1. Benign Tumors of the Oral Cavity

2. Benign Tumors of the Oral Cavity
The dentist has a vital role in the diagnosis and treatment of these lesions.
Although the dentist might not see all the types of benign oral tumors, it is important to be familiar about them so as to manage them whenever necessary.

3. What is a tumor?
The tumor, by definition is simply a swelling of the tissue; in the strict sense, the word does not imply a neoplastic process.
Many of the lesions to be discussed now are called tumors only because they are manifested as swellings; they are in no way actually related to true neoplasms.

4. Difference between a Benign and malignant tumor?
Benign Tumor
It is a locally
controlled growth or lesion, generally encapsulated, which does not produce metastases, and therefore not endangering life.
Malignant Tumor
It is an independent uncoordinated new growth of tissue which is potentially capable of unlimited proliferation and which does not regress after removal of the stimulus which produced the lesion.

5. Benign tumors of the Oral Cavity - Classification
Tumors of Epithelial Tissue origin.
Tumors of Connective Tissue origin.
Tumors of Muscle Tissue origin.
Tumors of Nerve Tissue origin.

6. Benign Tumors of Epithelial Tissue origin
Papilloma

7. Benign Tumors of Epithelial Tissue origin Papilloma
It is an exophytic growth made up of numerous,small finger like projections which result in a roughened surface.
It is well circumscribed pedunculated tumor.
It is found in the tongue, lips, buccal mucosa, gingiva and palate and are mainly few millimeters in diameter.

8. Benign Tumors of Epithelial Tissue origin Papilloma
It is seen at any age and probably caused by the Human Papilloma Virus.
The common skin wart (verruca vulgaris) is a frequent tumor of the skin analogous to the oral papilloma.
Treatment includes excision including the base of the mucosa into which the pedicle inserts.

9. Pigmented cellular Nevus
Benign Tumors of Epithelial Tissue origin
Pigmented cellular Nevus

10. Benign Tumors of Epithelial Tissue origin Pigmented cellular Nevus
A nevus is defined as a congenital, developmental tumor like malformation of the skin or mucous membrane that contains melanin pigment.
In the skin it is called as the “common mole”.
This lesion is composed of so-called nevus cells.

11. Benign Tumors of Epithelial Tissue origin Pigmented cellular Nevus
The following are the different types of nevi that are recognized now,
Intradermal nevus
Junctional nevus
Compound nevus
Juvenile melanoma
Blue nevus

12. Benign Tumors of Epithelial Tissue origin Pigmented cellular Nevus
Pigmented nevi of all types, except the juvenile melanoma, occasionally occur on the oral mucosa.
They are well circumscribed lesions and may occur at any site intra-orally but are more commonly seen in the anterior gingiva, lips and palate.
Treatment is surgical excision.

13. Benign Tumors of Connective Tissue origin
Fibroma

14. Benign Tumors of Connective Tissue origin - Fibroma
It is the most common benign soft tissue tumor occurring in the oral cavity.
It is intimately related to fibrous hyperplasia.
It appears as an elevated lesion of normal color with a smooth surface and a sessile or pedunculated base.
The tumor maybe small or in some cases up to several centimeters in diameter.

15. Benign Tumors of Connective Tissue origin - Fibroma
It is always a well defined, slow growing lesion that occurs in any age , but is more common in the third, fourth or fifth decade of life.
It is most frequenly seen in the buccal mucosa, gingiva, tongue, lips and palate and is firm on palpation.
Treatment is surgical excision.

16. Benign Tumors of Connective Tissue origin
Central Ossifying Fibroma of Bone

17. Benign Tumors of Connective Tissue origin - Central Ossifying Fibroma of Bone
This tumor occurs as a central tumor of bone and is a separate entity from the fibrous dysplasia and other fibro-osseous lesions of the bone.
It occurs at any age, but is more common in young adults.
Either jaw may be involved, but more common in the mandible.

18. Benign Tumors of Connective Tissue origin - Central Ossifying Fibroma of Bone
The lesion is slow growing, and generally asymptomatic until the growth produces a noticeable swelling and mild deformity.
Displacement of teeth may be an early feature.
X-ray examination presents an extremely variable appearance depending upon it’s stage of development.

19. Benign Tumors of Connective Tissue origin - Central Ossifying Fibroma of Bone
In the early stages the lesion appears as a radiolucent area with no internal radiopacities and as the tumor matures there is increasing calcification and the radiolucent area becomes a uniform radiopaque mass.

20. Benign Tumors of Connective Tissue origin - Central Ossifying Fibroma of Bone
However in all the stages the X-ray shows that the lesion is always well demarcated from surrounding bone, in contrast to the fibrous dysplasia.
The lesion should be excised conservatively and recurrence is rare.

21. Benign Tumors of Connective Tissue origin
Peripheral Giant Cell Granuloma

22. Benign Tumors of Connective Tissue origin - Peripheral Giant Cell Granuloma
This tumor is similar to the central giant cell granuloma of bone, because of the presence of multinucleated giant cells in the lesion, however it occurs peripherally in the oral cavity.
The role of trauma as in tooth extraction, calculus deposits, ill fitting dentures and poor restorations may be a source of etiology of this lesion.

23. Benign Tumors of Connective Tissue origin - Peripheral Giant Cell Granuloma
It always occurs on the gingiva or alveolar process, most frequently anterior to the molars.
Thus it seems to originate from either the periodontal ligament or mucoperiosteum.
The lesion is usually between 0.5 to 1.5 cm in diameter.

24. Benign Tumors of Connective Tissue origin - Peripheral Giant Cell Granuloma
The lesions typically present with a bluish – purple color.
Females are affected twice as much as males.
It is more commonly seen between the age of 30 to 50 years.
Treatment is surgical excision.

25. Central Giant cell tumor of the bone.
Benign Tumors of Connective Tissue origin
Central Giant cell tumor of the bone.

26. Benign Tumors of Connective Tissue origin - Central Giant cell tumor of the bone.
There is a longstanding controversy regarding the relationship between giant cell tumors of the axial skeleton and giant cell granulomas of the jaws.

27. Benign Tumors of Connective Tissue origin – Central Giant cell tumor of the bone.
Currently there are two schools of thought regarding the existence of giant cell tumors in the facial skeleton.
Some like Jaffe, firmly believe that true giant cell tumors either do not exist or occur very rarely in the maxillofacial region.
However other pathologists and clinicians remain convinced that giant cell tumors do occur within the jaws.

28. Benign Tumors of Connective Tissue origin – Central Giant cell tumor of the bone.
Abrams and shear in 1974, consolidated these two positions, and suggested that certain jaw lesions may be true giant cell tumors and certain giant cell lesions outside the jaws maybe giant cell granulomas.

29. Benign Tumors of Connective Tissue origin – Central Giant cell tumor of the bone.
These lesions occurs between the age of 2 to 81 years, but the average age is within the second decade of life.
Sex: 2:1 female predilection.
The mandible is clearly the preferred site.

30. Benign Tumors of Connective Tissue origin – Central Giant cell tumor of the bone.
These lesions mainly occur in the anterior portion of the maxilla and mandible.
Posterior maxilla or mandible is rarely involved.
A painless local swelling is the most commonest presenting symptom although some patients may have pain or anesthesia.

31. Benign Tumors of Connective Tissue origin – Central Giant cell tumor of the bone.
The X-ray feature is a radiolucency within bone and can either have an multilocular or unilocular configuration.
Resorption of teeth very common.
V-shaped bony ridges separating the locules.

32. Benign Tumors of Connective Tissue origin – Central Giant cell tumor of the bone.
Small, slow growing, asymptomatic mass responds well to curettage.
However, the large and aggressive mass produces recurs frequently, especially in younger patients.
Surgical curettage is the most commonest procedure.
Large aggressive lesions of the maxilla and mandible may require an en-bloc resection.

33. Benign Tumors of Connective Tissue origin – Central Giant cell tumor of the bone.
Some lesions both the overlying mucosa and periosteum must be removed.
Non surgical modalities of treatment include systemic calcitionin administration, anti-angiogenic therapy with interferon, and intra-lesional corticosteroids.

34. Benign Tumors of Connective Tissue origin
Aneurysmal bone cyst

35. Benign Tumors of Connective Tissue origin – Aneurysmal bone cyst
There is controversy regarding the etiology of this lesion.
For the moment there are no strong evidences to prove that these lesions develop primarily, or to say that they develop secondarily due to another underlying disease process.

36. Benign Tumors of Connective Tissue origin – Aneurysmal bone cyst
Lichenstein indicates that this lesion results from a localized vascular disturbance such as a venous thrombosis or arteriovenous malformation.
Others believe that this lesion can either be a separate reactive process, arising from another primary bone lesion such as fibrous dyplasia, central giant cell granuloma, or pagets disease.

37. Benign Tumors of Connective Tissue origin – Aneurysmal bone cyst
This lesion occurs in younger patients usually below 20 years of age.
The mandible appears to be more commonly affected than the maxilla.
The posterior molar-bearing segments of the maxilla and mandible seem to be more commonly affected region.
Clinically these lesions are characterized by a non-pulsatile swelling of variable duration.

38. Benign Tumors of Connective Tissue origin – Aneurysmal bone cyst
50% of patients present with pain in the affected region.
Tooth displacement and external root resorption may also be seen.
There is a slight female predilection in both the long bones and jaw lesions.

39. Benign Tumors of Connective Tissue origin – Aneurysmal bone cyst
This lesion is classically described as an expanded, cystically transformed, eccentric ballooning of the bone.
Fine bony trabeculations in the lesion give a “soap bubble appearance”.

40. Benign Tumors of Connective Tissue origin – Aneurysmal bone cyst
The recurrence rate of these lesions in the jaws is about 19%.
Despite the recurrence rates, a thorough curettage is the most commonest treatment modality for this lesion.

41. Benign Tumors of Connective Tissue origin – Aneurysmal bone cyst
In some lesions with associated vascular malformations, preoperative super-selective embolization of the feeding vessels to the lesion is mandatory before surgery.
Following embolization either curettage or en-bloc resection can be performed.

42. Benign Tumors of Connective Tissue origin
Lipoma

43. Benign Tumors of Connective Tissue origin - Lipoma
It is a relatively rare intraoral tumor, although it occurs more frequently in the subcutaneous tissues of the neck.
It is a benign, slow growing tumor composed of mature fat cells.
The cells of lipoma differ metabolically from normal fat cells though they are histologically similar.

44. Benign Tumors of Connective Tissue origin - Lipoma
The tumor occurs in the tongue, floor of the mouth, buccal mucosa, gingiva, and mucobuccal folds.
It appears as a single or lobulated, painless lesion attached by either a sessile or a pedunculated base.
The lipoma is yellowish and soft on palpation.

45. Benign Tumors of Connective Tissue origin - Lipoma
Lipomas can be of the superficial or deep type.
Those that are deep produce only a slight surface elevation.
Treatment of lipoma is surgical excision.

46. Benign Tumors of Connective Tissue origin
Hemangioma

47. Benign Tumors of Connective Tissue origin - Hemangioma
It is a common tumor characterized by the proliferation of blood vessels.
It is often congenital in nature and is not a true neoplasm but a developmental anomaly i.e an abnormal proliferation of tissues of structures native to the part.

48. Benign Tumors of Connective Tissue origin - Hemangioma
Classification
Capillary
Cavernous
Angiobastic
Racemose
Diffuse systemic
Port-wine stain
Hereditary hemorrhagic telangiectasia

49. Benign Tumors of Connective Tissue origin - Hemangioma
Most cases of hemangioma are present at birth or arise at an early age.
Intraorally they appear as a flat or raised lesion of the mucosa, usually deep red or bluish red and seldom well circumscribed.
It commonly occurs in the tongue, lips, buccal mucosa and palate.

50. Benign Tumors of Connective Tissue origin - Hemangioma
Central hemangiomas of the maxilla and mandible occur and have to be carefully diagnosed and managed.
In the bone, the tumor is destructive lesion.
Some of them present a honeycombed appearance in the X-rays.

51. Benign Tumors of Connective Tissue origin - Hemangioma
Treatment
Some congenital hemangiomas have been found to undergo spontaneous regression at arelatively young age.
Surgery, sclerosing solutions, cryotherapy, interferon therapy and laser treatment are used according to the type of hemangioma in most of the cases.

52. Benign Tumors of Connective Tissue origin
Lymphangioma

53. Benign Tumors of Connective Tissue origin - Lymphangioma
It is a benign tumor of the lymphatic vessels.
It is present at birth in most of the cases.
It most commonly occurs in the tongue, but is also seen in the palate, buccal mucosa, gingiva and lips.

54. Benign Tumors of Connective Tissue origin - Lymphangioma
The superficial lesions are papillary and slightly red in color, but the deep lesions appear as diffuse nodules or masses without any change in color.
Treatment is by surgical excision for small lesions and large deeper lesions are treated by sclerosing agents.

55. Benign Tumors of Connective Tissue origin
Myxoma

56. Benign Tumors of Connective Tissue origin - Myxoma
It is the tumor of the soft tissues and is made up of tissue resembling primitive mesenchyme.
The tumor is benign but can infiltrate into adjacent tissues.
Most of them are deep seated lesions and are very rare intraorally.

57. Benign Tumors of Connective Tissue origin - Myxoma
The myxomas ocurring in the jaws are often referred to as odontogenic myxomas (odontogenic tumor).
Treatment of myxoma is surgery.

58. Benign Tumors of Connective Tissue origin
Chondroma

59. Benign Tumors of Connective Tissue origin - Chondroma
It is a benign central tumor composed of mature cartilage and is not very common in the maxilla or the mandible.
It can undergo malignant transformation.
It can develop at any age and has no sex predilection.

60. Benign Tumors of Connective Tissue origin - Chondroma
It often appears as a painless, slowly growing swelling of the jaw and may cause loosening of teeth.
The anterior portion of the maxilla is commonly involved.
In the mandible it involves the condyle or the coronoid process and in some cases the body.

61. Benign Tumors of Connective Tissue origin - Chondroma
Treatment of chondroma is surgical and the tumor is resistant to radiation.

62. Benign Tumors of Connective Tissue origin
Osteoma

63. Benign Tumors of Connective Tissue origin - Osteoma
It is a benign tumor characterized by proliferation of either compact or cancellous bone usually in an endosteal or periosteal location.
It is not a common oral lesion.
It is common in young adult and is a slow growing lesion.

64. Benign Tumors of Connective Tissue origin - Osteoma
There is seldom pain associated with this tumor.
Multiple osteomas of the skull and jaws are seen in patient’s with Gardner’s syndrome.
Treatment is surgical removal of the lesion.

65. Benign Tumors of Connective Tissue origin
Torus palatinus

66. Benign Tumors of Connective Tissue origin – Torus palatinus
It is a slow growing, flat-based bony protuberance which occurs in the midline of the hard palate.
Women are more affected than men.
It’s peak incidence is shortly before the age of 30 years.

67. Benign Tumors of Connective Tissue origin – Torus palatinus
The torus itself is composed of either dense compact bone or a shell of compact bone with a center of cancellous bone.
The Torus palatinus does not require any treatment unless it produce any mucosal surface ulceration due to trauma as in eating or for prosthodontic reasons.

68. Benign Tumors of Connective Tissue origin
Torus Mandibularis

69. Benign Tumors of Connective Tissue origin – Torus Mandibularis
It is an exostosis or outgrowth of bone found on the lingual surface of the mandible.
It occurs above the mylohyoid line in the mandible, usually opposite the bicuspid teeth.
It may vary in size and shape and can be seen as unilateral or bilateral.

70. Benign Tumors of Connective Tissue origin – Torus Mandibularis
Surgical removal of the Torus-Mandibularis is carried out for prosthodontic reasons.

71. Benign Tumors of Muscle Tissue origin
Leiomyoma

72. Benign Tumors of Muscle Tissue origin - Leiomyoma
It is a benign tumor derived fro smooth muscle.
It is uncommon in the oral cavity, probably because of the absence of smooth muscle except in the blood vessel walls and circumvallate papillae of the tongue.
Intraorally the majority of cases occur on the posterior portion of the tongue.

73. Benign Tumors of Muscle Tissue origin - Leiomyoma
The oral lesion is slow growing painles lesion which is superficial and often pedunculated.
It resembles normal mucosa in color.
The presenting symptoms are that of “sore throat” or “tumor in the throat”.
It is treated by conservative surgical excision.

74. Benign Tumors of Muscle Tissue origin
Rhabdomyoma

75. Benign Tumors of Muscle Tissue origin - Rhabdomyoma
It is a benign tumor of striated muscle origin.
The most common locations are the tongue and the floor of the mouth.
It is a painless, well circumscribed tumor mass that is slow growing.
Treatment is surgical excision.

76. Benign Tumors of Nerve Tissue origin
Neurofibroma

77. Benign Tumors of Nerve Tissue origin - Neurofibroma
It is a tumor of nerve tissue origin, specifically arisng from cells of the sheath of schawnn with intermingled neurites.
It most frequently involves the skin and oral mucosa and does not differ form the multiple form of the disease known as neurofibromatosis or von recklinghausen’s disease.

78. Benign Tumors of Nerve Tissue origin - Neurofibroma
It has a slight predilection in men.
The individual lesion is of two types.
In one form, numerous sessile or pedunculated, elevated smooth-surfaced nodules of variable size are scattered over the skin surface, chiefly the trunk, face and extremities.

79. Benign Tumors of Nerve Tissue origin - Neurofibroma
In the other form there are deeper, more diffuse lesions which are often of greater proportions than the superficial nodules.
It is important to be aware that one or more of these lesions can undergo malignant transformation.

80. Benign Tumors of Nerve Tissue origin - Neurofibroma
Intraorally discrete, nonulcerated nodules with the same color of normal mucosa is noted in the tongue, buccal mucosa and palate.
Macroglossia is evident in some cases.
There is no satisfactory treatment for the Neurofibromatosis.
Solitary lesions can be excised.

81. Benign Tumors of Nerve Tissue origin
Neurilemmoma

82. Benign Tumors of Nerve Tissue origin - Neurilemmoma
It is a common tumor of the sheath of schwann (Neuroectodermal in origin).
It is a slow growing lesion and arises at any age.
There is no sex predilection.
It can occur anywhere in the oral cavity.

83. Benign Tumors of Nerve Tissue origin - Neurilemmoma
It can occur as a central lesion inside the bone.
The soft tissue lesion is a single well circumscribed nodule of varying size.
Treatment of this lesion is surgical excision.

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