DONTOGENOUS TUMOURS (grech, odus, odontos tooth + gennao to create, reproduce) — the tumors of the epithelial and connective tissue nature developing from elements of tooth fabrics at various stages of their development.
On morfol, Dontogenous tumors divide WHO classifications (1971) on high-quality (an ameloblastoma, ameloblastichesky fibroma, an odontoma, cementoma, dontogenous fibroma) and malignant (dontogenous cancer, Dontogenous sarcomas). An ameloblastoma call the tumor developing from a dontogenous epithelium, in a cut the structures reminding enamel body form (see. Adamantinoma ). Ameloblastichesky fibroma of laying of tooth reminds fabric of a gingival nipple. Microscopically the tumor consists from tyazhy and complexes of epithelial cells and the expressed connective tissue stroma, edge can be friable, cellular, and sometimes fibrous with the phenomena of a hyalinosis. Odontoma (see) has peculiar gistol, the structure caused by maldevelopment of the created tooth fabric. Cementoma develops around roots of one or group of teeth and is characterized by formation of fabric, similar to cement of tooth. In some cases in cementoma fibroblastichesky fabric prevails, in a cut dense calciphied roundish or lobular cement-like masses is located. In process of growth of a tumor cement-like masses can merge in large conglomerates. Dontogenous fibroma develops from mesenchymal dental fabric and consists preferential of connecting fabric rich with fibroblasts, sometimes single epithelial tyazhy, rare cement-like structures. Absence in about donto to gene fibroma of epithelial follicular structures distinguishes it from an ameloblastoma. Gistogenetichesky communication of dontogenous fibroma and a myxoma of a jaw is noted. Rather rapid growth of a tumor is caused by considerable products of the main mucoid substance.
High-quality O. of the lake differ in a long current. A wedge, their manifestations are a little characteristic. At a research define a thickening of the site of a jaw with a smooth or chicken skin. At tumors of the big sizes and accession of inflammatory process observe increase and morbidity regional limf, nodes. Cementoma causes deformation of a jaw and can be painful at a palpation. Germination of a tumor in soft tissues is followed by an ulceration of a mucous membrane. Teeth in a zone of defeat can be displaced and mobile.
Dontogenous cancer develops from the remains of a dontogenous epithelium or from elements of a cyst. Meets at advanced age more often. At the same time early there comes the ulceration of a mucous membrane of a gingiva, there are metastasises in regional limf, nodes. Dontogenous sarcomas belong to very rare O. lakes, as a rule, are characterized expressed a sign of an amianaplaziya, rapid growth, cause severe pains and a caries.
Diagnosis By the lake of the lake it is complicated, is based on the analysis kliniko-rentgenol. and morfol, data.
Treatment high-quality O. of the lake operational; the volume of operation depends on the size and localization of a tumor. At odontogeniy fibroma and cementoma the tumor can be completely a vylushchena. At malignant O. the lake by method of the choice is the combined treatment — preoperative radiation therapy and radical operation. The volume of the excised fabrics depends on prevalence of tumoral process: make either a resection of a mandible, or its half exarticulation (see. Jaws ). In the presence of metastasises in regional limf, nodes in one step with a resection of a jaw the uniform block carry out fascial futlyarnoye excision of cellulose of a neck or Krayl's operation (see. Krayla operation ).
Forecast high-quality O. of the lake favorable. At malignant O. of the lake 5-year survival after operation makes 20 — 30%.
Bibliography: Vernadsky IG. I. Fundamentals of surgical stomatology, page 363, 372, Kiev, 1970; The Guide to pathoanatomical diagnosis of tumors of the person, under the editorship of Y. A. Krasvsky and A. V. Smolyannikov, page 129, M., 1976; P i n d b about r g J. J. a. Kramer I. R. II. Histological typing of odontogenic tumors, jaw cysts, and allied lesions, Geneva, 1971.
A. I. Paches, O. M. Maximova.