maxillamandible
maxillamandiblemaxillamandibleAmeloblastomaMandible-MaxillaOsteosarcomaMultipleMyelomaMandible-MaxillaMetastasisBenignandMalignantTumoursAmeloblastomaDefinition:Benignbutlocallyaggressiveneoplasmoriginatingfromodontogenicepithelium.Previouslycalledadamantinoma.Thistermisinaccurateasitimpliesthepresenceofhardtissues,whichdonotoccurinameloblastomaEtiology:Unknownandsomewhatcontroversial,butleadinghypothesesincluderemnantsofdentallamina,basallayeroforalmucosaand,lesscommonly,arisingwithinpre-existingdentigerouscystEpidemiology:Represent1%ofalllesionsofmandibleandmaxilla2ndmostcommonodontogenictumor(35%)2ndmostcommonbenignmandibulartumorAge:Mostcommonlypresentsin30-50yearoldsUnilocularlesionsoftenseeninyoungeragegroupLocation:Mandible:Usuallycenteredin3rdmolar,mandibularramusregionMaxilla:Usuallycenteredinpremolar,1stmolarregionAffectsmaxillarysinusbeforenasalcavitySize:2cmatdiscoveryinmostcasesPresentation:Mostcommonsigns/symptomsHard,painlessmandibularmassOthersigns/symptomsLooseteeth,painlessswellingBleeding,poorlyhealingtoothextractionMaybenoearlyclinicalsymptomsClinicalprofile:Adultwithpainless,slowlygrowingmandibularmassBestdiagnosticclue:Bubbly,multilocular,mixedcystic-solidmassinposteriormandibleormaxillaassociatedwithunerupted3rdmolartoothRadiography:Unilocularormultilocular(80%)radiolucentmasswithscallopedbordersandexpanded,thinnedcorticalmarginsNocalcificationsinmatrixPanoramicradiographshowingmixedradiolucentradio-opacityinmaxillaryrightposteriorregionCTFindings:CECTSmallerlesionswithmarginalenhancementonlyLargerlesionswithextraosseousextensionshowmoderatesofttissueenhancementmixedwithcystic(low-density)areasExtraosseousextensionisuncommonBoneCTUni-(20%)ormultilocular(80%)withscallopedbordersBubblypatternistypical;notpathognomonicUneruptedmolartoothassociationcommonResorptionofadjacentteethExtensivethinningofmandibleormaxillacortexLow-densityosteolyticlesionthatdoesnotmineralizeitsmatrixLateralgraphic(Leftimage)showsmandibularameloblastomaasabubbly,multilocular,expansilelesion.Thelocationproximaltothe3rdmolaristypical.AxialboneCT(Rightimage)showstheclassicappearanceofsolid/multicysticameloblastomaasamultiloculatedexpansilemassinthe2nd-3rdmolarregionofthemandible.Notethethinnedoverlyingcortexandthecharacteristicmultiplecoarseseptations.MRFindings:T1WIMixedsignalintensityLowT1signalintensity(cystic)typicalbuthighsignaloccasionallyseenT2WIMixedsignalintensityWhenlargewithextraosseousextension,highT2signalhelpsdifferentiatefrommalignanttumorsSTIRIncreasedsignalintensityofcysticareasDWISolidareasshowADCCysticareasshowADCkeratocysticodontogenictumorT1WIC+Smallertumors:EnhancingmuralnoduleMayrepresenttumorgrowthcenter,whichmustbecompletelyresectedtoachievesurgicalcureEnhancementofseptationsfrequentlyseenSolidregionsshowrapidenhancementondynamicMR,reachingmaximumcontrastby60secondsCysticareasshownoenhancementEnhancedimagingmayoverestimateregionoftruetumorinvolvementNoevidenceofperineuralspread(Left)AxialT2WIFSMRofamaxillaameloblastomashowsbothsolidandcysticcomponentsinamultiloculatedpattern.NotethetypicalbrightT2signalofthecysticcomponentsandtheexpansionoftheposteriormaxillarysinuswalls.(Right)CoronalT1WIC+FSMRofthesameameloblastomademonstratesthetypicalenhancementoftheseptations.Thelocallyaggressivenatureoftheselesionsislikewiseevidentbytheextensionintothenasalcavityandethmoidaircells.Differentialdiagnosis:Periapical(Radicular)CystClinicallypainfulwithcariouslesionorperiodontaldiseaseBoneCT:LossoflaminaduraandwideningofperiodontalligamentspaceLargerlesionsaredestructive,notexpansileDentigerousCystoneCT:UnilocularcysticlesionsurroundingtoothcrownNoenhancingmuralnoduleUnilocularandsmallermultilocularameloblastomamaymimicdentigerouscystsKeratocysticOdontogenicTumorBoneCT:UnilocularormultilocularcysticlesionofmandibleassociatedwithuneruptedtoothLesionenvelopsaroundorincorporatescrownandtoothrootTendencyforlessbuccal-lingualexpansionthanameloblastomaNoenhancingmuralnoduleUnilocularandsmallermultilocularameloblastomamaymimickeratocyticodontogenictumorTreatment:CompletesurgicalexcisionwhensmallCurettementnolongeracceptabletherapyEnblocremovalforlargerlesionsChemotherapyandradiotherapyarecontraindicatedNaturalHistory&Prognosis:Slow-growing,sometimesindolent,benignneoplasmOftentakesyearstobecomesymptomaticMalignanttransformationisrare(1%)ReferredtoasameloblasticcarcinomaTumorrecurrenceiscommon(33%)Recurrencemayrequiremoreaggressive2ndenblocresectionUniloculartumorrecursmuchlessfrequently(15%)thanmultiloculargroupMaxilla-MandibleOsteosarcomaDefinition:MalignanttumorarisingfrombonewithabilityofneoplasticcellstoproduceosteoidEtiology:ItusuallyoccursdenovoPrimaryosteosarcomaisassociatedwithgeneticsyndromesMayalsobeassociatedwithradiationtherapy,PagetdiseaseofboneorfibrousdysplasiaEpidemiology:MostcommonnonhematopoieticbonemalignancySecondmostcommonbonemalignancyaftermyelomaCraniofacialosteosarcomasrepresentabout6.5%-7%ofallosteosarcomasAge:Patientswithosteosarcomasofthejawaregenerally10to20yearsolderthanthosewithosteosarcomasoflongbonesMalesareaffectedmorefrequentlythanfemalesLocation:MandiblemorecommonthanmaxillaAngle,ramus,orbodyofmandibleSize:Variable;usuallywhitesMostcommonvhematologicdiseaseinblackslivinginUSAAge:Mostcommonlypresentsin30-50yearoldsUnilocularlesionsoftenseeninyoungeragegroupGender:MalefemaleLocation:InoralcavityMandiblemaxillaPosterioranteriorSize:Small:UsuallymalesIncreasedserumcalciumLangerhansHistiocytosisLesionsofLangerhanshistiocytosisarealsodescribedaspunchedoutLangerhanshistiocytosisinmuchyoungeragegroupLesionsinmandiblemayappearscoopedoutandanyinvolvedteethmayappeartobefloatingSimple(Traumatic)BoneCystMayappearsimilartosolitarymandibularlesionofMMMoreoftencorticatedLesionsusuallylargerandscallopbetweenteethSeeninyoungeragegroupPrimaryIntraosseourcinomaUsuallysolitary,ill-definedlesionMayhaveassociatedsofttissuemassRareinjawsTreatment:Currently,multiplemyelomaremainsincurablechemotherapy,bonemarrowtransplantation,antitopoisomeraseIIalphaagentsmayhelpNaturalHistory&PrognosisOverallpoorprognosis;1yearifmultiplelesionsandnotreatment;manyyearsifthedisesesisindolentMandible-MaxillaMetastasisDefinition:SpreadofmalignantdiseasefromdistantprimarytumorEtiology:Pathogenesisoforalmetastasesisnotfullyunderstoodbutcurrenthypothesesinclude:AmultistageprocessinwhichcellsdetachthemselvesfromtheprimarytumorandaretransportedbylymphaticorbloodvesselsIntheoralsofttissues,chronicallyinflamedmucosa,especiallygingiva,hasarichcapillarynetwork,whichcantrapthemalignantcellsandcausemetastasesEpidemiology:Metastasestojawsrareandaccountfor1%oforalmalignanciesMostcommonprimarylesionsfrombreast,lung,kidney,thyroid,prostate,colon,rectum,stomach,testis,bladder,cervix,andovary25%ofmetastaticjawlesionsrepresent1stsignofdiseaseAge:5th-7thdecadesmostcommonLocation:Ramus,premolar-molarregionofmandiblemostcommon;canbebilateralInvolvementofbothjawsextremelyrareOthersites:Mandibularangle,condyle,maxillarysinus,anteriorpalateOccasionallyatrootapexordentalpapillaofdevelopingtoothandmimicsperiapicalinflammationMetastasestobonemorecommonthantogingiva:2.5:1Bestdiagnosticclue:Patchyormoth-eatenbonedestructionwithperiodontalligamentspacewideninginpatientwithknownprimarycarcinomaRadiographicFindings:Earlydisease:PatchyareasofbonedestructionseparatedfromeachotherbynormalboneLatedisease:RadiolucentareascoalescetoformlargerlesionsGeneralizedradiolucency,moth-eatenappearanceorfrankbonydestructionCorticalboneofadjacentstructures(mandibularcanal,maxillarysinus,nasalfloor)resorbedPathologicfractureMostmetastasescausebonedestruction,butbreastandprostatemetastasesmaycauseboneformationandscleroticappearanceMayseecombinationofbonedestructionandformationSpiculatedperiostealreactionoccasionallyseen,especiallywithprostatecarcinomaMaycausesymmetricwideningofperiodontalligamentspace,lossoflaminadura,lossofdevelopingtoothcryptcortexComputedtomographyscanofthefacewiththree-dimensionalreconstructionrevealedawell-definedosteolyticlesionwithmultipleirregularcalcificationsthatextendedintothelingualandmandibularsofttissuesCroppedpanoramicradiographshowsbreastmetastasesaffectingtheleftmandibleandramus.Notethelossofinferiorcorticalborder,lossoflaminadura,andlossofnormaltrabeculararchitecture.AxialsofttissuewindowNECTinthesamepatientatalowerlevelshowsnodalenlargementandmedialdisplacementofthepharyngealconstrictormuscleTreatment:surgicalresection,sometimescombinedwithradiationtherapyorchemotherapyNaturalHistory&PrognosisMetastasestothejawoftenindicateendstagedisease,andareassociatedwithpoorsurvivalMeantimetodeathfromdiagnosisofjawmetastasiswas12monthsversus8monthsfororalsofttissuemetastasisThankyouforyourattention结束语结束语谢谢大家聆听！谢谢大家聆听！54
收藏
- 资源描述：
-
maxillamandiblemaxillamandibleAmeloblastomaMandible-MaxillaOsteosarcomaMultipleMyelomaMandible-MaxillaMetastasisBenignandMalignantTumoursAmeloblastomaDefinition:Benignbutlocallyaggressiveneoplasmoriginatingfromodontogenicepithelium.Previouslycalledadamantinoma.Thistermisinaccurateasitimpliesthepresenceofhardtissues,whichdonotoccurinameloblastomaEtiology:Unknownandsomewhatcontroversial,butleadinghypothesesincluderemnantsofdentallamina,basallayeroforalmucosaand,lesscommonly,arisingwithinpre-existingdentigerouscystEpidemiology:Represent1%ofalllesionsofmandibleandmaxilla2ndmostcommonodontogenictumor(35%)2ndmostcommonbenignmandibulartumorAge:Mostcommonlypresentsin30-50yearoldsUnilocularlesionsoftenseeninyoungeragegroupLocation:Mandible:Usuallycenteredin3rdmolar,mandibularramusregionMaxilla:Usuallycenteredinpremolar,1stmolarregionAffectsmaxillarysinusbeforenasalcavitySize:2cmatdiscoveryinmostcasesPresentation:Mostcommonsigns/symptomsHard,painlessmandibularmassOthersigns/symptomsLooseteeth,painlessswellingBleeding,poorlyhealingtoothextractionMaybenoearlyclinicalsymptomsClinicalprofile:Adultwithpainless,slowlygrowingmandibularmassBestdiagnosticclue:Bubbly,multilocular,mixedcystic-solidmassinposteriormandibleormaxillaassociatedwithunerupted3rdmolartoothRadiography:Unilocularormultilocular(80%)radiolucentmasswithscallopedbordersandexpanded,thinnedcorticalmarginsNocalcificationsinmatrixPanoramicradiographshowingmixedradiolucentradio-opacityinmaxillaryrightposteriorregionCTFindings:CECTSmallerlesionswithmarginalenhancementonlyLargerlesionswithextraosseousextensionshowmoderatesofttissueenhancementmixedwithcystic(low-density)areasExtraosseousextensionisuncommonBoneCTUni-(20%)ormultilocular(80%)withscallopedbordersBubblypatternistypical;notpathognomonicUneruptedmolartoothassociationcommonResorptionofadjacentteethExtensivethinningofmandibleormaxillacortexLow-densityosteolyticlesionthatdoesnotmineralizeitsmatrixLateralgraphic(Leftimage)showsmandibularameloblastomaasabubbly,multilocular,expansilelesion.Thelocationproximaltothe3rdmolaristypical.AxialboneCT(Rightimage)showstheclassicappearanceofsolid/multicysticameloblastomaasamultiloculatedexpansilemassinthe2nd-3rdmolarregionofthemandible.Notethethinnedoverlyingcortexandthecharacteristicmultiplecoarseseptations.MRFindings:T1WIMixedsignalintensityLowT1signalintensity(cystic)typicalbuthighsignaloccasionallyseenT2WIMixedsignalintensityWhenlargewithextraosseousextension,highT2signalhelpsdifferentiatefrommalignanttumorsSTIRIncreasedsignalintensityofcysticareasDWISolidareasshowADCCysticareasshowADCkeratocysticodontogenictumorT1WIC+Smallertumors:EnhancingmuralnoduleMayrepresenttumorgrowthcenter,whichmustbecompletelyresectedtoachievesurgicalcureEnhancementofseptationsfrequentlyseenSolidregionsshowrapidenhancementondynamicMR,reachingmaximumcontrastby60secondsCysticareasshownoenhancementEnhancedimagingmayoverestimateregionoftruetumorinvolvementNoevidenceofperineuralspread(Left)AxialT2WIFSMRofamaxillaameloblastomashowsbothsolidandcysticcomponentsinamultiloculatedpattern.NotethetypicalbrightT2signalofthecysticcomponentsandtheexpansionoftheposteriormaxillarysinuswalls.(Right)CoronalT1WIC+FSMRofthesameameloblastomademonstratesthetypicalenhancementoftheseptations.Thelocallyaggressivenatureoftheselesionsislikewiseevidentbytheextensionintothenasalcavityandethmoidaircells.Differentialdiagnosis:Periapical(Radicular)CystClinicallypainfulwithcariouslesionorperiodontaldiseaseBoneCT:LossoflaminaduraandwideningofperiodontalligamentspaceLargerlesionsaredestructive,notexpansileDentigerousCystoneCT:UnilocularcysticlesionsurroundingtoothcrownNoenhancingmuralnoduleUnilocularandsmallermultilocularameloblastomamaymimicdentigerouscystsKeratocysticOdontogenicTumorBoneCT:UnilocularormultilocularcysticlesionofmandibleassociatedwithuneruptedtoothLesionenvelopsaroundorincorporatescrownandtoothrootTendencyforlessbuccal-lingualexpansionthanameloblastomaNoenhancingmuralnoduleUnilocularandsmallermultilocularameloblastomamaymimickeratocyticodontogenictumorTreatment:CompletesurgicalexcisionwhensmallCurettementnolongeracceptabletherapyEnblocremovalforlargerlesionsChemotherapyandradiotherapyarecontraindicatedNaturalHistory&Prognosis:Slow-growing,sometimesindolent,benignneoplasmOftentakesyearstobecomesymptomaticMalignanttransformationisrare(1%)ReferredtoasameloblasticcarcinomaTumorrecurrenceiscommon(33%)Recurrencemayrequiremoreaggressive2ndenblocresectionUniloculartumorrecursmuchlessfrequently(15%)thanmultiloculargroupMaxilla-MandibleOsteosarcomaDefinition:MalignanttumorarisingfrombonewithabilityofneoplasticcellstoproduceosteoidEtiology:ItusuallyoccursdenovoPrimaryosteosarcomaisassociatedwithgeneticsyndromesMayalsobeassociatedwithradiationtherapy,PagetdiseaseofboneorfibrousdysplasiaEpidemiology:MostcommonnonhematopoieticbonemalignancySecondmostcommonbonemalignancyaftermyelomaCraniofacialosteosarcomasrepresentabout6.5%-7%ofallosteosarcomasAge:Patientswithosteosarcomasofthejawaregenerally10to20yearsolderthanthosewithosteosarcomasoflongbonesMalesareaffectedmorefrequentlythanfemalesLocation:MandiblemorecommonthanmaxillaAngle,ramus,orbodyofmandibleSize:Variable;usuallywhitesMostcommonvhematologicdiseaseinblackslivinginUSAAge:Mostcommonlypresentsin30-50yearoldsUnilocularlesionsoftenseeninyoungeragegroupGender:MalefemaleLocation:InoralcavityMandiblemaxillaPosterioranteriorSize:Small:UsuallymalesIncreasedserumcalciumLangerhansHistiocytosisLesionsofLangerhanshistiocytosisarealsodescribedaspunchedoutLangerhanshistiocytosisinmuchyoungeragegroupLesionsinmandiblemayappearscoopedoutandanyinvolvedteethmayappeartobefloatingSimple(Traumatic)BoneCystMayappearsimilartosolitarymandibularlesionofMMMoreoftencorticatedLesionsusuallylargerandscallopbetweenteethSeeninyoungeragegroupPrimaryIntraosseourcinomaUsuallysolitary,ill-definedlesionMayhaveassociatedsofttissuemassRareinjawsTreatment:Currently,multiplemyelomaremainsincurablechemotherapy,bonemarrowtransplantation,antitopoisomeraseIIalphaagentsmayhelpNaturalHistory&PrognosisOverallpoorprognosis;1yearifmultiplelesionsandnotreatment;manyyearsifthedisesesisindolentMandible-MaxillaMetastasisDefinition:SpreadofmalignantdiseasefromdistantprimarytumorEtiology:Pathogenesisoforalmetastasesisnotfullyunderstoodbutcurrenthypothesesinclude:AmultistageprocessinwhichcellsdetachthemselvesfromtheprimarytumorandaretransportedbylymphaticorbloodvesselsIntheoralsofttissues,chronicallyinflamedmucosa,especiallygingiva,hasarichcapillarynetwork,whichcantrapthemalignantcellsandcausemetastasesEpidemiology:Metastasestojawsrareandaccountfor1%oforalmalignanciesMostcommonprimarylesionsfrombreast,lung,kidney,thyroid,prostate,colon,rectum,stomach,testis,bladder,cervix,andovary25%ofmetastaticjawlesionsrepresent1stsignofdiseaseAge:5th-7thdecadesmostcommonLocation:Ramus,premolar-molarregionofmandiblemostcommon;canbebilateralInvolvementofbothjawsextremelyrareOthersites:Mandibularangle,condyle,maxillarysinus,anteriorpalateOccasionallyatrootapexordentalpapillaofdevelopingtoothandmimicsperiapicalinflammationMetastasestobonemorecommonthantogingiva:2.5:1Bestdiagnosticclue:Patchyormoth-eatenbonedestructionwithperiodontalligamentspacewideninginpatientwithknownprimarycarcinomaRadiographicFindings:Earlydisease:PatchyareasofbonedestructionseparatedfromeachotherbynormalboneLatedisease:RadiolucentareascoalescetoformlargerlesionsGeneralizedradiolucency,moth-eatenappearanceorfrankbonydestructionCorticalboneofadjacentstructures(mandibularcanal,maxillarysinus,nasalfloor)resorbedPathologicfractureMostmetastasescausebonedestruction,butbreastandprostatemetastasesmaycauseboneformationandscleroticappearanceMayseecombinationofbonedestructionandformationSpiculatedperiostealreactionoccasionallyseen,especiallywithprostatecarcinomaMaycausesymmetricwideningofperiodontalligamentspace,lossoflaminadura,lossofdevelopingtoothcryptcortexComputedtomographyscanofthefacewiththree-dimensionalreconstructionrevealedawell-definedosteolyticlesionwithmultipleirregularcalcificationsthatextendedintothelingualandmandibularsofttissuesCroppedpanoramicradiographshowsbreastmetastasesaffectingtheleftmandibleandramus.Notethelossofinferiorcorticalborder,lossoflaminadura,andlossofnormaltrabeculararchitecture.AxialsofttissuewindowNECTinthesamepatientatalowerlevelshowsnodalenlargementandmedialdisplacementofthepharyngealconstrictormuscleTreatment:surgicalresection,sometimescombinedwithradiationtherapyorchemotherapyNaturalHistory&PrognosisMetastasestothejawoftenindicateendstagedisease,andareassociatedwithpoorsurvivalMeantimetodeathfromdiagnosisofjawmetastasiswas12monthsversus8monthsfororalsofttissuemetastasisThankyouforyourattention结束语结束语谢谢大家聆听！谢谢大家聆听！54
展开阅读全文