Breakthrough in Minimally Invasive Management of Odontogenic Tumours

At the Head & Neck Cancer Foundation, we aim to minimise surgery and make treatment less invasive for patients and with fewer side effects. We believe a revolution has started in the management of odontogenic diseases which will reduce the impact of surgery. New developments have shown that, for some disorders, surgery can be complemented with simple drug therapy. These new developments are not always widely appreciated by the surgical community who historically use aggressive surgery. We aim to inform patients and our colleagues in the medical community of new developments in treatment options.

What Are Odontogenic Tumours?

Fundamentally, the bones that form the jaws and face develop in a different way to the long bones of the skeleton. Consequently, they have unique disorders. One group consists of tumours arising from abnormalities of tooth development. A prime example is ameloblastoma. The second group are disturbances of bone growth. These are described as a fibro-osseous lesion or giant cell lesions.

What Is The Relevance Of These Lesions?

Odontogenic lesions are uncommon and the pathology community divide them into several categories. This rare disorder is divided into over 30 categories and is treated by over 250 surgeons around the UK. Experience is also limited in managing these cases and there is little progress with new therapeutic ideas. No one knows the exact incidence as national registries do not collect data. We are aiming to address this by surveying the pathology laboratories in the UK.

Traditional Treatment of Odontogenic Tumours

Odontogenic tumours mainly occur in the lower jaw and are locally invasive. As they originate from tooth remnants they do not move outside the bone. These lesions are silent and are normally discovered incidentally on a dental X-ray. When the lesions are discovered they are usually quite large.

The traditional treatment of surgically removing lesions from the jaw causes facial disfigurement. This can be particularly distressing, as the majority of such patients are often adolescents or young adults. Additionally, these are large operations that can take ten hours to perform, transferring bone from the hip or leg to reform the jaw. Patients are in hospital for a minimum of ten days and the procedure carries significant rates of morbidity.

However, new developments have shown that this approach is not necessary. It can be replaced by a much smaller operation where the tumour lining is removed from the jaw and the cavity sterilised with a special solution. The recurrence rate is approximately ten percent, and if it does occur, the procedure can be repeated. The difference in treatment is one to two days in the hospital and no dramatic change in appearance due to surgery. This minimally invasive approach has been adopted by surgeons in Japan, Malaysia, France and in some places in the UK.

Traditional Treatment of Fibro-osseous and Giant Cell Lesion of the Jaws

This group of disorders are related to abnormalities of bone metabolism. The result is the growth of large bony swellings that can produce significant distortion of the face and jaw. Traditionally, the approach was to surgically remove the abnormal tissue and repair the defect with new bone taken from elsewhere on the body. Over the last two decades, it has become increasingly obvious that the process of bone growth can be controlled by new drugs. These drugs slow down and direct bone growth by controlling the giant cells. The lumps can then be pared down, rather than removed, and then controlled with medication. These lesions tend to burn out naturally so the drugs only have to be used while the patient is growing.

How Is HNCF Helping YOU

We aim to make you aware of the changes that are occurring in the treatment of odontogenic diseases. Additionally, we raise awareness of minimally invasive options that may be ideal for your case. These options can be discussed with your surgeon or second opinion doctor. The recent Montgomery ruling means you have the right to be informed of all treatment options. You can discuss these options objectively with your surgeon.