Prof. Liu Jianhua PhD. MS. DDS. Dept. of Oral-Maxillofacial Surg.

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Prof. Liu JianhuaPhD. MS. DDS.Dept. of
Oral-Maxillofacial Surg. DentistryFirst
affiliated hospitalZhejiang university school of
medicine
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Tumorsin oral maxillo-facial region

• Namingoriginal tissue, biological type,
  position. Such as squamous cell carcinoma of
  right tongue
• Critical t. biologically benign tumor, but has
  malignant tendency and infiltrating growth. such
  asameloblastoma, mixed tumor, papiloma.

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A mass in left submandibular region for 5 years,
slow growing, with no symptom. Diagnosis?
Further examination?
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Left tongue ulcer 3 months, painful, Poor
condition of oral cavity, what to do next?
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Black lesion in soft palate, grows rapidly recent
3 months, shall we make a biopsy?
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• manifestations diagnosis
• Judgement of a mass on patient
• 1)tumor / not tumor(inflam. TB, malformation,
  etc.)
• 2)benign / malignant

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• Differentiation
• benign tumor
  malignant tumor
• Age any age
  carcinoma/agednesssarcoma/young
• Growth speed slow
  faster
• Growth manner bulge
  invasive
• Boundary smooth,movable
  unclear,unmovable
• Symptom generally no
  painful/numbness/funct.limmit
  
• Metastasis no
  maybe
• Body affect generally no organ
  destroy/system destroy
• Histology struct. well differentiated
  worse diff./abn. nuclear
• close to
  norm.cell/tissue
  division

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benign/malignant?
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benign/malignant?
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• Means of diagnosis
• 1)case historyarise,progress
• 2)clinical examinelook?touch? listen to(with
  stethoscope )
• 3)imageX-ray,panoramic radiograph,CT,MRI,
  DSA,B-ultrasonic,PET/CT
• 4)puncturefor liquid
• 5)biopsyno melanoma/parotid g.
• 6)tumor markersCEA, AFP, CA50/125/153/242/724
  etc.

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• treatment
• 1)treatment principle benign tumorsurgery
  firstmalignant t.combined
• 2)methods
• Surgery. safe edge1 cm for malignacy
• Radiotherapy. oral preparationremove ill tooth
  and metal crown fill decayed tooth tooth
  cleaning---(to prevent jaw infection, necrosis,
  redial beam focus)
• Chemotherapybefore,during, post-operation
• othersthermotherapy./immunother. /herbs/
  biotherapy

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• Prevention of oral cancer
• eliminate or reduce carcinogenincomplete tooth
  root or crown?displaced tooth?sharp tooth
  edge?poor denturehot food?tobacco and
  alcoholenvironment contamination(air
  pollution,paint,glue)psycho-problem.
• treat precancerous lesion in timemucosa
  erythema?leukoplakia ?oral lichen planus
  ?papilloma etc.
• investigate vulnerable population and give
  education

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• questionhow to prevent oral cancers?

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??? Oral Maxillofacial cyst???????
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Commonness of Cysts????

• ???wall?????content(??/???liquid/solid)
• ????
• ????
• ???????????????expansile absorbing

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????????????sebaceous cyst

• ??pathogeny???sebaceous gland?????,?????----???re
  tentive???
• ?????????????pigment dot????----?????
• ????shuttle??--??????(??)

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??????????dermoid / epidermoid cyst

• ?? ??embryo?????remnant?????(?????)
• ??????????----?????????----?????????????----?????
  ??????????
• ?? ???????????????----????????

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????????thyroglossal tract cyst

• ???????----?????----????----??????,?????????????
  ----???????----??????
• ????1-10?gt??? ???----????????????????,??,???,????
  ????,??----??/????,B????----?----???

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• (????)
• ?????????,???,??,?????
• 1??????????,???????
• 2?????????,?????
• ?-131/?-99????????
• ??
• ???????????
• ???????----?????

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? ????branchial cleft cyst

• ?? ?????----5???----4???----??????----??
• ???? 20-50?(????????)???,???fluctuate,??????----?
  ?,??----???,??----???fistula(??????),???congenital
  ----??????(???????),??----??/???/??????,B??

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??????maxillary cyst

• ???????odontogenic jaw cyst
• ????/?----????(???????????)
• ????????non-odontogenic
• ?????????----????
• ??----??????intra-bleeding

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??????? odontogenic jaw cyst

• ????(radicular cyst)
• ??????----???----???????----????----??
  
• ????(residual cyst)??????????

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• ???? (primordial cyst)
• ???????----?????----??
• ???? (dentigerous cyst)
• ????????????----??
• ???? (keratocyst)
• ????/????----??(????,??,??/???)

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????clinical characteristics

• ????????----??????----???----???----??

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??

• ??
• ?????
• X?
• ????----?????,??
• ????----?8?/?????
• ????----?????
• ????----?8?/?????

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??

• ????
• ??/??,??/??
• ???????/?????/???????
• ????

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??? ?????????benign tumor tumor-like lesion

• ??????/?????????????????,????(???????)?

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?? ????
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???nevus
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???nevus

• ??????
• ???????????????
• ???---???,?????????,?????
• ???---??????????????---???
• ???---??????????,????

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???(epulis)

• ????/??????---????(?????)
• ????---??????????,???
• ???---?????????,????
• ???---????,????(?????)
• ???? ???---??????????

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??????
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(?)???????(ameloblastoma)

• ????????????????????????(?)/??(???),????
• ????????,???/??,????,??????----??????(????????)??
  ??(?)?
• ??X????----????????,????,?????,?????
• ?????,?????0.5cm????????
• ?????????????????

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hemangioma ???

• 1) authentic tumor
• 2) account for 60 of body hemangiomas
• 3) head vs.body? 19?
• 4) most disappear before 10 year-old
• 5) surgery or not?

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Clinical characteristics

• 1) newbornstrawberry like on skin
• 2) rapid growthafter 1 month
• 3) stillness or shrinkingafter 1 year
• 4) disappear50-60 within 5 year 75 within 7
  year 90 within 10 year.
• 5) end of disappear10-12 year
• Question shall we recommend surgery?
• Advantage ? Disadvantage?

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vascular malformation

• A) venular(???) malformation -- 50200um, former
  grape wine splash(??????)
• Clinic characteristics
• Pressdisappear, distinguish from nevus(???)

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grape wine splash
sponge-like
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B) venous malformation(????)

• Former cavernous (sponge-like????) hemangioma
  (old textbook)
• clinic characteristics
• 1) Compress test
• 2) Head down test
• 3) Puncture
• 4) Vein calculi (stone)
• Question is angiography(????) helpful?

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venous malf-before after surgery
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c)Arterio-venous malformation

• Or congenital(???) arteriovenous malf.
• Former grape-vine-like hemangioma??????.
• Outstretched artery and vein connecting directly,
  omitting capillary net.
• Clinic characteristics
• 1) earthworm like 2) throbbing/pulsate
• 3) souffle (???,caused by vortex)

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Treatment methods

• 1) surgery once or several times
• 2) intra cavity injectionfor venous malf., with
  Bleomycin, maximum 6mg/once.
• 3) hormone / isotopefor infant within 1
  year-old.
• 4) laser lightfor superficial lesion.
• 5) embolism of blood vesselglutin(??)sponge/
  metal spring, reopen in a few days.
• 6) trans-catheter(??)arterial embolizationunder
  DSA, dangerous.
• Question can ligation of external carotid artery
  cure arteriovenous malf.?

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(?)???????

• (????neurolemmoma)
• ??????,?????Schwannoma?
• ??????/??,??(????),????,????????(????),????????,?
  ??????,?????????????????
• ??????????????????

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?????neurofibroma

• ??????????????
• ?????????????,??,??????,????????,??,????????,????
  ???????????gt1.5cm, gt56??----??????(??)?
• ???????????

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Before sugr.
Before sugr.
After sugr.
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(?)??????osteogenetic tumor

• ??????(?????)
• ????(????)
• ????????(????)

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??????ossifying fibroma

• ??????????????,???????????????
• ???????,??,??gt??,??gt??,????,???,X????,?????
• ????????????----????,??,??gt??,X?????,???????
• ??????/?????

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(?)?????

• ????????????????(mixed tumor).
• ??????gt???gt?????????,????????????????
• ?????

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??? ????

• ? ???(?????30)
• (carcinoma of tongue)
• ????-??????-????
• ????,??,??
• ????????
• ??????????????????????????? ?????????????????
  ???
• ??????(??????????????)??????????????

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• ?????gingival(?25)?????,?????
• ????buccal(?20)?????????
• ????palate(10)?????????
• ?????oral floor????,????

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??????carcinoma of maxillary sinus

• ???????????????????????????
• 1)????????
• 2)????????
• 3)???????
• 4)????????????
• 5)???????
• ????????????????

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????carcinoma of lip

• ??????????crater???/???cauliflower???
• ??????(1??)???????????????

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• ?????????????-??????
• ??????fibrosarcoma????
• ??????osteosarcoma????????????
• ????????malignant lymphoma
• HLNHL15(NHL???)
• ???????,???????????????????????????
• ???????