Tumours of the Jaws

Malignant Tumors Tumor: –Is a mass of cells, tissues or organs resembling those normally present but arranged atypically and behave abnormally. Behavior is very essential and is of great importance.

Malignant Tumors Classification: –Histogenetic: Epithelial origin connective tissue origin –Histological: Degree of differentiation. –Well –moderate –poorly differentiated

Malignant Tumors –Clinical behavior: Benign: –slowly growing and expanding causing pressure atrophy but remain within the capsule. –Very few mitosis could be seen. Malignant: –Invade surrounding tissues and locally invasive. –Progressive growth and metastasize to distant organs, embolic spread due to lack of cell adhesion –Mitosis. Intermediate: –Locally invasive, no metastasis. Basal cell carcinoma and Ameloblastoma

Malignant Tumors Oral lesion are: – Carcinomas: Non ‑ secreting epithelial –Squamous cell 90% Secreting epithelial –Adenocarcinoma 5% –Sarcomas: LymphomasOthers

Malignant Tumors Early diagnosis is very essential for management Clinical diagnosis from the signs and symptoms Referral for essential investigation

Malignant Tumors CLINICAL DIAGNOSIS OF ORAL CANCER –Symptoms vary according to the site of the lesion painless in the early stages painful and tender when secondarily infected or involves a sensory nerve painless lump or ulcer on the lip Posteriorly no symptom until it reach a size of 2 ‑ 3 cm swelling, –pain and difficulty in deglutition absence of symptoms until the tumor metastasize to regional lymph nodes –hard lump on the neck

Malignant Tumors late symptoms: –pain due to secondary infection or nerve involvement –excessive salivation –difficulty in deglutition, speech –haemorrhage Within bone : –painless swelling involving the buccal and lingual or palatal sulci – teeth become loose and painful ‑ acute alveolar abscess –edentulous pt. the denture does not fit –denture hyperplasia –anaesthesia of the upper or lower lip and the cheek.

Malignant Tumors Carcinoma of lip: age 50 ‑ 70 years. Male lower class. –Predisposition factor: dirty, jagged and stained teeth irritation. tobacco smoker leukoplakia. intense solar radiation ‑ blistering cheilitis due to sunshine.

Lower lip affected in 93% Upper lip affected in 5% Angle of mouth affected in 2% Metastases within a year ‑ submental, submandibular and upper jugular. D.D.: –Molluscum pseudo­ carcinomatosurn lower lip. Death due to infection and bronchopneumonia.

Malignant Tumors Carcinoma of tongue Anterior 2/3, affect males Posterior 1/3 equal in both sexes. Age over 60 years. –Predisposing factors: Female with cancer tongue suffer from Paterson ‑ Kelly syndrome. Bad oral hygiene Heavy alcoholic with element of Vit.B deficiency. Producing precancerous mucosal atrophy Syphilitic and leukoplakia. 25% and 5%. Superficial glossitis, papilloma, fissures and non ‑ specific ulcers.

Malignant Tumors Site & Types: –1. lateral edge of tongue 58% –2. tip of tongue 2 ‑ 4% –3. dorsum. of tongue 7 ‑ 15% –4. posterior 1/3 21 ‑ 33% 1. ulcerative 2. fissured malignant 3. papillary 4. flat nodules 5. scirrhous or atrophic type

Malignant Tumors Clinically: –Painless swelling –Painful infected ulcer, referred pain to the ear. –Excessive salivation, marked factor oris, haemorrhage –loss of mobility due to fixation to the floor of the mouth.

Malignant Tumors –Fixation occur at first on one side, when tongue is protruded it deviate toward the affected side –indurations, fungation or ulceration which spread to the floor of the mouth and alveolar process and from post. 1/3 to the fauces, valleculae and epiglottis bilaterally. –Spread to regional lymph nodes. –Death: Inhalation bronchopneumonia, haemorrhage, cachexia and starvation and asphyxia.

Malignant Tumors Carcinoma of the mouth: –Floor of the mouth. Typical malignant ulcer extend to alveolar process & tongue. –The cheek: warty and proliferative. –The alveolar process: warty, nodules or proliferative.

Malignant Tumors –Palate: spread extensively before involving bone papillary or ulcerative. –Soft palate and fauces: Poor prognosis. bilateral Lymph node involvement Proliferative, fungating lesion spread to base of tongue. Pain, dysphagia and death due to erosion of carotid artery

Malignant Tumors Malignant neoplasm of antrum: –Squamous cell carcinoma 93% of cases. –Infiltrate soft tissue, destroys bone, fungate either through cheek, mouth or pharynx. –Spread to deep upper cervical lymph nodes. Adenocarcinoma lympho ‑ epithelioma sarcoma rare

Malignant Tumors Clinically: –earliest symptom: unilateral sera ‑ sanguineous discharge or frank epistaxsis in elderly. unilateral swelling of cheek, buccal sulcus or palate dislodging denture, loose Painful and periostitic teeth &alveolar abscesses Denture hyperplasia or granuloma.

Malignant Tumors Anaesthesia of cheek due to involvement of infra orbital nerve. Anaesthesia and/or paraesthesia of the palate due to involvement of sphenopalatine ganglion

Malignant Tumors –Medial spread : occlusion of nasolacrimal duct (epiphora) blocked nostril and blood ‑ stained discharge of pus –Superior spread: Eye is proptosed and with involvement of Ms & Ns strabismus, limitation of movement, diplopia –Trismus due to involvement of medial pterygoid muscle. –Pain due to secondary infection.