DIFFERENTIAL DIAGNOSIS PERIPHERAL OSTEOBLASTOCLASTOMA AND EPULID
Among the primory tumours of osteoclastoma’s lower jaw comprise 65 % - central located – 17%, peripheral – 18% (so called giant cell epulis).
Mostly osteoclastoma affects females aged from 10 to 20 years. Osteoclastoma is localized on the lower jaw almost in 2 times more often then on the upper one; the most favorite site is the place of lower tricuspid teeth; but on the upper jaw there is the place of bicuspid teeth. Clinical progression of peripheral osteoclastomabasically is not different from typical epulis: rose pink or gray brown tumor finds a place on the dental curve, on the wide flap if it is located on the alveolar portion without teeth, but if there are teeth it can comprise several teeth which are more or less loose. The tumor grows slowly and it’s painless. Taking into account different histological structure of osteoblastoclastoma and epulis, growth areas, as well as their causes, the similarity of clinical manifestations, there is a need for differential diagnosis of these tumors, because their surgical treatment is different, which is the purpose of our study. There were 17 patients under our care in the surgical department of the clinic. All the patients were between 20 and 67 years old, among them 3 men and 14 women. Among all the patients, the diagnosis of peripheral osteoblastoclastoma was diagnosed in 3 people, pregnancy epulis in 3 women and typical epulis was diagnosed in 11 patients.
Complaints of the patients with osteoblastoclastoma were about the presence of a tumor that was bleeding or preventing them from chewing. Radiographs of each patient showed the centers of destruction within the alveolar process without clear bounds.
Surgery was performed for each patient: the tumor with a pedicle was removed under local anesthesia, after which there was a considerable bleeding from the wound, which caused the partial resection of the alveolar process. In addition, centers of destruction of the alveolar process were identified. Wounds were healing by secondary intention. Histological examination revealed the presence of osteoblasts and osteoclasts.
In 3 pregnant women the tumor was located on the gums of chewing teeth on the right or on the left. The tumor was bright red and had soft consistency. It was painless, easily bleeding and located from the vestibular surface of the molars and premolars. Pregnant patients were epulis-diagnosed. In each patient the tumor was removed, growth area was destroyed with electrocoagulator deep in the periodontium. Histological examination revealed the presence of a large number of blood cells, epithelial and fibrotic cells.
In 11 patients the tumor was located in the alveolar ridge, where there were intact or damaged teeth. Most patients (5 persons) had the tumor at the central maxillary incisors and premolars, 3 persons had it at the central mandibular incisors.
Tumors were coated with a pale pink mucosa. They were dense, painless, not bleeding, had a thin pedicle associated with periodontium, and were located mainly from vestibular surface ranging from 0.5 to 2 cm in diameter. In 3 patients teeth were destroyed, the tumor covered the roots. X-ray study of pathology in the periodontal tissues was not detected. All patients underwent surgical treatment: removal of the tumor, in 3 patients with decayed teeth in the premolar area of the tumor was removed together with the roots of the teeth. All patients, after tumor removal carried out the destruction of the growth area in periodontal for the prevention of periodontal recurrence.
Thus, peripheral osteoblastoclastoma different from epulis as clinically: often toothless alveolar bone, wide dedendum, dense texture, grey-brown colour, the site of the fracture at the base of the tumor on the alveolar ridge and histologically: composed of cells of osteoblasts and osteoclasts, radiographically in the bone is the fracture, therefore, surgical treatment should be expanded - with partial resection of the alveolar process.
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