Clinical presentation of maxillary and mandibular carcinomas
Malignant lesions of the jaws are most often secondary in nature. In the maxilla, the process usually originates in the epithelium of the maxillary sinus, whereas in the mandible, it starts on the mucosa of the alveolar process.
In the early stages, the disease is asymptomatic. The complaints that bring patients to the physician typically indicate the presence of an advanced tumor (stages II–III).
Signs of progressive maxillary cancer:
- Nasal obstruction and chronic rhinitis with purulent-hemorrhagic discharge.
- Headaches and toothaches.
- Numbness (paresthesia) in the cheek area.
- Eyelid edema, lacrimation, and, in later stages, visible bone deformation.
Features of mandibular cancer: The tumor is most frequently localized in the molar region. Patients complain of neuralgic pain, numbness of the chin, and tooth mobility. If the process involves the posterior segment, the tumor invades the masticatory muscles, causing trismus (contracture). In the anterior regions, a bleeding ulcer with rolled edges rapidly forms. Metastasis occurs primarily via lymphatic pathways (to the submandibular lymph nodes).
Instrumental and morphological diagnostics
Clinical data combined with instrumental methods help identify the oncological process:
- Radiography and CT. In early-stage maxillary cancer, opacification of the sinus is visible, followed later by destruction and complete disappearance of its wall contours. In the mandible, the bone defect initially has a crescent shape, after which the borders become blurred, resembling the "melting sugar" sign.
- Ultrasound and endoscopy. Sinuscopy allows visual inspection of the maxillary sinus from the inside and targeted tissue sampling for analysis.
- Biopsy and cytology. This is the definitive method. The material is obtained by puncture or excision of a tumor fragment at the border with healthy tissue.
Important: When performing differential diagnosis with sinusitis or benign processes, it is strictly prohibited to prescribe physiotherapy, extract teeth, or perform socket curettage — incorrect management provokes accelerated tumor growth.
Treatment tactics and prognosis
A combined approach is used to treat malignant jaw tumors, which includes:
- Preoperative radiation therapy (telecobalt therapy at doses of 40–42 Gy; up to 70 Gy for unresectable forms).
- Surgical stage (electrosurgical or conventional resection of the affected bone).
- Removal of regional lymph nodes (if they are enlarged and involved in the process).
Despite radical treatment, the prognosis remains guarded. The five-year survival rate following combined treatment for maxillary cancer is 35–49%, while for mandibular cancer it is only 20–30%.
Pleomorphic adenoma of the salivary glands
Benign neoplasms (accounting for 1–2% of all tumors) most commonly affect the parotid gland. The most frequent histological type is pleomorphic adenoma (mixed tumor).
It grows slowly, painlessly, and may cause no discomfort for years. On palpation, it is a dense, relatively immobile mass with a smooth or nodular surface (nodularity does not indicate malignancy). The skin over the node is unchanged, and the secretory function of the gland is preserved.
A special case is "iceberg tumors". They are located in the deep lobe of the parotid gland, grow inward (into the parapharyngeal space), and externally cause almost no change in facial symmetry. Bimanual palpation helps detect them.
On sialography, benign adenoma presents as a clear filling defect with preserved duct continuity (the "ball in the hand" sign).
Briefly: answers to topical questions
Which histological forms of malignant tumors are most frequently found in the maxillofacial region?
Carcinomas are the absolute predominant malignant neoplasms in the maxillofacial region. Sarcomas are significantly less common.
- Carcinomas are malignant neoplasms of epithelial origin.
- The disease can occur at any age, but primarily affects individuals over 40 years old.
- The definitive diagnosis is established solely after histological examination of tissue material.
What instrumental diagnostic methods are used to detect maxillofacial tumors?
A comprehensive set of instrumental diagnostic methods is used to detect maxillofacial tumors.
- Radiography provides the most complete information; extraoral, intraoral, and panoramic views are used.
- Computed tomography (CT) is indicated for precisely determining the extent of tumor spread and the nature of destruction of the maxillary sinus walls.
- Ultrasound examination (US) is an additional non-invasive scanning method for the maxillary sinuses.
- Endoscopic examination (sinuscopy) allows visual assessment of the sinus condition and targeted biopsy.
- Orthopantomography is used to obtain an overview image of the teeth and jaws and is effective in the primary diagnosis of tumors.
What specific complications arise after radiation therapy to the maxillofacial region?
Radiation therapy to the maxillofacial region can lead to specific complications affecting bone tissue and mucous membranes.
- Osteoradionecrosis of the jaws is a severe complication primarily affecting the mandible.
- Radiation osteomyelitis is an inflammatory process frequently caused by tooth extractions within the irradiation zone.
- Mucosal ulceration leads to exposure of the underlying bone followed by the development of osteomyelitis.
Normal tissues within the irradiation zone become extremely vulnerable, therefore any invasive interventions in the early stages are not recommended.
By what criteria is the stage of jaw cancer determined according to the TNM classification?
The stage of the tumor process according to the international TNM classification is determined based on the assessment of the primary tumor and the presence of metastases.
- T (tumor) characterizes the extent of the primary tumor (its size, degree of organ involvement, and involvement of surrounding tissues).
- N (nodulus) reflects the extent of metastasis to regional lymph nodes.
- M (metastasis) indicates the presence or absence of distant hematogenous metastases.
In cases of cancer recurrence following surgical treatment, the lowercase letter "p" is added to these symbols (e.g., pT, pN, pM).
Dangerous errors in unclear jaw pathology: P-S-I-P — Physiotherapy, Surgical extraction (tooth removal), Incisions, Punctures/curettage (iatrogenic). These actions can provoke rapid tumor growth!
Class and exam questions
Why do patients with maxillary cancer often present at advanced stages?
In the early stages, cancer is asymptomatic. Noticeable complaints, such as breathing difficulty, pain, and epiphora, appear only once the tumor is established (stage II–III).
How to differentiate maxillary sinus cancer from chronic sinusitis?
In cancer, nasal discharge is purulent-hemorrhagic, palpation of the anterior sinus wall is painless, and radiographs show destroyed bone walls whose contours cannot be traced.
Is salivary gland function preserved in pleomorphic adenoma?
Yes, in benign pleomorphic adenoma, the duct orifice is unchanged, and the secretory function of the salivary gland itself is not impaired.
What else to study on this topic
- Pathways of regional and distant metastasis when cancer invades various parts of the jaws.
- Changes in the complete blood count (anemia, ESR, leukocytosis) during malignant tumor breakdown.
- Differential diagnosis of jaw cancer with chronic osteomyelitis and specific infections (syphilis, tuberculosis).
- International Histological Classification of Salivary Gland Tumors (WHO, 1976 and ICD-O, 1997).
- Mechanism of obstructive sialadenitis development due to duct compression by an adenoma.
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Other topics from the section "Chapter 14. Tumors and Tumor-like Lesions of the Maxillofacial Region (V.N. Bogatov, S.N. Lebedev)"
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