CYST AND TUMORS OF THE JAW & FACE
Jaw tumors and cysts are growths or lesions that develop in the upper or lower jawbone/ soft tissues in the mouth and face. They are either referred to as odontogenic (tooth related) or nonodontogenic (bone related), Based on their origin — can vary in size and severity. They are usually noncancerous, but can be aggressive (fast growing) and expand, displace or destroy the surrounding bone, tissue and teeth.
Treatment options vary, based on the growth type or lesion you have, the stage and symptoms. These are treated by your Mouth, jaw and face (oral and maxillofacial) surgeons usually by surgery, or by medical therapy or a combination.
How do they represent?
A tumor is an abnormal mass of tissue that continuously grows either slow or at a faster rate. A cyst is a empty lesion that may contain liquid or semisolid material. Examples of jaw tumors and cysts include:
Ameloblastoma. This type of tumour is rare but not uncommon, usually noncancerous (benign) tumor begins in the cells that form the protectivel lining on the teeth. It develops most often in the lower jaws near the molars. The most common type which is aggressive that forms large lesions and grows into the jawbone. Although this can recur after treatment, aggressive surgical treatment will reduce the recurrence. rate as theses tumors have a history of coming bach again.
Central giant cell granuloma. They are benign lesions of bone cells. They mostly occur in the anterior region of the lower jaw. some types of tumors can grow rapidly, destroy bone and cause pain and and has a tendency to recur after surgery as well. Some other types are less aggressive and may not have complaints. Rarely, a tumor will resolve on its own, but typically they require surgical treatment.
Dentigerous cyst. This is the most common form that affects the jaws. It originates from tissueand bone that surrounds a tooth before it erupts into the mouth. Most often they involve the lower wisdom teeth that are not fully erupted, but they also involve other teeth in the jaws.
Odontogenic keratocyst. This cyst is typically slow growing, but can be destructive to the jaw if left unnoticed or unattended causing bony expansion and swelling around the jaw. It develops most commonly in the lower jaw near the third molars. Also found in people with in a nevoid basal cell carcinoma syndrome.
Odontoma. most common benign odontogenic tumor. They often have no symptoms, but they interfere with tooth development or eruption. Odontomas are made up of dental tissue and might look similar to teeth shape making it look like multiple small teeth arranged in a cluster form. They grows around a tooth in the jaw. These tumors may be part of some genetic syndromes.
Odontogenic myxoma. Most commonly seen in lower jaws, it is A rare, slow-growing, benign tumor. The tumor can be large and aggressively eat the jaw and displace teeth and surrounding tissues.
Odontogenic myxomas are known to come back after surgical treatment; however,the chances are decreased with more-aggressive forms of surgical treatment.
When to see a doctor ?
Many times, these lesions do not have symptoms and are discovered on routine screening X-rays done for other reasons. If you are diagnosed with or suspected of having a jaw tumor or cyst, your dentist can refer you to a specialist for diagnosis and treatment.
Odontogenic jaw tumors and cystic lesions originate from cells and tissues that are involved in normal tooth development. Generally, the cause is not known but they are associated with gene mutations or syndromes.
On rare ocassion, some People are affected with a syndrome called nevoid basal cell carcinoma syndrome/ Gorlin-Goltz syndrome, where they lack a gene that suppresses tumors. The genetic mutated gene are usaully inherited. This syndrome shows development of multiple cysts specifically odontogenic keratocysts within the jaws, multiple basal cell skin cancers and others.
Best methods to diagnose and get more information is by the following tests that are recommended prior to treatment.
- Imaging studies : X-ray (OPG), CT or MRI
- Biopsy: A sample of tumor or cyst cells for laboratory analysis
- Aspiration : These cysts and tumors sometimes contains purulent materials that determines what type of lesion it is and helps your surgeon tie understand what treatment can be implemented. Your surgeon with use a syringe and take the material from the cyst and send to lab.
Your physician uses this information to suggest a treatment plan that’s best and most effective option for treating your tumor or cyst.
Radiological representation of these jaw cysts or tumors
Replacement type: in place of normal tooth
Envelopmental type: surrounds or envelops an adjacent unerupted tooth
Extraneous type: occurs in bone away from the teeth
Collateral type: occurs near the roots of the teeth
Our Goals of Surgery
- Complete elimination of the lesion/ pathology
- Decrease the recurrence rate & morbidity for the patient
- Improving the quality of life postsurgically
- Minimum trauma to the adjacent structures (dentition and nerves)
- Restore/Preserve/Maintain function & esthetics
Factors we consider for the Choice of Optimum Surgical Strategy
- Patient factors & lesion characteristics
- Patient’s general health and coexistence of NBCCS-Nevoid Basal Cell Carcinoma Syndrome/ any other syndrome
- Patient’s compliance to follow up
- Size and number (solitary/multiple) of the cystUni – single type/multilocular – multiple cysts at a time
- Location and approachability of the lesion-surgical access
- Cortical bone involvement by perforation/Soft tissue/adjacent structure involvement Presence or absence of infection
- Any previous History of recurrence/previous surgery
- Histological types
Reasons for the Definitive Treatment
- Cysts continue to slowly grow and increase in size after a point
- chances of secondarily infected
- Cyst can make the jaw bones weak, leading to risk of fracture
- Few cysts can undergo transformation to aggressive pathological lesions like ameloblastoma or squamous cell carcinoma
- Cysts prevent eruption of teeth (as in the case of a dentigerous cyst)
- Cysts can involve neighbouring structures like teeth, maxillary sinus, nasal cavity, inferior alveolar nerve, etc.
SURGICAL TREATMENT OPTION WE PROVIDE:
Conservative Surgical Treatment
- Decompression only : drainage tube placement (decrease in lesion size)
- Decompression + Enucleation + adjuvant therapy (two-staged procedure)
- Marsupialization only (making a pouch)
- Marsupialization followed by Enucleation (Waldron’s method)
- Enucleation + packing with primary closure (or) with primary closure + bone grafting/ reconstruction
- Enucleation + excision of overlying oral mucosa
- Enucleation + various Adjuvant Therapies
Enucleation with Adjunctive Therapies to Eliminate the Microscopic lesions
- Peripheral ostectomy (Mechanical/physical methods, Hand instruments like curettes, & use of rotary bur for removal of perimeter of investing bone)
- Electrocauterization (buccal and lingual perforation areas)
- Cryotherapy (liquid nitrogen)
- Chemical cauterization treatment using Carnoy solution (1.5 mm depth of bone penetration for 5 min)
- Combination Approach (decompression, enucleation, peripheral ostectomy, and cauterizing bone cavity by carbolic acid)
Aggressive Surgical Treatment
- Resection – causing a continuity defect-peripheral ostectomy
- Resection + continuity defect–segmental resection
- Resection + disarticulation of condyle
After surgery, the resected part of the lesion along with bone and surrounding soft tissues are sent to the lab for examination. A pathologist examines and reports a diagnosis during the procedure so that the surgeon can provide further information and fate of the lesion.
Other treatments may include:
- Reconstruction of the jawbone or other structures
- Medical therapy for certain types
Examples of jaw tumors and cysts treated at FORT HOSPITAL :
- Adenomatoid odontogenic tumor
- Aneurysmal bone cyst
- Calcifying epithelial odontogenic tumor
- Central giant cell granuloma
- Dentigerous cyst
- Odontogenic keratocyst
- Odontogenic myxoma
- Ossifying fibroma
- Squamous odontogenic tumor