Osteoid osteoma and cartilage-forming tumors
These neoplasms predominantly affect the bony structures of the jaws.
Osteoid osteoma presents as a small bone thickening. Macroscopically, it consists of a "nidus" (loose reddish tissue) surrounded by a dense zone of osteosclerosis. Patients complain of escalating pain that worsens at night and during meals. Radiography reveals a clear, round radiolucent lesion surrounded by a zone of sclerosis. Treatment consists of en bloc tumor resection.
Chondroma is a rare tumor arising from mature hyaline cartilage. It is most frequently localized in the anterior region of the maxilla. According to their location, they are classified into:
- Enchondroma (develops centrally deep within the bone, leading to tooth displacement);
- Exchondroma (peripheral form causing nodular deformity of the jaw and face).
Chondroma grows slowly, but if present for a long time, it can degenerate into malignant chondrosarcoma. Radiologically, a destruction focus with the presence of petrifications (areas of calcification) is detected. Treatment is exclusively radical resection, as enucleation leads to recurrences.
Giant cell tumor (osteoclastoma)
Osteoclastoma (solitary osteogenic tumor) accounts for about 30% of all facial bone tumors. It is more common in women aged 30–40 years in the premolar area. Trauma often precedes its development.
Microscopically, the tumor consists of small osteoblast-like cells and giant multinucleated osteoclasts. Macroscopically, it has a mottled appearance: red-brown areas alternate with yellowish zones of necrosis and cysts. Despite its benign structure, osteoclastoma can metastasize to blood vessels and undergo malignant transformation.
Clinical and radiological forms:
- Cystic. The onset is asymptomatic, followed by tooth pain. The jaw expands in a fusiform shape. When the cortical plate thins, the "egg-shell crackling" sign appears. Radiographically, it presents as a homogeneous oval radiolucency.
- Trabecular (honeycomb). Develops slowly; the "egg-shell crackling" sign is absent. Radiologically, the bone is divided by bony septa into multiple small and large cavities (resembling ameloblastoma).
- Lytic. A rare form with rapid growth, characteristic of children. Severe pain, local hyperthermia, and tooth mobility are prominent. X-ray shows a structureless bone radiolucency with destruction of the cortical layer.
Treatment of osteoclastoma is primarily surgical. Radiation therapy is used only if the patient refuses surgery, as it can provoke malignant transformation.
Cysts of the soft tissues of the face and neck
Cysts of the maxillofacial region are divided into congenital (embryonic) and acquired (retention, post-traumatic).
Dermoid and epidermoid cysts develop from displaced areas of the ectoderm.
- The wall of a dermoid cyst contains all layers of the skin, as well as hair, sweat, and sebaceous glands. The content is a pasty mass with an unpleasant odor.
- Epidermoid cyst has a thin lining consisting solely of epidermis, without skin appendages. It contains keratin flakes.
Typical localization includes the floor of the mouth, submental region, and neck. The tumors grow slowly and painlessly, but growth may accelerate during puberty. Treatment is complete enucleation.
Median cysts and fistulas of the neck (thyroglossal duct cysts) result from the non-closure of the thyroglossal duct (ductus thyroglossus). They are localized strictly along the midline between the hyoid bone and the upper edge of the thyroid cartilage. Palpation reveals a firm, elastic swelling with limited mobility due to its anatomical connection with the hyoid bone and the foramen cecum of the tongue root.
Briefly: answers to topical questions
What surgical treatment methods are used for jaw osteoclastoma?
The primary surgical method for jaw osteoclastoma is complete tumor removal via resection of the affected area. Depending on the extent of the pathological process, the following options are used:
- Radical resection is performed with or without preservation of jaw continuity, after which recurrences are not observed.
- Non-radical surgery is characterized by a high risk of recurrence and malignant transformation of the neoplasm.
What are the types of odontogenic jaw cysts?
Odontogenic jaw cysts are classified into developmental and inflammatory cysts. Developmental cysts include:
- «Gingival cyst» of infants — Epstein pearls.
- Odontogenic keratocyst — primordial cyst.
- Dentigerous cyst — follicular cyst.
- Eruption cyst — classified as a developmental cyst.
- Lateral periodontal cyst — classified as a developmental cyst.
- Gingival cyst of adults — classified as a developmental cyst.
- Glandular odontogenic cyst — sialo-odontogenic cyst.
Inflammatory odontogenic cysts include:
- Radicular cyst — includes apical, lateral, and residual.
- Paradental cyst — inflammatory collateral, mandibular, infected buccal cyst.
What is the source of development of lateral (branchiogenic) neck cysts?
The source of development of lateral neck cysts is remnants of the thyroglossal duct. In origin, they are analogous to median neck cysts, which also form from elements of this embryonic structure. Anatomically, such cysts are located between the larynx and the sternocleidomastoid muscle (m. sternocleidomastoideus), extending upward toward the pharynx.
What types of acquired soft tissue cysts of the face and neck exist?
Acquired cysts of the maxillofacial soft tissues and neck are divided into several main types. These include:
- Retention cysts of sebaceous glands — atheromas.
- Mucous gland cysts — localized in the maxillary sinuses.
- Post-traumatic cysts — arise as a result of trauma.
There is also a special group of lesions that are usually acquired but can occasionally be congenital:
- Salivary gland cysts — affect major and minor salivary glands.
- Cyst-like changes — occur in the excretory ducts of salivary glands.
To memorize the clinical forms of osteoclastoma, use the acronym "C-T-L": Cystic, Trabecular (honeycomb), Lytic. To remember the difference between dermoid and epidermoid, keep in mind: "A dermoid is miniature skin" (includes dermis, glands, and hair).
Class and exam questions
Why are cysts filled with avascular fluid in osteoclastoma?
In the central parts of a giant cell tumor, an avascular tissue blood flow is formed, in which blood circulates directly between the cells, leading to the formation of cysts.
What is the danger of non-radical removal of a chondroma?
Non-radical surgery (enucleation or curettage) of a chondroma often leads to tumor recurrence and increases the risk of its malignant transformation into chondrosarcoma.
Which symptom occurs in the cystic form of osteoclastoma when bone thinning takes place?
Palpation of the bone wall thinned by the tumor reveals the characteristic "egg-shell crackling" sign.
What else to study on this topic
- Macro- and microscopic features of the giant cell tumor
- Radiological differential diagnosis of trabecular, cystic, and lytic forms
- Surgical approaches for the removal of dermoid cysts of the floor of the mouth
- Specifics of the differential diagnosis between chondroma and chondrosarcoma
- Complications associated with suppuration of congenital neck cysts
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Other topics from the section "Chapter 14. Tumors and Tumor-like Lesions of the Maxillofacial Region (V.N. Bogatov, S.N. Lebedev)"
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