2-1. ORAL TUMORS
a. Definition. A neoplasm (tumor) is an abnormal growth of new tissue that grows independently of surrounding structures and serves no physiological purpose. A tumor can usually be removed surgically. Since benign tumors grow by expansion, when removed, they are less likely to recur than malignant tumors. Malignant tumors (cancers) grow by extension into the surrounding contiguous tissues. They tend to spread (metastasize) to other parts of the body by way of the blood vessels, lymphatic system, or membranous surfaces.
b. Examining the Oral Cavity. The oral cavity is a common site for many types of tumors. Early treatment of tumors is essential. Examination and diagnosis by the dental officer must include a consideration of suspicious lesions, such as leukoplakia, or conditions that might develop into tumors. Any abnormal condition seen by a dental specialist, such as unexplained swelling, abnormal discoloration, or ulceration, should be reported to the dental officer immediately.
|2-2. FIBROMA (Figure 2-1) |
Fibromas are the most common benign tumor growths in the oral cavity. They are a connective tissue response to irritations resulting in a well-defined, slow-growing firm mass. The overlying tissue (oral mucosa) is usually normal in appearance and color. A common site for irritation fibromas is the buccal mucosa, although they may be found throughout the oral cavity. After surgical removal, there is no recurrence.
NOTE: The biting line of the buccal mucosa is a common area for fibroma development. Fibromas are benign, mucosal-covered, traumatically-stimulated growths of fibrous connective tissue which are removed surgically by excision.)
Figure 2-1. Fibroma.
2-3. PAPILLOMA (Figures 2-2 and 2-3)
Papillomas are benign stalk-like (pedunculated) growths originating from the surface tissues. This outward growing, cauliflower-like, surface tumor is common within the oral cavity and may occur anywhere on oral mucosa. Surgical removal is curative.
Figure 2-2. Papilloma, cauliflower shape.
NOTE: The lingual frenum of the tongue is a common site of papilloma development. This possibly is due to constant irritation of this tissue by irregular or sharp lower incisor teeth. Surgical removal is indicated. Notice the cauliflower shape of the papilloma.)
Figure 2-3. Papilloma, variation in appearance.
NOTE: This papilloma does not have the normal warty appearance (cauliflower-like). The biopsy confirmed an epithelial tissue abnormality. Variation in appearance from the classically-described lesion should always be considered in evaluation of tissue irregularity. Multiple papillomas may indicate secondary syphilis.)
|2-4. PYOGENIC GRANULOMA (Figure 2-4) |
A pyogenic granuloma may develop as a part of the wound repair process that has been modified by the hormonal changes of puberty or pregnancy. Pyogenic granulomas appear as hemorrhagic tissue growths (bright red in appearance) that are usually found on gingival tissue in pregnant females in response to irritation from subgingival calculus. Surgical removal of the tumor mass and removal of the causative factor result in normal healing. However, if the irritant is not removed, the pyogenic granuloma may recur.
NOTE: The high degree of vascularity can be seen in the bright red appearance of this pyogenic granuloma. Ease of bleeding is characteristic. Irritation can be a cause. Removal of the lesion is necessary, but the causative factor must also be identified and removed.
Figure 2-4. Pyogenic granuloma.
2-5. ODONTOMA (Figures 2-5 and 2-6)
An odontoma is a benign odontogenic tumor of mixed tissue origin that is located within the facial bones. An odontoma is usually diagnosed from a radiograph. Odontomas appear as either irregular masses of calcified material or as numerous tooth-like structures. Compound odontomas (figure 2-5) have a similarity to normal teeth and are generally found in the anterior arch (canine and incisor teeth). Complex odontomas (figure 2-6) are irregular masses and are generally found in the posterior dental arch (premolar and molar teeth).
Figure 2-5. Compound odontoma.
NOTE: This compound odontoma has resulted in the lack of eruption of the permanent central incisor and retention of the deciduous central incisor. A recognizable tooth form with abnormal crown enamel development and enamel pearl can be observed.
Figure 2-6. Complex odontoma.
NOTE:This large complex odontoma consists of dental structures (dentin, cementum, enamel, pulpal tissues) and has no recognizable tooth form. Note the displacement of the permanent second molar and lack of third molar development.
2-6. ORAL CANCER (Figures 2-7 and 2-8)
The most common form of oral cancer is squamous cell carcinoma. It is most commonly found on the lips, especially the lower lip. Inside the mouth, the posterior lateral border of the tongue is the most common site for squamous cell carcinoma, followed by the floor of the mouth. Oral cancer may appear as leukoplakia (white plaque), erythroplakia (velvet-red plaque), or an ulceration. The red patches (plaques) have a much higher potential of becoming malignant than do the white plaques. Oral cancer is painless during the initial phase of development. It is generally found in older individuals, occurring with greater frequency in males. Metastatic potential varies with location. Cancer of the lip tends to metastasize later in development, while cancer of the tongue tends to metastasize early. Tobacco is regarded as the most important contributing factor for developing oral cancer. With the use of smokeless tobacco, there is a significantly higher risk of developing oral cancer. Since alcohol consumption also appears to add to the risk of oral cancer development, lifestyle habits that mix smoking and drinking impose even greater risks for developing oral cancer.
Figure 2-8. Oral cancer, floor of the mouth.
NOTE: The clinical appearance of leukoplakia revealed a squamous cell carcinoma on histologic examination. The mouth floor is a common site for oral cancer. All oral tissues must be evaluated for abnormality with each oral examination so that malignant growths may be recognized early in development.
Figure 2-7. Oral cancer, lower lip.
NOTE: The lower lip is a common site of oral cancer. Lesions are often present for an extended time before being evaluated. Often a small chronic scab may be the only abnormality. Most affected lips show evidence of continuous, solar, ultraviolet light damage to the tissues.
a. General. Biopsy is the procedure for obtaining a tissue specimen for microscopic examination in order to establish a diagnosis. This procedure is used when tissue growth cannot be diagnosed by clinical observation alone. Biopsy is extremely important in diagnosing malignant growths (tumors) requiring early treatment and in identifying other conditions requiring early treatment or specific types of treatment. Surgical excision (complete removal of involved tissues) or removal of a part of the tissue may be done. Excision is the method of choice when the lesion is small and complete removal is the treatment.
b. Processing the Specimen. After the tissue specimen has been removed surgically, it should be placed in a container with 10 percent formalin. The container should be large enough to accommodate fixative solution equal to about 20 times the volume of the specimen. Usually 48 to 72 hours is enough time to ensure adequate fixation. However, the time will be determined by the size of the specimen. The specimen, a properly completed clinical record-tissue examination form, a clinical history, and appropriate dental radiograph should all be forwarded to the oral-maxillofacial pathologist.
NOTE: The container must be properly identified in case it is separated from the SF 515, to include the patient's name and social security number, type of tissue sample (for example, soft tissue, bone), doctor's name, clinic address, and date.