some diseases than others, particularly when the time-line or natural history is considered. There may be greater overlap at the incipient stages. Endodontists and dentists should therefore, remain familiar with alternative diagnoses and retain a broad surgical sieve at their finger-tips. 2. THE SPECIFIC AIMS: 2.1. To analyze the results of examination of patients with benign tumors and tumor- like lesions of soft tissue of maxillofacial region. 2.2. To explain the results of additional investigations. 2.3. To propose the plan for the treatment of patients with benign tumors and tumor- like lesions of soft tissue. 2.4. To classify benign tumors and tumor-like lesions of soft tissue. 2.5. To interpret the etiology and clinical manifestations of benign tumors and tumor- like lesions of soft tissue. 2.6. To analyze the basic principles of diagnosis. 2.7. To analyze the basic principles of treatment of these diseases. 2.8. To offer the plan of diagnostics, differential diagnostics and treatment of benign tumors and tumor-like lesions of soft tissue. 3. BASIC KNOWLEDGE, ABILITIES, SKILLS, WHICH ARE NECESSARY FOR STUDY THEMES (intradisciplinary integration) Names of previous disciplines The received skills 1. Topographical anatomy. To determine topographic-anatomic location of the lesions. 2. Histology. To know the histological structure of the skin and oral mucosa. 3. Propaedeutics of surgical To be able to conduct curation of patient with stomatology. benign tumors and tumor-like lesions of soft tissue. 4. General surgery. To be able to carry out infiltration anesthesia of the skin, preparing of the surgical field 4. Tasks for independent work in preparation for the lesson 4.1. The list of the basic terms, parameters, characteristics which the student should master at preparation for employment: Term Definition 1. Tumor Abnormal tissue mass with excessive uncoordinated growth that lasts after stopping of stimulating factors action. 2. Biopsy. Surgical removal of tissue specimen from living organism for histological research. 3. Incisional biopsy Diagnostic surgical procedure in which a sample or portion of a lesion is removed for histological review. 4. Excional biopsy Diagnostic surgical procedure in which all clinically abnormal tissue is removed for microscopic analasis. 4.2. Theoretical questions to lesson: 1. What is a benign tumor? 2. What is a tumor-like lesion? 3. Factors that provocative the benign tumors and tumor-like lesions of soft tissue. 4. Classification of benign tumors and tumor-like lesions of soft tissue. 5. Clinical picture of benign tumors and tumor-like lesions. 6. Histological features, etiology of benign tumors and tumor-like lesions of soft tissue. 7. Diagnostic methods. 8. Differential diagnosis of benign tumors and tumor-like lesions of soft tissue. 9. Prevention of benign tumors and tumor-like lesions of soft tissue. 10. Methods of the treatment of benign tumors and tumor-like lesions of soft tissue. 4.3. Practical work (task) that is performed in class. 1. To be able to collect anamnesis from a patient. 2. To be able to examine a patient. 3. To be able to prescribe additional examination methods. To make biopsy. To make cytological investigation. 4. To be able to read laboratory data. 5. To be able to read x-rays foto of the head. 6. To be able to carry out a differential diagnosis. 7. To know how to write a medical card for dental patient. THE CONTENT OF THE TOPIC: Soft tissue swellings derived from connective tissue Papilloma is benign epithelial neoplasm composed of fingerlike projections of squamous epithelium. The cause is unknown, although a virus is most likely. Figure. Viral papilloma (wart). Atheroma («athere» - porridge) is a retentional cyst of sebaceous gland, which appears after corking of conclusion channel of gland of skin. More frequent it has place at the traumatic damage of skin during shaving and other. Atheromas are more frequent singl, but can be and plural (atheromatosis). Atheroma grows slowly and painlessly, localized in any area of skin of face and head. Objectively: atheroma has a spherical form, a skin is not changed in a color, mobile. Skin is adhes with the membrane of cyst in one place (in the area of entrance of duct of sebaceous gland). There is contraction of skin in this place. As skin is folded there, there is a symptom of «lemon crust». Atheroma is mobile, painless at palpation, it has densely elastic consistency, the surface is smooth, borders are clear. It has size from a few millimeters to a few centimeters in a diameter. In some cases at the pressure on atheroma from depression porridge-like mass with unpleasant smell is discharged. Atheromas can purulented. In such cases it loses mobile, a skin is red, there is an edema of surrounding tissues, an abscess is formed. The capsule of atheroma is formed from connecting tissues, inwardly covered a flat epithelium. Treatment of atheroma is surgical – delete of capsule together with the region of skin which is accrete with the overhead pole of cyst. In the case of suppuration of atheroma it treat as an ordinary abscess, and a capsule of atheroma is deleted after complete liquidation of inflammation’s symptoms. Rhinophyma is chronic inflammation of skin of nose with the lesion of all its elements and hyperplasia of sebaceous glands and vessels. More frequent meets for old men, that has problem with an alcohol. A disease develops slowly. Objectively: painless nodosal purple-blue color neoplasm in the area of tip and wings of nose. On the skin’s surface there is extended vessels – telangioectasies. Rhinophima results to deformations of nose and distortion of face. Disease is divided into two forms – fibrotic and glandular (nodosal, knotted). A fibrotic form is characterized by the increase of nose and it does not lose the form. At a glandular form knots are formed on wings and tag of nose which in future meet between itself. Treatment of rhinophima is surgical. Pathological vegetations must be removed with direct skin transplantation. Keratoacanthoma is a tumor-like epithelial formation, that clinically and histologically resemble epidermoid carcinoma but it heals spontaneously without treatment (self limiting lesion) It is of unknown etiology. Clinical features: common age – over 50 years of age, common sex: males more than females, common site: sun exposed skin, including the lip, rarely intraorally. Keratoacanthoma appears as an elevated dome-shaped nodule with a depressed central keratinfilled core giving it a crater-like appearance. It does not exceed 1 to 1,5 cm in diameter, it reaches its maximum size within 4-8 weeks, persists static for another 4-8 weeks, then regresses spontaneously within another 6-8 weeks. Histologically keratoacanthoma is characterized by a central keratin formation, surrounded by hyperplastic epithelium (pseudoepitheliomatous hyperplasia), with mixed inflammatory cells infiltration. It simulates the histological features of a well- differentiated squamous cell carcinoma but with absence of deep invasion. Keratoacanthoma is a self limiting lesion, but careful follow up is required. Warty (skin) horn (keratolytic papilloma) has appearance of formation conic form as a horn, on wide basis, grey or umber color. It can has the appearance of hemisphere. Neoplasm is painless, has a smooth or layer surface, hard, as a horn. Size of skin horn is from a few millimeters till a few centimeters in length. Formation has clear borders. Treatment is surgical excision till the unchanged (normal) tissues. Fibroma is a benign tumor which develops from the fibred connective tissue. It can be localized on the skin of any area of head and neck or on the oral mucosa. Fibroma is divided into hard (does not contain fatty tissues) and soft (contains the elements of fatty tissues). Fibroma of skin is painless neoplasm densely elastic or soft consistency, it is located in skin or comes forward above its surface as a hemisphere.
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