Oral Cancer Epidemiology, Risk Factors, and Prevention (OPATH-2 Finals PDF)

DOPA412: ORAL PATHOLOGY 2 FINALS LECTURED BY: DR. IDA I. BALANAG 4TH YEAR, 1ST SEM, SY. 24-25 ORAL CANC...

DOPA412: ORAL PATHOLOGY 2 FINALS LECTURED BY: DR. IDA I. BALANAG 4TH YEAR, 1ST SEM, SY. 24-25 ORAL CANCER: New cases 19.3M Deaths 9.9M EPIDEMIOLOGY, RISK ASIA FACTOR AND PREVENTION New Cases 49.3% Deaths 58.3% Dentist are the first health care professional who examine the oral cavity and, therefore, have the opportunity to screen oral cancer Incidence of Cancer in Males CANCER ▪ Prostate cancer is the most frequently diagnosed cancer Group of diseases characterized by the UNCONTROLLED ▪ Lung cancer is the most frequently occurring cancer GROWTH and spread of ABNORMAL CELLS Rate of Mortality of Cancer in Males ▪ Lung cancer is the leading cause of cancer death, followed by liver cancer and prostate cancer Incidence of Cancer in Females ▪ Breast cancer is the most commonly diagnosed cancer ▪ Breast cancer is the most leading cause of death Acc to WHO: Cancer is a global health problem GLOBAL EPIDEMIOLOGY ▪ The profile of cancer, globally and by world region, is built up using the best available sources of cancer incidence and mortality data within a given country ▪ The validity of the national estimates depends on the degree of representatives and quality of the source information Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence Males and Mortality Worldwide For 36 Cancer 185 Countries 1st Lung Cancer ▪ Estimate of the cancer incidence and mortality produced by 2nd the international agency for research on cancer Colorectal ▪ The estimate do not reflect the impact of severe acute Cancer respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus 3rd Prostate responsible for covid-19 Cancer ▪ Full extent of the impact of the covid-19 pandemic is currently unknown in different world regions 1|D M D YANDOC  DOPA412: ORAL PATHOLOGY 2 FINALS LECTURED BY: DR. IDA I. BALANAG 4TH YEAR, 1ST SEM, SY. 24-25 Females 1st Breast Cancer 2nd Cervical Cancer 3rd Colorectal Cancer ▪ Ranked 16th among all cancers worldwide o Ranked 13th when combined with cases of Incidence Data Source oropharyngeal cancers ▪ Cebu cancer registry, ▪ Manila cancer registry Oral cancer ▪ Rizal cancer registry → Includes malignant neoplasm occurring in the mucosa of the lips and oral cavity New cases 1, 561 Deaths 870 Oropharyngeal cancer → Includes cancer of the tonsils and other parts of the oropharynx 90% Squamous Cell Carcinoma 9% Carcinoma of Salivary Gland Tissues 1% Metastatic Carcinomas → Lung → Breast → Prostate → Kidney Oral Cancer Risk ▪ Oral cancer is a multifactorial lesion Not Modifiable Modifiable Emerging Risk Factors → Age → Smoking → Human → Ethnicity → Alcohol papilloma virus → Social- consumpti infection (HPV) econom on → Immunosuppressi ic status → Diet on → Betel quid → Mate drinking Controversial factors with Inconsistent, limited or no limited evidence evidence → Oral hygiene and → Hereditary and family risk dentition → Cannabis use (head and neck, 657,7% naka bilog) → Indoor air pollution → Khat chewing → NRT ORAL CANCER → HIV infection ▪ Includes malignant neoplasm occurring in the mucosa of the → Alcohol in mouth washes lips and oral cavity o Mucosal lip o Buccal mucosa Major Risk Factor o Alveolar ridge 1. Tobacco Dose o Retromolar trigone 2. Alcohol Frequency of use o Floor of the mouth 3. Butternut chewing Duration of use o Hard palate o Anterior 2/3 of the tongue  Tobacco ▪ Effects to the oral cavity o Increased risk of dental caries 2|D M D YANDOC  DOPA412: ORAL PATHOLOGY 2 FINALS LECTURED BY: DR. IDA I. BALANAG 4TH YEAR, 1ST SEM, SY. 24-25 o Abrasion and staining of tooth structure and dental Lesion HPV Subtype restoration Oral papilloma 2, 6, 11, 57 o Periodontal disease Focal epithelial 13, 32 o Mucosal lesions hyperplasia o Premalignant lesions Dysplastic wart 16, 18, others o Malignant lesions (HIV) Most sexually o Regarded as the most important risk factor transmitted o Form of tobacco among HIV px → Smoked: cigarettes, cigars, pipes Verruca vulgaris, 2, 4, 40, others skin → Smokeless: chewing tobacco Flat wart 3, 10 Condyloma 6, 11, others ▪ Cigars and pipes greater risk for oral acuminatum cancer than cigarette Laryngeal 11 ▪ Reverse smoking → palatal and papilloma lingual tissue Conjunctival 11 ▪ Smokeless tobacco→ SCCA of papilloma gingiva and buccal mucosa ▪ 99% with an active HPV oral infection will be cleared by the immune system ▪ Pipe smoking → SCCA of the lower ▪ 1% infected with HPV-16 will cascade into cancer lip ▪ Mode of transmission Carcinogens Oral cancer risk o Sexual transmission Smoking tobacco 4.65 times ▪ Mouth-to-mouth Smokeless tobacco 4.7 times ▪ Oral sex Paan (betel nut and areca 7.1 times ▪ Genital sex nut) with tobacco o Non-sexual transmission Secondhand smoke 1.51 times ▪ Mother-to-child 2.07 times (duration of o Autoinoculation (keep touching the lesion and exposure 10-15 yrs spread) ▪ High risk group  Alcohol o Early relationship ▪ Effects to the oral cavity o High number of sexual partners o Poor dental health habits o Smoking o Increase in dental caries o Another sexually transmitted infection o Increased risk of periodontal disease o Irritation of soft tissue HPV – Associated Cancers? o Poor healing after dental surgery o Higher incidence of oral cancer Cancer Cases in women Cases in men o Not a recognized initiator Back of the throat 2,300 12,500 Cervical 11,100 0 o But a promoter when coupled with smoking Anus 4,700 2,200 tobacco Vulva 2,900 0 o Effects of its contaminants and its ability to solubilize Penis 0 900 carcinogens and enhance their penetration into Vagina 700 0 oral mucosa Total 21, 700 15, 600 Carcinogen Frequency Oral cancer risk Alcohol Risk factors Moderate drinking 1-2 drinking per 10 times ▪ Human papillomavirus (HPV) day o Connection with oral cancer was initially suggested in Heavy drinking >2 drinks per day 34 times 14g alcohol – one beer, 1 glass wine or 1.5 oz shot 1985 o Increasing incidence of head neck cancer in younger non-smoker and no-alcohol drinkers Carcinogens Oral cancer risk Alcohol and tobacco 4.74 times o Connection with oral cancer was initially suggested in smoking 1985 Alcohol and smokeless 7.78 times HPV Subtype HPV – Associated Cancers tobacco 16 Oropharyngeal SCCA Alcohol, tobacco smoking 16.17 times 18, 31 Cervical cancer and smokeless tobacco 33, 35 o Site specific Human Papillomavirus Infection ▪ Higher percentage in ▪ Most common of all sexually transmitted diseases oropharynx compared with ▪ 2/3 of those who had sexual contact with HPV- infected oral cavity and larynx persons will become infected ▪ Has been identified also in ▪ Highest rate of infection: 19-26 years of age nodal metastasis 3|D M D YANDOC  DOPA412: ORAL PATHOLOGY 2 FINALS LECTURED BY: DR. IDA I. BALANAG 4TH YEAR, 1ST SEM, SY. 24-25 Clinicopathologic Characteristics for HPV-Positive and HPV- Tobacco Harm Reduction Negative Head and Neck SCCA HPV-POSITIVE HPV-NEGATIVE Conventional Heated not burn E-cigarettes TUMORS TUMORS cigarettes cigarettes Anatomic site Tonsil, base of All sites (+) tobacco (+) tobacco (+/-) tobacco tongue extract Histology Basaloid Keratinized (+) nicotine (+) nicotine (+/-) nicotine Age Younger Older Burning of Heating of Heating of e-liquid Social economic High Low tobacco (>800 C) tobacco ( 2 mm or skull base or encases internal carotid artery, o 45.6% failure rate UNRESECTABLE o 38% lymph node metastasis REGIONAL LYMPH NODES PANENDOSCOPY Node Description Triple endoscopy NX Regional lymph nodes cannot be assessed o Rigid bronchoscope N0 No regional lymph node metastasis o Esophagoscope N1 Metastasis in a single ipsilateral (same side) lymph o Laryngoscope node, 3 cm or less in greatest dimension 9|D M D YANDOC  DOPA412: ORAL PATHOLOGY 2 FINALS LECTURED BY: DR. IDA I. BALANAG 4TH YEAR, 1ST SEM, SY. 24-25  PRIMARY TUMOR Synchronous tumor o Second histologically confirmed malignancy discovered at the time of initial tumor evaluation Metachronous tumor o Second primary tumor discovered EACH LESION SHOULD BE STAGED SEPARATELY ASSESSMENT OF REGIONAL METASTASIS Lymph node involvement o Digital palpation – gold standard o Imaging techniques ▪ Ct scan ▪ MRI ▪ Ultrasound ▪ Position emission tomography DIGITAL PALPATION LEVEL II Gold standard in staging the neck II III IV – are jugular lymph nodes All levels of the neck bilaterally spinal accessory – separate the IIA & IIB No correct order established a sequence ▪ (upper jugular LN surrounding the internal jugular vein Palpable mass and spinal accessory nerve) o Size ▪ Level II A o Surgical neck level → horizontal plane created by the inferior body of o Fixed or movable the hyoid bone inferiorly → skull base superiorly Suggested sequence → stylohyoid muscle anteriorly - Maxillary → spinal accessory nerve posteriorly - Preauricular ▪ Level II B - Postauricular → horizontal plane created by the inferior body of - Occipital the hyoid bone inferiorly - Submental → skull base superiorly - Neck level up to → spinal accessory nerve anteriorly supraclavicular → lateral border of SCM posteriorly LEVEL III ▪ (middle jugular LN surrounding the internal jugular vein) → horizontal plane created by the inferior border of the cricoid cartilage inferiorly → horizontal plane created by the inferior body of the hyoid bone superiorly → lateral border of the sternohyoid muscle anteriorly → lateral border of the SCM or sensory branches of the cervical plexus posteriorly LEVEL IV ▪ (lower jugular LN surrounding the internal jugular vein) → clavicle inferiorly → horizontal plane created by the inferior border of the cricoid thyroid superiorly LEVEL I → lateral border of sternohyoid anteriorly ▪ Level IA → lateral border of the SCM or sensory branches → submental group of the cervical plexus posteriorly → hyoid bone inferiorly → mandibular symphysis superiorly LEVEL V → anterior bellies of digastric muscles laterally Cricoid cartilage - Separate the VA & VB ▪ Level IB ▪ (includes all nodes in the posterior triangle, spinal → submandibular group accessory and all the upper, middle and lower jugular → posterior belly of digastric inferiorly LN on the posterior aspect of SCM) → mandibular body superiorly ▪ Level VA → anterior belly of digastric muscle anteriorly → horizontal plane created by the inferior border → stylohyoid muscle posteriorly of the cricoid cartilage inferiorly → convergence of the SCM and trapezius muscles superiorly 10 | D M D YANDOC  DOPA412: ORAL PATHOLOGY 2 FINALS LECTURED BY: DR. IDA I. BALANAG 4TH YEAR, 1ST SEM, SY. 24-25 → posterior belly of the SCM or sensory branches FLOOR OF THE MOUTH of cervical plexus anteriorly Incidence 8-25% of oral cavity cancers → anterior belly of the trapezius muscle posteriorly Lymph Node Superficial system drains bilaterally into the ▪ Level VB Metastasis submandibular nodes (Level IB) → clavicle inferiorly → horizontal plane created by the lower border Deep system drains into the ipsilateral of the hyoid bone superiorly submandibular, upper and middle → posterior belly of the SCM or sensory branches jugulodigastric nodes (Levels IB, II and III) 50% of all presenting patients of cervical plexus anteriorly → anterior belly of the trapezius muscle posteriorly HARD PALATE Incidence 3-6% of oral cavity cancers LEVEL VI Lymph Node Levels I and II 10-25% of all presenting ▪ Also known as Anterior Compartment (Delphian LN – Metastasis patients includes pretracheal, paratracheal and prelaryngeal) Retropharyngeal nodes → suprasternal notch inferiorly Common complaints – nonhealing ulcers and poor fitting → hyoid bone superiorly dentures → common carotid arteries laterally ORAL TONGUE (ANTERIOR 2/3) MUCOSAL LIP Incidence 22-49% of oral cavity cancers Incidence 2-42% of oral cavity cancers Lymph Node Level II followed by levels III and I Regional Lower lip Metastasis Lateral border – ipsilateral metastasis Tip or Metastasis Submental, submandibular and perifacial body – bilateral metastasis nodes 40% of presenting patients Level I more commonly than level II Upper lip and commissure Preauricular, periparotid and submandibular COMPUTED TOMOGRAPHY nodes Level II more commonly than level I Performed preoperatively with intravenous contrast to help Bilateral neck metastasis delineate vascular from lymph structures - Lower lip near or has crossed the Involves 3 to 5 mm slices from skull base to clavicle midline - Upper lip rarely LYMPH NODES NORMAL ABNORMAL/ BUCCAL MUCOSA METASTASIS Incidence 2-10% of oral cavity cancers Size 1.0 cm >1.0 cm Regional First echelon lymphatic drainage is Level I 1.5 cm >1.5 cm Metastasis followed by level II jugulodigastric jugulodigastric Cervical metastases observed in 10-27% of regions regions presenting patients Shape Bean shaped Round / sphere like Pan – combination of tobacco, betel nut and lime Intranodal necrosis (-) (+) ALVEOLAR RIDGE (GINGIVA) MRI Incidence 2-18% of oral cavity cancers Predominantly on Ultrasound the mandibular alveolus (64-76%) Positron Emission Tomography Lymph Node More frequently in mandibular ridge tumors Metastasis than in maxillary tumors ASSESSMENT OF DISTANT METASTASIS Levels I and II for both maxillary and Involves mandibular lesions o Lung – most frequent Found in 24-28% of patients at diagnosis o Liver o Bone Metastatic work-up Alveolar Ridge Carcinomas o Posterior-anterior and lateral chest radiographs Masquerading as (mimic) o Liver function test o inflammatory lesions o CT of chest, abdomen and pelvis o periodontitis or gingivitis o Bone scan – should be symptom driven o tooth abscess - denture sores o FDG-PET – 2-18F-Fluoro-2-deoxy-D-glucose positron emission tomography RETROMOLAR GINGIVA (RETOMOLAR TRIGONE) SCREENING OF ORAL CANCER Incidence 2-6% of oral cavity cancers Toluidine Blue Lymph Node Level IB (submandibular nodes) Brush cytology Metastasis Level II (upper jugulodigastric nodes) Toluidine Blue More aggressive in nature 27-56% of ▪ Metachromatic dye used as a nuclear stain presenting patients ▪ Mechanism of action (theories) Primary complaints - sore throat, otalgia and trismus 11 | D M D YANDOC  DOPA412: ORAL PATHOLOGY 2 FINALS LECTURED BY: DR. IDA I. BALANAG 4TH YEAR, 1ST SEM, SY. 24-25 1. Dye selective stains cells with increased deoxyribonucleic acid synthesis or qualitatively more nucleic acids than other cells 2. Binds to sulfated mucopolysaccharides, found in higher quantities in actively growing cells ▪ Monitoring of suspicious lesions over time ▪ Screening for oral mucosal malignancy and potentially malignant lesions in high risk individuals and population groups ▪ In the follow-up of patients already treated for upper aero digestive tract cancer ▪ In helping to determine an optimal site for biopsy when a suspicious lesion is present **most affected is lower lip If nag stay yung stain it can have dysplastic or carcinoma changes Squamous Cell Carcinoma ▪ Carcinoma of the tongue Epidermoid Carcinoma ▪ Carcinoma of the floor of the mouth most common malignant neoplasm of the oral cavity ▪ Carcinoma of the lips Clinical Features ▪ Carcinoma of the buccal mucosa and gingiva o Early presentations: leukoplakia and erythroplakia ▪ Carcinoma of the palate Leukoplakia - white patches that cannot rub off Erythroplakia – red patch LOWER LIP o Advanced lesions: painless ulcer, a tumorous mass, 5th - 8th decade of life or a verrucous growth Occurs either on the right or left vermilion borders, seldom at o Infiltration to deeper tissue: firm indurated (matigas the midline upon palpation) area with associated loss of tissue Usually preceded b a prolonged period of cheilitis → mobility recurring ulceration and encrustation → ulcers fail to heal ▪ Floor of the mouth - fixation of tongue or and develop a rolled border surrounded by indurated tissue inability to open the mouth Slow to metastasize ▪ Gingiva - invades underlying bone Metastasis: regional submental lymph node → digastric and resulting in loosening or loss of teeth cervical nodes ▪ Mandible - paresthesia of teeth and lower lip TONGUE Histopathology Appears initially as an area of leukoplakia / erythroplakia → o Presence of invasion into the underlying connective ulcerates → raised or rolled borders tissue Advanced lesions o Potential of malignant cells to erode the lymphatic Ulcerate and produce extensive induration of the and blood vessel walls surrounding tissue Histologically the feature of squamous cell carcinoma is infiltrative. Pain, immobility and altered speech This would result into invasion in the underlying connective tissue Metastasis: submandibular and deep cervical lymph nodes and potential for malignant cells to erode the lymphatic and blood vessel wall FLOOR OF THE MOUTH To compare the squamous cell carcinoma vs carcinoma in situ, Anterior areas adjacent to the orifices of Wharton ducts the carcinoma in situ or intraepithelial carcinoma the basement Begins as an area of erythroplakia or speckled erythroplakia membrane is intact that’s why metastasis is not a feature of → irregularly shaped central ulcer → nodular and indurated carcinoma in situ while squamous cell carcinoma it can invade Advanced lesions - fixation of the tongue and extension onto through the connective tissue kaya merong metastasis and the gingiva metastasis is through blood vessels and lymphatic vessels Metastasis: submandibular triangle and upper jugular chain of lymph nodes Incidence of Oral Carcinoma SOFT PALATE Lateral posterior regions adjacent to anterior faucial pillars 12 | D M D YANDOC  DOPA412: ORAL PATHOLOGY 2 FINALS LECTURED BY: DR. IDA I. BALANAG 4TH YEAR, 1ST SEM, SY. 24-25 Erythroplakia or mixture of red and white plaque-like areas primary lesions: skin, eye, Metastasis: cervical and jugular lymph nodes before large mucous membranes ulcerative or nodular lesions are clinically apparent Sa soft palate palang nag metastasize na sya before it becomes deeply pigmented, may be evident with the ulcer formation ulcerated and hemorrhagic, increase progressively in size GINGIVA AND ALVEOLAR RIDGE Mandible more often than maxilla, posterior areas Kaposi’s Sarcoma Invade underlying bone via periodontal ligament aka Angioreticuloendothelioma Signs: mobility of tooth, early tooth loss in the absence of malignant neoplasm of capillaries may be part of AIDS advanced periodontal disease and sockets that fail to heal usually on extremities but may be oral after extraction reddish brown or red to blue nodules Metastasis: submandibular and cervical lymph nodes Ewing’s Sarcoma BUCCAL MUCOSA Uncommon malignant neoplasm which occurs as a primary Ulcers along the occlusal line and are associated with destructive lesion of bone surrounding induration children and young adults Metastasis: submandibular lymph nodes earliest clinical sign: swelling of the involved bone intermittent pain facial neuralgia and lip paresthesia VERRUCOUS CARCINOMA radiograph: onion-skin appearance A diffuse, largely exophytic, superficial spreading, highly infection that would show an onion skin appearance is gares keratinized, warty form of well-differentiated SCCA osteitis. Males, 60 y/o what malignancy would show onion like appearance? Ewings Locations: gingiva, alveolar mucosa and buccal mucosa Burkitt’s Lymphoma / aka African Jaw Lymphoma White, exophytic, papillary caused by Epstein-Barr virus pattern children 2-14 years of age primarily involves extranodal tissues rapidly growing tumor mass of the jaws, destroying the bone and causing loosening of the teeth with extension to Histopathology maxillary, ethmoid and sphenoid sinuses o extensive keratin production viral in nature o fingerlike projections o acanthosis with broad blunt bulbous rete ridges Viruses Associated with Malignancy Cytomegalovirus – Kaposi’s sarcoma ADENOSQUAMOUS CARCINOMA Herpes simplex virus - cervical cancer Rare, aggressive carcinoma of the mucosa consisting of a Epstein-Barr virus - nasopharyngeal carcinoma, Burkitt’s mixture of malignant squamous and glandular cells lymphoma Locations: o Oral cavity - floor of the mouth and hard palate Hodgkin’s Disease o Nasal cavities nLymph nodes of the head and neck any organ of the body o Larynx First sign: painless enlargement of cervical lymph nodes, firm and rubbery, overlying skin is normal pain in the abdomen BASAL CELL CARCINOMA and back generalized weakness, loss of weight, cough, Malignant tumor of hair-bearing areas of dyspnea, anorexia the skin Histopathology: Reed-Sternberg cell Does not arise on mucous membranes Sun-exposed skin of upper part of the face Multiple Myeloma Males Neoplasm of bone that originates from cells of the bone marrow Starts as a slightly elevated papule, slowly Oral manifestations: enlarges, eventually develops a central, o ramus, angle and molar region crusted ulcer with an elevated smooth- o pain, swelling, jaw expansion, numbness, mobility of rolled border teeth o extraosseous lesions Melanoma radiograph: punched-out areas in the bone (vertebrae, ribs, Neoplasm of epidermal melanocytes skull, jaws and ends of long bones) 2 phases: laboratory: Bence-Jones protein in urine anemia o radial-growth phase: confined to the epidermis o vertical-growth phase: populate the underlying Metastatic Carcinoma dermis Metastases to jaws most commonly originate from primary carcinomas of the breast, kidney, lung, colon, prostate and thyroid gland mechanism of spread is hematogenous 13 | D M D YANDOC  DOPA412: ORAL PATHOLOGY 2 FINALS LECTURED BY: DR. IDA I. BALANAG 4TH YEAR, 1ST SEM, SY. 24-25 angle and body of the mandible ENUCLATION bone pain, loosening of teeth, lip paresthesia, bone swelling, Total removal of a cystic lesion; a shelling out of the entire gingival mass and pathologic fracture cystic lesion without rupture In case na mapunit sometimes remnants may natitira and this can be source of recurrence A rupture cystic lining is difficult to remove from the surrounding bone Advantages o No need for constant cleaning of the cystic cavity o Entire lesion may be brought to the pathologic for histopathologic examination Disadvantages: o May devitalize adjacent teeth, damage the surrounding structure, pathologic fracture and inadvertent extraction of unerupted teeth MANAGEMENT OF ORAL PATHOLOGICAL LESIONS Management of cyst Goal o Eliminating the potential for recurrence while also minimizing the surgical morbidity Conservative approach Radical approach o Factors to consider → Size and extent → Location → Presentation of perforation or soft tissue involvement → Age of individual → Primary or recurrent nature of lesion Conservative therapies “Enucleation, curettage and marsupiazation” Aggressive treatment “that which use in addition to enucleation and included curettage (mechanical, and/or chemical) and/or resection without loss of jaw continuity” RADICULAR CYST Non-surgical approach o Root canal therapy followed by periodic observation Surgical approach o Enucleation o Marsupialization o Marsupialization followed by enucleation o Enucleation with peripheral ostectomy o Application of Carnoy’s solution The radiolucency take 2-3 yrs for it to be completely filled with bone na mawawala yung radiolucency. As long as it is not No open cavity. Primary healing as if walang nangyari symptomatic or show signs of reinfection hayaan lang yung radiolucency 14 | D M D YANDOC  DOPA412: ORAL PATHOLOGY 2 FINALS LECTURED BY: DR. IDA I. BALANAG 4TH YEAR, 1ST SEM, SY. 24-25 Used to define the lining of the cyst and to trim the wall for ease of manipulation in surgically removing abnormal soft tissue Promoted chemical necrosis of up to 1.5 mm and elimination of epithelial remnant and possible microcysts Voorsmit demonstrated the mean depth of bone penetration by CS with respect to time (1.54mm after 5 min) Used to define the lining of the cyst and trim the wall for ease of manipulation in surgically removing abnormal tissue Cavity is painted, leaving it in place for 5 minutes Involves removal of 1-2mm of bone Neurotoxic and chemically fixes the IAN and lingual nerve if it comes in contact with them for up to 2mm ENUCLEATION WITH CRYOTHERAPY Liquid nitrogen o Has the ability to devitalize bone in situ while leaving the inorganic framework untouched to allow for osteoconduction o Sprayed twice for 1min, with a 5-min thaw between freezes MARSUPIALIZATION Aka Partsch operation Creating a window in the cystic wall to remove the contents and decompress the cyst Allows shrinkage of the cysts and eventually allowing bone to fill the defect Advantages o Minimal tissue damage o Access to the entire lesion is not needed ENUCLEATION WITH PERIPHERAL OSTECTOMY o Aid in eruption of impacted or unerupted teeth Removal of 1-2 mm of bone around the entire periphery of o Decrease chance of pathologic fracture cystic cavity with a sharp curette or bone bur with sterile Disadvantages irrigation o Pathologic tissues in left in place To remove any remaining epithelial cells that may be present o Constant cleaning of the cavity in the periphery of the cystic wall or bony cavity which can o Possibility of a second surgical procedure cause proliferation and recurrence of the cyst If it’s OKC based on initial biopsy u have to extract the teeth in the area kahit hindi involve and kahit vital pa yung teeth pero yun ang recommendation APPLICATION OF CARNOY’S SOLUTION (sa exam) Composed of o 6ml absolute alcohol – fixative agent o 3ml chloroform – dissolves lipids to devitalize the cells o 1ml glacial acetic acid – hemostatic agent o 1g ferric chloride – staining and tannic agent 15 | D M D YANDOC  DOPA412: ORAL PATHOLOGY 2 FINALS LECTURED BY: DR. IDA I. BALANAG 4TH YEAR, 1ST SEM, SY. 24-25 o Total → Resection of a tumor by removal of the involved bone → Maxillectomy and mandibulectomy o Composite → Resection of a tumor with bone, adjacent soft tissue and contiguous lymph node channels → Used most commonly for malignant tumors 1. Lateral periodontal cyst 2. Unicystic ameloblastoma MARSUPIALIZATION FOLLOWED BY ENUCLEATION Once the cyst has decreased to size that is amenable to complete surgical removal, enucleation is performed When bone is covering adjacent vital structures preventing injury and providing enough strength preventing jaw fracture MANAGEMENT OF TUMORS → Surgical removal → Radiation therapy → Chemotherapy SURGICAL REMOVAL OF JAW TUMOR Enucleation and\or o Local removal of a tumor by instrumentation in direct contact with the lesion o Used for very benign typed of lesions RESECTION o Removal of a tumor by incising through uninvolved tissues around the tumor, thus delivering the tumor without direct contact during instrument o Also known as en bloc resection o Marginal → Also known as segmental resection → Resection of a tumor without disruption of the continuity o Partial → Resection of a tumor by removing a full- thickness portion of the jaw → Jaw continuity is disrupted 16 | D M D YANDOC