Oral Facial & Bone Neoplasms

• What is neoplasia?


  New growth
• What is a neoplasm?

  An abnormal growth that exceeds normal tissue

  It is uncoordinated & persists after the cessation of the stimulus that caused it
• How do we differentiate neoplasia?

  Into benign and malignant.

  
• How do benign and malignant neoplasms look?

  In malignant neoplasms, rate of division of cells is v high so it outstrips its blood supply. This causes starvation of blood = Necrosis

  
• What are some examples of benign oral neoplasia?

  Haemangioma

  Lipoma

  Fibroepithelial polyp

  Papilloma

  Naevus

  Pyogenic granuloma

  Ameloblastoma

  Pleomorphic adenoma

  Bony exostosis

  
  

  Most of these have the word 'oma' at the end. So 'Oma' usually indicates benign neoplasia
• Haemangioma is abenign vasoformative neoplasm.What does this mean?

  -It's formed from either capillaries or blood vessels.

  
  

  -So can either be described as a capillary or cavernous haemangioma

  
• What is characteristic of a haemangioma?

  Blanches on pressure
• What can a haemangioma cause?

  Troublesome bleeding or oral cosmetic defects e.g on the lip
• How do you treat a haemangioma?

  Cryotherapy/sclerotherapy (inject irritant into vascular space causing scaring) /excision
• What is a lipoma and where can it occur?

  -It's a benign neoplasm of adipose tissue

  
  

  -can occur anywhere where there is subcutaneous/dermal fat (fatty tissue eg neck, oral cavity ,face.
• What does a lipoma look like and how is it treated?

  Soft yellow or pink with overlying mucosa/skin

  
  

  Treat with surgical excision

  
• What is a fibroepithelial polyp (FEP)?

  It's the most common benign epithelial tumour of the oral cavity (although uncommon before the age of 30)

  
  

  & it's a painless flat or pedunculate lesion

  
• How can a FEP be caused and how do you treat it?

  Inflammatory hyperplasia due to chronic irritation e.g. cheek biting

  
  

  Treat by local surgical excision if troublesome

  
• What is a papilloma?

  -Benign proliferating lesion caused by human papilloma virus (HPV-not oral cancer)

  
  

  -is most common between age 30 - 50
• What is a papilloma caused by?

  HPV strains 6 & 11, not the cancer inducing type 16 & 18
• Where are papillomas most common and how do you treat them?

  -Soft palate and tongue

  
  

  -Local surgical excision or cryotherapy if troublesome

  
• What is a melanocytic naevi and how do you treat it?

  -Pigmented mole that develops in childhood & early adult life (30-40)

  
  

  -Runs in families (sun exposure/sun burn)

  
  

  -Remove by local surgical excision if troublesome or of concern

  
• What is a pyogenic granuloma?

  -It's a reactive hyperplasia of connective tissue (no pus &nota granuloma)

  -Usually due to low grade irritation, trauma, poor oral hygiene, hormonal change (so it's more common in females than in males)

  
• Where are pyogenic granulomas most commonly found?

  Gingiva, buccal mucosa, tongue & lips
• How do you treat pyogenic granulomas?

  Local surgical excision (including base) plus improved Oral hygiene
• What is an ameloblastoma?

  Benign tumour of odontogenic epithelium - usually found in x-rays

  
  

  80% of these occur in the mandible, most commonly in the posterior region

  
• What can ameloblastomas cause?

  Expansion of the bone & resorption of adjacent tooth roots

  
• Are ameloblastomas invasive?

  Yes, they are actually locally invasive (very rarely metastatic spread to lung)
• How do you treat ameloblastomas?

  Surgical excision with margin/enucleation possible

  
  

  Must be monitored - could re-occur
• What are pleomorphic adenomas and what/who does it affect?

  Most common salivary gland tumour (accounting for 80% of them)

  
  

  Parotid gland more commonly affected

  
  

  F>M 2:1

  
  

  it can occur at any age but it's most frequent in 30-60 year olds

  
• How are pleomorphic adenomas treated?

  Careful surgical excision required

  
  

  Can get bigger overtime and risk of malignancy.

  
• What is a bony exostosis/ torus and where is it most common?

  Benign localised peripheral overgrowth of bone.

  
  

  Most common in palate and lingual aspect of mandible.
• Why are bony exostoses frequently traumatised?

  Due to location & thin mucosa
• How do you treat a bony exostosis/torus?

  Surgical reduction if functionally/cosmetically problematic

  
• Summarise the content in this lecture.

  -many do not need treatment