Oral Pathology
Tri-County Oral Facial Surgeons is pleased to have Dr. Stephen Engroff associated with our practice. As a fellowship trained oral and maxillofacial oncologist, Dr. Engroff will be able to provide the most up-to-date diagnosis and treatment of oral and head and neck cancer. Dr. Engroff will be participating with the cancer committees at Mount Nittany Medical Center as well as Lewistown Hospital. He will also be affiliated with the new Cancer Center developed in conjunction with Mount Nittany Medical Center and the Hershey Medical Center.
The inside of the mouth is normally lined with a special type of skin (mucosa) that is smooth and coral pink in color. Any alteration in this appearance could be a warning sign for a pathological process. The most serious of these is oral cancer. The following can be signs at the beginning of a pathologic process or cancerous growth:
- Reddish patches (erythroplasia) or whitish patches (leukoplakia) in the mouth
- A sore that fails to heal and bleeds easily
- A lump or thickening on the skin lining the inside of the mouth
- Chronic sore throat or hoarseness
- Difficulty in chewing or swallowing
These changes can be detected on the lips, cheeks, palate and gum tissue around the teeth, tongue, face and/or neck. Pain does not always occur with pathology, and curiously, is not often associated with oral cancer. However, any patient with facial and/or oral pain without an obvious cause or reason may also be at risk for oral cancer.
We would recommend performing an oral cancer self-examination monthly and remember that your mouth is one of your body's most important warning systems. Do not ignore suspicious lumps or sores. Please contact us so we may help.
Benign lesions
Benign lesions that occur in the facial region are often related to the development of teeth. They are referred to as odontogenic in origin. They frequently present as cysts but can also form various benign tumors, some of which can behave aggressively and possibly recur. To learn more about these lesions, click a topic from the menu to the left.
Odontogenic Cysts
There are several varieties of cysts that are related to teeth. The most common are referred to as periapical cysts. These cysts usually occur subsequent to inflammation at the root of a tooth. This most often accompanies a necrotic or infected tooth. Cells at the root area respond to the inflammation and can develop a cyst. Over time these cysts can grow locally and destroy the surrounding bone and become quite large. Often they are associated with infection. They are treated with a procedure called enucleation, which means the cyst lining is removed. Frequently, the associated tooth also needs to be removed or treated with a root canal. If completely removed, it is rare that these cysts recur.
Dentigerous cysts are the next most common cyst. They frequently are associated with an unerupted (impacted) tooth. The follicle that originally formed the crown of the tooth undergoes changes and slowly grows. Frequently, these cysts are not accompanied by many symptoms and can grow to significant size before they are discovered. They are treated by enucleation of the cyst. Frequently, the impacted tooth also requires removal.
The third type of cyst is termed an Odontogenic Keratocyst. These cysts are less common, but behave in a more aggressive way. They can be associated with a tooth, but can also develop in the absence of a tooth. The lining of this cyst produces keratin which fills the inside of the cyst. Frequently, they grow to a large size before they are noticed. Symptoms include vague pain, swelling or expansion along the jaw, and occasional drainage of thick fluid from the area involved. The lining of these cysts is very thin, and they form “daughter” cysts within the cyst lining. When they are treated with simple enucleation, they have a definite chance of coming back (recurring). Therefore, these cysts are frequently biopsied to determine the type of cyst. Treatment varies depending on the size and location of these cysts. Your doctor will discuss these options with you if you have this type of cyst.
Odontogenic Tumors
Cells related to the formation of tooth structure are sometimes left behind in the jaw bones after the teeth have developed. Rarely, these cells can begin to grow in an unorganized fashion and develop a tumor.
Ameloblastoma is one such tumor. This tumor arises from the cells that develop enamel (the ameloblast). We do not know why this happens in some people. The most common age for this tumor to occur in is the mid 30’s, however, it can occur in almost any age group. The lower jaw is more frequently involved, but it can arise in any part of the upper or lower jaw. There is a higher frequency in African American patients though we don’t know why.
The ameloblastoma, although benign, grows in an aggressive manner. When treated conservatively, it has a substantial risk of recurring. Generally, it is treated much like a cancer, in that it is completely removed with a margin of normal bone to best ensure that all cells are removed and reduce the chance of recurrence. This type of surgery may involve the removal of some teeth in the area near the tumor.
Consideration for reconstruction of the area that is involved by the tumor is given a high priority. These techniques vary between patients depending on many factors. Please refer to the reconstruction section for more details.
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