1、Prof. Liu Jianhua PhD. MS. DDS. Dept. of Oral-Maxillofacial Surg. & Dentistry First affiliated hospital Zhejiang university school of medicine,Tumors in oral & maxillo-facial region,Naming：original tissue, biological type, position. Such as: squamous cell carcinoma of right tongue Critical t. ：biolo
2、gically benign tumor, but has malignant tendency and infiltrating growth. such as：ameloblastoma, mixed tumor, papiloma.,A mass in left submandibular region for 5 years, slow growing, with no symptom. Diagnosis? Further examination?,Left tongue ulcer 3 months, painful, Poor condition of oral cavity,
3、what to do next?,Black lesion in soft palate, grows rapidly recent 3 months, shall we make a biopsy?,manifestations & diagnosisJudgement of a mass on patient ： 1）tumor / not tumor(inflam. TB, malformation, etc.) 2）benign / malignant,Differentiation benign tumor malignant tumorAge any age carcinoma/a
4、gedness；sarcoma/young Growth speed slow faster Growth manner bulge invasive Boundary smooth，movable unclear，unmovable Symptom generally no painful/numbness/funct.limmit Metastasis no maybe Body affect generally no organ destroy/system destroy Histology struct. well differentiated worse diff./abn. nu
5、clearclose to norm.cell/tissue division；,benign/malignant？,benign/malignant？,Means of diagnosis 1）case history：arise，progress 2）clinical examine：look、touch、 listen to(with stethoscope ) 3）image：X-ray，panoramic radiograph，CT，MRI， DSA，B-ultrasonic，PET/CT 4）puncture：for liquid 5）biopsy：no melanoma/paro
6、tid g. 6）tumor markers：CEA, AFP, CA50/125/153/242/724 etc.,treatment 1）treatment principle ：benign tumorsurgery first；malignant bined 2）methods ： Surgery. ：safe edge1 cm for malignacy Radiotherapy. ：oral preparationremove ill tooth and metal crown; fill decayed tooth; tooth cleaning-(to prevent jaw
7、infection, necrosis, redial beam focus) Chemotherapy：before,during, post-operation others：thermotherapy./immunother. /herbs/ biotherapy,Prevention of oral cancer eliminate or reduce carcinogen：incomplete tooth root or crown、displaced tooth、sharp tooth edge、poor denture；hot food、tobacco and alcohol；e
8、nvironment contamination（air pollution，paint，glue）；psycho-problem. treat precancerous lesion in time：mucosa erythema、leukoplakia 、oral lichen planus 、papilloma etc. investigate vulnerable population and give education,question：how to prevent oral cancers？,第二节 Oral & Maxillofacial cyst口腔颌面部囊肿,Commonn
9、ess of Cysts 囊肿共性,有囊壁wall、囊内容物content（液体/固形物liquid/solid） 边界清楚 缓慢增大 颌骨囊肿可造成骨组织压迫性吸收expansile absorbing,软组织囊肿 一、皮脂腺囊肿 sebaceous cyst,病因pathogeny：皮脂腺sebaceous gland排泄管阻塞，分泌物蓄积-潴留性retentive囊肿。 临床表现：与皮肤粘连。色素点pigment dot。恶性变-皮脂腺癌。 治疗：梭形shuttle切口-疤痕。二次法（刘氏）,二、皮样、表皮样囊肿 dermoid / epidermoid cyst,病因： 胚胎embry
10、o期上皮残留remnant、后天植入（手术、外伤） 临床表现：青少年。皮样-口底、颏下。表皮样-面部。与皮肤无粘连。面团样-上皮细胞、毛囊、毛发、皮脂腺。 治疗： 手术摘除。下颌舌骨肌、颏舌骨肌-上、下进路不同。,三、甲状舌管囊肿 thyroglossal tract cyst,病因：胚胎第四周-甲状腺始基-甲状舌管-第六周：管消失，留下甲状腺、舌盲孔。管残留-囊肿。下移障碍-异位甲状腺。 临床表现：1-10岁成年。 舌盲孔-胸骨切迹之间。舌骨上下最多。圆形，质中，囊性感，随吞咽、伸舌运动，穿刺-无色/有色液体，B超。感染-瘘-癌变。,（鉴别诊断） 舌异位甲状腺：舌根部，蓝紫色，柔软，“含橄榄
11、”音。 1、迷走甲状腺：除异位外，颈部无甲状腺。 2、副甲状腺：颈部也有，舌根也有。 * 碘-131/锝-99扫描为可靠依据。 治疗 囊肿+舌骨中段一起切除。 误切迷走甲状腺-终身服药。,四 鳃裂囊肿 branchial cleft cyst,病因： 胚胎第三周-5对鳃弓-4对鳃裂-鳃裂上皮残余-囊肿 临床表现： 20-50岁（第一鳃裂年龄较小）。质软，波动感fluctuate，上呼吸道感染-增大，恶变-鳃裂癌，感染-鳃裂瘘fistula（有外口无内口），先天瘘congenital-原发性鳃裂瘘（有外口也有内口），穿刺-有色/无色；含/不含胆固醇液，B超。,二、颌骨囊肿 maxillary c
12、yst,牙源性颌骨囊肿odontogenic jaw cyst造牙组织/牙-演变而来（根尖、含牙、角化、始基） 非牙源性颌骨囊肿non-odontogenic胚胎期面突残余上皮-面裂囊肿创伤-血外渗性囊肿intra-bleeding,牙源性颌骨囊肿 odontogenic jaw cyst,根尖囊肿（radicular cyst)慢性根尖周炎-肉芽肿-牙周膜上皮残余-上皮团块-液化 残余囊肿（residual cyst)：拔牙后肉芽肿残留所致,始基囊肿 (primordial cyst)造釉器发育早期-星网层变性-渗出 含牙囊肿 (dentigerous cyst)牙冠表面与缩余釉上皮之间-渗出 角化囊肿 (keratocyst)原始牙胚/牙板残余-增生（含角化物，壁厚，子囊/上皮岛）,临床表现 clinical characteristics,缓慢、膨胀性生长-颌骨坚硬肿块-乒乓感-波动感-骨折,诊断,穿刺草黄色液体 X线根尖囊肿-根尖在囊内，死髓始基囊肿-下8区/升支部好发含牙囊肿-牙冠在囊内角化囊肿-下8区/升支部好发,治疗,手术摘除局麻/全麻，口内/口外角化囊肿易复发/癌变：石炭酸/硝酸银腐蚀骨壁死腔消除,
