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Jaw Tumors

by Bradley A. Schiff, MD

Numerous tumor types, both benign and malignant, originate in the jaw. Symptoms are swelling, pain, tenderness, and unexplained tooth mobility; some tumors are discovered on routine dental x-rays, whereas others are found on routine examinations of the oral cavity and teeth. Treatment depends on location and tumor type. Benign tumors may be observed and may not need surgical excision, although most tumors require resection with possible reconstruction.

If not initially detected on x-ray, jaw tumors are diagnosed clinically because their growth causes swelling of the face, palate, or alveolar ridge (the part of the jaw supporting the teeth). They can also cause bone tenderness and severe pain.

Bony outgrowths (torus palatinus, torus mandibularis) may develop on the palate or mandible. These are common growths and may prompt concerns about cancer, although they are benign and of concern only if they interfere with dental care or function of the submandibular gland. When on the palate, they are in the midline and have intact, smooth mucosa. Multiple osteomas seen on dental x-ray may suggest Gardner syndrome.

The most common tumor of the mandible and maxilla is squamous cell carcinoma invading the bone through dental sockets. These can involve any portion of the intraoral mandible or maxilla.

Ameloblastoma, the most common epithelial odontogenic tumor, usually arises in the posterior mandible. It is slowly invasive and rarely metastatic. On x-ray, it typically appears as multiloculated or soap-bubble radiolucency. Treatment is wide surgical excision and reconstruction if appropriate.

Odontoma, the most common odontogenic tumor, affects the dental follicle or the dental tissues and usually appears in the mandibles of young people. Odontomas include fibrous odontomas and cementomas. A clinically absent molar tooth suggests a composite odontoma. Typically, these tumors are excised, particularly when the diagnosis is in doubt.

Osteosarcoma, giant cell tumor, Ewing tumor, multiple myeloma, and metastatic tumors may affect the jaw. Treatment is the same as for those tumors in other bony sites.

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