How to recognize cancer of the upper and lower jaw: symptoms of sarcoma and other malignant tumors. Description and photo of jaw cancer: its causes, symptoms and methods of recognition

Presented with some abbreviations

All types bone tumors, both benign and malignant, can be found in the lower jaw. In practice, the overwhelming majority of malignant tumors of the lower jaw are secondary, i.e. the primary focus tumor growth located outside the jaw.

Primary tumors of the lower jaw can be of either epithelial or connective tissue nature. Tumors such as fibroma, osteoma, chondroma, giant cell tumor, fibrosarcoma, osteogenic sarcoma, chondrosarcoma, Ewing's sarcoma and plasmacytoma, which can occur in the lower jaw, differ little in nature, clinical picture and treatment from identical skeletal tumors. Therefore, they are not described in this chapter (see bone tumors).

Epulid

Until recently, the term “epulid” (supragum) combined true tumors and inflammatory-hyperplastic processes. IN lately from the group of these pathological processes, the true one is isolated benign tumor, developing from the peridontium or wall of the alveoli and alveolar process. It develops most often in people aged 10-30 years. Epulides are more common in women than in men. An opinion has been expressed about the connection of epulids with chronic irritation by sharp edges of tooth roots and crowns destroyed by dental caries and poorly stabilized dentures.

Pathological anatomy. Epulid is a growth of soft gum tissue, covered with a mucous membrane, the size of a cherry pit or larger, of a dense or soft consistency, often with ulceration on the surface. Microscopic examination distinguishes between fibrous, angiomatous and giant cell epulids.

Clinic. The epulid is located either in the area of ​​the gingival papilla or in other parts of the gum, near its edge in the form of a rounded brown-brown formation. The base of the epulid is wide. There is no pain. There is almost always a separation of the nearest teeth. When tumors are damaged, there are heavy bleeding. Repeated bleeding is sometimes the only symptom that worries patients. The rate of growth of epulid varies: sometimes its increase lasts for months, years, but often develops within several weeks. There are no descriptions of cases of malignancy in epulid in the literature.

Diagnostics. Epulids have a characteristic clinical picture. In addition, X-ray examination helps in correct diagnosis. On the radiograph, the affected bone has a clearly defined focus of lysis of a round or oval shape with transversely running trabeculae. There is swelling of the bone, thinning of the cortical layer without the tumor breaking into the surrounding tissue.

Differential diagnosis carried out with gingival polyps (false epulids), dental pulp polyps, giant cell and other tumors. In cases difficult to diagnose, the true nature of the disease is clarified after histological examination.

Treatment. Due to the fact that non-radical tumor removal always leads to relapse, resection of the alveolar process with the removal of one or two teeth is indicated. The epulid is removed as a single block along with the bone, gum and teeth. The resulting defect is filled with iodoform tampons. Radiation treatment methods are ineffective.

Forecast. The prognosis is good. Properly performed surgery provides a permanent cure.

Adamantinoma

Synonyms: ameloblastoma, adamantine epithelioma. Adamantinoma is a benign tumor originating from the tooth germ on various stages its development (from the remains of the dental plate or from the enamel organ). These tumors are uncommon. In 80-85% of cases the lower jaw is affected. It occurs equally often in both men and women. Largest quantity Patients are observed at the age of 20-40 years. The etiology and predisposing factors are unknown.

Pathological anatomy. There are solid and cystic forms of adamantinoma. Solid adamantinoma is a node of dense or soft consistency, white-grayish or brownish in color with a granular surface. Microscopically, the tumor consists of characteristic epithelial strands or rounded complexes, along the periphery of which tall cylindrical cells are located in one row.

Cystic adamantinoma consists of several interconnected cysts filled with light or brownish liquid or colloidal masses. Microscopically, the walls of the cysts are lined columnar epithelium. In the partitions between them, strands of epithelial cells can be observed. In the tumor stroma there are deposits of lime salts and areas bone tissue. Malignant transformation with adamantine is sometimes observed.

Clinic. Deformation and thickening of the jaw develops slowly and painlessly in a small area (most often in the posterior part of the lower jaw). Over time, facial deformation develops, movement disorder in the jaw joint, disturbances in swallowing and breathing, pain and bleeding appear from the gum ulcer above the tumor. In the case of malignancy, the growth rate of the tumor accelerates, and it may grow into the upper jaw and into the orbit, followed by blindness. The malignant form of adamantinoma metastasizes through the lymphogenous route.

Diagnostics. In addition to the characteristic clinical picture, the basis for confirming the diagnosis of adamantinoma is a biopsy of the lesion and data x-ray examination. The X-ray shows very typical signs: a centrally located well-demarcated mono- or polycystic shadow is visible, the bone is swollen, there is no reaction of the periosteum. Differential diagnosis includes cysts, epulide, giant cell tumor and fibrous dysplasia.

Treatment. The treatment of choice is resection of the affected area of ​​the bone. Surgical interventions such as tumor enucleation and curettage are non-radical, are always accompanied by relapse and lead to accelerated tumor growth. Radiation treatment methods are ineffective.

Forecast. Timely and correctly performed surgical intervention leads to a cure with a good functional and cosmetic result. Non-radical operations accelerate the growth rate of the tumor and can lead to its malignancy.

Lower jaw cancer

Cancer of the lower jaw is 2-3 times less common than cancer upper jaw. The disease is most often observed in men aged 40-60 years; It should be noted that the disease occurs more often in men than in women. In the occurrence of cancer of the lower jaw, an undoubted role is played by such irritating factors as incorrectly made dentures, large deposits of tartar due to gingivitis, alveolar pyorrhea, poor care behind the oral cavity, large number unremoved teeth destroyed by caries, etc.

Pathological anatomy. Primary cancer of the lower jaw most often comes from epithelial elements located deep in the bone (remnants of Hertwig's membrane), and is called central cancer. By histological structure refers to squamous cell carcinoma with or without keratinization.

Clinic. There are primary and secondary cancers of the lower jaw. In approximately 50% of cases, the primary focus of the cancerous lesion originates from the oral mucosa and secondarily spreads to the lower jaw. Primary cancers arising from the tissues of the jaw itself occur in approximately a third of all cases. In 15-20% of cases, the localization of the primary focus is difficult to determine. The constant symptoms of primary central cancer are loose teeth and shooting pains along the mandibular nerve for no apparent reason or pain similar to pain due to pulpitis.

For a long time, the disease proceeds latently, and its first manifestations, to which the patient pays attention, correspond to the stages of a very common process. Later spread of cancer towards the bottom of the mouth or, conversely, towards the chin manifests itself in the form of a tumor infiltrate, causing noticeable deformation of the face.

The posterior part of the jaw is most often affected, from where the process quickly spreads to the temporal region, to the ascending branch of the lower jaw, to the parotid salivary gland, to the submandibular region, to the neck and floor of the mouth. The most characteristic is lymphogenous metastasis to the lymph nodes of the submandibular region and neck. Metastases to internal organs (liver, spine, etc.) are observed ocularly in the later stages of the disease.

Diagnostics. The central form of cancer of the lower jaw, unfortunately, in early stages difficult to recognize. These patients, as a rule, turn to dentists due to pain. It is necessary to carry out scrapings and histological examination more often from the surface of extracted teeth when they are loosened, especially if the cause of this loosening remains unclear. All removed tumors should be examined microscopically, even if macroscopically they do not raise suspicions of malignancy.

The X-ray method of examination is of particular value for early diagnosis. It is most advisable to take intraoral photographs. Radiographs reveal the following changes: bone irritation, vagueness, blurring of the affected bone area, widening of the periodontal spaces and destruction of the cortical plate of the alveolar wall with extensive destruction of the cancellous substance around the circumference. Lost teeth being immersed in the mass tumor tissue, are held in place by the remnants of the ligamentous apparatus.

In all doubtful cases, it is advisable to perform a biopsy or cytological examination of punctate from the lesion. Differential diagnosis is carried out with cysts, osteomyelitis, actinomycosis and other benign and malignant tumors that may be located in the lower jaw.

Treatment. Currently, the leading and most effective treatment for cancer of the lower jaw is a combined method. It consists of preoperative telegammatherapy followed by resection of the lower jaw.

Radiation treatment is preceded by sanitation of the oral cavity. To prevent complications, irradiation is recommended against the background of antibacterial therapy. Irradiation is carried out daily from two fields. Single dose 200-300 r, total dose 5000-6000 r. 2-4 weeks after the end of radiation therapy, after a decrease in reactive phenomena on the skin and in the oral cavity, surgery is performed. Most often, partial resection and half-articulation of the lower jaw are performed. The lymph nodes and submandibular salivary gland are removed as a single block along with the resected bone. The operation begins with ligation of the external carotid artery throughout. After resection of the lower jaw great value has fixation in the correct position of the remains of the jaw. For this purpose they use various ways: external extraoral, supradental aluminum wire splints, rubber and plastic splints, etc.

In recent years, the method of one-stage defect repair using a bone autograft taken from a rib or tibia. In patients who are not subject to surgical treatment, it is recommended to carry out radiation therapy with preliminary ligation of the external carotid arteries, which makes it possible to increase the total radiation dose.

Forecast. There is no reliable information about the long-term results of treatment of primary cancer of the lower jaw. The data published in the literature on this issue are very contradictory. However, there is a unanimous opinion that the results of treatment for this form of cancer are much worse than for cancer of the upper jaw. The most accurate figures seem to be a 5-year cure rate of 20-25% of cases.

In the number of all registered cases cancer diseases, however, this does not make it any less dangerous or difficult to treat.

Oncological lesions of the jaw occur in 15% of cases when patients visit dentists.

Due to its location, such a disease causes difficulties in its treatment - the maxillofacial area includes large vessels and vital ganglia, requiring attention different specialists: from dentist to ophthalmologist, etc.

Jaw cancer develops from blood vessels, glands, and neurogenic cells, but the main process occurs from bone tissue (in the periosteum).

Neoplastic neoplasms are also called squamous cell carcinoma or adenoid cystic carcinoma, which affect the bones and mucosa. They occur in children and adults - the risk group is not precisely defined, although statistics indicate an increased proportion of treatment with characteristic symptoms among people 40 - 55 years old.

In this case, squamous cell carcinoma is isolated in separate group lesions that occur, in principle, not as often as other subtypes.

An accurate diagnosis can sometimes be difficult to make, and the success of treatment depends on timely treatment. In general, jaw cancer is difficult to treat, since lesions arise from any cells - epithelial, dental, even maxillary sinuses.

Why can it develop?

Oncology of the jaw is still not sufficiently studied to clearly determine the causes of the disease.

However, doctors note that cancer cells most often develop in this localization due to:

• damage to the mouth, including bruises, chronic injuries, caries, incorrect fillings or crowns installed on teeth, constantly rubbing dentures, tartar, etc.;
• inflammation - the appearance of cysts or other benign tumors;
• long practice of smoking;
• metastasis of tumors localized in other places on the body - as a result of cancer of the tongue, thyroid gland, etc.;
• ionizing type irradiation (effect of radiation), toxicological contamination of tissues, exposure to harmful fumes.

Also, the reasons are the general negative environmental situation in the world, the lack of useful substances in nutrition, untreated infections, neglected state of the body and, as a consequence of all this, decreased immunity.

The combination of several factors gives impetus to the development of cancer cells in any location.

How to recognize the first signs?

Symptoms of jaw cancer at an early stage of development usually include:

• pain in a specific affected area of ​​the face and general headache;
• worsening bad breath in the presence of inflammation;
• discharge - from the nose, gums, etc.;
• numbness of areas of the skin, jaw, face.

It is difficult to determine the presence of the disease at an early stage due to vague symptoms that can be perceived as a general malaise or dental problems.

Patients do not admit the possibility of developing oncology and can easily confuse their condition with more common ailments - for example, sinusitis, sinusitis, etc.

Sarcoma of the jaw grows rapidly, gives extensive metastases and pain, so it is detected already at those stages when it is practically impossible to prevent the spread.

Further manifestations of the disease include increased discomfort and the emergence of new problems:

• teeth and gums ache, begin to loosen or swell, and subsequently difficulty closing the jaw;
• the face becomes asymmetrical due to swelling and periostitis (flux);
• alveolar processes increase;
• appetite decreases, sharp decline weight;
• the jaw is subject to deformation or curvature;
• appears general weakness and constant malaise;
• ulcers appear, purulent formations on the chin, tongue, cheek or lips;
• jaw fractures occur that are not caused by external factors.

If the tumor is localized from above, these symptoms include tearing, nosebleeds, sore ears and shift of the eyeball.

If from below, the problems relate to the teeth and the inability to eat.

Diagnostic methods

Diagnosis of the jaw usually does not show cancer in the early stages, which adds to the complexity of its treatment. Serious disorders are detected in the last stages of the disease, when they can be identified during examination.

To make a diagnosis, the doctor must clarify the presence of oncology:

• Send the patient for an x-ray - this will determine the presence of deformation of the alveolar processes, septa, etc. Studies are carried out in two projections (lateral and facial) to clearly determine the presence of a tumor.
• Take blood for analysis to detect inflammation in the body;
• Conduct tomography (CT), which will show the affected area layer by layer (it is possible to prescribe additional thermography and scintigraphy). This will allow you to assess the spread of the tumor.
• Schedule a biopsy for research lymph nodes(most often submandibular) and other possible lesions;
• Take a sample for histological tests - a section of bone tissue or a tooth.

During the examination, specialists from all related specialties are involved to exclude metastases and more. extensive lesions– contact an otolaryngologist, neurologist, etc.

Confirmation of the diagnosis occurs mainly through cytological tests, but examination by other doctors, rhinoscopy, neurological examination and other studies gives a complete picture of the extent of the damage.

Classification and stages of development

Jaw cancer affects the upper and lower parts of the jaw. Depending on the location of the disease, one of two codes according to ICD-10 (international classification) is awarded:

• C41.0 – malignant formation of bones and joints (upper part of the jaw);
• C41.1 – lower part of the jaw.

C41.1 statistically occurs more often than superior lesions.

The tumor also comes in 2 degrees:

• Primary cancer of the (lower) jaw that arises in the bone - this includes Ewing's sarcoma, giant cell malignancies and osteosarcomas;
• Secondary cancer of the jaw is the metastatic type and occurs due to the spread of cancer cells from another affected organ (consequences of tumors of the head or neck).

To determine the stages of development, the TNM scale is used:

1. T1 – stage during which only one part of the human anatomy is affected;
2. T2 – damage already in two locations;
3. T3 – two or more areas of cancer;
4. T4 is the fourth stage, when part of the organ is affected and cells spread to tissue at other local points.

Cancerous tumors of the jaw usually penetrate first to the “neighbors” - the upper or bottom part mouth, nose, affect the orbit of the eyes, etc. The formations can be benign or combined, when the lesion develops into malignant in the epithelium.

How is the treatment carried out?

The stage is determined by the attending physician, having received the results of tests and studies. Treatment methods for cancer of the upper jaw and lower localization include:

• operations;
• irradiation;
• chemotherapy.

Surgery

Surgery occurs through resection of the tumor, that is, its complete removal, including all damaged tissue and healthy areas under increased risk occurrence of metastases.

Resection happens:

• partial, if the jaw is superficially affected - only the tumor is removed;
• segmental, if the alveolar processes were not affected and the doctor did not identify deep lesions;
• with the need to remove the jaw - half or the entire joint when severe lesions bone structure;
• with the need to remove bones or soft tissues when sarcoma is detected on the chin;
• with the need to remove upper sky– maxielectomic surgery, before which the production of a prosthesis is required;
• with the need to remove the tongue - glossectomy, complete or partial, depending on the affected area.

If surgery requires resection of most of the face or mouth, facial bone grafting is performed to preserve appearance patient and functionality required for later life organs.

Radiation therapy

Radiation therapy is a method used in the postoperative period to exclude metastases. In some cases, it is performed before surgery or instead of it if surgical intervention is not possible.

Irradiation is carried out in two stages:

• Sanitation of the oral cavity, including removal of loose molars and all affected teeth;
• Direction of radio rays to specific foci of the disease - two weeks after sanitation.

The duration of gamma irradiation depends on the width of the lesion and the stage of cancer:

• Two weeks – palliative model;
• A few months is a radical method.

Consequences include:

• infectious infections of the area;
• loss of healthy parts of teeth;
• constant dry mouth and sore throat;
• distortion of tastes and smells;
• voice change;
• osteonecrosis – destruction of bones due to tissue death.

Chemotherapy

It acts as both the main method of treating jaw cancer and as an auxiliary therapy. The patient is prescribed cytostatic drugs, destroying cancer cells and blocking their spread to other areas.

Most often, chemotherapy is prescribed as a separate method for inoperable cases, or in preoperative period to reduce tumor size for further resection.

Due to the different possibilities of cancer spread, in clinics, when treating the upper jaw, a combination of radiation and chemotherapy is prescribed, while for the lower jaw, one of the methods is prescribed.

Features of rehabilitation

The patient’s recovery after aggressive treatment methods is carried out under the supervision of doctors, since complications and relapses are possible. In this case, they apply repeated operations, speech correction methods, prosthetics, wellness treatments in sanatoriums, etc.

The patient’s future ability to work and general well-being depend on rehabilitation, however, when jaw cancer is diagnosed, it is indicated to award group 2 disability due to the severity of the disease.

Life expectancy forecast

How long patients with this disease live depends on the stage of cancer spread and its location.

Thus, cancer of the upper jaw leads to serious complications in the ophthalmological field - damage to the eyes and vision is possible. This worsens the prognosis, as does failure to file complaints in a timely manner.

A patient with stage 4 jaw cancer will live five years or less. Only 20% of sick people have the opportunity to extend this period. The rate of development of Ewing's sarcoma or osteogenic damage is high, so life expectancy with these diagnoses is short.

Preventive measures

Prevent occurrence cancerous tumor in the maxillofacial area the patient is able to:

• giving up bad habits and food;
• without exposing yourself to radiation, reagents and toxic substances;
• visiting the dentist as regularly as possible;
• improving the circumstances of your life, reducing stressful situations.

A positive outlook on the world, support from family and friends, sports and nutrition reduce the risk of developing cancer and affect overall health.

- malignant neoplasm originating from epithelial tissue. The clinical picture is determined by the localization of the primary lesion. The first signs of a neoplastic neoplasm of the upper jaw are similar to the symptoms chronic sinusitis. When the mandibular bone is damaged, intact teeth acquire degree 2-3 mobility, and numbness of the lower lip occurs. Advanced jaw cancer occurs with intense pain. Diagnosis of the disease includes collection of complaints, clinical examination, radiography, and pathohistological examination. Treatment of jaw cancer is combined. Along with tumor removal, courses of radiation therapy are indicated.

General information

Jaw cancer is a pathological process of primary or secondary origin, which is based on transformation healthy cells bone tissue into tumor tissue. Malignant neoplasms of the upper jaw are more often diagnosed. In 60% of cases, the neoplastic process develops from the epithelial tissue lining the maxillary sinuses. According to the histological structure, jaw cancer is predominantly squamous cell keratinizing. The main group of patients who came to the clinic were people aged 45-50 years. Along with the oncologist surgeon, an ophthalmologist and an otorhinolaryngologist take part in the examination of the patient. Treatment of malignant neoplasm is combined. The prognosis for jaw cancer is unfavorable, with a five-year survival rate observed in 30% of patients.

Causes of jaw cancer

In central (true) cancer of the jaw, the tumor originates from the islets of Malasse. Secondary neoplasms occur when cancer cells grow deep into bone tissue from the maxillary sinus, alveolar process, palate, lateral surfaces of the tongue, and floor of the mouth. Most often, the neoplastic process of the upper jaw develops in patients against the background of chronic inflammation of the mucous membrane maxillary sinus. Prolonged course of sinusitis leads to transformation of epithelial tissue cells.

The root causes of secondary jaw cancer can also be trauma to the mucous membrane, exposure to ionizing radiation, bad habits (smoking, chewing nasa), occupational hazards(work in hot shops or dusty rooms), poor nutrition (excessive consumption spicy, spicy foods). In addition, there is a risk of developing jaw cancer of metastatic origin in cancer patients with tumors of the kidneys, stomach, and lungs.

Symptoms of jaw cancer

In the initial stage of carcinogenesis, there are usually no complaints. With jaw cancer originating from the epithelium of the maxillary sinus, patients indicate nasal congestion, difficulty breathing through the nose, and the presence of mucous discharge mixed with blood. When the primary tumor is localized in the area of ​​the superior internal angle of the maxillary sinus, in addition to the above symptoms, thickening and deformation of the inferomedial wall of the orbit occur. With jaw cancer that has developed as a result of the spread of malignant tumor cells into the bone from the lateral sections of the sinus, numbness of the skin and mucous membrane of the infraorbital zone appears. Patients complain of severe pain in the molar area. With tumors of the lower jaw, paresthesia of the lower lip and chin tissues may occur. Intact teeth become mobile. Stage III-IV jaw cancer is indicated by the development of exophthalmos, impaired mouth opening, and the addition of neurological symptoms.

With a neoplastic process of bone tissue, jaw deformation occurs and the risk of pathological fractures is high. If left untreated, areas of ulceration may appear on the skin. If the primary lesion in jaw cancer is a malignant tumor of the mucous membrane, examination reveals a cancerous ulcer or growth of the mucous membrane. A neoplasm with an endophytic type of growth is a crater-shaped ulcerative surface with an infiltrated bottom and compacted edges. With exophytic tumors in the oral cavity, mushroom-shaped growths with a pronounced infiltrate at the base are found.

Diagnosis of jaw cancer

Diagnosis of jaw cancer is based on an analysis of complaints, physical examination data, as well as x-ray, histological, and radioisotope research methods. During an external oral examination of patients with jaw cancer, the dentist identifies asymmetry, facial deformation, and possible ulceration skin. Often, with jaw cancer, paresthesia of the area that corresponds to the location of the malignant tumor is diagnosed. During palpation examination, bone thickening is detected. The teeth located in the affected area are mobile. Vertical percussion is positive. In case of jaw cancer of secondary origin, an ulcer with signs of malignancy or papillary growths are detected on the mucous membrane, at the base of which a pronounced infiltrate is determined by palpation. Lymph nodes in patients with jaw cancer are enlarged, hardened, and painless.

X-rays of jaw cancer reveal diffuse bone loss. No reparative or periosteal reaction is observed. To confirm the diagnosis, a cytological examination of material taken from the surface of the ulcer is indicated. In case of primary cancer of the jaw, a pathohistological analysis of the trepanned area of ​​the affected bone is performed. The radioisotope method can also be used to detect a malignant tumor. Differentiate jaw cancer from chronic osteomyelitis, specific diseases jaws, benign and malignant odontogenic and osteogenic tumors. The patient is examined by a maxillofacial surgeon, oncologist, ophthalmologist, and otolaryngologist.

Jaw cancer treatment

When jaw cancer is detected, combined treatment is used. Along with the removal of the tumor, a course of pre- and postoperative radiation therapy is carried out. On preparatory stage In dentistry, taking impressions is indicated for the manufacture of prostheses that replace the defect. Regarding mobile teeth, conservative tactics are followed, since after surgery the risk of dissemination of cancer cells through the network of lymphatic vessels increases. If, with jaw cancer, several enlarged mobile cervical lymph nodes or at least one fused lymph node are detected, cervical dissection begins.

Depending on the clinical situation, Vanach, Crail or fascio-sheath excision operations can be used. The affected area of ​​bone tissue in case of jaw cancer is resected along with the periosteum. If the tumor grows into adjacent areas, radical surgery, expanding the boundaries of the surgical field. When jaw cancer has spread to the base of the skull, the use of gamma radiation is indicated. The prognosis for jaw cancer depends on the stage of the disease, age, immune status of the patient, and choice of treatment method.

Jaw tumors are an oncological disease of the jaw bone that originates from the structure of the tooth or bone tissue. The development of neoplasms is accompanied by pain, changes in the shape of the jaw bone, and agnosia of facial symmetry. There is mobility and a change in the position of the teeth. Patients are diagnosed with a malfunction of the temporomandibular joint and swallowing reflex. The progression of the disease is accompanied by tumor penetration into nasal cavity or upper jaw. Depending on the nature of the disease, tumors can be malignant, but more often benign.

Causes of jaw tumors

Tumor diseases tend to change their nature of origin, which is why it is not possible to name a single cause for the occurrence of a tumor in the jaw. Modern medicine continues to study various circumstances that provoke a tumor process in the jaw. The only reason for the appearance of a tumor, as all experts believe, is a jaw injury. In all other respects, opinions differ to a greater or lesser extent. The nature of the injury can be either protracted (internal injury to the mucous membrane oral cavity), and single (jaw bruise). Also a common cause of the disease are foreign bodies (material for filling a tooth or its root) and inflammatory processes that develop over a long time.

Promotes the formation of tumors bad habits in the form of smoking and poor oral hygiene. There is a high probability of a jaw tumor appearing during chemotherapy and radiotherapy treatment.

Tumors of the jaws can appear as a distant focus of pathology oncological diseases.

Classification of jaw tumors

Tumors of the jaws are of the following types:

1. Odontogenic - organ-nonspecific formations associated with the tissues that form the tooth.
2. Nonodontogenic - organ-specific formations associated with bone.

In addition to this classification, tumors can be benign or malignant in nature, occurring in epithelial (epithelial) or mesenchymal (mesenchymal) tissues. Combined neoplasms - epithelial-mesenchial - may occur.

The main representatives of benign organ-specific tumors are:

• ameloblastoma;
• odontoma;
• odontogenic fibroma;
• cementoma.

The main representatives of benign organ-nonspecific tumors are:

• osteoma;
• osteoid osteoma;
• osteoblastoclastoma;
• hemangioma.

Malignant organ-specific neoplasms include cancer and sarcoma.

Symptoms of jaw tumors

Based on the classification of jaw tumors, experts distinguish various symptoms neoplasms.

Benign odontogenic tumors

Ameloblastoma. Its characteristic feature is bright pronounced change facial shape associated with a violation of symmetry proportions as a result of the development of a tumor located in the lower jaw. The violation of symmetry can be mild or pronounced. The degree of distortion of the face shape is influenced by the size and position of the tumor. For example, the localization of a tumor along the body and ramus of the lower jaw is characterized by a change in the shape of the lower lateral part of the face. The color of the skin does not change, and it can be easily moved in the area of ​​the tumor.

Inflammatory processes accompanying the tumor can give similar symptoms to phlegmon or mandibular osteomyelitis. During palpation, the body of the tumor is felt, which makes it possible to assess the degree of distortion of the shape of the face. The lymph nodes located directly next to the tumor do not change in size, and the deformed area is clearly defined. The formation has a thick filling and a wavy surface. Examination of the oral cavity shows thickening of the alveolar ridge, soft fabrics may be swollen and teeth tend to shift or move.

Odontoma. Often this type of tumor is diagnosed in adolescence. The neoplasm has similar symptoms with other tumors localized in the jaw bones. The course of the disease is quite slow and ambiguous. During development, there is a gradual swelling of the jaw bones, which leads to delayed or absent teeth eruption. Large sizes tumors can change the shape of the jaw or contribute to the formation of a fistula. Despite the fact that the course of the disease passes practically without symptoms, the upper layer of the jaw may be damaged, and the tumor itself may contain teeth or their rudiments. When diagnosing, it is necessary to differentiate the tumor from adamantinoma. Odontoma can be simple, complex, soft or mixed.

Odontogenic fibroma. The nature of the development of this neoplasm is very slow; the tumor is mainly diagnosed in young children. A clear symptom of tumor development is impaired teething; pain is not observed during the period of tumor growth. Odontogenic fibroma can be located equally on both jaws and is rarely accompanied by an inflammatory process. It differs from similar neoplasms in its composition, which includes remnants of the epithelium that forms the teeth.

Cementoma. Distinctive feature tumor is the presence of tissue similar to cement. The tumor grows quite slowly and is manifested by a change in the shape of the jaw. The tumor is clear and round, has pronounced boundaries, most often affects the upper jaw and is almost always connected to the root of the tooth.

Benign non-odontogenic tumors

Osteoma. This tumor is not often diagnosed, and men are more susceptible to developing osteoma than women. Occurs mainly during adolescence. Tumor development proceeds without pain syndrome, quite slowly and is localized in the nasal cavity, orbit or sinuses of the upper jaw. Tumor growth can occur both inside the jaw bones and on the surface. The mandibular location of the tumor is characterized by pain and a violation of the symmetry of the face, as well as the motor abilities of the jaw in this area. The maxillary localization of the tumor leads to failure of nasal breathing, doubling of the image perceived by the eyes, and bulging of the eyes.

Osteoid osteoma. The main symptom of the development of this tumor is the presence of pain, which intensifies with the progression of the tumor. It is noted that people with osteoid osteoma especially feel increased pain at night. Establishing a correct diagnosis is made difficult by the nature of the pain syndrome, which tends to spread, resulting in the activation of other diseases. In diagnosing a tumor, the action of medications (analgesics) that suppress the occurrence of pain helps. The affected areas appear swollen and the motor function joints. The difficulty of making a diagnosis is due to the small size of the tumor and the absence of special symptoms.

Osteoblastoclastoma. The tumor is a single separate formation. It is extremely rare to see a double appearance of a tumor on adjacent bones. Mostly young people under the age of 20 are susceptible to developing the disease. The most pronounced symptoms are increased pain in the jaw, impaired facial symmetry and tooth mobility. The manifestation of the main symptoms depends on the location of the tumor. The peri-tumor tissues become pronounced, and fistulas begin to appear. Quite often, patients notice an increase in average body temperature, the cortical layer becomes thin, which can cause a fracture of the lower jaw.

Hemangioma. As an independent disease, it is relatively rare; a combination of hemangioma of soft facial tissues or the oral cavity with a jaw hemangioma is often diagnosed. The disease is characterized by a color change in the mucous membrane to bright red or blue-purple shades. This symptom is the main one at the time of diagnosis. However, diagnosis can be difficult in situations where the soft tissues of the oral cavity are not involved in the inflammatory and tumor process. Increased bleeding of the gums and root canals is considered to be a symptom of isolated hemangioma.

Malignant tumors of the jaws

Malignant jaw tumors are not observed in patients as often as benign ones. Oncological damage is accompanied by pain that has the ability to self-propagate. Teeth become loose and prone to rapid loss. Some tumors, due to their morphological manifestations may cause jaw bone fractures. With the progression of a malignant tumor, erosion of bone tissue is observed, while the growth of the parotid and submandibular glands is noticeable, and the masticatory muscles. The source of the disease penetrates the cervical mandibular lymph nodes.

Some tumors affecting the upper jaw extend into the eye socket or nasal cavity. As a result, complications of the disease may occur in the form of bleeding from the nose, a suppurating one-sided runny nose, difficulty with nasal breathing, pain in the head, increased production of tears, bulging eyes and double vision.

Malignant tumors affecting the lower jaw quite quickly penetrate the soft tissues of the mouth and cheeks, begin to bleed, resulting in disruption and difficulty in closing the jaws.

Malignant tumors originating from bone tissue are characterized by rapid progression and penetration into soft tissues, which leads to disruption of facial symmetry, increased pain and the rapid appearance of foci of disease in the lungs and other organs.

Diagnosis of jaw tumors

The nature of the formation of tumors, both malignant and benign, is sluggish, which significantly complicates the diagnosis of the disease in initial stages. In this regard, contacting specialists and making a diagnosis occurs at later stages of development of the neoplasm. The reason for this is not only the specificity of the disease with a characteristic asymptomatic course, but also the careless attitude of people towards their health, neglect of regular preventive examinations, a lowered level of awareness of the seriousness of the disease associated with the development of cancer in them.

It is possible to determine a possible tumor of the jaw through high-quality collection of information provided by the patient about his condition, complaints about any ailments. A thorough examination of the oral cavity and facial skin is also carried out to identify tumors. In the diagnosis of neoplasms, one of the main roles is played by palpation examination, which makes it possible to determine the size and location of the neoplasm. It is also necessary to do x-rays and perform a computed tomography scan paranasal sinuses nose A radionuclide study, which records infrared radiation from the human body, can help in making a diagnosis.

The increased size of the lymph nodes located near the neck and in the lower jaw indicates the need for a biopsy. If there is any doubt about determining the nature of the tumor, you should consult with an otolaryngologist and perform rhinoscopy and pharyngoscopy. If there is insufficient information, you should contact an ophthalmologist for qualified advice.

Treatment of jaw tumors

Basically, all benign formations are subject to treatment surgically, during which the tumor is removed with excision of the jaw bone to healthy areas. This treatment helps prevent recurrence of the disease. If teeth are involved in the tumor process, then most likely they will have to be removed. In some cases, gentle removal using curettage is used.

Malignant tumors are treated using a complex method, including surgical treatment and gamma therapy; in particularly difficult situations, a course of chemotherapy may be prescribed.

The postoperative period involves orthopedic restoration and wearing special splints.

Prognosis of jaw tumors

In situations where the tumor is benign and has undergone timely surgical intervention, the prognosis for recovery is favorable. Otherwise, there is a risk of relapse of the disease.

Malignant tumors, as a rule, do not have a favorable prognosis. Five-year survival rate for sarcoma and jaw cancer after combination treatment is less than 20%.

Oncology of the jaw is diagnosed in 1-2% of the total number of cancers. It has no clear gender and develops at any age. At the same time, lesions of the lower jaw are less common than pathologies of the upper jaw. Because of complex structure tumors of its different parts are possible in the maxillofacial system.

Malignant tumors of the jaw are divided into osteosarcoma and epithelial cancer. Bones, soft tissues, and blood vessels suffer. Treating the disease is not easy, so it is of great importance early diagnosis. Consultation with an otolaryngologist, dentist, ophthalmologist, surgeon and oncologist plays an important role in it.

Jaw cancer concept

Cancer of the lower jaw (or upper jaw) is also called squamous cell formation, adenocarcinoma, adenoid cystic carcinoma. The pathology is based on the transformation of healthy cells of the maxillofacial zone into tumor cells. In 60% of cases, the process develops from the epithelial tissues that line the maxillary sinuses. The prognosis of the disease is unfavorable, therapy is long and complex.

Causes of the disease

Malignant tumors arise and develop under the influence of several factors. The main provocateur of the disease is considered to be injuries in the facial area. Additional reasons speakers:

• smoking, habit of chewing tobacco;
• improper care of teeth and gums;
• radiation exposure;
• foci of chronic inflammation on the mucous membrane;
• progressive caries;
• mucosal injuries due to malocclusion;
• low-quality prostheses;
• osteomyelitis;
• a consequence of oncology of the tongue, kidneys, thyroid gland (we recommend reading:).

Diagnostic methods

When diagnosing jaw cancer, specialists rely on the patient’s complaints, the results of palpation and visual examination. To recognize the disease, an additional x-ray is taken in several projections, which allows you to see the picture of jaw cancer and differentiate it according to the following characteristics:

• destruction of loops of spongy substance;
• destructive changes in bone;
• foci of destruction and contours of transition to them from healthy tissues.

The diagnosis of cancer of the upper jaw can be confirmed by a general clinical examination, blood and urine tests, fluorography, and histological examination of the affected tissues. Additionally, scintigraphy, computed tomography of the nasal sinuses, and biopsy are indicated submandibular lymph nodes. The examination includes a consultation with an ophthalmologist and an ENT specialist, which will allow you to find out about the condition of the maxillary sinuses. In some cases, puncture of the lymph nodes is prescribed to determine metastasis in cancer of the upper jaw.

The pathology is differentiated with symptoms of chronic osteomyelitis, osteogenic and odontogenic tumors, certain bone diseases. Once the diagnosis is confirmed and the extent of the damage is determined, the doctor prescribes a course of treatment consisting of chemotherapy, radiation, and surgery.

Stages of development and symptoms of jaw cancer

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A malignant lesion develops in several stages, as can be seen in the photo. By TNM classification The following sequence of spread of the disease is distinguished:

• T1 - cancer affects one anatomical part. There are no destructive bone changes.
• T2 - pathology affects two anatomical parts. On the affected side, metastasis is detected.
• T3 - the tumor affects more than 2 anatomical parts. During the examination, it is possible to identify 1-2 metastases.
• T4 - pathology spreads further to other tissues. Metastases fused with surrounding tissues are detected.

Symptoms of the disease become noticeable quite quickly, since the oral mucosa immediately reacts to the inflammatory process. With a tumor of the maxillofacial zone, painful sensations, the bite changes, the shape of the nose changes. Additionally, numbness of the skin, headache, bad breath, purulent discharge from the nose. Also possible:

• periodic throbbing pain in the teeth area;
• changes in facial bones (overgrowth of pathological tissues);
• progression of facial asymmetry;
• tooth displacement;
• pain when swallowing, eating;
• limited jaw mobility.

Such symptoms may indicate not only osteogenic sarcoma of the jaw, but also other complex ailments. For example, neuritis, sinusitis, sinusitis. Doctors take this into account, and when making a diagnosis, a comprehensive examination is prescribed.

Primary and secondary tumor type

Oncology develops in the cheekbone area, near the eyes, in the subtemporal region, and around the nose. According to the degree of development, the tumor is classified as:

What is sarcoma?

Sarcoma of the jaw is the most aggressive form of oncology. It progresses faster than a cancerous tumor, and from timely diagnosis The patient's life depends. The formation originates from connective or cartilaginous tissues and most often affects top part. With an advanced form of osteosarcoma of the upper jaw, damage is observed in the mouth area. Pathology is more often diagnosed in men 25-40 years old.

Causes

Osteogenic sarcoma of the jaw is characterized by rapid growth. Common causes of damage are:

• heredity;
• the effect of radiation;
• drug addiction, smoking, alcohol abuse;
• history of tumor pathologies;
• traumatic factors;
• contact with carcinogens (cobalt, mercury, lead and others);
• poor ecology in the region.

Classification and signs of disease manifestation

Jaw sarcomas are formed in the form of Ewing's sarcoma, fibrosarcoma, chondrosarcoma, and osteogenic sarcoma of the jaw. According to their location, they are maxillary and mandibular, divided into central, peripheral and soft tissue. Round cell sarcomas of the lower jaw are known, which developed over 2 months and manifested themselves as intense toothache. At the same time, the relief of bone tissue was rapidly destroyed, teeth crumbled and fell out.

The first sign of jaw sarcoma is the appearance of a small round formation with clear boundaries. Other signs of this cancer:

• Pain syndrome. The patient finds it difficult to determine the location of the pain. It is present in the area of ​​the teeth close to the tumor. Possible nagging discomfort, shooting in the temples.
• Deformations of facial contours. Redness of the mucous membrane is observed as the tumor grows. Possible swelling of the face, destruction of bone tissue, compaction in the cheek area. If the process is located in the upper part, problems with nasal breathing and nosebleeds are possible.
• Numbness of areas of the face. With mechanical compression nerve endings sarcoma of the lower jaw, there is a lack of sensitivity in the chin and lower lip.
• Difficulty swallowing and chewing food. Over time, with osteosarcoma, problems with bite are added to this.
• General deterioration in health. Weakness, fever, enlarged lymph nodes, and other symptoms are observed.

Treatment of sarcoma and other malignancies

Treatment of osteosarcoma of the jaw, squamous cell carcinoma and other forms of oncology are prescribed only after a complete diagnosis. Due to the severity and rapid spread of the disease, it cannot be delayed.

Under general anesthesia the affected tissue is surgically removed. Then, before gamma irradiation, loose teeth are removed, radiation treatment or chemotherapy. After recovery, implants are installed to restore facial contours and improve quality of life.

Surgical methods

First of all, surgical treatment is performed, the technique of which depends on the extent of the lesion. Modern surgery uses the following methods:

• for superficial lesions - partial resection;
• in the absence of deep foci and interference with the alveolar processes - segmental resection;
• if the angle of the jaw is affected by cancer, half of it is removed;
• when osteosarcoma is located in the chin area - resection of soft tissues and bones.

Radiation therapy

Radiation therapy and chemotherapy is part of a combinatorial intervention for jaw cancer. They are prescribed to inoperable patients, and are also carried out to ensure the effectiveness of surgical treatment. Contraindications to gamma therapy remain until the patient’s loose and damaged teeth are removed from the area of ​​future irradiation.

The preparation stage for the procedure includes sanitation of the oral cavity, as well as identifying the lesions to which radioactive rays will be directed. The first session is carried out 2 weeks after sanitation of the oral cavity. Manipulations are divided into palliative (two weeks) and radical, carried out over several months. After the procedure, skin burns, distortions in taste perception, difficulty swallowing, and dry mucous membranes are possible. Complications go away during rehabilitation.

Chemotherapy

Chemotherapy for cancer of the upper and lower jaw involves taking cytostatic medications that can destroy cancer cells, prevent their proliferation and destroy metastases. Treatment regimens depend on the type and stage of the tumor (sarcoma of the lower jaw, upper jaw, squamous cell lesion). For inoperable tumors, palliative therapy is carried out. In preparation for surgical intervention Curative chemotherapy is indicated. It can reduce the size of osteosarcoma or completely eliminate cancer cells.

Treatment of upper jaw cancer involves a combination of radiation and chemotherapy. When treating mandibular cancer, cytostatic substances are injected into the artery and regional chemotherapy is performed.

Recovery after treatment

Methods to combat jaw cancer are aggressive, and after them the patient needs rehabilitation. In addition to complex prosthetics, a person requires updated operations, speech correction, and health improvement in general sanatoriums. Three-stage prosthetics are usually used:

• Before the operation, an individual prosthetic plate is made;
• production of a formative prosthesis within 2 weeks after surgery;
• creation of the final prosthesis, compensation of soft tissue defects using splints and bone plates.

For cancer of the upper jaw, a commission is carried out (disability group II). Bone grafting is recommended 10-12 months after tumor removal. Radical intervention leads to disability and decreased ability to work, but over time, patients can return to mental work and other activities.

Prognosis for cancer of the upper and lower jaw

Jaw cancer can quickly spread to the eye area. As it germinates, it causes the following consequences:

Can jaw cancer recur after treatment? According to the experience of oncologists, this is possible within several years after therapy. The five-year survival rate for cancer of the lower jaw is no more than 20-30%. With Ewing's sarcoma, osteogenic sarcoma and other forms, the prognosis for survival is even more unfavorable.

Prevention of jaw cancer

Primary prevention of jaw cancer includes measures aimed at preventing the disease. These include:

• life without smoking and other bad habits;
• work with chemicals and reagents only for safety reasons;
• regular examinations by the dentist (they become especially important if there is a genetic predisposition to cancer or sarcoma of the jaw);
• fight against stress, good food, improvement of living conditions.

Prevention of recurrence of cancer of the lower jaw is based on the same postulates as primary prevention. Very important positive attitude, support from loved ones and self-confidence. It is required to maintain moderate activity, do not give up lungs physical activity, follow all recommendations prescribed by the doctor. Taking good care of your health and giving up bad habits will reduce the risk of cancer, increase your vitality and allow you to reconsider your priorities.