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Squamous cell carcinoma originating in maxillary sinus Squamous cell carcinoma originating in a cystCentral mucoepidermaiod carcinomaMalignant ameloblastoma and Ameloblastic carcinomaMetastatic tumorsOsteosacomaDone By : Rehab SabeelSquamous cell carcinoma originating in a :cystDisease Mech.:Uncommon and exclude invasionsMay arise from inflammatory periapical, residual, dentigerous and OKC. Squamous epithelium lining gives rise to malignant neoplasm

Clinical features: Pain ( dull/long duration ) , Swelling , Pathologic fracture fistula formation and regional lymphadenopathy, sinus pain and swelling -2Location : mostly Mand. , few cases in Ant Max. Periphery and shape:Round/ oval( small lesion ) Well defined/corticated > (advanced) ill-denfined / lack cortication Internal structure: Radiolucent Effect on surrounding: destroy lamina dura of adjacen teeth/adjacent cortical boundaries/complete destruction of alveolar processD/D:Inflamed dental cysts Multiple myelomaMetastatic disease

Squamous cell carcinoma originating in maxillary sinus Disease mech.:Rick factors: chronic sinusitis, chemicals(volatile hydrocarbons , isopropyl oils, wood dust), metals(Ni , Cr)Clinical features:commonly(Africans/Asia heritage)M>FInitial sings=to inflammatory disease and may include recurrent sinusitis, sinus pain , nasal obstruction, epistaxisImaging features: Opacification of max. sinus with soft tissue / destruction of the sinus borders and adjacent max alveolar process / soft tissue mass in oral cavity

Central mucoepidermaiod carcinomaDisease Mech.:epithelial tumor arising in bone originate from(pluripotential odontogenic epithelium , or a cyst lining)Presence of intact cortical plates, radiographic evidence of bone destruction Clinical features: F>MMimic a benign tumor or cyst Painless swelling / facial asymmetry / tenderness / parasthesia of ID / spreading to regional lymph nodesLocation: 3-4times mand>maxPremolar/ molar region and few cases in Ant. Mand.Commonly above the Mand. CanalPeriphery and shape: uni/multilocular massWell defined / well corticated (rarely not corticated)

Internal structure: Often multilocular / soap bubble / honeycomb Round radiolucent area with/without thick sclerotic bony peripheries

Effect on surrounding structures: Expansion of adjacent cortical plates Expansion into the surrounding soft tissue Mand canal may depressed/ push laterally-medially Adjacent lamina dura may lost / unaffected teeth

D/D: Recurrent ameloblastoma = peripheries and internal structuresOdontogenic myxoma CGCGManagement :Treated surgically with resection encompassing a margin of adjacent normal bonePostoperative radiation therapy ( to control spread to lymph nodes ) Malignant ameloblastoma and Ameloblastic carcinomaDisease Mech.:Malignant ameloblastoma: Typical benign histological features and malignant of its biologic behavior (metastasis) Ameloblastic carcinoma : malignant histology Clinical features:M>F Common btw the 1st and 6th decadesMass of the jawDisplaced/loosened teeth and mucosaMetastatic to cervical lymph nodes, lung, spineLocal extension into adjacent bones, CT, salivary glandsLocation: mand>max / premalar, molar region Periphery and shape: Well defined / corticatedPresence of crenations , scalloping of the borderInternal structures:Unilocular / commonly multilocular (honey comb, soap bubble pattern) with thick septa

Effect on surrounding structures:Displace teeth / root resorptionErode lamina dura Displace normal anatomic boundaries ( max sinus , floor of the nose )Displace/erode mand neurovascular canal D/D:Benign ameloblastomaOdontogenic keratocystOdontogenic myxomaCentral mucoepidrmoid tumer Carcinoma in dental cyst / CGCGFinal diagnosis is the result of hitological evaluation / metastasis Management: Surgical resection

Metastatic tumorsDisease Mech.:Usually by blood vessels Metastatic lesions in jaws usually arise from sites inf to clavicle>1%Clinical features: (2)f>MCommon in 5th-7th decadeDental pain/ numbness/ parasthesia of 3rd branch of trigemenal nerve / pathologic fracture / hemorrhage Imaging features:Location:1st common: post. area / mand>max 2nd common: max sinus . Followed by ant hard palat and mand condyleFrequently Bilateral in mandMay locate in periodontal ligament space / papilla of developing toothPeriphery and shape: Moderately well demarcated / no cortication or encapsulation / may have ill defined invasive marginsPolymorphous in shape

Metastatic breast carcinoma . It has destroy Inf. border of mand .

Bilateral metastatic lesions from the lung destroying the mand. ramus

Metastatic thyroid lesion destroying left condyle

Invasion into surrounding soft tissueInternal structures:Generally radiolucentSclerotic metastases (prostate/breast)

Effect on surrounding structures:Stimulate periosteal reaction (prostate/neuroblastoma)Effect lamina dura / increase width of PDL spaceLoss of bone support Cortical bone of adjacent structures destroyedResorption of teeth rare

Prostate metastatic causing sclerosis and periosteal reactionWidening in periodontal spaceD/D:Multiple myelomaPeriapical inflammatory lesionOdontogenic cystSCCManagement:Poor prognosisUsually dies within 1-2 yrsChemotherapy , radiotherapy , surgery , immunotherapy , hormone therapy OsteosacomaDisease Mech.:Unknown cause (genetic/ viral cause have been suggested)Associated with paget dis , fibrous dyplasia after radiotherapy Osteoid is produced directly by malignant stromaThree major histologic types: Chondroblastic , osteoblastic , fibroblastic

Clinical features:Rare ( 7% of all osteosarcoma )(2)M>F 4th decade Rapid swelling / pain / tenderness / loose teeth/ erythemaMay involve neurovascular canalsLocation :mand>max(commonly post areas , lesion occur in any part)May cross the midlineInternal structure :radiolucent/ mixed/ radiopaqueGranular/ sclerotic appearing , cotton balls , honeycomb Periphery and shape:Ill defined Radiolucent/ radiopaque with no encapsulationTypical sunray spicules / hair-on-end trabeculae (when periosteum is displaced)Laminar periosteal new bone ( rare )Extension into surrounding soft tissue ( cause a mass )

Effects on the surrounding structure :Widening of the periodontal membraneMax lesions -> loss of antral/nasal wall corticesMand lesions -> loss of adjacent lamina dura , enlarged/destroyed neurovascular canal

D/D:Minimal/absent of abnormal bone (fibrasarcoma/ metastatic carcinoma)Osseous structure is visible ( chondrosarcoma )New bone presence ( prostate/ breast metastases )Ewing sarcoma , osteomyelitis , solitary plasmacytomaManagement: - Resection with large border-radio/chemotherapy