Oral and maxillofacial tumors
Introduction
Introduction to oral and maxillofacial tumors Oral and maxillofacial tumors: The oral and maxillofacial region is one of the most prevalent sites of the tumor, and various types of tumors can occur. Various benign tumors can occur in the oral and maxillofacial regions. Occurs in soft tissue, such as mixed tumors of the parotid gland, gingival tumor, hemangioma, lymphangioma, neurofibromatosis, fibroids, etc. Occurred in bone tissue, such as giant cell tumor, osteoma and so on. Some orthotopic tumors in the oral and maxillofacial regions are associated with odontogenic tissues, and are odontogenic tumors such as dental tumors and ameloblastomas. Malignant tumors of the oral and maxillofacial regions are common with cancer, and there are fewer sarcomas. The majority of cancers are squamous cell carcinoma, followed by glandular epithelial cancer, basal cell carcinoma, undifferentiated carcinoma, and lymphoid epithelial cancer. The treatment plan should be determined according to the lesion condition of the cancer (tissue source, degree of differentiation, growth site, lesion size, lymph node metastasis, etc.) and the general condition of the patient. Treatments include surgical resection, radiation therapy, chemotherapy, immunotherapy, cryosurgery, laser and Chinese herbal medicine. basic knowledge The proportion of illness: 0.001%-0.003% Susceptible people: no specific population Mode of infection: non-infectious Complications: oral cancer
Cause
Oral and maxillofacial tumor etiology
Alcohol and tobacco stimulation (25%):
The carcinogenic factors in tobacco are mainly chemical substances, benzoquinone. The possibility of cancer in long-term smokers is much higher than that of non-smokers. Smoking, cigars or chewing tobacco mainly cause oral cancer, and the face of the cigarette is prone to lip cancer. Related to long-term burning. Alcohol increases the risk of developing oral cancer because of its toxicity to normal cells, which impairs the immunity of the liver, and its incidence increases with the increase in alcohol consumption. At the same time, people with tobacco and alcohol hobbies have a higher risk of developing oral cancer, which is 2 to 3 times higher than those who are smothered with smoke or alcohol. It is generally believed that smoking more than 1 pack / day or drinking more than 25 grams / day, the probability of suffering from oral cancer or oropharyngeal cancer for 10 years is much higher than non-smoking or drinkers.
Chronic irritation and injury (15%):
In the oral cavity, there are sharp cusps, residual roots, residual crowns, gingiva and poor prosthesis. The corresponding parts may have cancer after long-term chronic stimulation, especially in tongue and cheek cancer. Statistics show that 1/5 of patients with oral cancer have sharp stimulating factors at the cancerous site. In addition, long-term chronic inflammatory stimuli in people with poor oral hygiene may also be a cancer-promoting factor.
Ultraviolet and ionizing radiation (10%):
Engaged in outdoor workers, long-term exposure to direct sunlight, the incidence of both lip and skin cancer is high. Ionizing radiation can cause changes in the DNA of genetic material, activate tumor genes and cause cancer, and both gamma rays and x-rays have carcinogenic effects. Due to the widespread use of radiotherapy for nasopharyngeal carcinoma, the risk of developing a second primary cancer in the oral and maxillofacial regions of the radiation zone has increased.
Virus factor (5%):
For example, nasopharyngeal carcinoma is associated with Epstein-Barr virus, and squamous cell carcinoma is associated with human papilloma (HPV) virus.
Intrinsic factor (5%):
Including genetic mutations, genetic factors, immune status, endocrine factors and neuropsychiatric factors.
Nutritional factors (3%)
Such as vitamins A1 and B2 and trace element iron, zinc and arsenic deficiency will increase the body's sensitivity to carcinogens. In addition, chronic hepatitis, cirrhosis, and viral infections have a certain relationship with the development of oral cancer.
Prevention
Oral and maxillofacial tumor prevention
Implement the three-and-three-year policy:
Three pre-cancerous findings, precancerous diagnosis, precancerous treatment prevent precautions.
Three early detection, early diagnosis, early treatment prevention of the beginning, can get twice the result with half the effort.
(1) Elimination or reduction of carcinogenic factors: removal of the cause is the best preventive method.
(2) Dealing with precancerous lesions in time: it is an important link to prevent and block the development of oral cancer.
Precancerous condition: A general condition that significantly increases the risk of cancer. Common oral lichen planus (1-10%), discoid lupus erythematosus, epithelial hyperkeratosis, congenital keratosis and pigmented dry skin disease.
Precancerous lesion: A tissue that has been morphologically altered and has a greater likelihood of developing cancer than its corresponding tissue. White spot (1-60%), usually at 5%, and red class malignant change to 80%.
(3) Strengthening anti-cancer propaganda.
(4) Conducting anti-cancer screenings or monitoring of susceptible populations.
Complication
Oral and maxillofacial tumor complications Complications, oral cancer
1. The oral ulcer is not healed, the peripheral edge is raised, the center is uneven, and the pain is obvious.
2, local lymphadenopathy, oral cancer often metastasize to the nearby cervical lymph nodes, if the neck lymph nodes such as sudden swelling, you need to check the oral cavity, to rule out tumor metastasis.
3, the occurrence of loose teeth, shedding, bad teeth occlusion when chewing food, facial nerve abnormalities, numbness, unexplained nasal bleeding and other symptoms, should also seek medical attention as soon as possible.
4. The function of other organs in the affected area is limited, infection, etc.
Symptom
Oral and maxillofacial tumor symptoms Common symptoms Oral ulcers Oral mucosa on white... Nodular subcutaneous tissue induration
Oral cancer can be divided into Carcinoma of gingivae, Carcinoma of lip, Carcinoma of buccal mucosa, Carcinoma of tongue, Carcinoma of floor of The mouth), carcinoma of palate, carcinoma of the maxillary sinus, and the like. It is generally believed that the degree of cancer differentiation in the anterior part of the mouth is higher, and the degree of cancer differentiation in the posterior part of the mouth is lower.
Oral cancer is often characterized by ulcer, invasive and nipple types. From the beginning, it is often a local ulcer, induration or small nodules. Generally, there is no obvious spontaneous pain, and pain may occur as the cancer grows rapidly and infiltrates into the surrounding and deep tissues. The induration is enlarged, the protrusion of the tumor, the surface ulcer, or the edge bulge is cauliflower-like, the base is hard, and the center may have necrosis and stench. Often accompanied by infection, the surface is prone to bleeding. Different parts of the cancer have different symptoms and dysfunctions due to the destruction of adjacent tissues and organs. For example, tongue cancer has obvious pain and varying degrees of tongue movement limitation, affecting swallowing, speaking and other functions, with a higher degree of malignancy, rapid development, and lymph node metastasis in the early stage. Hepatic cancer often affects the alveolar bone, which tends to loosen or fall off the teeth. It can continue to expand and invade the jaw bone. The maxilla can invade the maxillary sinus, and the mandible can affect the inferior alveolar nerve, causing pain or numbness.
The metastasis of oral cancer is mainly through lymphatic drainage to regional lymph nodes, the most common being submandibular lymph nodes and deep cervical lymph nodes. A small number can be transferred according to blood. In the advanced stage, there may be distant metastasis, and the lung is common, and cachexia may occur.
Examine
Oral and maxillofacial tumor examination
Film degree exam
(1) X-ray inspection:
Understand the extent of bone tissue tumors and invasion.
Such as: odontogenic cysts, benign and malignant tumors of the jaw, etc., often photographed with curved flat slices, maxillary Valsal position, positive mandibular lateral position, maxillary bite and so on. Chest radiography is routinely performed on malignant tumors for pulmonary metastasis. The nature of parotid tumors can be understood by parotid angiography.
(2) CT examination:
(3) MRI examination:
It is suitable for the diagnosis of carotid body tumor, tongue root tumor, parotid tumor and lymph node metastasis.
(4) Ultrasound examination:
Principle: When ultrasound is transmitted in human tissues, there are different echo maps due to the different density and characteristics of various tissues. It can be determined whether the soft tissue tumor is substantial or cystic, and accurately indicates the tumor size. In addition, it is judged whether the tumor is benign or malignant according to the definition of the perimeter and the uniformity of the distribution of the light spots in the tumor.
(5) Radionuclide examination (isotopic examination).
Diagnosis
Diagnosis and differentiation of oral and maxillofacial tumors
diagnosis
Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.
Differential diagnosis
Need to be differentiated from the following diseases:
Tongue hemangioma is a common benign tumor of the tongue and is more common in children and young adults. Cavernous hemangioma is the most common. Cavernous hemangioma can occur in any part of the tongue. When the tumor starts, it has a nodular bulge higher than the surface of the tongue. The tongue is purple-red, and the tongue is lymphatic hemangioma of the tongue. The body is obviously enlarged, the mass of the contact is soft, the boundary is unclear, and the mass of the tumor is reduced. When the pressure is relieved, the tumor quickly returns to its original state, and the tumor gradually invades the surrounding tongue tissue. When the tumor enlarges, it affects the function of the tongue and speaks. Unclear, difficulty swallowing and difficulty breathing, the hemangioma is further enlarged to cause tongue deformity.
Cavernous lymphangioma, mainly composed of dilated and deformed lymphatic vessels. Occurs in the skin, subcutaneous tissue and intermuscular connective tissue gap. The color of the epidermis is unchanged, compressive, very soft, and multiple atrial cysts are connected to each other, and the structure is sponge. The incidence of the head and neck is the most, followed by the lower limbs, arms, tendons and trunk, the formation of the lips and tongue can form a giant lip (tongue).
