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

27.5. OSTEOSARCOMA

osteosarcoma is a malignant tumor that develops from osteoblast progenitor cells and is characterized by the formation of atypical bone or osteoid. Synonyms osteosarcomas:osteogenic sarcoma, osteoblastosarcoma, osteoblastic sarcoma, osteolytic sarcoma, osteoid sarcoma.

Rice. 27.5.1. Appearance of children with osteosarcoma of the upper jaw (a - front view, b side view) and with osteomyelitis mandible(c - front view, d - side view).

Previously, under this term, all sarcomas that are formed from bone tissue were combined. Subsequently, separate independent forms were isolated from osteosarcomas - chondrosarcomas And fibrosarcomas, which will be discussed in the relevant sections.

H Most often, young and middle-aged males are affected. Although they may occur in children (Fig. 27.5.1), as well as in the elderly. Most often localized on the lower jaw. During the period of intensive growth of the skeleton, osteogenic sarcomas are somewhat more common. In the elderly, osteosarcoma occurs less frequently, as a rule, against the background of an osteogenic tumor (osteoblastoma), chronic osteomyelitis or previous injury. In recent years, advanced forms of the development of this malignant tumor are extremely rare, which was often encountered earlier. (Fig. 27.5.2). Osteogenic sarcoma of the jaw is characterized by early hematogenous metastasis to the lungs. Osteosarcomas of the jaws are fast-growing tumors.

Rice. 27.5.2. Appearance of a patient with an advanced form of osteosarcoma upper jaw.

Pathomorphology . Macroscopically the tumor on the cut has a variegated appearance due to foci of necrosis and hemorrhage, areas of tumor and reactive bone formation. Areas of ossification alternate with areas of cartilaginous consistency.

Microscopically allocate osteoblastic, osteolytic (osteoclastic) And mixed tumor variants. osteoblastic the variant is characterized by the formation of atypical tumor bone tissue (dense whitish bone-like tissue). At osteolytic form, the tumor tissue grows (crumbling and bleeding mass), the cellular tumor component of the polymorphic composition predominates (atypical multinucleated cells).

Rice. 27.5.3. Appearance of a patient with osteosarcoma of the upper jaw (a - front view, b - side view).

Osteosarcoma that occurs in the thickness of the jaw is called central, and a tumor that develops from the peripheral parts of the bone - peripheral.

Clinic. The presence of a tumor that is painful on palpation in the region of the body or the alveolar process of the jaw is characteristic. The teeth within the tumor are mobile. Pain in intact teeth occurs for no apparent reason, radiating to the ear, eye. Night pains are typical. Patients often wake up in the middle of the night due to the presence of pain in the jaws or teeth. When the tumor grows into the nerve trunks in the jaw, paresthesia occurs, and then numbness (anesthesia) of the corresponding part of the jaw (symptom of Vincent).

P as osteosarcoma grows, deformation of the corresponding jaw, exophthalmos, congestion in soft tissues appears (Fig. 27.5.3). The mucous membrane of the alveolar process in the area of ​​the tumor is hyperemic, edematous, cyanotic (cyanotic), ulcers appear on the gums in case of injury. Osteosarcoma can suppurate with the appearance of appropriate symptoms. The tumor grows into the surrounding soft tissues. There is weakness, malaise, loss of appetite, fever. Regional lymph nodes are usually not enlarged.

For central osteosarcoma, the first clinical symptoms are often jaw pain and tooth mobility, and for peripheral- deformity of the jaw. osteoblastic sarcoma more common in children (Fig. 27.5.1) and in persons young age, A osteolytic (osteoclastic)- in adults.

Rice. 27.5.4. X-ray picture of the osteoblastic variant of osteosarcoma of the upper jaw

The radiographic picture of osteosarcoma of the jaw depends on the variant (form) of its course. For osteoblastic forms, it is characteristic that along with the destruction of bone tissue, there is an excessive formation of immature coarse fibrous bone. This is manifested on the radiograph by foci of osteosclerosis, and as the tumor grows beyond the compact jaw plate, a periosteal reaction appears in the form of a linear or needle periostitis (Fig. 27.5.4). On x-rays, so-called spicules- bone needles located perpendicular to the surface of the jaw.

Rice. 27.5.5. X-ray picture of the osteolytic (osteoclastic) form of mandibular osteosarcoma

Rice. 27.5.6. X-ray picture of odontogenic osteomyelitis of the lower jaw, which resembles osteosarcoma.

At osteolytic (osteoclastic) In the form of sarcoma, there is destruction of bone tissue with jagged areas (spicules). Teeth that are within the boundaries of the tumor are radiographically identified as devoid of surrounding bone tissue. (Fig. 27.5.5). At mixed variant, there are foci of osteolysis and osteosclerosis at the same time.

Diagnosis osteosarcoma is established on the basis of clinical, radiological and pathohistological data. Morphologically, the diagnosis of a tumor must be confirmed by cytological examination or incisional biopsy.

Differential diagnosis carried out with tumors of the jaws and odontogenic osteomyelitis (Fig. 27.5.1 and 27.5.6). Secondary tumors of the jaws of metastatic origin (with thyroid, breast or prostate cancer, kidney cancer) can be located in the jaw.

Treatment osteogenic sarcomas consists in resection of the jaw with affected surrounding soft tissues, followed by replacement of the defect with a graft. Combined and radiation (with a palliative purpose) therapy is used. The choice of treatment method depends on the location, size and prevalence of the tumor process, as well as on the general condition of the body and the age of the patient.

Oncology of the jaw is diagnosed in 1-2% of the total number cancer. It does not have a clear gender, develops at any age. At the same time, lesions of the lower jaw are less common than pathologies of the upper. Due to the complex structure of the maxillofacial system, tumors of its various departments are possible.

Malignant formations of the jaw are divided into osteosarcoma and epithelial cancer. Bones, soft tissues, blood vessels suffer. It is not easy to treat the disease, therefore great importance acquires early diagnosis. In it, an important role is played by the consultation of an otolaryngologist, dentist, ophthalmologist, surgeon and oncologist.

The concept of jaw cancer

Cancer of the lower jaw (or upper jaw) is also called squamous cell formation, adenocarcinoma, adenocystic carcinoma. The pathology is based on the transformation of healthy cells of the maxillofacial zone into tumor cells. In 60% of cases, the process develops from the epithelial tissues that line the maxillary sinuses. The prognosis of the disease is unfavorable, the therapy is long and complicated.

Causes of the disease

Malignant tumors arise and develop under the influence of several factors. The main provocateur of the disease are injuries in the face area. Additional reasons are:

• smoking, habit of chewing tobacco;
• improper care of teeth and gums;
• exposure to radiation;
• foci chronic inflammation on the mucosa;
• progressive caries;
• mucosal injury with malocclusion;
• low-quality prostheses;
• osteomyelitis;
• a consequence of oncology of the tongue, kidneys, thyroid gland(We recommend reading:).

Diagnostic methods

When making a diagnosis of jaw cancer, specialists rely on the patient's complaints, the results of palpation and visual inspection. To recognize the disease, an additional x-ray is taken in several projections, which allows you to see the picture of jaw cancer and differentiate it according to the following signs:

• destruction of spongy substance loops;
• destructive changes in the bone;
• foci of destruction and contours of transition to them from healthy tissues.

To confirm the diagnosis of cancer of the upper jaw allows a general clinical examination, blood tests, urine tests, fluorography, histological examination of the affected tissues. Additionally, scintigraphy is shown, CT scan sinuses, biopsy submandibular lymph nodes. The examination includes a consultation with an ophthalmologist and an ENT specialist, which will allow you to find out about the condition maxillary sinuses. In some cases, a puncture of the lymph nodes is prescribed to determine metastasis in cancer of the upper jaw.

Pathology is differentiated with symptoms of chronic osteomyelitis, osteogenic and odontogenic tumors, certain bone diseases. When confirming the diagnosis and identifying the degree of damage, the doctor prescribes a course of treatment, consisting of chemotherapy, radiation, and surgery.

Stages of development and symptoms of jaw cancer

This article talks about typical ways to solve your questions, but each case is unique! If you want to know from me how to solve exactly your problem - ask your question. It's fast and free!

A malignant lesion develops in several stages, as can be seen in the photo. According to the TNM classification, the following sequence of the spread of the disease is distinguished:

• T1 - cancer affects one anatomical part. There are no destructive changes in the bone.
• T2 - pathology affects two anatomical parts. Metastasis is found on the side of the lesion.
• T3 - the tumor affects more than 2 anatomical parts. During the examination, it is possible to identify 1-2 metastases.
• T4 - the pathology spreads further to other tissues. Metastases soldered to surrounding tissues are found.

Symptoms of the disease become noticeable quickly enough, since the oral mucosa immediately reacts to the inflammatory process. With a tumor of the maxillofacial zone, there are always observed pain, the bite changes, the shape of the nose. Additionally, there may be numbness of the skin, headache, bad smell from mouth, purulent discharge from the nose. Also possible:

• periodic throbbing pain in the area of ​​​​the teeth;
• changes in the facial bones (fouling with pathological tissues);
• progression of facial asymmetry;
• displacement of teeth;
• pain when swallowing, eating;
• limited jaw mobility.

Similar symptoms can speak not only about osteogenic sarcoma of the jaw, but also about other complex ailments. For example, neuritis, sinusitis, sinusitis. This is taken into account by doctors, and when making a diagnosis, a comprehensive examination is prescribed.

Primary and secondary type of tumor

Oncology develops in the cheekbones, near the eyes, in the infratemporal region, around the nose. According to the degree of development, the tumor is classified as:

What is a sarcoma?

Jaw sarcoma is the most aggressive form of cancer. It progresses faster than a cancerous tumor, and from timely diagnosis the patient's life depends. Education originates from connective or cartilaginous tissues, often affects upper part. With the advanced form of osteosarcoma of the upper jaw, damage is observed in the mouth area. Pathology is more often diagnosed in men 25-40 years old.

Causes

Osteogenic sarcoma of the jaw is characterized by rapid growth. Common causes of damage are:

• heredity;
• the effect of radiation;
• drug addiction, smoking, alcohol abuse;
• tumor pathologies in history;
• traumatic factors;
• contact with carcinogens (cobalt, mercury, lead and others);
• bad environment in the region.

Classification and signs of the manifestation of the disease

Jaw sarcomas are formed in the form of Ewing's sarcoma, fibrosarcoma, chondrosarcoma, osteogenic sarcoma of the jaw. By location, they are maxillary and mandibular, divided into central, peripheral and soft tissue. Known round cell sarcomas of the lower jaw, which developed over 2 months, manifested themselves as intense toothache. At the same time, the relief of bone tissue was rapidly destroyed, teeth crumbled and fell out.

The first sign of jaw sarcoma is the appearance of a small rounded formation with clear boundaries. Other signs of this cancer:

• Pain syndrome. The patient finds it difficult to determine the localization of pain. It is present in the area of ​​teeth close to the tumor. Possible pulling discomfort, shooting in the temples.
• Facial deformities. There is reddening of the mucosa with the growth of the tumor. Possible swelling of the face, destruction of bone tissue, compaction in the cheeks. When the process is located in the upper part, problems with nasal breathing, nosebleeds are possible.
• Numbness of the face. With mechanical pressure nerve endings sarcoma of the lower jaw, there is a lack of sensitivity of the chin and lower lip.
• Difficulty swallowing, chewing food. Over time, with osteosarcoma, bite problems join this.
• General deterioration of well-being. There is weakness, fever, swollen lymph nodes, and other symptoms.

Treatment of sarcoma and other malignancies

Treatment of osteosarcoma of the jaw, squamous cell carcinoma and other forms of oncology are prescribed only after complete diagnosis. Due to the severity and rapid spread of the disease, it cannot be delayed.

Under general anesthesia surgically remove the affected tissue. Then, before gamma irradiation, loose teeth are removed, radiation treatment or chemotherapy. After recovery, implants are installed to restore facial contours and improve the quality of life.

Surgical methods

First of all, surgical treatment is carried out, the technique of which depends on the degree of damage. Modern surgery uses these methods:

• with superficial lesions - partial resection;
• in the absence of deep foci and grazing of the alveolar processes - segmental resection;
• in case of cancer of the angle of the jaw - removal of its half;
• at the location of osteosarcoma in the chin area - resection of soft tissues and bones.

Radiation therapy

Radiation therapy and chemotherapy are part of a combinatorial intervention for jaw cancer. They are prescribed for inoperable patients, and are also carried out for effectiveness. surgical treatment. Contraindications to gamma therapy remain until the patient has loosened and decayed teeth removed from the area of ​​​​future irradiation.

The stage of preparation for the procedure includes the sanitation of the oral cavity, as well as the determination of lesions to which radioactive rays will be directed. The first session is carried out 2 weeks after the sanitation of the oral cavity. Manipulations are divided into palliative (two-week) and radical, carried out for several months. After the procedure, skin burns, distortion of taste perception, difficulty swallowing, overdrying of the mucous membranes are possible. Complications go away in the process of rehabilitation.

Chemotherapy

Chemotherapy for cancer of the upper and lower jaw involves taking cytotoxic drugs that can destroy cancer cells, prevent their reproduction and destroy metastases. Treatment regimens depend on the type and stage of the tumor (sarcoma of the lower jaw, upper jaw, squamous cell lesion). With inoperable neoplasms, palliative therapy is performed. In preparation for surgery, therapeutic chemotherapy is indicated. It can reduce the size of osteosarcoma or completely eliminate cancer cells.

Treatment of cancer of the upper jaw involves the combination of radiation and chemotherapy. When exposed to cancer of the lower jaw, cytostatic substances are introduced into the artery and regional chemotherapy is performed.

Recovery after treatment

Methods of fighting jaw cancer are aggressive, and after them the patient needs rehabilitation. In addition to complex prosthetics, a person needs updated operations, speech correction, and health improvement in general sanatoriums. Three-stage prosthetics are usually used:

• before the operation, an individual plate-prosthesis is made;
• making a forming prosthesis within 2 weeks after the operation;
• creation of the final prosthesis, compensation of soft tissue defects with splints and bone plates.

In case of cancer of the upper jaw, a commission is performed (II group of disability). Bone grafting is recommended to be performed 10-12 months after tumor removal. Radical intervention leads to disability and reduced ability to work, but over time, patients can return to mental work and other activities.

Prognosis for cancer of the upper and lower jaw

Jaw cancer can quickly spread to eye area. Growing, it causes the following consequences:

Can jaw cancer recur after treatment? According to the experience of oncologists, this is possible for several years after therapy. The five-year survival rate for cancer of the lower jaw is no more than 20-30%. With Ewing's sarcoma, osteogenic sarcoma, and other forms, the prognosis for survival is even more unfavorable.

Prevention of jaw cancer

Primary prevention of jaw cancer includes measures aimed at preventing the disease. These include:

• life without smoking and others bad habits;
• work with chemicals and reagents only for safety reasons;
• regular examinations at the dentist (acquire special significance with a genetic predisposition to cancer or jaw sarcoma);
• fight stress, good food, improvement of living conditions.

Prevention of recurrence of cancer of the lower jaw is based on the same postulates as primary prevention. A positive attitude, support from loved ones and faith in yourself are very important. It is required to observe moderate activity, not to give up light physical activity, to follow all the recommendations prescribed by the doctor. A careful attitude to health and the rejection of bad habits will reduce the risk of cancer, increase vitality and allow you to re-evaluate your priorities.

A rare but rather dangerous malignant neoplasm requiring emergency and multicomponent therapy - osteosarcoma jaws. The tumor, as a rule, is formed from the connective tissue, periosteum or cortical bone and spongy bone marrow of the upper jaw.

The disease is characterized by rapid growth and early metastasis, it responds poorly to therapeutic measures and has an unfavorable prognosis. Pathology can be diagnosed at any age, but more often in people 10–30 years old. The peak occurs during puberty. The incidence rate in representatives of the strong half of humanity is several times higher than in women.

Main reasons

To this day, justified reasons why osteosarcoma is formed in some people, while others safely avoid cancer, experts have not established.

There are theories that the formation of a focus of atypia in the jaw is based on a failure in the mechanism of bone growth in puberty life Studies have shown that the majority of cancer patients had an increased rate of skeletal formation.

Predisposing negative factors;

• jaw trauma;
• exposure to ionizing radiation;
• Availability benign neoplasms, Paget's disease.

Bone exostoses, fibrous degeneration, and deforming osteosis can degenerate into osteogenic sarcoma.

Symptoms

At the initial stage of its formation, the oncoprocess in the jaw may not manifest itself in any way. However, as it grows, the tumor focus affects neighboring structures and the patient begins to feel:

• discomfort in the affected area, for example, a foreign body;
• pain impulses with a load on the jaw;
• change in the location of the tongue and larynx;
• an increase in the size of the lymph nodes;
• loosening of teeth.

Cancer in the lower jaw is diagnosed earlier. Since the negative clinical manifestations appear already at 1-2 stages of the disease. Whereas, with osteogenic sarcoma of the upper jaw, symptoms form later, so diagnosis may be delayed.

Increasing in size, the neoplasm leads to a visual deformation of facial features. Often, the sensitivity of the surrounding soft tissues also changes. A characteristic clinical sign is swelling in the area of ​​the tumor. It may differ in diameter and consistency, palpation reveals soreness.

If the sarcoma has formed in the immediate vicinity of the temporomandibular joint, its contracture subsequently occurs. Decrease in mobility provokes difficulty in talking, eating. Dental elements suffer less than any ulcer defects on the mucosa with sarcoma, as a rule, is not observed.

In advanced cases, the deformation of the jaw is significant, the cancerous focus is huge, there are metastases in distant organs. Against this background, typical symptoms of intoxication are observed - severe weakness, fatigue, cachexia, subfebrile temperature.

Treatment tactics

After confirming the diagnosis - X-ray, CT, MRI, biopsy, the specialist will select the optimal scheme medical procedures. The main emphasis is on surgical excision of the tumor focus in combination with radiation therapy.

If the neoplasm is not large sizes and was diagnosed at 1–2 stages of formation, it is permissible to perform a jaw resection followed by autoplasty. The prognosis for five-year survival in this case is quite favorable.

Radiation therapy is usually given before surgical intervention to suppress the growth of atypical elements and reduce the size of the tumor. If it is impossible radical removal osteosarcoma, due to a number of objective reasons, radiation therapy combined with polychemotherapy.

Modern cytostatics have the ability to inhibit the growth cancer cells at the very beginning of their appearance. Thanks to this, it is possible to prevent metastasis, the main complication of the oncological process.

The prognosis is much more favorable and the five-year survival rate is higher if the patient applied for medical care, A medical measures were carried out comprehensively.

If you find an error, please highlight a piece of text and click Ctrl+Enter.

Sarcoma of the jaw is a very aggressive malignant tumor of non-epithelial origin that develops from the bone or connective tissue of the lower or upper jaw. According to statistics, men are more likely to get sick (about 60% of cases). The risk group includes young people from 20 to 40 years old, although cases of jaw sarcoma have been recorded in both the elderly and young children.

Reasons and forms

The most common form of spindle cell sarcoma has two varieties: small cell and large cell. The spindle-shaped form of cells is especially well expressed at small-cell sarcoma. The large-cell variety is characterized by polymorphism of cellular elements, and along with spindle-shaped cells, round and, often, process cells are observed. Both varieties have common feature- the development of powerful strands, consisting of closely lying cells of the described shape. The stroma is rather weakly expressed, especially when early stages tumor development. On each preparation, strands are visible in longitudinal, oblique and transverse sections. Round cell sarcomas and pigmented tumors that develop in the jaw region do not differ in their histological picture from those of tumors in other organs.

The rapid growth of the sarcoma and its tendency to extensive germination of neighboring organs, no less than when, make it difficult to determine primary focus sarcomatous growth. Often, the jaw is affected a second time, for example, when the initial focus is localized in the nasal cavity. In the primary lesion of the jaw, the sarcoma develops either from the central part of the bone, or the periosteum turns out to be the primary source of malignant growth. Accordingly, in relation to the lower jaw, two forms of sarcomas are distinguished: central, emanating from cancellous bone bones, and periosteal. The source of jaw sarcoma may also be connective tissue submucosal gums and periodontal teeth.

Sarcoma is characterized by a rapid increase in the mass of the tumor: this sign to a certain extent is important in the differential diagnosis. Large sarcomatous tumors without ulceration are often observed, which is very rare in cancer. Periosteal sarcomas of the lower jaw envelop the outside with a thick layer of bone and early give protrusion and displacement of the surrounding soft tissues. The floor of the mouth rises on the diseased side, the tongue shifts to the healthy side. Often, bone substance takes part in the structure of these tumors: bone plates begin to form in the mass of the tumor, sometimes having a radial arrangement, sometimes anastomosing with each other. These bone plates seem to make up the skeleton of the tumor.

Central jaw sarcomas are often giant cell intraosseous tumors. For a long time, these formations have been described as "striped", "brown" tumors. Their propensity to intratumoral hemorrhages and to the formation of necrosis of significant sections of the tumor is striking, accordingly, alternating red and yellow areas are visible on the section of the tumor. This picture is very typical for the described group of tumors. Growth is relatively slow, but, in any case, until the breakthrough of the cortical layer. Germinating, the latter begins to show signs of enhanced growth. In advanced cases, it is sometimes difficult to decide whether the tumor originates from the periosteum or from the central parts of the bone.

With sarcoma of the upper jaw, especially coming from the periosteum of the outer wall, there is a very large deformation of the face with a sharp displacement of the eye, nose and corner of the mouth.

Symptoms and course

Patients with malignant tumors of the jaws, of course, belong to the group of the most severe patients due to the difficulty and danger of surgical intervention, often great difficulties in choosing the method of prosthetics, and finally, due to little hope for a favorable outcome, not only remote, but also immediate.

The presence of a malignant neoplasm in the oral cavity often entails a violation of the functions of eating and speech quite early. A number of special conditions under which tumors of the oral cavity and jaws develop undoubtedly influence the early formation of ulcers and the decay of the tumor. The temperature of the oral cavity, a humid environment, constant exposure to mechanical strokes (eating) and the impossibility of thorough cleaning - these are the points that cause tumors to be prone to early ulceration if the oral mucosa is also affected by the tumor. The resulting ulcer rapidly increases both on the surface and in depth, due to necrosis of the bottom and walls. From now on clinical picture drastically changes for the worse, inflammatory phenomena appear to one degree or another, intoxication intensifies, the body's resistance decreases sharply.

Intense odor from the mouth, difficulty in eating, difficulty in swallowing create particularly difficult living conditions for the patient. Difficulties in eating in jaw sarcoma appear to play the greatest role lowering the body's resistance. most common cause death of these patients is aspiration pneumonia.

The rate of tumor growth and the progression of general depletion of the body depends on the type of tumor and its location. Slowly, over the years, intraosseous giant cell tumors develop. Often, squamous epithelial cancer has a long, slow course. The most intense malignant growth seems to be found in pigmented tumors that generalize very far over a short period of time, and some sarcomas. A sharp acceleration of growth and germination into the surrounding tissues can occur after a mechanical injury to the tumor. If until this moment the tumor did not give any signs, then it is sometimes extremely difficult to recognize the presence of blastomatous growth against the background of clinical phenomena after injury.

Pathological fractures of the lower jaw, due to infiltration of the entire thickness of the bone by tumor elements, are observed much more often in cancer than in sarcomas.

The increase in regional lymph nodes in malignant tumors of the jaws for the most part has a twofold origin. On the one hand, according to the anatomical conditions, there is the possibility of early and extensive damage to the nodes by metastatic transfer of tumor elements. Their defeat is especially pronounced in cancer of the lower jaw. On the other hand, the tendency of jaw tumors to disintegrate early with sharp inflammatory phenomena reactive amplification lymph nodes (inflammatory order).

Lymph nodes affected by a cancerous tumor, in advanced cases, solder together into huge conglomerates and grow together with surrounding tissues. When metastases break through skin deep, crater-shaped ulcers with purulent-ichorous discharge are formed. In slow-growing forms of sarcomas (eg, intraosseous giant cell tumor), inflammatory processes predominate in the lymph nodes.

Diagnostics

Pathological anatomical examination of a piece of the tumor finds a very wide application V clinical practice. General principles techniques for taking a piece of the tumor are entirely applicable in the study of tumors of the jaws. If possible, without anesthesia, a piece of tissue is cut out at the border of a healthy and tumor-grown area. The material is processed according to certain rules of histological technique.

Puncture of the tumor with a syringe with a wide needle often (for small tumors) makes it possible to obtain a cylindrical piece of tissue suitable for sectioning.

The presence of tumor infiltration, the nature of inflammatory infiltration, the degree of differentiation shaped elements, the number of dividing cells, the presence of special formations (pearls, giant cells, foci of necrosis, hemorrhage) are the main signs that serve as a criterion for making a pathological and histological diagnosis in case of suspected jaw sarcoma.

Blood and urine tests should be done in all cases; these studies are auxiliary diagnostic techniques that allow you to find out, for example, the degree of anemia, the intensity of inflammatory processes, side diseases.

A very great service in the diagnosis of jaw sarcoma is provided by x-ray examination. The main value of the radiograph in determining the boundaries of the tumor. When reading a radiograph, it is necessary to find out, if possible, the area of ​​​​primary localization of the tumor, its shape, relation to neighboring organs and the degree of bone damage. For malignant tumors vagueness ("blurring") of borders of a tumor is characteristic. It is necessary to pay attention to the loss of the pattern of the bone structure, to the state of the cortical layer, whether there is a pathological fracture. Be sure to find out the ratio of the tops of the roots to the tumor, which is important in differential diagnostic terms.

The diagnosis of jaw sarcoma is relatively simple when it is located on the mucosal sections accessible for inspection. Considerations regarding the age of the patient, the detection of moments that cause irritation of certain parts of the oral cavity and jaws, should also be taken into account in the clinical recognition of tumors.

Recognition of more deeply located tumors is much more difficult. In symptomatological terms, there is a fundamental difference in the localization of sarcoma in the lower or upper jaw. On the lower jaw, it is quite early to ascertain the presence of a tumor, to detect deformation of the dental arch, displacement of organs and formations of the floor of the mouth, especially with periosteal sarcomas.

If periosteal sarcomas are recognized early due to a certain availability of external examination, then central tumors that develop in the thickness of the lower jaw, for a long time may not show any outward signs. Quite strong, but indeterminate in terms of localization of pain, causeless local loosening of the teeth, often their spontaneous loss - these are the most characteristics tumor that develops in central departments lower jaw.

With sarcomas of the upper jaw emanating from the wall of the maxillary cavity, sometimes only indirect signs can be ascertained, for example, neuralgic pain, darkening of the maxillary cavity, serous-purulent exudation from the nose, repeated bleeding, etc. However, these symptoms, without directly indicating the development of a tumor can give rise to diagnostic misconceptions for a long time, and the true nature of the disease becomes clear only after the tumor, having occupied the entire maxillary cavity, begins to either infiltrate the nasal wall or spread to the side alveolar process, causing loosening of the teeth, or the outer wall of the jaw sprouts; in this case, a noticeable deformity of the face is formed with successive ulceration through the skin.

The removal of loosened teeth soon entails infiltration and germination of the walls of the free hole with tumor elements.

With cysts, the mucous membrane covering the protrusion has a normal appearance, is not inflamed; with sarcoma, the mucosa is more often changed - edematous and hyperemic. With sarcoma, the bone wall is softened and lends itself to pressure even with a large bone thickness; with a cyst, the bone springs due to its thinning (softening of the cysts).

Bleeding tendencies, unreasonable looseness of the teeth, and symptoms of bone rarification are the main Clinical signs, which have to be guided by differential diagnosis. The data of X-ray diagnostics and histological examination make it possible to finally orientate in the essence and distribution of the process.

Diagnostically difficult cases should be considered cases of development of jaw sarcoma from the wall of the periodontal cyst: but even here there are signs that suggest a malignant tumor: the absence of clear cyst boundaries, softened spongy part of the bone and a strong tendency to bleed during surgery and during dressings.

Finally, touch differential diagnosis between the periodontal cyst and the central sarcoma of the mandible. Radiographs, examination data and mechanical examination can sometimes have a great similarity. The anamnesis and objective data regarding the connection with the dental system do not always clarify the case. In any case, a mixture of these completely various forms diseases are observed.

Recognition in doubtful cases is most likely to be clarified by a test puncture and aspiration of the contents: with a cyst, a light yellow transparent liquid with crystals of cholesterol (or pus) is extracted, with a tumor - blood. With a cyst and with a sarcoma, a puncture is sometimes not possible, due to the strength and thickness of the outer bone wall. It must be borne in mind that the lingual wall, which is poorly accessible to palpation and puncture, may also be thinned. If the suspicion of a cyst cannot be completely eliminated, then an operative trial trepanation of the bone wall is necessary.

Treatment

A thorough removal within the boundaries of healthy tissues of a malignant tumor is the most the right way treatment of jaw sarcoma. Features of the operation on the jaws are determined by the need to restore as best as possible after the removal of all the affected parts as appearance faces, and very important features: eating and chewing, isolated nasal breathing and speech.

Typical operations are possible only in cases where the tumor extends within the bone and is surrounded by an unchanged bone or fibrous capsule that pushes aside adjacent soft tissues. Then it is relatively easy to extirpate the tumor and enlarged The lymph nodes and maintain the normal ratio of soft tissues, the shape of the face and, subsequently, restore the defect of the skeleton.

Less typical operations for jaw sarcoma, in which parts of the muscles have to be excised along with the bone, salivary glands, fiber, mucous membrane and skin, give a worse prognosis, both in terms of recurrence and in terms of the immediate outcome of the operation and the nearest restoration of the defect. Nevertheless, here it is very important to immediately, within the limits of the possible, form the natural outer walls of the oral cavity, thanks to which the patient retains the ability to speak and more or less normally eat.

In young individuals, with fairly well-defined sarcomatous tumors, complete removal of the tumor is easier, and recovery should be carried out most completely. The skeletal defect is initially replaced by a prosthesis and can later be restored by free bone grafting. After removing large cancerous tumors in old age, the main focus should be on the thorough removal of all diseased tissue, and recovery is minimized. Large defects in the mucous membrane and skin lead to severe scarring of the soft tissues, which, as a result, do not hold the prosthesis well and are subsequently unsuitable for bone grafting. The possibility of recurrence is often a contraindication to any irritation of the healed surgical wound, both by the prosthesis and plastic surgery. Complete closure of the surgical defect with large plastic flaps is not indicated in some cases also because it makes it difficult to subsequently control local recurrence and prevents radiation therapy.

Unfortunately, the risk of cancer is on the rise these days. Malignant tumors tend to form in almost all organs and systems. human body. Bones can also be affected. Among the many pathologies, such a disease as osteosarcoma of the upper jaw is distinguished.

The development of malignant tumors has a number of reasons and is different character. In order to have an idea of ​​what constitutes osteosarcoma of the upper jaw in humans, for what reasons it occurs and what measures should be taken, it is advisable to study the corresponding amount of information.

What is osteosarcoma

Cancerous neoplasms are formed from different tissues of the human body. Osteogenic sarcoma is formed from bone tissue. This disease is aggressive and is a tumor. In most cases, the course of the disease is characterized by rapid development with the formation of metastases, not excluding the initial stage. Most often, the formation of a tumor develops in the tubular bones.

The formation of osteosarcoma occurs directly in the bone, is not related to other tumors, is not their metastases. Very rare disease of this type acts as a consequence of osteomyelitis.

IN medical practice only a few such cases have been recorded, and this happens only as a result of chronicity of the underlying disease with an independent course.

Causes of development of jaw osteosarcoma

Sarcoma of the lower jaw, as well as the upper one, has certain causes. As provoking factors can be:

1. injuries, fractures of varying degrees;
2. mutation of bone tissue at the cellular level;
3. effects of radiation on bones;
4. active inflammatory process, both independent and as a result of osteomeoitis, osteochandroma or osteitis;
5. infiltration of cancer cells bone tissue from other malignant tumors;
6. rhinoblastoma;
7. hereditary pathologies.

In addition to the jaw region, other parts of the inert system can be localized sites of osteosarcoma. The hips, knees, shoulders, and elbows are most commonly affected in this area. The rarest places of localization are:

• lower jaw;
• sacrum;
• foot.

The onset of the disease is characterized by soreness, resembling the manifestations of rheumatism. After some time, formation takes place. Manifestations are accompanied by a violation of the functionality of the joint, as evidenced by increased pain.

Symptoms and course of osteosarcoma of the upper jaw

Osteosarcoma of the upper jaw is a rather dangerous disease, which is a malignant neoplasm. Manifestations of the disease are characterized by symptoms such as:

1. pain sensations;
2. headache;
3. discharge of pus from the nose;
4. development of deformative processes on the face;
5. loosening of teeth;
6. swelling, accompanied by swelling;
7. the occurrence of tangible discomfort and impaired functionality of the affected area.

For the development of the disease, a sluggish process is characteristic, accompanied by the occurrence of a slight dull pain. At first, her appearance is stated in the morning. Over time, the pain intensifies. In this case, the bone may increase in size. On palpation, there is a pain syndrome.

Gradually, the pain not only becomes more noticeable, but also becomes permanent. It is most pronounced at night and acts as a consequence after physical activity. Osteosarcoma of the upper jaw tends to recur at an accelerated pace, capturing the surrounding tissues and being accompanied by lightning-fast metastasis.

The general condition of the patient is gradually deteriorating. The tumor can interfere with chewing movements, the face swells, sensitivity is lost in the affected area, accompanied by tingling.

Osteosarcoma of the upper jaw, the symptoms of which are identical to the lower section, has its own classification.

Types and stages of the disease

In addition to the stages of development of osteosarcoma of the upper jaw, of which there are only four, the disease is divided according to the nature of development and can be of the following forms:

• mixed;
• osteolytic;
• osteoplastic.

According to the degree of malignancy, the tumor can be:

• low;
• intermediate;
• high.

The nature of the disease is:

• metastatic, when cells that have undergone a mutation are transported throughout the body with the bloodstream, which leads to the formation of additional inflammatory foci;
• localized.

This disease requires high-quality diagnostics and timely treatment.

Diagnosis and treatment of osteosarcoma

The whole complexity of diagnosing jaw osteosarcoma on initial stage is the absence of severe symptoms. High-quality diagnostics is carried out through:

• computed tomography;
• x-ray;
• magnetic resonance therapy.

This approach allows you to accurately determine the location of neoplasms.

As for the treatment this disease, then it is:

• in the course of chemotherapy;
• in surgical intervention.

The first method is reproduced through the use of certain drugs, which include:

1. etoposide;
2. adriblastin;
3. cisplatin and a number of others.

Surgical treatment consists in resection of the affected area with subsequent removal of the tumor. In most cases, there is a need to replace the cut section of the bone.

In the event that a large area of ​​\u200b\u200bthe bone is affected, then it is necessary to remove it all. Sometimes cancer cells affect nearby lymph nodes, which also need to be removed.

After surgery, a second course of chemotherapy is prescribed. It is carried out in order to completely eliminate residual cancer cells, if any.

As for survival, it is directly dependent on the prevalence of osteosarcoma, its form, as well as on the treatment and individual characteristics human body.