CYST AND TUMOR OF JAW AND FACE

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Odontogenic jaw cysts and tumors originate from cells and tissues that are involved in normal tooth development. Others tumors that affect the jaws can be nonodontogenic, meaning that they can develop from other tissues within the jaws that are not related to the teeth. Generally, the cause of jaw tumors and cysts is not known; however, some are associated with genetic syndromes.

Around 10% of people develop abnormal masses in their jaws. These abnormal lesions are often found around impacted third molars that were never removed. Others occur spontaneously, or are caused by inflammation or genetics. While usually benign, they can invade the surrounding jaw leading to bony destruction and displacement of the teeth.

Cystic jaw lesions tend to grow very slowly and in many patients, they are asymptomatic (i.e. they do not cause any noticeable symptoms). Due to this nature, they are mostly found incidentally when radiographic imaging is conducted for another unrelated dental or head and neck pathology. However, if the cysts become infected then they may evolve into painful entities.

Abnormal jaw masses (Tumors) are often slow growing and painless. They result in gradual destruction of the bone and expansion and weakening of your jaw. Over time the mass can displace or loosen your teeth, resulting in changes to your bite. Other jaw masses are fast growing and can result in pain and swelling. The nerves in your jaw can be compressed resulting in numbness to your lips, gums, or teeth.

Facial and jaw cysts and tumors often do not have any symptoms. Your doctor or dentist may discover them during regular check-ups or x-rays. When they do cause symptoms, they usually look like a non-painful bump or lump. These cysts and tumors are often benign (not cancer), but all tumors in the head and neck must be examined by oral and maxillofacial surgeon as soon as possible. 

After a surgeon examines the cyst or tumor, we will often recommend a panorex x-ray (an x-ray of your mouth and jaw), CT scans (an X-ray showing the inside of a body part), or an MRI of your head (test that uses a strong magnet in order to create detailed images of organs and tissues within the body) to determine what kind of treatment you need. 

Jaw cysts and Tumors grow very slowly and in the vast majority of cases patients do not have any symptoms. They are often discovered as an incidental finding when x-rays are taken to look for other things. But, if the cyst becomes infected they can become painful.

To gather more information about your jaw tumor or cyst, your doctor may recommend tests prior to treatment. These test may include: 

• Imaging studies, such as X-ray, CT scan, CBCT or MRI
• A biopsy to remove a sample of tumor or cyst cells for laboratory analysis

Your doctor uses this information to put together a treatment plan that's best for you and the most effective option for treating your tumor or cyst.

·  Hospital stay: Many patients are able to go home after their procedure. Depending on the type of surgery and anaesthesia used. Patients can generally expect to go home after they recover from anesthesia (the medication that put you sleep during surgery). In some cases, patients may need to stay overnight at the hospital depending on the extent of the surgery. 

·  Return to work/school: We usually advise taking between 2 days to 2 weeks off before returning to work or school. This period may be shorter or longer based on the type of surgery you had. It takes at least 6 weeks for initial healing of your jaw.

·  Physical activity: You can resume light physical exercise as soon as you feel able following your surgery. You must not participate in any exercise or sports that may involve hitting your jaw. This includes all contact sports. Do not clench or stress your jaw muscles with heavy lifting more than 10 pounds. 

·  Diet: For the first 2 weeks after surgery you will follow a soft diet. On your 2-week follow-up appointment we will explain what type of diet you will transition to at that time. This depends of the type and extent of surgery. After the initial 2 weeks, you may use a straw to eat. 

·  Pain control: Your doctor may prescribe anti-inflammatory or opioid pain medications to help control pain or discomfort following surgery. 

·  Swelling: Swelling is a normal side-effect of surgery but the degree varies between individuals. You can expect to have the most swelling between days 3-5 after your surgery. 

·  Scarring: Most of this type of surgery is carried out inside the mouth, which means no obvious scars. In some cases, very small incisions may be placed on the outside of your mouth on your face. 

·  Follow up: We will follow up with you about 2 weeks after your surgery. We will check to make sure you are healing properly. At this appointment we will explain when you need to follow up with us again. The type of cyst or tumor you had will determine future follow-up and treatment. 

Overall, surgery on jaw cysts and tumors is safe when done by a well-trained, experienced oral and maxillofacial surgeon in a centre that performs many similar surgeries like Nuface Clinic. Any surgery has the possibility for risks and complications. Your surgeon will discuss these in detail after they decide on the type of surgery that best fits your needs. 

Some of the possible complications with Jaw Cyst and Tumor surgery are:

·  Bleeding

·  Paresthesia or Anaesthesia (Injury to sensory nerve of face)

·  Damage to adjacent Teeth

·  Fracture of Jaw bone

·  Infection

·  Loss of Bone

As with all surgery there is a risk of pain, swelling, bruising, bleeding and infection.

• Some slight bleeding from the cuts inside your mouth is common in the first day or so. It is

unlikely to be a problem and it can usually be stopped by putting pressure on the area for at least 15 minutes with a rolled up damp handkerchief or gauze swab.

• The area can get infected – this can be treated with antibiotics.

• There is a nerve that runs through a tunnel in the centre of your lower jaw. This gives the feeling to your lower lip, chin and bottom teeth. This nerve may be bruised or torn when the cyst lining is removed and as a result you may feel some tingling or numbness in your lip and/or chin. For most people who have tingling or numbness it does get better on its own - although this can take several months. Some people have permanent numbness afterwards.

• If the cyst is very large in size there is a very small risk that your jaw may break during or after the surgery and need to be repaired.

• If you wear a denture it may not fit properly following the surgery.

Benign cysts and tumors of jaw and face are usually treated by oral and maxillofacial surgeon. Oral and maxillofacial Surgery is a speciality of dentistry. Oral and maxillofacial surgeons are well trained for treating pathology of Jaw bone, mouth and face. A board certified Oral and Maxillofacial surgeon with wide experience in treating cyst and tumors of jaw is the best choice for treatment of Cyst and Tumors of Jaw and Face.

At Nuface Clinic, Dr. Parit Ladani is one of the most experienced Oral and Maxillofacial Surgeon in India with experience of treating abnormal cysts and tumors of jaw and face. We strive to provide the highest level of care and exceptional results using the best scientific evidence and proven surgical techniques.

The price jaw tumours or cysts is determined based on the clinical situation, types of cyst or tumor, size, location and type of anaesthesia. It also depend on the hospital facility used and experience of surgeon. The average cost of surgery for cyst or tumor of jaw under local anaesthesia in office base procedure range from 5000-20000 INR at Nuface Clinic. 

This is the most common odontogenic cyst and has various names, including radicular cyst, apical periodontal cyst, root end cyst, or dental cyst. It may develop rapidly from a periapical granuloma, as a consequence of untreated infection at the apex of tooth roots. Most frequently, periapical cyst is located in the maxillary anterior region, the cyst is caused by pulpal necrosis secondary to dental caries or trauma. The process of pulpal necrosis causes inflammation and the release of toxins at the apex or end of the root tip and leads to formation of cyst. Such cysts are very common. Although initially asymptomatic, they are clinically significant because secondary infection can cause pain and damage. 

Periapical cysts begin as asymptomatic and progress slowly. Subsequent infection of the cyst causes swelling and pain. Initially, the cyst swells to a round hard protrusion, but later on the body resorbs some of the cyst wall, leaving a softer accumulation of fluid underneath the mucous membrane. Larger cysts may cause bone expansion or displace roots. Discoloration of the affected tooth may also occur. Expansion of the cyst in the maxilla causes erosion of the floor of the maxillary sinus.

Dental cysts are usually caused due to root infection involving tooth decay or trauma. Untreated dental caries then allow bacteria to reach the level of the pulp, causing infection. The bacteria gains access to the periapical region of the tooth through deeper infection of the pulp, traveling through the roots. The resulting pulpal necrosis causes proliferation of epithelial rests of Malassez which release toxins at the apex of the tooth leading to periapical inflammation. The many cells and proteins that rush to an area of infection create osmotic tension in the periapex which is the source of internal pressure increase at the cyst site. These lesions can grow large because they apply pressure over the bone, causing resorption.

On examination, there is bone expansion and displacement of tooth roots as well as crepitus noise during palpation indicates extensive bone damage. Involved tooth is usually non vital and deeply carious or past history of trauma.

Your surgeon with advise Intraoral X-rays or a 3-D cone beam scan of the affected area to confirm diagnosis of cysts in the periapical area. Circular or ovoid radiolucency surrounding the root tip of approximately 1-1.5 cm in diameter is indicative of the presence of a periapical cyst. 

The infected tissue of the periapical cyst must be entirely removed, including the epithelium of the cyst wall; otherwise, a relapse is likely to occur. Root canal treatment should be performed on the affected tooth/teeth. According to the most modern treatment methods, retrograde root canal filling should be used at the time of surgery to remove cyst. 

In case the endodontic treatment is not effective, the extraction of the tooth is used, the place of cyst is cleaned and filled with the artificial bone material.

Dentigerous cysts are the second most common type of odontogenic cyst, which is a fluid-filled sac that develops in the jaw bone and soft tissue. They form over the top of an unerupted tooth, or partially erupted tooth, most commonly found in the area of the lower wisdom teeth or the permanent upper canines, develop around the crown of an unerupted tooth.  Dentigerous cysts usually grow and expand rapidly. While dentigerous cysts are benign, they can lead to complications, such as infection, if left untreated.

Smaller dentigerous cysts might not cause any symptoms. However, if the cyst grows larger than 2 centimeters in diameter, you may notice:

• Swelling
• Tooth sensitivity
• Tooth displacement

If you look inside your mouth, you may also notice a small bump. If the cyst causes tooth displacement, you might also see gaps slowly forming between your teeth.

Dentigerous cysts are caused by a buildup of fluid over the top of an unerupted tooth. The exact cause of this buildup is unknown. While anyone can develop a dentigerous cyst, they’re more common in people who are in their 20s or 30s.

Small dentigerous cysts often go unnoticed until you have a dental X-ray. If your dentist notices an unusual spot on your dental X-ray, they may use a CT scan or MRI scan to make sure it’s not another type of cyst, such as a periapical cyst or an aneurysmal bone cyst.

In some cases, including when the cyst is larger, your dentist may be able to diagnose a dentigerous cyst just by looking at it.

Treating a dentigerous cyst depends on its size. If it’s small, your dentist might be able to surgically remove it along with the affected tooth. In other cases, they might use a technique called marsupialization.

Marsupialization involves cutting open the cyst so it can drain. Once the fluid has drained, stitches are added to the edges of the incision to keep it open, which prevents another cyst from growing there.

Even if your dentigerous cyst is small and not causing any symptoms, it’s important to have it removed to avoid complications. An untreated dentigerous cyst can eventually cause:

• Infection
• Tooth loss
• Jaw fracture
• Ameloblastoma, a type of benign jaw tumor

Also known as keratocystic odontogenic tumour (KCOT), odontogenic keratocyst is a rare and benign but locally aggressive developmental cyst. It most often affects the posterior part of lower jaw (mandible) and most commonly presents in the third decade of life. Odontogenic keratocysts make up around 19% of jaw cysts and the third most common tooth-derived cyst. The odontogenic keratocyst (OKC) is known for its high recurrence rate, aggressive behavior, and its occasional association with the nevoid basal cell carcinoma syndrome (NBCCS).

Odontogenic keratocysts can occur at any age, however they are more common in the third to sixth decades. The male to female ratio is approximately 2:1. The majority are found in the mandible, with half occurring at the angle of the mandible.

Early odontogenic keratocysts usually do not display symptoms. Typically, clinical signs and symptoms present with bony expansion, or infection. However, bony expansion or swelling is uncommon as odontogenic keratocysts grow due to increased epithelial turnover rather than osmotic pressure. When symptoms are present they usually take the form of pain, swelling and discharge due to secondary infection. Odontogenic keratocysts are usually noted as incidental radiographic findings. 

They can be mistaken for other cysts such as residual cysts or a dentigerous cyst if they occur over an unerupted tooth.These cysts also are found as part of the Basal Cell Nevus Syndrome, also known as Gorlin syndrome.

There are several theories surrounding the origin of the keratocyst. Some experts believe the cyst develops in the place the tooth should have. Others argue that the tumors arise from the lamina of impacted teeth.

Diagnosis is usually radiological. Radiographically they can be seen as unilocular or multilocular radiolucencies. However, definitive diagnosis is through biopsy. Aspirational biopsy of odontogenic keratocysts contains a greasy fluid which is pale in colour and contains keratotic squames. 

The odontogenic keratocyst has a number of 'compartments' and has connecting smaller cysts that extend into the surrounding bone.  Because of this, there is frequent tendency for the condition to recur, particularly if the original surgical treatment did not result in complete removal of the cyst.

Removal of the cyst with removal of surrounding bone and cryosurgery (intense cold is applied to the cyst and bone) or chemical cauterisation of bone (with Carnoy’s solution) are the most common forms of treatment. In case of large odontogenic keratocyst, resection of part jaw is necessary followed by reconstruction of jaw.

Long-term follow-up with monitoring by X-ray is important, as if these cysts are left untreated, they can become quite large and locally destructive.

Odontome also known as an odontoma, is a benign tumor linked to tooth development that affect less than 1% of the population. Odontomes are the most common type of odontogenic tumor among patients younger than 20 years. These tumors are composed of various dental tissues, that is, enamel, dentine, cementum and sometimes pulp that invade the jaw around your teeth and could affect how your teeth develop. In children, odontomes mainly result in eruption disturbances of the permanent teeth, whereas this is rare regarding the primary dentition (baby teeth). Fortunately, treatment is pretty straightforward and usually require surgical removal.

There are 2 main types of odontomes:

Compound:

·  Consisting of many, tiny tooth-like bits

·  Usually found in the lower jaw

·  Most often occurs during your teenage years

Complex:

·  Made up of an assortment of dental tissue (enamel, dentin, etc.)

·  Usually found within the upper jaw

·  Most often occurs during your 20s

Odontomes are commonly asymptomatic, clinical indicators of odontoma may include retention of deciduous teeth (baby teeth), non-eruption of permanent teeth, pain, swelling in the jaw and tooth displacement. Other symptoms include anaesthesia in the lower lip and swelling in the affected area. Generally, these tumors occurs within the bone but occasionally they may erupt into the oral cavity. Odontomes can measure anywhere from a few millimetres to many centimetres in their greatest dimension.  The largest found in a human weighed 0.3 kg. Odontomes may be diagnosed at any age but they are usually detected during the first two decades of life.  

Cause for Odontome development is unknown. However, odontomes have been related to local trauma, inflammatory and/or infectious processes, hereditary anomalies such as Gardener's syndrome and Hermanns syndrome, odontoblastic hyperactivity, mature odontoblasts and dental lamina remnants.

Since odontomes grow internally around your teeth, an X-ray from your dentist is necessary to identify them.The odontomes appears as an irregular mass of calcified structures resembling teeth on dental radiograph or panorex. A developing odontoma can be discovered by routine radiography but may cause difficulty in identification due to lack of calcification.

Removal surgery has been the tried-and-true treatment plan for odontomas — especially if they are causing any pain or affecting your teeth to erupt unnaturally. Surgery to remove your odontomas is very common with few complications. Plus, since they're noncancerous, they rarely grow back after removal.

The unerupted tooth associated with odontoma could be extracted if it's not developing correctly. If you have a tooth that needs extraction, discuss tooth replacement options and alignment issues with your Oral and Maxillofacial Surgeon and/or orthodontist

Plus, Just remember to see your dentist regularly so they can identify the odontomas as early as possible on your X-rays.

Ameloblastoma is a rare, benign tumor of odontogenic epithelium (cells that form the enamel that protects your teeth) much more commonly appearing in the lower jaw than the upper jaw, often near your wisdom teeth or molars. Ameloblastoma is very aggressive, therefore the resulting lesions can cause severe abnormalities of the face and jaw. Additionally, because abnormal cell growth easily infiltrates and destroys surrounding bony tissues, wide surgical excision is required to treat this disorder. If an aggressive tumor is left untreated, it can obstruct the nasal and oral airways making it impossible to breathe without oropharyngeal intervention. If it goes untreated for a long time, it may become cancerous and spread to your lymph nodes or lungs.

Ameloblastoma occurs in men more often than it occurs in women. Though it can be diagnosed at any age, ameloblastoma is most often diagnosed in adults in their 30s through 60s.

The tumors usually grow slowly over many months or even years. For a while, the only symptom may be swelling in the back of your jaw. You also might have tooth or jaw pain.

Some people don't have any symptoms. It's found when they have an imaging scan done for some other reason.

Occasionally, ameloblastomas grow quickly and painfully. This can uproot and move your teeth. They also can spread to your nose, eye socket, or skull.

In rare cases, they can grow so large that they block your airway, make it difficult to open and close your mouth, or affect how your body takes in nutrients from food.

Doctors aren't sure what causes ameloblastomas or why certain people get them. They do know they're more common in men than in women, and certain genes seem to play a role.

An injury to your jaw or an infection in your mouth also might raise your risk. And scientists think some viruses or a lack of protein or minerals in your diet may be linked to them as well.

Imaging tests such as, X-ray, CT and MRI scans help doctors determine the extent of an ameloblastoma. Dentists often spot these tumors on X-rays -- they can look like soap bubbles on film.

Your doctor may want to take a small sample of tissue to look at under a microscope. To take the sample, they'll use a needle or make a small cut. This is called a biopsy and it can confirm it's an ameloblastoma and help determine how fast it's growing.

Surgery 

Ameloblastoma treatment usually includes surgery to remove the tumor and the affected part of the jawbone. To make sure the tumor cells don't grow back, your doctor will take out the tumor and some of the healthy tissue around it. An aggressive approach to surgery reduces the risk that ameloblastoma will come back.

Surgery to repair the jaw.

Because the surgery must be performed aggressively, teeth will be extracted, and extensive hard and soft tissue plastic surgery reconstruction may be necessary. If surgery involves removing part of your jawbone, surgeons can repair and reconstruct the jaw using bone from somewhere else in your body or artificial bone. This can help improve how your jaw looks and works afterward. The surgery can also help you to be able to eat and speak.

Drug and radiation

Drugs and radiation don't seem to have much effect on most non-cancerous.

Supportive care.

A variety of specialists can help you work through speaking, swallowing and eating problems during and after treatment.

After treatment

You'll likely have regular follow-up appointments for several years and may require CT scan at regular interval to rule out recurrence. 

Ossifying fibroma, sometimes called cemento-ossifying fibroma, Ossifying fibroma is a rare, non-cancerous tumor that occurs in the jawbones. The term "ossifying" means to turn into bone or bony tissue, and these tumors often contain calcified tissue that resembles bone, cementum (dental tissue), or both. Ossifying fibromas often manifest as round, painless, and slow-growing masses with well-defined borders.

Ossifying fibroma often occurs between the second and fourth decade of life and is more common in females, suggesting a hormonal influence on development. Still, ossifying fibromas can occur for patients of any age and sex. Trauma, irritation caused by dental restorations, and plaque underneath the gums might also all play a role in development, but the precise cause is still unknown.

You might first notice ossifying fibroma by swelling in the face. These slow-growing tumors are often painless and asymptomatic, but they can gradually displace teeth or cause root resorption. If you notice any facial swelling, see your dental professional as soon as possible to determine the source of the issue.

Your dental professional will take X-rays to determine the exact location of the tumor and confirm a diagnosis. The clear outline around their perimeter usually identifies the growth as ossifying fibroma; however, the X-ray appearance can differ depending on the tumor's development stage and how much of the mass has calcified.

Treatment for ossifying fibroma usually requires surgical excision where the oral surgeon will remove the tumor completely from the tissue. Larger tumors might require a more invasive procedure to reconstruct the affected bone. After healing, your dental professional will determine if any additional treatment is needed to restore and replace affected teeth.

Removing the ossifying fibroma generally resolves any issues. Several studies have estimated the recurrence rate to be from 6.7% up to 28%. The recurrence rate is significantly higher for cases affecting children. For these reasons, make it a priority to see your dental professional for periodic follow-ups to monitor the site.

As with many dental issues, early diagnoses and appropriate treatment of ossifying fibroma can provide the best route to a healthy mouth. If you notice any swelling or growths along your gums or jaw, contact your dental professional immediately.

Central giant-cell granuloma (CGCG) is a localised benign fibrous tissue tumor of the jaws which contains osteoclast(bone resorbing cells). It is twice as common in females and is more likely to occur before age 30. Central giant-cell granulomas are more common in the anterior mandible where teeth have deciduous predecessors, often crossing the midline and causing painless swellings usually measures several centimetres. 

What are the symptoms of central giant cell granuloma?

Frequently, a painless swelling that grows and expands rapidly is present. This growth can also erode through bone including the alveolar ridge(gum), resulting in a soft tissue swelling that is purple in colour. Paresthesia of the lip has also been observed. Multiple CGCGs can be found in individuals with Noonan syndrome.

Radiographically, CGCGs have a rounded cyst-like radiolucent area with a well-defined margin with 53% showing scalloped margins. They can have a multilocular (honeycomb or soap bubble) appearance. Resorption of tooth roots is seen in 37% of cases compared to displacement of teeth in 50%. Two-thirds of lesions are found anterior to molars in the mandible. Histologically similar to brown tumour found in hyperparathyroidism. Biochemical investigation through serum calcium, to exclude hyperparathyroidism. 

The treatment for enlarged CGCG is usually thorough curettage. Recurrence ranges from 15%–20%, second curettage is sufficient to prevent further recurrence. Rapidly growing tumours are more likely to recur and can sometimes require full excision with surrounding bone. Large lesions may require removal of part of jaw.

Alternatives or adjuncts to surgery: 

·  Corticosteroids which convert lesions into fibrous tissue

·  Calcitonin which slows growth

·  Interferon α-2a which slow growth

·  Bisphosphonates which slow growth

These therapeutic approaches provide possible alternatives for large lesions which cannot go through immediate surgery or in children where facial growth following surgery might be affected. However, no significant differences have been found in the use of surgical and non-surgical methods for treating CGCGs. The long term prognosis of giant-cell granulomas is good and metastases do not develop. 

Peripheral giant cell granuloma is an oral pathologic condition that appears in the mouth as an overgrowth of tissue due to irritation or trauma. Because of its overwhelming incidence on the gingiva, the condition is associated with two other diseases, pyogenic granuloma and peripheral ossifying fibroma. These three diseases are associated because they appear frequently on gingiva. Due to its similar microscopic appearance, peripheral giant-cell granuloma is considered to be the soft tissue equivalent of central giant-cell granuloma.

Treatment usually involves surgical removal of the lesion down to the bone. If there are any adjacent teeth, they are cleaned thoroughly by scaling and root planing (SRP) to remove any possible source of irritation. Recurrence is around 10%.

A mucocele (Mucous Cyst) is a cyst-like lesion in your mouth, most commonly found at the surface of the lower lip. It can also be found on the inner side of the cheek, on the anterior ventral tongue, and on the floor of the mouth. Mucocele are usually temporary but, if not treated could become permanent.

Mucocele is caused by blockage of salivary gland duct due to trauma. Instances of this could be..

·  Piercings

·  Lip Biting

·  Cheek Biting

·  Ruptured Salivary Gland

This blockage does not allow the saliva to be released into the mouth, which in turn causes saliva to back up into the gland, increasing its size. The thin, fluid-filled sac usually appears on the inside of the lip.

Mucoceles present themselves as a soft, painless, purple in color mass. The size of a mucocele varies from 1mm to several centimetres. Although they are painless they can become tender and uncomfortable. They most likely occur on the lower lip, but can occur in other places. In some cases, there is recurrent swelling, with occasional rupturing of the mucocele content. If you’re experiencing this, it’s important to contact an experienced mucocele surgeon. Mucoceles may also interfere with eating or speaking.

Oral mucocele are a benign lesion, usually caused by accidental biting the lip or cheek. Occasionally, patients with overbites or underbites get mucocele as well. This is caused by upper teeth biting on lower lip. The best way to correct this is by jaw surgery or orthodontics. This will help with the prevention of mucoceles but other oral health issues as well.

Oral and Maxillofacial Surgeon evaluate the lesion and rely on clinical symptoms to diagnose the lesion. But there are some lesions that look alike, therefore, the best way to diagnose any lesion is to have it sent to a pathology laboratory after excision.

Unfortunately, simply popping or removing the fluid from the gland does not resolve the problem because the duct will continue to stay blocked. That is why the preferred treatment of choice for mucocele is surgical removal. Because most mucoceles occur on the lips or inside the mouth, they can be easily removed through a simple, small incision. An experienced Oral and Maxillofacial Surgeon will be able to safely and easily remove affected gland without any complications. If done correctly, the risk of recurrence is low.

Any lesion should be seen and treated by an expert in the field. No lesion should be left untreated! If left untreated, they can organize and form a permanent bump on the inner surface of the lip.

A ranula is a fluid collection or cyst that forms in the mouth under the tongue. It is filled with saliva (spit) that has leaked out of a damaged salivary gland. Salivary glands are small structures around the mouth which make saliva. Saliva should drain from these glands directly into the mouth. If one of these glands is damaged then the saliva leaks out into the tissues next to the gland forming a cyst or bubble near the gland. This cyst is called a ranula.

If the ranula stays in the mouth underneath the tongue it is called a simple ranula and if it grows down into the neck under the mouth it is called a plunging ranula.

Ranulas are usually discovered by the patient, the patient’s family, or the patient’s medical caregivers like medical doctors and dentists. It usually is a 2-3 inch diameter painless soft swelling under the tongue or chin that is easy to identify. Occasionally, the fluid collection can hurt a little and sometimes is can spontaneously empty into the mouth only to slowly fill back up in the weeks after it empties. Usually, it just slowly grows in size until it is discovered.

Saliva is fluid formed primarily by three salivary glands on either side of the mouth: the parotid glands, the submandibular glands, and the sublingual glands. If one of the salivary glands, usually the sublingual gland, is injured or diseased the saliva will no longer reach the mouth where it can be swallowed. The saliva leaks out of the injured gland and forms a bubble of fluid in the tissue around the gland which is called a ranula.

The diagnosis is usually easy for an experienced surgeon to make based primarily on physical examination but often specialized radiology studies such as Ultrasound, Computed Tomography (CT Scan), or Magnetic Resonance Imaging (MRI) are needed to define the full extent of the problem and exclude other causes for swelling. No other laboratory tests are usually needed to make the diagnosis.

Rarely, a ranula can spontaneously go away without any treatment but usually a procedure will be needed to treat the problem. Simple drainage of the fluid collection rarely permanently fixes the problem as the diseased gland continues to leak saliva.

Open surgical procedures  to excise the ranula and remove the diseased gland through an incision in the mouth or under the chin.

An oral fibroma is a common benign scar-like reaction to persistent long-standing irritation in the mouth. It is also known as a traumatic fibroma, focal intraoral fibrous hyperplasia, fibrous nodule or oral polyp.

An oral fibroma is most commonly seen in older adults but can occur at any age. It affects 1–2% of adults. It is usually due to chronic irritation such as:

Cheek or lip biting

Rubbing from a rough tooth

Dentures or other dental prostheses.

An oral fibroma presents as a firm smooth papule in the mouth. It is usually the same colour as the rest of the mouth lining but is sometimes paler or, if it has bled, may look a dark colour. The surface may be ulcerated due to trauma, or become rough and scaly. It is usually dome-shaped but may be on a short stalk like a polyp (pedunculated). If it has developed under a denture it may be flat with a leaf-like shape.

The commonest location for an oral fibroma is on the inside of the cheek where the upper and lower teeth meet. Other common sites include the sides of the tongue, gums and inside the lower lip.

Apart from the feel and appearance, oral fibromas do not cause any symptoms. Oral fibromas develop over weeks or months to reach a maximum size usually about 1 cm in diameter, but can sometimes be larger.

In addition to the irritation fibroma, there are a number of other well-recognised types of oral fibroma:

·  Oral elastofibroma

·  Epulis fissuratum 

·  Giant cell fibroma

·  Myofibroma and myofibromatosis

·  Peripheral ossifying fibroma

·  Peripheral odontogenic fibroma

·  Retrocuspid papilla

·  Sclerotic fibroma.

The diagnosis of oral fibroma will be suspected clinically when there are the usual history and examination findings. A biopsy may be taken to exclude other conditions or to remove the lesion. Histology shows typical dense fibrous tissue with relatively few cells. The overlying epithelium may be ulcerated, thinned or thickened.

When treatment is required, the only option is surgical excision of the fibroma with narrow margins. It may recur after surgery if the source of irritation continues. It is therefore also important to manage the source of the irritation. Oral fibromas do not disappear without treatment.

An oral fibroma is a common benign scar-like reaction to persistent long-standing irritation in the mouth. It is also known as a traumatic fibroma, focal intraoral fibrous hyperplasia, fibrous nodule or oral polyp.Hemangiomas are growths of blood vessels. They’re also called birthmarks. But they often can't be seen at birth. They usually form in the first few weeks of life. These growths often start as faint red marks. They are the most common type of noncancerous (benign) skin growths. Females are 3 times more likely to get them than males. Hemangiomas are more common in multiple births and low-birth weight premature infants. Most hemangiomas are in the head or neck area, but they can occur anywhere in the skin, mucous membranes, or internal organs. Most will keep growing for the first 3 to 5 months of life. Then they start to shrink. Almost 50% disappear by the age of 5 and the vast majority are gone by age 10. The rate of shrinkage, however, varies. It is also important to know that complete shrinkage does not always result in normal looking skin. Up to 50% of children with hemangiomas have ongoing skin issues such as scarring, skin discoloration, and tissue wasting (atrophy).

Vascular malformations are abnormal development of blood vessels. They also are noncancerous. They might be found in the large arteries and veins, in smaller vessels called arterioles and venules, in microscopic capillaries, and/or in the lymphatic channels that carry lymphatic fluid and white blood cells outside of the arteries and veins. Over the years, malformations can grow larger and become problematic depending on what type(s) of vessel is involved. They can be harmless and minor or very serious, sometimes even life-threatening. They are present at birth. They’re also called birthmarks. But they may not be seen for months or weeks after birth. They grow slowly throughout life. They don’t shrink. 

Vascular malformations are rare with some types found in less than 1 percent of the population. If you have one, chances are it developed before you were born—many types of vascular malformations don’t cause symptoms until they are triggered by such events as adolescence, pregnancy, or some major surgery, trauma or injury.

There are 5 types of vascular malformations. They are:

·  Port wine stains (red or purple in color)

·  Venous malformations

·  Lymphatic malformations (Lymphangioma)

·  Arteriovenous malformations

·  Mixed malformations, a combination of any of the other types

The cause of hemangiomas and vascular malformations often isn’t known. They may be passed on (inherited) in some families. The way they’re passed on is called autosomal dominant inheritance. This means that only 1 parent needs to have the gene to pass it on. If the parent has the gene, the family has a 1 in 2 chance that each child will have this condition.

Hemangiomas are clusters of blood vessels that grow abnormally. Hemangiomas start as faint, red birthmarks. Then they grow very fast. Over time, they become smaller and lighter in color. They often appear on the face or neck but can form anywhere on the body. While most hemangiomas appear during the first six months of life, one-third are present at birth.

Most hemangiomas do not cause symptoms, other than raised, red or reddish-purple bumps on the skin. In some cases, blood vessels can be seen just under the skin. You might notice a spot on your child’s face or neck that grows and changes in color. Hemangiomas on or near vital organs can create problem with functions for example hemangiomas on or near an eye, can cause vision problems and affect development of the eye. The good news is that many hemangiomas begin to disappear by age 5, and most go away on their own by the time a child is 10 years old.

These are the most common vascular malformations. They affect the veins, which carry blood from organs back into the heart and lungs for re-oxygenation. They can occur anywhere in the body, and they can be isolated or part of a syndrome, most commonly Klippel-Trenaunay Syndrome. Venous malformation may cause pain where ever they are located. Venous malformations may cause a lump under the skin or mucous membrane on face or inside mouth. There may be an overlying birthmark on the skin. Bleeding may occur from skin lesions. These venous malformations tend to be identified later in life; typically, symptoms are triggered by an injury, or physiological changes such as puberty or pregnancy. Sometimes they are found incidentally, during MRI studies for other conditions. 

The lymphatic vessels carry lymphatic fluid and white blood cells outside of the arteries and veins. Malformations affecting the lymphatic channels may start to cause problems during infancy and early childhood. They can cause pooling of the lymph fluid into cysts or fluid-filled pockets of various sizes and may cause a lump under the skin or oral mucosa. These cysts, in turn, can develop problems such as infection, bleeding and erosion and lymph fluid leakage from skin erosion. 

Blood pumped from the heart to a given organ can’t get there and is instead sent back toward the heart., the target organ is deprived of needed oxygen and nutrients, and–in the worst scenarios—heart and/or organ failure can develop.

Fast-flow arteriovenous malformations develop as the result of an abnormal connection between arteries that supply the body’s part or organ, and the veins, which drain them. Picture these as being like short-circuits. The draining veins become dilated and engorged.

While there is currently no cure for arteriovenous malformations, various treatment options exist aimed at slowing their growth, and minimizing and at times eliminating symptoms.  Arteriovenous malformations may cause pain. They are also more stressful on the heart because of the rapid shunting of blood from arteries to veins. Depending on their location, they may also result in profuse bleeding.

Your child’s healthcare provider will diagnose your child’s skin growth. The diagnosis will be based on how it looks and if it changes over time. Your child may need to have an ultrasound. This can help his or her healthcare provider make the diagnosis.

After a thorough history and physical exam, the doctor’s first step is to determine whether the abnormality is, in fact, a vascular malformation or a hemangioma. 

Typically, doctors will order imaging studies to help with diagnosis. Imaging studies may include ultrasound, MRI, and/or angiography, an imaging procedure that involves the injection of dye that will outline the blood vessels on an X-ray.

Treatment needs depend on the size and location of the lesion and whether it is causing symptoms. Treatments options include:

Steroids. These medicines are used to shrink the blood vessels in a hemangioma. Steroids can be taken by mouth, injected into the lesion or applied to the skin.

Propanolol. This treatment works similar to steroids but has fewer side effects. Propranolol can be taken by mouth. If the hemangioma is small and thin, the medicine can be applied to the skin. Children who use propranolol should be monitored for any changes in heart rate and blood pressure when they start using this medicine.  

Beta blockers. These medicines are sometimes prescribed to help reduce the size of a hemangioma.

Laser treatments. Lasers can be used to stop hemangiomas from growing and to reduce redness of the skin.

Surgery. If a hemangioma is small and well defined, it can be surgically removed. 

Surgery is also used to remove hemangiomas that affect the eyes, nerves and organs.

Treatment varies, depending on the type of blood vessel that is involved, the type of vascular malformation or syndrome, and the overall health of the patient. Since there is no cure for most vascular malformations, treatment aims to minimize symptoms. Treatment options can range from addressing minor (cosmetic) concerns to providing life-saving care for critical conditions. 

They may include one or more of the following approaches:

Embolization. Catheter-based techniques such as embolization, a procedure to close off a problematic blood vessel.

Sclerotherapy. The injection of a chemical to cause a vessel to induce fibrosis in the vessels.

Laser therapy

Surgery. Sometimes followed by reconstruction, which may be used in conjunction with other treatments. If there are widespread, deep lesions, multiple treatments are often necessary. 

These conditions can be life-threatening if they’re large or affect your child’s airway or another organ. A hemangioma can also be serious if it has uncontrollable bleeding.

Depending on where your child’s growth is located, it may cause physical problems. Your child may have trouble seeing or moving part of his or her body.

The neurofibromatoses are a group of genetic disorders affecting more than 2 million people worldwide.  There are three distinct types of Neurofibromatosis: NF1, NF2, and schwannomatosis. Each type of neurofibromatosis is caused by a mistake (mutation) on different gene leading to a distinct form of the condition, with varying degrees of severity (meaning individuals experience different levels of severity). NF1 is the most common neurological disorder commonly affecting craniofacial region and the most common of the neurofibromatoses. It is also known as plexiform neurofibromas. It causes neurofibromas, or tumors, that form and grow on nerves. Almost always the tumors are not cancer (benign). 

NF is caused by a genetic change. About half of all NF1 patients inherit the condition from an affected parent and half have a new, spontaneous genetic mutation that causes the condition.

NF1 is usually diagnosed based on an examination by a craniofacial surgeon and  medical geneticist. Genetic testing for the mutations that cause the condition is available, but isn't necessary for diagnosis.

To decide if your child has NF1, craniofacial surgeon will:

·  Look for symptoms like skin changes or small bumps

·  Consider imaging studies such as MRI (magnetic resonance imaging) or X-ray

·  Check for bumps on the colored part of your child’s eye

There is no cure for neurofibromatosis. The primary goal of treatment is to relieve symptoms. Painful tumors on or under the skin, or on visible areas of the face may be removed surgically. Surgery also may be performed to remove tumors that are affecting function by pressing on the nerves or other vital parts of the face such as around eyes. Surgery may not be an option if the tumor is deep in the body or if removing it risks damage to healthy nerves and tissues. Surgical intervention focus on restoring function and esthetics, but recurrence of neurofibromatosis is expected, requiring repeated interventions.

What are dermoid cysts?

A dermoid cyst is a collection of tissue under the skin. It may contain hair follicles, oil, and sweat glands. In some cases it may contain bone, teeth, or nerves. A dermoid cyst may appear at birth or soon after. Dermoid cysts are often found on the head, neck, or face, most often around the eyes. They can also occur on other parts of the body.

What causes a dermoid cyst?

A dermoid cyst is present from birth (congenital). It happens when the skin layers don't grow together as they should. This happens during the early stages of a baby's development in the uterus.

What are the symptoms of a dermoid cyst?

A dermoid cyst looks like a small lump under the skin. The skin over the lump can easily be moved. The lump may be skin-colored, or may have a slight blue color. The symptoms of a dermoid cyst can seem like other health conditions. Have your child see his or her healthcare provider for a diagnosis.

How is a dermoid cyst diagnosed?

Your child’s healthcare provider will often diagnose a dermoid cyst based on what it looks like and where it is. He or she will look at the cyst and the nearby area. Your child may need imaging tests to find out if the cyst is connected to other tissue in the head and neck. Tests may include:

·  X-ray. This test gives images of the head, neck, face, or other area where the cyst is located.

·  CT scan. X-ray and a computer are used to make detailed images of any part of the body.

·  MRI. Large magnets, radio waves, and a computer make detailed images of organs and structures in the body.

How is a dermoid cyst treated?

The most common treatment is surgery to remove the cyst. Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.

What are possible complications of a dermoid cyst?

Depending on where the cyst is located, it can cause problems. For example, a dermoid cyst near the eye may affect your child’s eyesight. But this is uncommon. Cysts also can:

·  Damage nearby bone

·  Cause infections

·  Make a child feel embarrassed or uncomfortable

What is Epidermoid Cyst?

Epidermoid cysts are noncancerous small bumps beneath the skin. They can appear anywhere on the skin, but are most common on the face, neck and trunk. Epidermoid cysts are slow growing and often painless, so they rarely cause problems or need treatment. You might choose to have a cyst removed by a doctor if its appearance bothers you or if it's painful, ruptured or infected.

What are symptoms of Epidermoid Cyst?

·  A small, round bump under the skin, usually on the face, neck or trunk

·  A tiny blackhead plugging the central opening of the cyst

·  A thick, yellow, smelly material that sometimes drains from the cyst

·  Redness, swelling and tenderness in the area, if inflamed or infected

What Causes Epidermoid Cyst?

The surface of your skin (epidermis) is made up of a thin, protective layer of cells that your body continuously sheds. Most epidermoid cysts form when these cells move deeper into your skin and multiply rather than slough off. Sometimes the cysts form due to irritation or injury of the skin or the most superficial portion of a hair follicle.The epidermal cells form the walls of the cyst and then secrete the protein keratin into the interior. The keratin is the thick, yellow substance that sometimes drains from the cyst. 

How is Epidermoid Cyst Treated?

Your doctor can remove the entire cyst. You may need to return to the doctor's office to have stitches removed. Minor surgery is safe and effective and usually prevents cysts from recurring. If your cyst is inflamed, your doctor may delay the surgery.

Sebaceous cysts are common noncancerous cysts of the skin. Cyst are abnormalities in the body that may contain liquid or semiliquid material. Sebaceous cysts are mostly found on the face, neck, or torso. They grow slowly and aren’t life-threatening, but they may become uncomfortable if they go unchecked.

Doctors usually diagnose a cyst with only a physical examination and a medical history.

Sebaceous cysts form out of your sebaceous gland. The sebaceous gland produces the oil (called sebum) that coats your hair and skin. Cysts can develop if the gland or its duct (the passage from which the oil is able to leave) becomes damaged or blocked. This usually occurs due to a trauma to the area. The trauma may be a scratch, a surgical wound, or a skin condition, such as acne. Sebaceous cysts grow slowly, so the trauma may have occurred weeks or months before you notice the cyst.

Your doctor can treat a cyst by draining it or by surgically removing it. Normally, cysts are removed. This isn’t because they’re dangerous but rather for cosmetic reasons.

This is a benign cyst of a gland of Moll. This is a small sweat gland that sits at the base of an eyelash. It is a clear fluid filled cyst. It can be treated with surgical excision. Dr. Parit Ladani will remove the cyst in its entirety to reduce the risk of recurrence. 

Ameloblastoma is the most common jaw tumour. Though it is considered to be benign in nature, its growth and ability of destruction mimics that of malignant lesion. One has to be very careful in treatment of such lesions. Depending on the size and the incisional biopsy reports, the treatment can be either conservative or aggressive resection and reconstruction. In the conservative line of management, the lesion is removed along with the affected teeth, the remaining bone is treated with some chemical agents, and the defect is allowed to heal on its own. In aggressive treatment, the part of the affected jaw is removed and reconstruction is done using bone grafts.

Teeth that remain alive, rarely have cysts develop next to them. If the nerves in a tooth die (as a result of an infection or trauma), it should be treated professionally to stop it becoming a source of infection. If this is successful, the tissues next to the root shouldn’t be stimulated to form a cyst (or an abscess). This is the reasons why the regular visits to the dentist are very important.

Unfortunately, vascular malformations can come back. While there are many options for managing symptoms, these problems can recur even after successful treatment. For this reason, it’s important to schedule regular follow-up visits with a specialist to minimize recurrent symptoms and associated complications.