Jaw cancer is a malignant neoplasm originating from epithelial tissue. The clinical picture is determined by the localization of the primary lesion. The first signs of neoplastic neoplasm of the upper jaw are similar to the symptoms of chronic sinusitis. When the mandibular bone is affected, intact teeth acquire mobility of 2-3 degrees, numbness of the lower lip occurs. Common jaw cancer occurs with intense pain syndrome. Diagnosis of the disease includes collection of complaints, clinical examination, radiography, pathohistological examination. Treatment of jaw cancer is combined. Along with the removal of the tumor, courses of radiation therapy are indicated.
Jaw cancer is a pathological process of primary or secondary origin, which is based on the transformation of healthy bone cells into tumor cells. 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, disease is predominantly squamous keratinizing. The main group of patients who applied to the clinic are people aged over 45-50 years. An ophthalmologist and an otorhinolaryngologist take part in the examination of the patient along with an oncologist surgeon. The treatment of a malignant neoplasm is combined. The prognosis is unfavorable, five-year survival is observed in 30% of patients.
In central (true) jaw cancer, the tumor originates from the Malasse islets. Secondary neoplasms occur when cancer cells germinate deep into the bone tissue from the maxillary sinus, alveolar process, palate, lateral surfaces of the tongue, the bottom of the oral cavity. Most often, the neoplastic process of the upper jaw develops in patients with chronic inflammation of the maxillary sinus mucosa. The prolonged course of sinusitis leads to the transformation of epithelial tissue cells.
The root causes of secondary form can also be mucosal injuries, exposure to ionizing radiation, bad habits (smoking, chewing nasa), occupational hazards (working in hot shops or dusty rooms), improper nutrition (excessive consumption of spicy, spicy foods). In addition, there is a risk of developing metastatic jaw cancer in cancer patients with tumors of the kidneys, stomach, lungs.
In the initial stage of carcinogenesis, complaints are usually absent. With cancer of the jaw, originating from the epithelium of the maxillary sinus, patients indicate nasal congestion, difficulty nasal breathing, the presence of mucous secretions with an admixture of blood. When the primary tumor is localized in the area of the upper-inner corner of the maxillary sinus, in addition to the above symptoms, there is a thickening, deformation of the lower medial wall of the orbit.
In case of this disease, which has developed due to the spread of malignant tumor cells into the bone from the lateral parts of the sinus, numbness of the skin and mucous membrane of the under-eye area 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. Stages III-IV of jaw cancer are indicated by the development of exophthalmos, a violation of mouth opening, the addition of neurological symptoms.
During the neoplastic process of bone tissue, deformation of the jaw occurs, the risks of pathological fractures are high. In the absence of proper treatment, areas of ulceration may appear on the skin. If the primary lesion in jaw cancer is a malignant tumor of the mucous membrane, a cancerous ulcer or mucosal growths are detected during examination. 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, fungal growths with pronounced infiltration at the base are found.
Diagnosis of jaw cancer is based on the analysis of complaints, physical examination data, as well as X-ray, histological, radioisotope methods of research. During an external examination of patients with jaw cancer, a dentist reveals asymmetry, facial deformity, and possible ulceration of the skin. Often, with jaw cancer, paresthesia is diagnosed in the area that corresponds to the localization of a malignant tumor. During a palpatory examination, a thickening of the bone is detected. The teeth located in the affected area are mobile. The vertical percussion is positive.
With cancer of the jaw of secondary origin, an ulcer with signs of malignancy or papillary growths is 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, compacted, and painless.
Radiographically, diffuse bone rarefaction is detected in jaw cancer. There is no reparative or periosteal reaction. To confirm the diagnosis, a cytological examination of the material taken from the surface of the ulcer is shown. In primary jaw cancer, a pathohistological analysis of the trepanned area of the affected bone is performed. A radioisotope method can also be used to detect a malignant tumor.
Differentiate jaw cancer with chronic osteomyelitis, specific diseases of the jaws, benign and malignant odontogenic and osteogenic tumors. The patient is examined by a maxillofacial surgeon, oncologist, ophthalmologist, otorhinolaryngologist.
When detecting jaw cancer, combined treatment is used. Along with the removal of the neoplasm, a course of pre- and postoperative radiation therapy is carried out. At the preparatory stage in dentistry, the removal of impressions for the manufacture of prostheses replacing the defect is shown. Relatively mobile teeth adhere to conservative tactics, since after surgery the risk of dissemination of cancer cells by a network of lymphatic vessels increases. If several enlarged mobile cervical lymph nodes or at least one soldered lymph node are detected with jaw cancer, cervical dissection is initiated.
Depending on the clinical situation, Vanach, Krail or fascial-sheath excision operations can be used. The affected area of bone tissue in jaw cancer is resected together with the periosteum. When the tumor grows into adjacent zones, a radical operation is performed, expanding the boundaries of the surgical field. When the cancer of the jaw spreads to the base of the skull, the use of gamma radiation is shown. The prognosis for jaw cancer depends on the stage of the disease, age, the patient’s immune status, and the choice of treatment method.
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