Faculty of Dentistry

Oral &Maxillofacial Surgery Division

Maxillofacial tumors

Dr:Asmaa Helmy
Date : 30/9/2024
Neoplasm Abnormal growth of tissue Mass

A tumor is a swelling or mass caused by excessive, continued growth

of cells
within a tissue; growth is uncoordinated with that of normal tissue and
persists
in the same excessive manner after cessation of the stimulus that
.

evoked it
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Building a diagnosis ? Treatment plan
Building a diagnosis ?

Laboratory investigation

Biopsy

Imaging
History and Examination
 Histoty of the lesion ??

1. Duration
2. Mode of onset and progress
3. Exact site and shape
4. Change in character of the lesion
5. Associate symptoms
6. Similar swelling elsewhere
7. Loss of body weight
8. Recurrence Amount of tooth
9. Habit structure above bone
.

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 Duration

Prolonged •may be congenital

duration

Long duration •benign neoplasm

without pain

Short duration, •malignant growth

rapid growth .

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 1.Mode of onset and
progress How is the lesion progressing??

growing
Benign growth
slowly
Malignant transformation in a benign lesion
growing Malignant growth
again after
a stationary
period time
continuously .

increasing in
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What symptoms are associated with the lesion?

pain dysphagia

Is there any events

associated with the anesthesia or
lesion /.. paresthesia

1. Trauma
2. Parafuntional habits inflammatory or infectious cause or a
3. Fracture tooth
manifestation of malignancy.
.

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2-Clinical Examination
Single Vs
multiple
lesions
. Size and shape of Presence of
the lesion fluctuation
pulsation
Examination of
the lesion

The surface of the The consistency of

lesion the lesion
The color of the
lesion
.

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 ➢ Smooth surface or lobulated
,cauliflower appearance
❑ The color of the lesion: e.g., bluish
mass blanches on pressure may
indicate hemangioma
❑ The consistency of the lesion: It may be soft
(lipoma), firm (fibroma), hard (pleomorphic
adenoma) or bony hard (osteoma

. 3
Single Vs multiple lesions:
• Presence of multiple lesions is an important diagnostic sign.
• When multiple areas of ulceration are found within the mouth then
you can eliminate a carcinoma in the mouth.

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Lymph nodes examination
Palpation

Size
Tenderness
Fixation
Consistency
.

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Radiographic examination

Dentigerous cyst
Ameoblastoma
.
Keratocyst
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Squamous carcinoma
Intraosseous

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❑ Aspiration
Lab investigation
Tumor markers

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 Biopsy
A biopsy is a medical test commonly performed by a surgeon, The process
involves the extraction of sample cells or tissues for microscopic diagnostic
examination examination to determine the presence or extent of a disease

❑ Differentiation means the degree of resemblance of the

tumor cells to the tissue of origin both histologically and
functionally.
•Benign neoplasms are well differentiated.
•Malignant neoplasms range from well to poorly
differentiated. ❑ Accurate diagnosis
❑ Degree of malignancy
Importance of biopsy ❑ Prognosis
.

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 Indication of biopsy

❑ Lesion not responds to ttt within 14 days

• Erythroplasia: lesion is totally red or has a speckled red and

white appearance
• Fixation: lesion feels attached to adjacent structures
• Growth rate: lesion exhibits rapid growth
• Induration: lesion and surrounding tissue are firm to the touch
.

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❑ Incisional biopsy

❑ Part of the abnormal tissue excised

Diagnostic only

INDICATIONS:
• Large lesion > 1 cm diameter
▪ Location in risky or hazardous regions
▪ If the lesion nature is uncertain.

CONTRAINDICATIONS:
• Hemangioma.
• Malignant melanoma
 Guidelines for incisional biopsy

❑ sample is cut in a wedge shape, it is better to take a

narrow, deep specimen than a broad, shallow one.

❑ Biopsy must contain part of the normal healthy tissue .

❑ Several parts of the same mass are more likely to give

accurate diagnosis .
 ❑ . Avoid injection of local anesthetic directly into the tumor tissue
which may cause distortion of the tissues. Ring block or regional
nerve block is recommended..

❑ Avoid cauterization ,electrosurgery as it deform the cells

❑ . The sample should be placed in 10%

formalin solution in a wide mouth bottle
Demarcation of incision.

Surgical field after removal of specimen.

Operation site after suturing

Extensive palatal swelling Local anesthesia in normal
tissues

Site after placement of sutures

Surgical field after wedge-
Wedge-shaped incision
shaped excision
 ❑ EXCISIONAL BIOPSY

❑ the whole abnormal tissue

excised
• Diagnostic and therapeutic

2-3 mm of the surrounding normal

tissues

INDICATIONS:
1. Small superficial lesion (1-2 cm in
diameter).
2. Well encapsulated tumors
 Drill biopsy (intra-osseous biopsy)

1. For obtaining samples from deeply seated lesions.

2. Indication: intra osseous lesion

❑ Using trephine bur

 .4.Punch biopsy

1. It is indicated in inaccessible areas (larynx and oropharynx)

2. This is performed with a punch type forceps which punches

or bites out a portion of tissue

1. .
Frozen section biopsy

This is performed during surgery to attain

immediate information.
Aspiration biopsy
Fine needle
aspiration biopsy Core biopsy
(FNAC)

Removal of cells without Removal of cells with preservation

preservation of histological of histological architecture
architecture
 Fine needle aspiration
biopsy (FNAC)

1. A fine disposable needle of gauge 18-23 is used with 3-10 lcc disposable
plastic syringes.
2. The needle is inserted into the lesion and moved in and out and
laterally in three dimensional planes without being removed outside the
lesion.
3. Cells from the lesion will be collected inside the lumen of the needle.
Then the needle is withdrawn and the aspirate containing the cells is
disposed on a glass slides. It is then spread, fixed, stained and
examined microscopically
 Exfoliative oral cytology
1. It is performed by scraping the lesion's surface repeatedly and firmly by a spatula
or tongue depressor.

2. The cells obtained are smeared on a glass slide, fixed and stained, and
microscopically examined.

3. It is useful in poor surgical risk patients & in surface lesion when malignancy is
suspected.
❑ It is a valuable noninvasive tool for monitoring patients
with chronic mucosal changes (e.g., leukoplakia, lichen
planus, and irradiation damage)
Technique of oral brush cytological examination.

Brush used to Then it is The cells are

obtain rotated 5 to then
specimen 10 times with transferred to
moderate a microscopic
pressure. slide,