Showing posts with label Oral Medicine & Oral Pathology. Show all posts
Showing posts with label Oral Medicine & Oral Pathology. Show all posts

Ameloblastoma

Ameloblastoma is a rare head and neck tumor with an estimated annual incidence of 0.5 per million population. They constitute 1% of tumors and cysts involving the jaws and accounts for approximately 10% of the odontogenic tumors. Ameloblastomas are originated from the epithelial lining of odontogenic cysts, enamel organ or dental lamina, stratified epithelium of oral cavity or displaced epithelial remnants. They are primarily seen in adults during the third and fourth decade of life with no gender preference and more frequently located in the mandible (80%), especially in the angle and ascending ramus [1].

Even though they are benign and slow-growing lesions, ameloblastomas exhibit locally destructive behavior with a high recurrence rate. Thus, most relapses (50% and even over 80%) occur during the first 5 years after the primary surgery. The major contributing factor for recurrence seems to be the inadequate initial surgical procedure rather than the histological type [1].

Radiographic Features

Radiographically, ameloblastoma typically forms round, cyst-like, radiolucent area with well-defined margins. The smallest lesions appear unilocular; whereas larger ameloblastoma may comprise a few large clustered cysts, giving 'soap-bubble’ or 'multilocular appearance' or  ‘honeycomb’ appearance (Fig 1) Expansion of the lesion may be on both, lingual and buccal side.
Fig. 1. Ameloblastoma: multilocular appearance


Differential Diagnosis

Other multilocular lesions that may mimic ameloblastoma radiologically include odontogenic keratocyst, giant-cell granuloma and odontogenic myxoma. Ameloblastoma with a single bony cavity simulate many types of cyst and tumour radiographically.

Treatment

The surgical options for ameloblastoma vary from simple enucleation (with or without bony curettage) to radical excision.


Ref: 
  1. Medina A, Velasco Martinez I, McIntyre B, Chandran R. Ameloblastoma: clinical presentation, multidisciplinary management and outcome. Case Reports Plast Surg Hand Surg. 2021;8(1):27-36. Published 2021 Feb 22. doi:10.1080/23320885.2021.1886854

Supernumerary Teeth

Extra numbers of teeth are known as supernumerary teeth. When they are present in the anterior maxilla in midline, they are known as mesiodens. When the extra teeth are present in the molar region as fourth molar, they are known as paramolar teeth. The anterior midline of the maxilla is the most common site whereas the maxillary molar area is the second most common site for supernumerary teeth.

Supernumerary tooth-mesiodens in anterior mandible in midline [1]


Radiograph showing mesiodens in anterior maxilla [1]


The investigation involves routine blood examination and IOPA or OPG radiographs. Depending on the anticipated level of difficulty of the surgery, additional investigations may be advised.

Treatment involves surgical extraction.





Ref:
  1. Oral pathology clinical pathologic correlation, Regezi, Sciubba, Jordan 4th Ed Saunders

Oral Candidiasis

Oral candidiasis is a fungal disease that is caused by Candida albicans. It looks like a white  or creamy plaque or patch that can be wiped off with the help of a cotton swab or a tooth brush leaving a red base.

Gingival thrush

It occurs due to disturbance in the oral microflora due to antibiotics, corticosteroid, Xerostomia , immune defects especially in HIV infection, immunosuppressant, leukaemia or lymphomas and diabetes. It rarely occurs in a healthy individuals except in neonates.

Chronic mucocutaneous candidosis: note the wide adherent plaque.

Gram stain smear shows the Candida albicans hyphae. It should be differentiated from Koplik's spot or Fordyce's granules.

The treatment involves treating the cause. Antifungal agents, for example, nystatin oral suspension or pastilles, amphotericin lozenges, or miconazole gel or tablets or fluconazole tablets can be given.



Ref:

1. Oral diseases 2nd Ed. Crispian Scully, Roderick A. Cawson Churchill Livingstone

Cysts of the Jaws and Neck: Classification

 

Cysts of the Jaws and Neck 

Cysts can be classified in three types.

Odontogenic Cysts  

  1. Periapical (Radicular) Cyst  
  2. Lateral Periodontal Cyst  
  3. Gingival Cyst of the Newborn  
  4. Dentigerous Cyst  
  5. Eruption Cyst  
  6. Glandular Odontogenic Cyst  
  7. Odontogenic Keratocyst  
  8. Calcifying Odontogenic Cyst  

Nonodontogenic Cysts  

  1. Globulomaxillary Lesion  
  2. Nasolabial Cyst  
  3. Median Mandibular Cyst  
  4. Nasopalatine Canal Cyst  

Pseudocysts  

  1. Aneurysmal Bone Cyst  
  2. Traumatic (Simple) Bone Cyst  
  3. Static Bone Cyst (Stafne’s Bone Defect)  
  4. Focal Osteoporotic Bone Marrow Defect  
  5. Soft Tissue Cysts of the Neck  
  6. Branchial Cyst/ Cervical Lymphoepithelial Cyst  

Oral Leukoplakia

Oral leukoplakia

Oral leukoplakia (OL) is a clinical term for a nonremovable white lesion that is not easily recognisable as any particular condition and therefore requires further investigation.

Oral leukoplakia manifests as patches that are bright white and sharply defined. The surfaces of the patches are slightly raised above the surrounding mucosa.

Oral leukoplakia may be homogenous (uniform lesion often with a fissured surface), or nonhomogeneous (with surface irregularity and textural or colour variation for example speckled-see below given photograph.

Oral Lichen Planus

Oral Lichen Planus on left mucosa [1]


Question: What is oral lichen planus?

Answer: It is a chronic inflammatory condition that affects the skin, nails, hair, and mucous membranes, characterised by purplish, itchy, flat eruptions.


Question: How common is the condition?

Answer: It is a common condition in India. Its cases are reported more than 10 lakh per year in India. 


Question: How much time does it need for recovery?

Answer: It can last several years or remains lifelong.



Question: Is the condition treatable? 

Answer: Treatments can help manage conditions. There is no known cure present. 

 

Question: Does diagnosis require lab tests or imaging? 

Answer: Its diagnosis rarely requires lab tests or imaging. 

 

 

 

Condition Highlights 

  1. It commonly occurs for ages 35-50. 
  2. It is more common in females. 
  3. Family history may increase likelihood to occur. 

 

Odontogenic Keratocyst

 

 

 

Image Source: Recurrence of odontogenic keratocysts and possible prognostic factors: Review of 455 patients (researchgate.net)

Dentigerous/Follicular Cysts

Dentigerous (Follicular) Cysts are the second most commonly occurring odontogenic cysts after periapical cyst and the most common developmental cysts of the jaws. By definition, a dentigerous cyst is attached to the tooth cervix (enamel-cementum junction) and encloses the crown of the unerupted tooth.

Photograph1: Dentigerous cyst surrounding the crown of right mandibular third molar and going upward in ascending ramus. [1]

Etiology and Pathogenesis of Dentigerous Cyst 

A dentigerous cyst originates from the enamel organ remnant or reduced enamel epithelium. The expansion of the dentigerous cyst is related to epithelial proliferation, release of bone-resorbing factors, and an increase in cyst fluid osmolality. 

Clinical Features of Dentigerous Cyst 

Dentigerous cysts are most commonly seen associated with third molars and maxillary Canines. The peak incidence of dentigerous cysts occurs between twenty to 40 years. Males have more predilection with a ratio of l.6 to 1.  

Dentigerous cysts are generally symptomless. The delayed eruption is the most common indication of dentigerous cyst formation. This cyst can achieve significant size, occasionally causes cortical bone expansion but rarely reaches a size that predisposes the patient to a pathologic fracture. 

Radiographically, a dentigerous cyst manifests as a well-defined, unilocular or sometimes multilocular radiolucency with corticated margins in attached with the crown of an unerupted tooth. The concerned unerupted tooth is mostly displaced. In the mandible the related radiolucency may extend superiorly from the third molar site into the ramus or anteriorly and inferiorly along the body of the mandible. In maxillary dentigerous cysts in the canine region, extension into the maxillary sinus or to the orbital floor may be seen.

Histopathology.

The cyst is lined by stratified squamous epithelium. In a noninflamed dentigerous cyst the epithelial lining is nonkeratinized. It remains approximately four to six cell layers thick. Sometimes, numerous mucous cells, ciliated cells, and rarely, sebaceous cells may be found in the lining of the epithelium. The epithelium-connective tissue junction is generally flat. But when secondary inflammation established, epithelial hyperplasia may be noted.

Photomicrography 2: showed a thin non-keratinized epithelial lining composed of 2–3 layers of cuboidal epithelial cells and a fibrous connective-tissue wall loosely arranged. The arrow indicates an occasional mucous cell (bar = 0.2 mm) [1]

Differential diagnosis

When it is small, it is difficult to differentiate a dentigerous cyst from a large but normal dental follicle. When larger, the differential is essential that of lytic lesions of the jaw and includes:

  1. periapical cyst
  2. aneurysmal bone cyst
  3. ameloblastoma
  4. odontogenic keratocyst
  5. fibrous dysplasia
  6. Stafne cyst

Treatment

Removal of the associated tooth and enucleation of the soft tissue part is definitive therapy in most cases. When cysts affect significant portions of the mandible, exteriorization or marsupialization of the cyst is done to allow for decompression and subsequent shrinkage of the lesion followed by surgical enucleation. 

Ref:

  1. https://jcda.ca/article/c59
  2. https://radiopaedia.org/cases/dentigerous-cyst-9
  3. https://www.pathologyoutlines.com/topic/mandiblemaxilladentigerous.html
  4. https://www.nature.com/articles/modpathol2016191

Oral Ulcers: Clinical features, Causes & Treatment

Traumatic ulcers in healing stage caused by sharp teeth

An ulcer is a tissue defect which has penetrated the epithelial-connective tissue border, with its base at a deep level in the submucosa, or even within muscle or periosteum. An ulcer is a deeper breach of the epithelium than an erosion or an excoriation, and involves damage to both epithelium and lamina propria.

Oral Manifestations of Leukaemia

The oral manifestation of leukaemia can be summarized as follows.

In acute leukaemia- localized or generalized gingival hyperplasia is generally observed. It mainly affects the interdental papillae and the marginal gingiva.