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Cancer of the upper jaw
Last reviewed: 23.04.2024
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Most often, the cancer of the upper jaw arises from the mucous membrane of the maxillary sinus. As a rule, we are talking about squamous cell carcinoma, but there may be various forms of adenocarcinoma, cystadenoid carcinoma, mucoepidermoid carcinoma of the upper jaw. Less often the source of the tumor is the mucosa of the hard palate, the alveolar processes. It is also possible the germination of the tumor from the nasal cavity and the paranasal sinuses.
As a rule, in the early stages of cancer of the upper jaw flows asymptomatically, so the I-II stage of the disease is diagnosed accidentally with gaymorotomy. With a small tumor, the initial stages of the tumor process, nasal congestion and serous-purulent discharge from the nasal passage are observed. Such symptoms can be in patients for several months, then there is asymmetry of the face due to swelling, more often in the infraorbital area, the discharge from the corresponding nasal passage increases, a feeling of heaviness, and then pain.
Symptoms
Symptoms of the cancer of the upper jaw largely depends on the location of the tumor in this or that department. To determine the location of the tumor and the direction of growth, use the scheme of Ongren, with which the upper jaw is divided into segments. One oblique plane is directed from the inner edge of the eye socket to the corner of the lower jaw and divides the maxillary sinus into the lower and upper parts. The sagittal plane, which runs perpendicular to the pupillary line, divides each of the sections into internal and external. Thus, four segments are formed: the inferior inner and outer, the upper and the inner inside and the outer. The localization of the tumor mainly in one or another segment of the jaw determines, on the one hand, a characteristic clinical picture, on the other hand, clinical course and prognosis.
In tumors localized in the lower anterior inner segment of the maxillary sinus, in addition to nasal discharge, the mobility of small molars and canine is most characteristic, as well as the phenomenon of paresthesia. After the extraction of the teeth, tumor tissue proliferations appear in the well. A deformation of the corresponding department of the face is often noted.
When the lower inferior internal segment is affected, the tubercle is involved in the process, the mobility of large molars is noted, the jaw contracture appears early, resulting from the infiltration of the masticatory muscles.
In cancer of the upper jaw of the upper-posterior outer segment, as a rule, the latticed labyrinth is affected, it should be differentiated from the primary cancer of the cells of the latticed labyrinth. The most frequent symptom in the widespread cancer of this localization with orbital damage is narrowing of the eye gap with the displacement of the eyeball, sometimes exophthalmos.
From the upper-to-posterior outer segment, the cancer of the upper jaw germinates into the orbit, as well as the "cheekbone, the pterygopalus and the infratemporal fossa. Spreading the tumor into these areas can cause contracture and neurological symptoms. The most unfavorable prognosis is when the upper-posterior outer segment is affected, which is often due to the spread of the process on the reticular plate with the tumor germination into the anterior cranial fossa. The most favorable localization in the prognostic plan is the lower anterior inner segment.
Diagnostics
Radiographically, the cancer of the maxilla in the maxillary sinus at an early stage is marked by darkening without compromising the integrity of the bone, which is also characteristic of the picture of chronic sinusitis. When involved in the process of bone walls, bone destruction is observed, until complete disappearance. An important prognostic factor is the involvement in the process of the posterior wall of the maxillary sinus. In order to detect its defeat, it is necessary to perform CT of the upper jaw, which allows more accurate detection of lesions. Regional metastases with maxillary cancer occur rarely and are localized mainly in the upper deep jugular lymph nodes.
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Treatment
Cancer of the upper jaw is treated in combination, the therapy is carried out in two stages. The first stage shows preoperative radiation therapy at a dose of 50-60 Gy. And on the second - electroresection. The volume of resection depends on the prevalence of the tumor process and can vary from the removal of the alveolar process to the removal of part and all of the jaw together with the cells of the trellis labyrinth by the orbital exenteration. With regional metastases, a fascia-cervical excision of the neck tissue or Krajl's operation or an operation on deep lymph nodes is performed.