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How many types of tooth germ tumors do you know? Unveil the mystery of tradition and exception!
Dental germoma is a rare benign or malignant tumor that originates from the enamel epithelium during tooth development, which is more common in the lower jaw rather than the upper jaw.Since its first recognition by Cusack in 1827, tooth germ tumors have undergone multiple name changes and were eventually renamed as modern tooth germ tumors in 1930.Although these tumors rarely exhibit malignant or metastatic properties and grow slowly, facial and jaw abnormalities it causes can lead to severe appearance deformation.More importantly, abnormal cell growth is prone to invasion and damage surrounding bone tissue, so extensive surgical resection is required for treatment.
If an aggressive tooth germ tumor is not treated, it may hinder the airways of the nasal cavity and the mouth, causing dyspnea.
Species of tooth germ tumor
According to WHO's 2017 classification, there are four main types of dental germ tumors:
- Traditional dental germ tumor (solid state/polycystic type)
- Single-cystic tooth germoma
- Peripheral/Exosseous dental germoma
- Metastatic dental germoma
Traditional dental germ tumor
Also known as solid or polycystic tooth germoma, it usually manifests as multiple large cystic regions.
Single-cystic tooth germoma
About 10% of dental germ tumors, it is usually seen in young patients, especially in their twenties and thirties, and is often associated with the failure of third molars.
Metastatic dental germoma
Although very rare, histologically atypical dental germomas may cause metastasis, usually to the lungs.
Peripheral dental germ tumor
This isoform accounts for only 2% of all dental germomas.
Clinical manifestations
Tooth germoma can be found in the maxillary and mandibular, however, 80% of cases are located in the posterior branch of the mandibular.These tumors are often accompanied by unerupted teeth, resulting in changes in position and root absorption of adjacent teeth.Symptoms include slow growing painless lumps that eventually lead to facial deformation.As the swelling continues to increase, it may affect the surrounding structure, resulting in loose teeth and occlusal problems.
This tumor has a tendency to expand the bone cortex, and because it grows slowly, it gives the periosteum time to form a thin shell.
Histopathology
The histological characteristics of traditional dental germ tumors show cystic and solid tumor structures.There are two main histological patterns most common: follicular and mesh.
Follicular Type
The most common follicular type has a layer of columnar or narrow dental germ cells, and has triangular cells inside, similar to the star-shaped reticular tissue in the early stages of tooth development.
Mesh
The reticular epithelial tissue proliferates in the form of a "fish net" and shows the intercellular reticular structure.
Diagnosis
The initial diagnosis of dental germoma is usually based on radiological examinations and biopsies are taken for histological examinations.On the image, the tumor area usually has a round and clear intraosseous light transmission area, accompanied by polycystic imaging.
Treatment
Surgery resection or resection is the most certain treatment method despite poor efficacy in the treatment of dental germoma.In most cases, the purpose of the surgery is to remove the entire tumor and its surrounding normal tissue for a good prognosis.For smaller tumors, cyst removal can also be performed, but this treatment method has a higher recurrence rate.
Follow-up and relapse
Continuous follow-up examination is crucial, especially in the first five years after surgery, as about 50% of recurrence occurs during this period.Due to the possibility of recurrence, it is important to perform regular imaging examinations on patients.
After tumor resection, careful surgery and attention to adjacent soft tissues can reduce the probability of recurrence within the grafted bone.
Epidemiology
The incidence of African-Americans is significantly higher than that of whites and is usually located in the middle line of the lower jaw.Tooth germ tumors account for about 1% of all oral tumors, while 18% of dentate tumors.
Is it possible to find more effective treatment strategies to avoid future recurrence in the application of dental germoma?
