Benign tumors of the lower jaw. How to recognize cancer of the upper and lower jaw: symptoms of sarcoma and other malignant tumors

Neoplasms of the jaw bones, arising directly from bone tissue or structures of the odontogenic apparatus. Tumors of the jaws can manifest themselves clinically as pain syndrome, bone deformation, facial asymmetry, displacement and mobility of teeth, dysfunction of the TMJ and swallowing, often by growing into the nasal cavity, maxillary sinus, orbit, etc. Diagnosis of jaw tumors involves x-ray examination, CT, scintigraphy; if necessary, consultation with an ophthalmologist, otolaryngologist, rhinoscopy. Treatment of benign jaw tumors is surgical only (curettage, resection of a jaw fragment, tooth extraction); malignant – combined (radiation therapy and surgery).

General information

Tumors of the jaws - osteogenic and non-osteogenic, benign and malignant neoplasms of the jaw bones. Tumors of the maxillofacial region account for about 15% of all diseases in dentistry. Tumors of the jaws can occur at any age, including quite often in children. Tumors of the jaws are varied in their histogenesis and can develop from bone and connective tissue, bone marrow, tissues of the tooth germ, perimaxillary soft tissues. As jaw tumors grow, they cause significant functional disorders And aesthetic defects. Treatment of jaw tumors is a technically challenging task, requiring the combined efforts of specialists in the field of maxillofacial surgery, otolaryngology, ophthalmology, and neurosurgery.

Causes of jaw tumors

The question of the cause of jaw tumors is under study. To date, the connection between the tumor process and immediate or chronic trauma (jaw contusion, damage to the oral mucosa from teeth destroyed by caries, tartar, the edges of fillings, incorrectly fitted crowns and dentures, etc.), long-term inflammatory processes (chronic periodontitis, osteomyelitis) has been proven jaws, actinomycosis, sinusitis, etc.). The possibility of developing jaw tumors due to foreign bodies maxillary sinus: filling material, tooth roots, etc.

Among the possible causes of jaw tumors, the impact of unfavorable physical and chemical factors(ionizing radiation, radioiodine therapy, smoking, etc.). Secondary malignant tumors of the jaws can be metastases of breast cancer, prostate cancer, thyroid cancer, kidney cancer, the result of local spread of tongue cancer, etc. Jaw cancer can develop against the background of precancerous processes - oral leukoplakia, benign tumors of the oral cavity (papillomas), leukokeratosis and etc.

Classification of jaw tumors

Among tumors of the jaws, a distinction is made between odontogenic (organ-specific) neoplasms associated with tooth-forming tissues, and non-odontogenic (organ-nonspecific) tumors associated with bone. Odontogenic tumors of the jaws, in turn, can be benign or malignant; epithelial, mesenchymal and mixed (epithelial-mesenchymal).

Benign odontogenic tumors of the jaws are represented by ameloblastoma, calcified (calcifying) epithelial odontogenic tumor, dentinoma, adenoameloblastoma, ameloblastic fibroma, odontoma, odontogenic fibroma, myxoma, cementoma, melanoameloblastoma, etc.

Malignant odontogenic tumors of the jaws include odontogenic carcinoma and odontogenic sarcoma. Osteogenic tumors of the jaws include bone-forming (osteomas, osteoblastomas), cartilaginous (chondromas), connective tissue (fibromas), vascular (hemangiomas), bone marrow, smooth muscle, etc.

Symptoms of jaw tumors

Benign odontogenic tumors of the jaws

Ameloblastoma– the most common odontogenic tumor of the jaws, prone to invasive, locally destructive growth. It primarily affects the lower jaw in the area of ​​its body, angle or branch. Develops intraosseously, can grow into soft fabrics floor of the mouth and gums. It often appears between the ages of 20 and 40.

In the initial period, ameloblastoma is asymptomatic, but as the size of the tumor increases, jaw deformation and facial asymmetry occur. Teeth in the affected area often become mobile and shift, and toothache may occur. Tumor upper jaw can grow into the nasal cavity, maxillary sinus, orbit; deform the hard palate and alveolar process. There are frequent cases of suppuration, recurrence and malignancy of ameloblastoma. The clinical course of jaw tumors such as ameloblastic fibroma and odontoameloblastoma resembles ameloblastoma.

Odontoma most often occurs in children under 15 years of age. Typically, tumors are small in size and asymptomatic, but may cause delayed eruption permanent teeth, diastema and trema. Large tumors can lead to jaw deformation and fistula formation.

Odontogenic fibroma develops from the connective tissue of the tooth germ; occurs more often in childhood. Tumor growth is slow; localization - on the upper or lower jaw. Odontogenic fibroma is usually asymptomatic; in some cases there may be aching pain, tooth retention, inflammatory phenomena in the tumor area.

Cementoma– a benign tumor of the jaw, almost always fused to the root of the tooth. Most often develops in the area of ​​premolars or molars of the lower jaw. It occurs asymptomatically or with mild pain on palpation. Rarely, multiple giant cementomas occur, which may be hereditary disease.

Benign non-odontogenic tumors of the jaws

Osteoma may have intraosseous or superficial (exophytic) growth. The tumor can spread to the maxillary sinus, nasal cavity, or orbit; interfere with the fitting of dentures. Osteomas of the mandibular localization cause pain, asymmetry of the lower part of the face, impaired jaw mobility; maxillary localization - nasal breathing disorders, exophthalmos, diplopia and other disorders.

Osteoid osteoma accompanied by intense pain, worsening at night and during meals; facial asymmetry. When examining the oral cavity, bone protrusion is determined (usually in the area of ​​premolars and molars of the lower jaw), hyperemia of the mucous membrane.

Osteoblastoclastoma(giant cell tumor of the jaw) mainly occurs in at a young age(up to 20 years old). The development of the clinical picture is characterized by an increase in pain in the jaw, facial asymmetry and tooth mobility. The tissue over the tumor becomes ulcerated; fistulas form; there is an increase in body temperature. Thinning of the cortical layer leads to pathological fractures of the lower jaw.

Hemangioma jaw disease is relatively rarely isolated and in most cases is combined with hemangioma of the soft tissues of the face and oral cavity. Vascular tumors of the jaws are manifested by increased bleeding of the gums, bleeding from root canals during the treatment of pulpitis or periodontitis, from the socket during tooth extraction, etc. Upon examination, fluctuation, looseness of the teeth, and cyanosis of the mucous membrane may be detected.

Malignant tumors of the jaws

Malignant tumors jaws are found 3-4 times less often than benign ones.

With jaw cancer, radiating pain occurs early, tooth mobility and loss occur, and pathological fractures of the jaw are possible. Malignant tumors of the jaws destroy bone tissue; parotid and submandibular glands and masticatory muscles sprout; metastasizes to the cervical and submandibular lymph nodes.

Carcinoma of the maxilla can invade the orbit, nasal cavity, or ethmoid labyrinth. In this case, recurrent nosebleeds, unilateral purulent rhinitis, difficulty in nasal breathing, headaches, lacrimation, exophthalmos, diplopia, and chemosis are noted. When the branches of the trigeminal nerve are involved, otalgia is a concern.

Malignant tumors of the lower jaw early infiltrate the soft tissues of the floor of the mouth and cheeks, ulcerate, and bleed. Due to contractures of the pterygoid and masticatory muscles, closing and opening of teeth becomes difficult. Osteogenic sarcomas are characterized by rapid growth, rapidly progressing infiltration of soft tissues, facial asymmetry, unbearable pain, and early metastasis to the lungs and other organs.

Diagnosis of jaw tumors

In most cases, jaw tumors are diagnosed already in late stages, which is explained by the nonspecificity of symptoms or asymptomatic course, low oncological alertness of the population and specialists (pharyngoscopy; ophthalmologist with complex ophthalmological examination. In some cases, it is necessary to resort to diagnostic maxillary sinus or diagnostic puncture of the paranasal sinus, followed by cytological examination rinsing waters. Final histological verification is carried out using morphological research biopsy.

Treatment of jaw tumors

Treatment for most benign jaw tumors is surgical. The most optimal option is to remove the tumor with resection of the jaw bone within healthy boundaries; This volume of intervention helps prevent relapses and possible malignancy of the tumor. Teeth adjacent to the tumor are also often subject to extraction. It is possible to remove some benign jaw tumors that are not prone to recurrence using a gentle method using curettage.

Used for malignant tumors of the jaws combined method treatment: gamma therapy followed by surgical treatment (resection or disarticulation of the jaw, lymphadenectomy, exenteration of the orbit, surgery on the paranasal sinuses, etc.). IN advanced cases palliative radiation therapy or chemotherapy treatment is prescribed.

In the postoperative period, especially after extensive resections, patients may require orthopedic treatment with special splints, reconstructive surgery (bone grafting), long-term functional rehabilitation to restore the functions of chewing, swallowing, and speech.

Prognosis of jaw tumors

With timely and radical treatment Benign odontogenic and non-odontogenic tumors of the jaws have a good prognosis for life. In the case of a non-radical operation or an incorrect assessment of the nature of the tumor, there is a possibility of relapse or malignancy.

The course of malignant tumors of the jaws is extremely unfavorable. For cancer and sarcoma of the jaw, the five-year survival rate of patients after combination treatment is less than 20%.

Malignant tumors occur more often in the upper jaw than in the lower jaw. Pathological anatomy . Malignant tumors originate both from the mucous membrane lining the maxillary sinus, hard palate and alveolar margin, and grow secondarily into the jaw (epithelial), and directly from the bone and cartilage tissue, periosteum, bone marrow, etc. (connective tissue). Some tumors originate from tooth buds - so-called odontogenic tumors (see). Exists certain dependence between the histogenesis of the tumor, its morphological structure and clinical manifestations. Until now, there is no generally accepted classification of malignant tumors of the jaw. At the Institute of the USSR Ministry of Health named after. prof. N.N. Petrova (Leningrad) adopted the following classification (taking into account histogenesis and morphological structure tumors). I. Epithelial (carcinoma, cylindroma, malignant epithelioma). II. Connective tissue: 1) from cartilaginous tissue (chondrosarcoma); 2) from bone tissue (osteogenic sarcoma); 3) from connective tissue (fibrosarcoma, myxosarcoma); 4) sarcomas of unknown origin (spindle cell, round cell, polymorphic cell, giant cell). III. Rare tumors (lymphoepithelioma, reticulocytoma, malignant schwannoma, rhabdomyoblastoma, melanoblastoma).

Clinical course and diagnosis. A significant portion of malignant tumors of the jaw in the early stages are asymptomatic, which makes diagnosis difficult, and patients are admitted to the hospital in late stages. Recognition is difficult when the tumor is located in parts of the maxillary cavity that are difficult to access for examination.

Ongren conditionally divided the maxillary bone into 4 sectors with two planes. A tumor (both carcinoma and sarcoma), initially emanating from one of these sectors, has its own clinical picture and direction of growth.

Tumors of the superior posterior internal sector are diagnosed late; they are difficult to access for research. When growing into the nasal passages, bloody issues from the corresponding half of the nose with an admixture of foul-smelling pus, difficulty in nasal breathing. When germinating in ethmoid bone exophthalmos, dilation of retinal vessels, optic nerve atrophy and decreased visual acuity are observed; when growing into the orbit - displacement eyeball laterally, limited mobility without changes in visual acuity, persistent headaches, painful sensations along the second branch of the trigeminal nerve, sometimes with disruption skin sensitivity. When the tumor spreads to the nasopharynx, from where it often grows into the body of the main bone, the pain radiates to the temple.

With tumors of the upper posterior outer sector, there is an inward displacement of the eyeball, diplopia, swelling of the eyelids, narrowing of the palpebral fissure, facial asymmetry, pain along the second branch of the trigeminal nerve (small and large molars). The tumor can grow into the pterygopalatine fossa, involving the auditory tube, which leads to vague pain in the ear area. When the temporal and pterygopalatine muscles grow, the function becomes limited jaw joint, trismus of the temporal and masticatory muscles is observed.

Tumors of the lower anterior internal sector are diagnosed early; they destroy the alveolar edge, hard palate and the anterior wall of the maxillary sinus, causing painful loosening and loss of teeth with heavy bleeding; the holes are made with disintegrating tumor masses. The alveolar edge acquires an elastic consistency in places. The nasolabial fold is smoothed out, slight asymmetry of the face occurs, intense pain from the involvement of the dental nerves and compression or germination of the lower orbital nerve. When a tumor occurs in the lower nasal passage, there are corresponding symptoms.

Tumors of the lower anterior outer sector tend to invade the jaw joint and the ascending ramus of the mandible, then move to the tonsils and the lateral wall of the nasopharynx; There are difficulties in opening the mouth, asymmetry of the face due to the tumor growing outward and drooping of the lower corner of the mouth.

With cancer of the mucous membrane of the alveolar edge of the lower and upper jaws, most patients develop toothaches in the area of ​​ulceration, then teeth become loose and fall out with bloody-purulent discharge. Mucosal cancer hard palate in the early stages it manifests itself in the form of ulceration with dense roll-like edges and a necrotic bottom. Later, pain occurs, and when the hard palate grows, serous-purulent discharge from the lower nasal passage occurs.

Cancer According to its clinical course, the lower jaw has a number of specific features. Thus, more intense inflammatory processes in the surrounding tissues than with cancer of the upper jaw may be observed; In earlier stages, tumors invade the soft tissues of the cheek and the floor of the mouth. Due to the increased trauma of the tumor of the lower jaw, its growth rate is much higher than for tumors of the upper jaw. Gradually progressive pain is observed, deep cracks or ulcerations appear on the mucous membrane (usually at the tooth sockets), bleeding, loosening of the teeth with exposure of their neck. Tooth loss is accompanied by bleeding, the hole is filled with tumor growths. If centrally located cancer develops in the tissues of the lower jaw, the teeth become loose with inexplicable pain along the mandibular and mental nerves. Sometimes there are areas of hyper- and hypoesthesia of the skin and mucous membrane of the half lower lip. Subsequently, swelling and deformation are observed with the formation of a slit-like ulcer on the gum, while even its edges do not have the characteristic ridge-like structure. The ulcer produces foul-smelling pus. Growing into the thinner wall of the jaw, the tumor spreads as an infiltrate through the soft tissues of the floor of the mouth (where ulcerations occur). The tumor grows into the submandibular and parotid salivary glands, the masticatory muscle is infiltrated, which makes it difficult to open the mouth. Already in the early stages, regional metastases appear.

Sarcomas the lower jaw, characterized by a faster growth rate and spread than cancer, also gives early pain of a shooting nature, more intense than with cancer; the tumor, rapidly increasing in size, sharply deforms the mandibular bone, but teeth usually do not fall out. Sarcomas are not prone to ulceration. Often there is a displacement of the tongue, larynx, and walls of the middle part of the pharynx.

Jaw tumors tend to recur early. More often they occur when used exclusively surgical method treatment, as well as with combined, but without postoperative intracavitary therapy. Relapses should also be treated using a combination method with mandatory intracavitary administration of radioactive drugs. Recurrent jaw cancer can be re-treated relatively successfully, but treatment of sarcomas, especially chondrosarcomas and spindle cell sarcomas, gives extremely unsatisfactory results.

Metastases from malignant tumors of the jaws are quite common. Metastases to regional lymph nodes in cancer of the maxillary sinus most often occur in the submandibular region, much less often in the neck and in the preauricular region. More often, metastases are observed when the initial localization of cancer is in the upper-posterior outer sector. When cancer is located on the alveolar edge and hard palate, the submandibular lymph nodes are also predominantly affected. Most rational treatment regional metastases is their radical removal.

A comprehensive examination of a patient with a presumptive diagnosis of a malignant tumor of the jaws is necessary; Moreover, in addition to a thorough medical history, instrumental research(anterior, posterior rhinoscopy), X-ray tomographic examination is necessary, and in some cases contrast radiography and cytological study of punctures and smears from the discharge. You cannot begin treatment without a biopsy and morphological examination.

Dividing malignant tumors of the jaws into stages is necessary to prescribe one or another type of therapy. Stage I - tumors of the maxillary sinus without destruction of its walls; small tumors of the mucous membrane of the alveolar process and hard palate with marginal bone destruction; there are no metastases in the lymph nodes. Stage IIa - a tumor of the maxillary sinus, spreading to its bone walls, causing their focal destruction. On the mucous membrane of the alveolar edge, in addition to destruction of the underlying bone, the tumor occupies a transitional fold or spreads to the hard palate, but in a limited area; there are no metastases in the lymph nodes. Stage IIb - the tumor is locally widespread, as in stages I or IIa, but there are single regional metastases on the same side. Stage III - a tumor that has spread beyond the maxillary sinus and grows into the soft tissues of the cheek, nasal cavity, orbit, pterygopalatine fossa, ethmoid sinus; a tumor of the alveolar process or hard palate, germinating and spreading into the maxillary sinus, causing significant destruction of its bone walls and extending beyond them or infiltrating the soft tissues of the cheek, as well as with a limited transition to the opposite side of the upper jaw; there are no metastases in the lymph nodes. Stage III6 - tumors of the jaw with multiple displaced metastases in the lymph nodes of the same name in the submandibular region and neck. Stage IV - tumors of the jaw that have spread far beyond its limits, with multiple bilateral or unilateral non-displaceable (fused to the mandibular bone) regional or distant metastases.

Differential diagnosis. One should keep in mind inflammatory processes (osteomyelitis, sinusitis), specific infectious granulomas (tuberculosis, actinomycosis), then benign tumors (papillomas, epitheliomas, polyposis, osteomas, chondromas, etc.). We should not forget about maxillary sinus cysts, some blood diseases, as well as systemic bone diseases (Paget's disease, osteodystrophy, etc.). Some jaw tumors are metastatic. Thus, metastases to the lower jaw of stomach cancer, thyroid, prostate, breast, lung, and hypernephroma have been described. In the upper jaw there are metastases of breast cancer, ovarian cancer, chorionepithelioma, and seminoma.

Treatment of malignant tumors of the jaws presents significant difficulties, and long-term results still remain unsatisfactory. The most rational method of treating cancer and sarcomas sensitive to radiation therapy, is a combined: 1) course of telegammatherapy with 2 or 3 fields (total dose from 8,000 to 14,000 rubles); rest 1-1.5 months, until subsidence reactive changes on the skin and mucous membranes, improving blood composition and general condition; 2) surgical treatment, consisting of external dressing carotid artery on the corresponding side, electroresection of the upper jaw, if necessary extended up to exenteration of the orbit, with the introduction of radium preparations into the wound cavity during the operation for 2-3 days. The latter is dictated both by preventive considerations and medicinal purposes in cases where areas of tissue suspicious for tumor are left in the wound. For tumors of the lower jaw - partial or half resection with dissection from the jaw joint and simultaneous bone autoplasty with a rib or graft taken from the iliac wing. In the early stages of the disease, in some cases with limited tumors of the upper jaw of the anterior-inferior localization, it is possible to immediately undertake surgical treatment without preoperative radiation therapy. However, prophylactic administration of radioactive drugs is mandatory in these cases as well.

Jaw cancer is a group of diseases that affect bone, cartilage and other tissues. Such tumors are quite rare and account for up to 2% of all types of oncology, but in dental practice they account for 15% of detected tumors.

Causes

Pathologies are observed in people of both sexes, and children are no exception. The exact reasons for the appearance are unknown. Scientists and doctors have identified a number of factors that can affect their development, these are:

• nicotine addiction, not only smoking, but also chewing tobacco for a long time;
• regular alcohol consumption;
• injuries (rubbing with a denture, filling, bruises, fractures);
• chronic infections;
• congenital predisposition;
• low immunity;
• long-term exposure chemical substances(poor quality food, cheap materials for repairs, work in hazardous industries).

In the presence of chronic diseases or anatomical features epithelial cells maxillary sinuses can develop into cancer of the upper jaw.

When the disease is diagnosed in infants it is often associated with negative impact during intrauterine development (bad habits of the mother, penetration of carcinogenic substances, harmful radiation, taking certain medications, etc.). Heredity is often involved.

In people who adhere to a healthy lifestyle and monitor their health, this type of oncology is diagnosed extremely rarely.

Varieties

Malignant lumps affect the upper or lower jaw, but the latter are more common.

Cancer is formed from healthy cells bone or other tissue, or is a consequence of metastasis from other organs. More often, secondary lesions in this area are formed when the neck, head or brain are affected.

Neoplasms are:

• epithelial (carcinoma, squamous cell carcinoma);
• bone and cartilaginous (Ewing's tumor, chondrosarcoma);
• connective (sarcoma, fibrosarcoma);
• pigmented (melanoblastoma);
• vascular (angiosarcoma);
• nervous (malignant schwannoma).

Based on the degree of damage, malignant lumps in the upper or lower part are divided into the following stages:

• First (T1). The neoplasm is located in 1 anatomical region.
• Second (T2). The cancer spreads to adjacent areas but is confined to two sections.
• Third (T3). It expands its borders and grows into neighboring areas.
• Fourth (T4). It affects distant tissues and gives metastases.

The earlier the disease is detected, the greater the person’s chances for a complete cure, so it is important not to ignore the appearance of discomfort, but to consult a doctor as soon as possible.

Signs of illness

Symptoms of jaw cancer are very diverse and differ depending on the location malignant process and its degree.

Damage to the upper jaw is accompanied by:

• headache and dizziness;
• purulent nasal discharge;
• discomfort and burning in the affected area;
• numbness of individual segments of the face;
• bad breath.

As the formation progresses, it increases in size and damages neighboring areas. This may manifest itself:

• swelling in the cheekbones and cheekbones;
• deformation, swelling of the face;
• changes in the size of the alveolar processes;
• mobility of individual teeth, their loss.

When cancer spreads to the eye socket, the list of symptoms expands and includes:

• deterioration of lower bone mobility;
• pain in the eyes, lacrimation;
• periodic nosebleeds;
• difficulty closing teeth;
• severe headache radiating to the frontal or temporal lobe, ear.

When the lower jaw is affected, the patient complains of:

• difficulty chewing food;
• deterioration or total loss appetite;
• weight loss;
• general weakness;
• pain in the teeth that are located next to the tumor, their loss;
• the appearance of ulcers, erosions, ulcers in oral cavity;
• discomfort when opening the jaw and touching.

Most symptoms are not specific and often indicate other pathologies. Seeing a doctor will allow you to determine the exact causes of your illness.

Diagnostics

Depending on your symptoms, you should visit one of the following specialists:

• dentist;
• otolaryngologist;
• ophthalmologist.

They will spend initial examination and a number of diagnostic studies. The most informative is an x-ray, with or without contrast, in frontal and lateral projection. If doctors suspect the malignant nature of the disease, the patient is sent to oncology and surgery department for a consultation.

X-ray of the alveolar processes upper section visualized:

• destruction of the partitions between the teeth or their complete destruction, lack of attachment to the bone;
• expansion of periodontal fissures;
• jagged, blurry edges.

Cancer of the lower jaw is characterized by the following changes:

• destruction and rupture of loops of spongy substance;
• focal bone destruction;
• stripes that give the jaw the appearance of marble;
• spots forming a large area with bay-shaped edges.

Such a diagnosis makes it possible to talk about oncology with a high degree of probability, but to confirm the diagnosis one cannot do without a histological examination of the material. Considering that the tumor often affects bone tissue, the procedure requires trephination.

If the cancer is localized in the area of ​​the alveolar processes, a tissue sample is taken from the socket of the fallen tooth. For epithelial tumors, it is cut off with a scalpel, and the wound is cauterized.

Additionally carry out computed tomography sinuses. Using puncture, the condition of the submandibular and cervical lymph nodes is assessed. With cancer of the upper or lower section, they are compacted and enlarged, but, as a rule, they do not cause pain.

Treatment

The optimal therapeutic regimen includes:

• surgery;
• irradiation;
• recovery.

Each medical history is considered individually, taking into account the location of jaw cancer, symptoms, age and gender of the patient, test results, general state health.

Advantage is given surgical treatment. The neoplasm is cut off along with part of the jaw bone, periosteum, tongue, palate and other things.

Then courses of radiation therapy are carried out. This is necessary for destruction cancer cells, which could remain after resection or to combat metastases. Complex treatment can significantly reduce the risk of relapse.

If the patient has contraindications to surgery, courses of chemotherapy are prescribed as the main treatment. They are less effective against cancer of the upper or lower jaw and have a number of serious side effects.

• hair loss;
• bleeding;
• deterioration of the functioning of internal organs;
• development of osteoporosis;
• dyspeptic disorders;
• decrease in hemoglobin and others.

Relapses of the disease often appear 1–2 years after treatment.

Recovery period

After removal of the tumor, the patient needs to install implants, which should replace part of the removed bone, teeth, and palate. Excision of soft tissue may require the assistance of a plastic surgeon.

In addition to deterioration appearance, chewing, swallowing and speech functions may be affected. For their full or partial recovery, long-term training under the supervision of doctors will be required.

If there are no suspicious symptoms, then every few months the person should visit the hospital for diagnosis.

If the tumor is detected in the early stages, significant facial deformations and bone damage can be avoided.

Doctors say that in 97% of cases, jaw cancer can be prevented. To do this, you need to protect yourself as much as possible from harmful effects. external factors, drink properly and engage in simple sports. If there is a predisposition, it is necessary to see a doctor, assess your health status and promptly report any symptoms that appear.

Men are diagnosed with jaw cancer more often than women, and, as a rule, average age those affected are 40-60 years old. Sarcoma is the most common type of tumor. Cancer that primarily originates from the mandibular tissues can form from epithelial remnants of the Hertwig membrane or from elements of the cyst wall.

In the presence of secondary cancer of the jaw, in more than half of the cases the primary tumor is located on the mucous membrane. For this reason, it is hardly worth distinguishing secondary tumors of the lower jaw of a malignant nature, since in fact in such a situation it means cancer of the mucous membrane of the floor of the mouth, alveolar margin and other adjacent tissues and organs, which as a result grows into the lower jaw.

Jaw cancer is classified according to the TNM system

T1 (stage 1) - the tumor affects one anatomical part;
. T2 (stage 2) - cancer affects no more than two anatomical parts;
. T3 (stage 3) - the tumor affects more than two anatomical parts;
. T4 (stage 4) - cancer affects a large part of an organ and the process spreads to distant tissues.

Characteristic features

With central cancer, the tumor often develops latently, and the process lasts quite a long time. In some cases, cancer manifests itself as seemingly causeless shooting pains along the way. mandibular nerve or pain similar to pulpitis.

Also, the first sign indicating intraosseous cancer of the jaw may be loose teeth. A narrow ulcer is often detected on the mucous membrane of the alveolar edge, which does not increase in size for a long time, although cancer of the jaw in the bone spreads quickly. In the process, facial deformation occurs due to the spread of infiltration to the bottom of the oral cavity and the chin cavity.

In later stages there is involvement in tumor process submandibular salivary gland, then parotid. When the disease is cancer of the jaw, the ulceration of the tumor increases from the side of the oral cavity, and inflammatory phenomena appear. The pain becomes stronger, mouth opening is limited. Infiltration extends to the internal pterygoid and masseter muscles, to soft sky and the palatine tonsil with arches, on the lateral wall of the pharynx. The digestive process is disrupted, and cachexia develops as a result.

Symptoms

Symptoms of cancer growing in bottom part jaws, depend on the accompanying inflammatory process. As a rule, patients are early bothered by small ulcers on the mucous membrane of the alveolar margin. They can be clearly seen, so the reason that caused them can be immediately established.

The inflammatory process can also occur for other reasons, for example, a decayed tooth, an old denture, etc. In such situations, after using weak cauterizing drugs, small cracks and ulcers heal. But if this is not observed, then you should think about the development of jaw cancer. Particular attention should be paid to those people whose pain at the site of the ulcer increases or the ulcer periodically bleeds. Over time, the site of infiltration or ulcer increases, and loose teeth occur.

Typically, such patients are seen by dentists who provide anti-inflammatory treatment. That is why it depends on their attentiveness early detection jaw cancer diseases. Experience shows that often the time between the onset of the disease and the implementation of necessary treatment amount to several months.

Detection of pathology

Detection of tumors of the lower jaw is based on a thorough study of the course of the disease, as well as morphological and radiological data. The diagnosis is made by x-ray, since x-rays can detect destructive changes in the bone early.

IN initial stages sarcoma or jaw cancer, an x-ray shows bone loss. Its changed area does not have clearly defined boundaries; they are blurred. If jaw cancer is localized in the area of ​​the alveoli, then the cortical plates of its walls are destroyed, and an extensive zone of destruction of the spongy substance is visible around the circumference. If the process has spread, then the radiograph shows complete destruction of a certain part of the bone.

Informative is histological analysis surface tissues extracted tooth with his mobility. It is always necessary to strive to establish the cause of loose teeth. If the mucous membranes of the mouth have ulcerations and the area is clearly visible, a cytological analysis of the mucosa is performed to confirm the diagnosis.

Treating jaw cancer

Initially, it is necessary to carry out sanitation of the oral cavity. Carious and mobile teeth are not removed from the area where the tumor is located, as dissemination of cancer cells may occur. For small tumors limited to one anatomical part and not growing into the periosteum, resection of the lower jaw with primary bone autoplasty can be performed. If radiation therapy was performed before the operation, it is not recommended to postpone bone grafting after removal of the organ. But the operation can be performed no earlier than 3 weeks after completion of irradiation (this is the best time for the bone graft to engraft).

The most effective treatment for jaw cancer is considered to be a combined method, which involves preoperative radiation therapy followed by radical surgery. But many dentists and surgeons perform only surgery or perform post-operative radiation therapy.

For radiation therapy before surgery, it is better to use remote gamma therapy at linear accelerators. The number of fields is determined based on the size of the lesion and the presence of regional metastases. When irradiating pathology, the total dose is 5000-6000 rad.

Metastasis

The process of metastasis of pathology occurs through the lymphogenous route. Most often, metastases are observed in the submandibular zone and fuse with the lower jaw quite early, after which they infiltrate the skin.

If jaw cancer is in neglected form, then metastasis to the spine, liver and other distant organs is noted. But often metastasis to the cervical lymph nodes and distant organs is not present. In the case of sarcoma of the lower jaw, metastasis to distant organs rarely occurs, and they, as a rule, do not form in regional lymph nodes.

Secondary (metastatic) tumor formations are detected much less frequently compared to primary ones, and they are more often observed in women. Pathological metastases occur in lung, breast, thyroid, and stomach cancer.

In case of metastases, they are resected together with excision of the cervical tissue: if there is one metastasis in the submandibular region, then an upper fascial-sheath excision of the neck tissue is performed on one side, if metastases are present at the site of the branch of the common carotid artery, then a Krail operation is performed, if necessary, fascial-sheath excision cervical tissue.

Each patient is faced with the fact that chemotherapy at stages 3 and 4 ceases to reduce the tumor and metastases. This is an indication that it is time to switch to more modern methods of cancer therapy. For selection effective method treatment you can seek

During the consultation the following will be discussed: - methods of innovative therapy;
- opportunities to participate in experimental therapy;
- how to get a quota for free treatment at the cancer center;
- organizational matters.
After consultation, the patient is assigned a day and time of arrival for treatment, a therapy department, and, if possible, an attending doctor is assigned.

To identify the symptoms of jaw cancer, you must first understand the terminology of this word. Jaw cancer in oncology is called malignant neoplasms on the bones of the upper or lower jaw, originating directly from bone tissue. At the same time, approximately fifteen percent of the number of patients who turn to the dentist are due to complaints of jaw diseases. There is no specific age threshold, because a pathogenic change in the jaw can appear in both an infant and an elderly person. Since the structure of the maxillofacial part of the face is extremely complex due to the large number nerve endings, as well as large vessels, treatment is quite difficult - in each case it is individual. It is handled by a group of specialists consisting of: an oncologist, an ophthalmologist, a facial surgeon, and a dentist.
Phases of oncology spread:

• Pain in the jaw area (infrequent, periodic throbbing);
• Changes in the jaw bone (the process of “fouling” with foreign tissues);
• Changing facial symmetry
• Displacement, loosening of teeth;
• Impaired ability to swallow painlessly (even ordinary eating brings suffering with pain);
• The mobility of the jaw is severely limited (it is impossible to move the mouth).

Localization of the disease in the facial area

Cancer develops around the nose, the pterygoid part of the palate, near the eyes, in the pits under the temples, on the upper and lower jaws, and in the cheekbone area.The basis by which they began to designate the location of the disease was the work of Ongren; he characterized them as anterior inferior and posterior superior.
There are two degrees of development:

1. Primary cancer. Malignant neoplasm of bone. For example, osteosarcoma, which is a tumor of three types: osteolytic, osteoplastic, mixed. Or Ewing's sarcoma.
2. Secondary cancer. It forms a new tumor that metastasizes existing formations.

The size of the tumor is not very large, which makes its initial detection difficult. However, what was discovered at more early stage education is much easier to cure.

Determining the first symptoms

Below we will tell you how to recognize the symptoms of jaw cancer.
During its development, oncology occurs with virtually no symptoms. This makes it extremely difficult to diagnose. Over time they appear characteristic symptoms. What is important is that the symptoms of the upper and lower jaw are different.

Symptoms of cancer in the upper jaw

In the upper region, cancer develops in two phases.
Initial phase:

• Involuntary pain, unpleasant feelings;
• Headache;
• Pus from the nose;
• Numbness skin faces.

Second phase:

• Cheek swelling;
• The occurrence of numbness of the teeth, their instability;
• Change in facial ovality
• Growth of the alveolar region.

The type of oncology is diagnosed in 2% of cases malignant tumors.

Symptoms of cancer of the lower jaw

When a tumor forms in the upper posterior section, then developing into the lower part of the orbit the following symptoms occur:

• Deformation of the eye;
• Increased tear production;
• The occurrence of pain reflected in the temples.

Initial phase:

• Toothache;
• Numbness of the lower lips;
• Unsteadiness with possible loss of some teeth.

Second phase:

• Formation of ulcers on the alveoli;
• Unpleasant odor from the mouth;
• Acute dental pain;
• Bleeding;
• Bringing together both jaws;
• Development of cachexia.

The disease is much less common. Do not forget that sarcoma develops much faster than a new malignant tumor.
Due to the fact that the symptoms exhibited by cancer of the upper and lower jaws appear extremely dimly, patients either do not engage in treatment at all, or are trying to fight a completely different disease. At the same time, their actions only harm their own health. As a result, if you detect the smallest signs of such a formation as cancer of the upper and lower jaws, you must immediately contact the appropriate doctor.

Reasons for development

The problems of oncology are still being studied today. At the same time, experts, despite the long history of studying the disease, to this day have not been able to come to a consensus about the causes of its occurrence. According to some reports, cancer occurs due to:

• Injuries;
• Disorders of the oral mucosa;
• Dental defects - caries, stones;
• Constant inflammation - periodontal disease, sinusitis;
• The influence of foreign objects - crowns, dentures;
• Various radioactive radiation;
• Availability bad habits.

More serious reasons are:

• The presence of tumors located in other organs and tissues;
• The beginning of processes that contribute to its development - leukoplakia, papilloma, for example.

The problem of the disease has not yet been fully studied and requires continued research.

Ways to overcome the disease

All necessary procedures to get rid of the disease are prescribed exclusively after full examination. Diagnosis is carried out by a surgical dentist and an oncologist. Upon completion of the examination, the patient is sent for an x-ray. With its help, the degree and location of destruction of bone tissue is determined. Depending on the results, the countermeasures technique is determined. Despite its results, it is always complex. First there is an operation. Its complexity and technique depend on the location of the tumor.
Nowadays modern treatment methods use technologies such as:

1. Not complete resection. It is prescribed from the onset of the development of the disease, affecting exclusively the surface of the bone.
2. Segment resection. Treatment, in the absence of deep lesions, without intervention in the alveolar process.
3. Half resection. Necessary if the angular area is affected.
4. Absolute resection. Used when the chin area is infected.

Forecasting

With the development of new medical technologies, there are also modern techniques treatment of this disease. They include adjuvant, neo-adjuvant chemotherapy with the possibility of using radiotherapy. All of them can be used in conjunction with traditional surgical intervention. Treatment using the latest achievements of scientific and practical medicine makes it possible to alleviate the suffering of patients with pain, increase percentage surviving patients with osteolytic sarcoma. The likelihood of success in treatment increases extremely severe case with large metastases. However, it is worth noting that the diseases discussed above progress and go away much easier compared to oncological diseases, affecting the lungs, bones or other organs, tissues of the human body.
As a result, I would like to say that taking care of your own health should be a priority - a goal for absolutely every person. An incorrect lifestyle, the presence of bad habits, addictions, a negligent attitude towards one’s own health - all this leads to the fact that a person begins to suffer unbearably. He himself is to blame for all this. Taking care of your body, leading healthy image Throughout life, a person is largely able to protect himself from cancer.

Video on the topic “Life after cancer”

He didn't give up, and you?