Oral Pathologic Lesions (Dr. Sos)

Primary surgical goal of pathology is to

____ with a history diagnosis prior to treatment is essential

T/F: remove the entire lesion
True False

Secondary surgical goal is to

Reconstructive procedures considered prior to treatment of the lesion include:  (4)

An epithelium lined sac filled with fluid or soft material

Arise from ontogenic epithelium

Arise from trapped epithelium between fusing processes

What may play a role in cysts developing from granulomas?

Which cyst types commonly recurring and are more aggressive?

T/F: most cysts are asymptomatic unless infected
True False

The following are characteristics of what?

Radiographically- dense periphery of  reactive bone with a radiolucent center
Usually unilocular, may be multilocular  Usually do not cause tooth resorption

Treatments of Cysts (4)

Total removal of the cystic lesion without rupture and attempting to remove the cyst in one police without fragmentation is what?

When is enucleation indicated?

The following are adj and disadj of what?

Advantages: complete treatment of the  entire lesion, allows pathologic exam of  the entire cyst

Disadvantages: can jeopardize normal  tissue, possible fracture of the jaw,  devitalization of adjacent teeth

creation of a surgical window in cyst wall, evacuation of cyst content, and maintains continuity between cyst and structures (oral cavity, maxillary sinus, nasal cavity)

T/F: With marsupialization only a portion of the cyst removed creating a window and decreasing cystic pressure and promoting bone fill
True False

Indications for Marsupialization (5)

Indications:

The following is adj and disadj of what?

Advantages: simple procedure, spares vital structures

Disavantages: pathologic tissue still left  in situ with no histologic evaluation,  patient inconvenience (need for  irrigation / cleaning of defect)

T/F: Marsupialization is rarely used as sole form of treatment
True False

What is the benefit of combo enuc and marsup?

Indications for enuc and curettage (2)

The following is adj and disadj for what?



Advantage: Removes any epithelial  remnants left by enucleation alone 
Disadvantages: more destructive,
removal of adjacent bone and tissues  (teeth, nerves, vessels etc.)

Management of a benign non-aggressive tumor

Management of benign aggressive tumors

Management of aggressive tumors

What is the most important facto of the lesion that directs the final treatment?

T/F: maxillary tumors are less aggressive than mandibular
True False

T/F: tumors with extra osseous soft tissue invasion are more aggressive
True False

T/F: longer duration means less aggressive
True False

Ultimate goal of removing a tumor is?

Treatment of tumors of low recurrence (most odontogenic tumors)

Treatment of clinical or histopathological aggressive lesions (ameloblastoma, myxoma, CEOT, etc)

Treatment of malignant lesions (carcinomas, sarcomas, lymphomas, etc)

Refers to assessment of the extent of  the disease prior to treatment

Allows selection of the best treatment

Allows meaningful comparison of end results from different sources

Used for malignancies- lymphomas,  sarcomas, and carcinomas

Aggressive tumors

1 cm bony margins beyond radiographic  boundaries of lesion (cut with saw or bur)

Inferior border of mandible left intact if  possible (marginal resection) 
Segmental complete mandibular jaw
resection if lesion encroaches inferior  border of mandible (more difficult reconstruction)

which malignancies are most common?

Removal of lymph nodes  and possible visceral structures (jugular  vein, SCM, spinal accessory nerve)

Type of reconstruction with benign lesions, no recurrence, bone grafting performed at time of tumor removal (one surgical procedure)

Type of reconstruction that is more predictable, less infection and possible loss of  bone graft,  consideration maintaining bony segments  (bone plates), weeks to months after tumor removal (two surgical procedures)