Tumor process of maxillofacial region (1)

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Tumor processes in the maxillofacial region

• Swetha Durairaj
• Group-15
• 2nd year 3rd sem

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What is tumor??

• A tumor is also called neoplasm.
• Tumors are overgrowth of tissue and occur due
  to abnormal cell growth. Tumors can occur almost
  anywhere in the body.
• Types
• Benign (noncancerous),
• Malignant (cancerous).

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Tumors on maxillofacial region

• Cancer of the upper jaw and maxillofacial region
  is a dangerous disease that, due to late
  diagnosis and late treatment of the patients.
• Malignant tumors of the maxillofacial structures
  include oral cancer, oropharyngeal cancers,
  salivary gland malignancies and various types of
  non-oral epithelial malignancies.
• Squamous cell carcinoma (SCCA) constitutes
  approximately 90 of all malignancies found in
  the oral cavity and oropharynx.

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Oral cancers

• Mouth cancer, also known as oral cancer or
  cancer of the oral cavity, is often used to
  describe a number of cancers that start in the
  region of the mouth. These most commonly occur on
  the lips, tongue and floor of the mouth but can
  also start in the cheeks, gums, roof of the
  mouth, tonsils and salivary glands.

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• Causes
• Mouth cancers form when cells on the
  lips or on the mouth develop changes (mutations)
  in their DNA. A cells DNA contains the
  instructions that tell a cell what to do. The
  mutations changes tell the cells to continue
  growing and dividing when healthy cells would
  die. The accumulating abnormal cancer cells can
  form a tumor. With time they may spread inside
  the mouth and on to other areas of the head and
  neck or other parts of the body.
• Risk factors
• The main risk factors for most mouth
  cancers are tobacco and alcohol consumption.
  Other risk factors can include
• human papillomavirus (HPV)
• epstein-barr virus (EBV)
• family history of mouth cancers
• poor oral hygiene and gum disease
• exposure to the sun

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Symptoms of oral cancer
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• Treatment
• Treatment for mouth cancer depends
  on your cancers location and stage, as well as
  your overall health and personal preferences. You
  may have just one type or may undergo a
  combination of cancer treatments. They include
  surgery, radiation and chemotherapy.
• -Surgery
• Surgeon may cut away the tumor and a
  margin of healthy tissue that surrounds it to
  ensure all of the cancer cells have been removed.
  Smaller cancers may be removed through minor
  surgery. Larger tumors may require more-extensive
  procedures. For instance, removing a larger tumor
  may involve removing a section of your jawbone or
  a portion of your tongue.

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• Radiation therapy
• Radiation therapy uses X-rays and
  protons, to kill cancer cells. Radiation therapy
  is often used after surgery. But sometimes it
  might be used alone if you have a early-stage
  mouth cancer. In other situation, radiation
  therapy may be combined with chemotherapy. This
  combination increases the effectiveness of
  radiation therapy.
• The side effects of radiation therapy
  to your mouth may include dry mouth, tooth decay
  and damage to your jawbone.
• Chemotherapy
• Chemotherapy is a treatment that uses
  chemicals to kill cancer cells. Chemotherapy
  drugs can be given alone, or in combination with
  other cancer treatments.
• The side effects include nausea, vomiting
  and hair loss.

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• Targeted drug therapy
• It treats mouth cancer by altering specific
  aspects of cancer cells helps their growth. These
  drugs can be used alone or in combination with
  chemotherapy or radiation therapy.
• Cetuximab (Erbitux), is one of the targeted drug
  used to treat mouth cancer .Side effects are skin
  rash, itching, headache, diarrhea and infection.
• Immunotherapy
• Immunotherapy uses your immune system to fight
  cancer. Your bodys disease-fighting immune
  system may not attack your cancer because the
  cancer cells produce proteins that blind the
  immune system cells. Immunotherapy works by
  interfacing with that process.
• Example nivolumab and pembrolizumab

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Oropharyngeal cancer

• Oropharyngeal cancer is a type of head and neck
  cancer. Sometimes more than one cancer occur in
  the oropharynx and in other parts of the oral
  cavity, nose, pharynx, larynx, trachea or
  esophagus at the same time.
• The most common cause of oropharyngeal cancer is
  HPV- Human Papilloma Virus can infect the mouth
  and throat ( back of the throat, including the
  base of the tongue and tonsils ) and also people
  who use tobacco and alcohol.
• Symptoms lump in the neck, neck mass,
  difficulty or pain with swallowing, muffled
  voice, ear pain, throat pain, lump or mass in the
  back of the throat.

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• Treatment Surgery (minimally invasive robotic
  surgery and neck dissection), radiation and
  Chemotherapy.

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Salivary gland cancer

• Mucoepidermoid carcinoma are the most common type
  of salivary gland cancer. Most start in the
  parotid glands. They develop less often in the
  submandibular glands or in minor salivary glands
  inside the mouth. These cancers are usually low
  grade, but can sometimes be intermediate or high
  grade.
• Its risk factor increases with age.
• Radiation treatment to the head and
• neck area can also increase your risk.

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Intraoral carcinoma

• The most common sites for intraoral carcinoma are
• Tongue (usually the posterior lateral and ventral
  surfaces)
• Floor of mouth
• Gingiva
• Alveolar bone,
• Buccal mucosa
• Labial mucosa
• Hard palate

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Carcinoma in tongue

• 25 to 50 of all intraoral cancer.
• Less common in women than in men.
• Essentially a disease of the elderly, but it may
  occur in young persons.
• Etiology
• 1.Syphilis
• 2. Leukoplakia
• 3.Poor oral hygiene
• 4. Chronic trauma
• 5. Alcohol and tobacco.

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• Clinical Features
• Painless masses or ulcers
• Lesion ultimately becomes painful, especially
  when it becomes secondarily infected
• Present in mostly posterior lateral border
• 20 occur on anterior lateral or ventral surfaces
  and only 4 occur on the dorsum (syphilitic
  glossitis)

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Carcinoma of floor of the mouth

• 15 of all intraoral carcinomas
• Average age -57 years, mostly men.
• Most often arise in the midline region near the
  frenum.
• Etiology
• Preexisting leukoplakia or erythroplakia
• Alcohol
• Tobacco
• Poor oral hygiene

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• Clinical Features
• Indurated ulcer of varying size
• May or may not be painful
• More frequently in the anterior portion of the
  floor than in the posterior area
• May invade the deeper tissues and may extend into
  the submaxillary and sublingual glands.
• Limitation of motion of tongue, often induces a
  peculiar thickening or slurring of the speech.

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Carcinoma of gingiva

• Gingival squamous cell carcinoma (GSCC) is a rare
  neoplasm, which often presents with nonspecific
  features such as toothache, lymph nodes swelling,
  oral bleeding, and congestion that may lead to a
  misdiagnosing.
• Clinical Features
• Present in mandibular gingiva gt maxillary gingiva
• Initially as an area of ulceration which may be a
  purely erosive lesion or may exhibit as granular
  growth.
• Often destroy the underlying bone and cause tooth
  mobility.

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• Treatment
• Treatment includes root planning was performed
  in teeth systemic antibiotics.
• The patient was advised to take amoxicillin 250
  mg clavulanic acid 125 mg three times a day,
  diclofenac 50 mg paracetamol 500 mg twice
  daily for 5 days and clorhexidine mouthwash twice
  daily for 7 days.

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Carcinoma of alveolar bone

• Alveolar carcinoma usually painless
• Most frequently arise from posterior mandibular
  region
• Sometimes as extension of gingival carcinoma
• Mimic common, benign inflammatory and reactive
  lesions
• Tumors of the maxillary alveolar ridge may extend
  onto the hard palate.

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Carcinoma of buccal mucosa

• Occurs chiefly in elderly persons of 58 years
• Caused due to chewing tobacco and habit of
  chewing betel nut and precursor of leukoplakia.
• Also causes painful ulceration.

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Carcinoma of the palate

• Poorly defined, ulcerated, painful lesion
• May extend laterally to lingual gingiva or
  posteriorly or involve the tonsillar pillar or
  even uvula.
• May invade into the bone or occasionally into the
  nasal cavity, while infiltrating lesions of the
  soft palate may extend into the nasopharynx.

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Carcinoma of retromolar trigon

• May spread to numerous adjacent structures,
  including the oropharynx, buccal mucosa, alveolar
  ridge, and pterygomandibular raphe.
• Invasion of the pterygomandibular raphe may lead
  to involvement of the skull base,masticator
  space, and floor of mouth.

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Carcinoma of maxillary sinus

• An exceedingly dangerous disease.
• Uncommon malignancy
• Squamous cell carcinomas if the paranasal sinuses
  have been associated only weakly with tobacco use
• Etiology factor HPV
• If the tumor perforates the lateral wall of the
  sinuses, unilateral facial swelling and pain are
  present.
• With medical extension, nasal obstruction and
  hemorrhage are common.

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• When the second division of trigeminal nerve is
  involved, intense pain or paresthesia of the
  midface or maxilla may occur, perhaps stimulating
  a toothache.

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Squamous cell carcinoma

• Almost all of the cancers in the oral cavity and
  oropharynx are squamous cell carcinomas, also
  called squamous cell cancers.
• These cancers start in squamous cells, which are
  flat, thin cells that form the lining of the
  mouth and throat.

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• Risk factors Tobacco use of any kind, including c
  igarettes, cigars, pipes, chewing tobacco and
  snuff, among others. Heavy alcohol use. Excessive
  sun exposure to your lips. A sexually transmitted
  virus called human papillomavirus (HPV)
  A weakened immune system.

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• Variants of squamous cell carcinoma
• Some of the variants of squamous cell carcinoma
  are
• Verrucous Carcinoma
• Spindle cell carcinoma
• Adenoid squamous cell carcinoma
• Basaloid squamous cell carcinoma
• Adenosquamous carcinoma

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Spindle cell carcinoma
Adenoid squamous cell carcinoma
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• Treatment
• Surgery is usually the recommended treatment.
  This involves removing the SCC with a margin of
  normal skin around it, using a local anaesthetic.
  
• The skin is then closed with stitches or
  sometimes a skin graft is needed. Sometimes other
  surgical methods are used such as curettage and
  cautery.

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Ameloblastoma

• Ameloblastoma is a rare, noncancerous (benign)
  tumor that develops most often in the jaw near
  the molars. Ameloblastoma begins in the cells
  that form the protective enamel lining on your
  teeth. The most common type of ameloblastoma is
  aggressive, formiAmeloblastoma is a rare,
  noncancerous (benign) tumor that develops most
  often in the jaw near the molars. Ameloblastoma
  begins in the cells that form the protective
  enamel lining on your teeth. The most common type
  of ameloblastoma is aggressive, forming a large
  tumor and growing into the jawboneng a large
  tumor and growing into the jawbone