Jaw Tumours: Dr. Shabin Fahad Dept. of General Surgery

Jaw tumours
Dr. Shabin Fahad

Dept. of General Surgery
Zygomatic fractures
 Types
 Simple and undisplaced
 Simple and medially displaced
 Unstable fractures with rotation in horizontal axis with medial or lateral tilt
 Comminuted fractures
 Zygomatic arch fractures which impinge on coronoid process of mandible
 Blow-out fracture of the orbit
Zygomatic fractures
 C/F
 Swelling and bruising of the cheek; subconjunctival haemorrhage
 Flattening of cheek prominence
 Step in the margin of the bony orbit
 Sensory loss over the area of supply of superior orbital nerve teeth on the affected
side are anesthetised
 Sensory loss of the area supplied by infraorbital nerve; upper lip and alar region
 Enophthalmos
 Diplopia
 Trismus, epistaxis
 Panda sign
Zygomatic fractures
 Inv: Xrays/ CT 30/ 60 degrees occipitomental xrays

 Treatment: every pt need not require correction
 Trismus
 Sensory loss
 Diplopia enophthalmos
 Flattening of the cheeks
Zygomatic fractures
 Surgical approaches
 Closed reduction using Gillies temporal approach
 Internal fixation by open reduction
 Unstable, comminuted, zygoma fractures; wire/ plate fixation
 Exploration of orbital floor

Mandibular fractures
 Types
 Neck of condyle, weakest point, 35%, painful jaw movements
 Angle of mandible; if upwards and inwards, it is favourable as it is impacted;
opposite requires surgery
 Near the mental foramen; displacement associated with tongue fall
 Also classified as simple, compound, comminuted, pathological (fracture of ramus)

Dentoalveolar fractures
 Horizontal fractures
 Segment freely mobile with tooth split vertically/ horizontally
 Derangement in occlusion, gingival laceration, bleeding
 Management
 Xrays
 Dentoalveolar segment reduction/ central occlusion position
 Interdental wire stabilisation
Mandibular fractures
 C/F
 Pain, tenderness, bruising over the surface
 Hematoma in the floor of mouth: Coleman’s sign
 Trismus; difficult mouth opening, speech, swallowing
 Deranged dental occlusion
 Xrays, OPG
 Antibiotics, open fixation with wires

 Interdental wires, arch bars, silver alloys
 Oral hygiene
Classifications of jaw tumours
 Swelling arising from the gums (epulis)

 Congenital, fibrous, pregnancy, giant cell, myelomatous, sarcomatous,
carcinomatous
 Swellings from dental epithelium (odontomes)
 Ameloblastoma, compound odontome, enameloma, cementoma, dentinoma,
odontogenic fibroma, radicular odontome, composite odontome
 Swelling arising from mandible and maxilla
 Osteoma, osteoblastoma, fibrous dysplasia, osteoclastoma, osteosarcoma,
secondaries
 Surface tumours
 Ossfying fibroma, carcinoma, osteofibrosis of maxilla
Epulis
 Swellings from the mucoperiosteum of the gums

 Congenital epulis
 Benign condition, granular cell myoblastoma variant, more in girls, more common in
upper jaw
 Well localised swelling, firm, bleeds on touch
 Treatment : excision
 Fibrous epulis (commonest)
 Benign, red, firm/hard, sessile/pedunculated
 Arising from the periodontal membrane
 Painless well localised, hard, non tender, bleeds on touch
 Mimics SCC rule out with biopsy
 Treatment : excision with extraction of the adjacent roots
 Pregnancy epulis
 Pregnant women due to inflammatory gingivitis
 3rd month of pregnancy
 Resembles fibrous, resolves with delivery (or excise)
 Myelomatous epulis
 Seen in leukemic patients
 Granulomatous
 Granulation tissue in the gum around a cries tooth; soft/ firm/ mass bleeds on
touch
 Giant cell epulis
 Osteoclastoma associated
 Carcinomatous epulis
 SCC of the alveolus
Ameloblastoma
 Adamantinoma, eve’s disease, multilocular cystic disease of the jaw

 Arises from dental epithelium
 In mandible or maxilla
 Variant of basal cell carcinoma
 Locally malignant tumor
 Does not spread, can cure
 Unilateral
 Can arise from a dentigerous cyst
Clinically
 Swelling of the jaw, in the mandible near the angle, attains large size,
eggshell crackling
 Progressive painless, smooth, hard swelling
 No lymph nodes
 Common in males
 D/D: osteoclastoma, dentigerous cyst, dental abscess
 Inv: OPG, biopsy, CT
Ameloblastoma
 Treatment
 Segmental resection of mandible
 Hemimandibulectomy with reconstruction
 Recurrent lesions can spread to the lungs
 ? Jaffe’s tumour: swelling that happens due to haemorrhage into the bone
marrow; D/D
Please read
 Dentigerous cyst vs dental cyst
 Fibrous dysplasia of the jaw
 Osteomyelitis of jaw
Thank you and ALL THE BEST!

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Jaw Tumours: Dr. Shabin Fahad Dept. of General Surgery

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Jaw tumours

Dr. Shabin Fahad

 Inv: Xrays/ CT 30/ 60 degrees occipitomental xrays

 Exploration of orbital floor

 Also classified as simple, compound, comminuted, pathological (fracture of ramus)

 Antibiotics, open fixation with wires

 Swelling arising from the gums (epulis)

 Swellings from the mucoperiosteum of the gums

 Adamantinoma, eve’s disease, multilocular cystic disease of the jaw

 Recurrent lesions can spread to the lungs

 Dentigerous cyst vs dental cyst

 Fibrous dysplasia of the jaw

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