X-ray signs of malignant jaw tumors

Depending on the histological features, a distinction is made between epithelial tumors - cancer and connective tissue - sarcomas (osteogenic, chondrosarcomas, reticulosarcoma, etc.). Damage to the jaws occurs secondarily as a result of tumor growth that has developed from the epithelium of the mucous membrane of various parts of the oral cavity. Cancer predominates among tumors, with sarcomas accounting for no more than 10%. Metastases in the jaws occur with adenocarcinomas of the mammary, thyroid, and prostate glands, and hypernephroma.

Cancer of the mucous membrane of the maxillary sinus. Squamous cell cancers mainly develop from the mucous membrane of the maxillary sinus. Sometimes, destruction of the cortical plate of the alveolar bay is detected on intraoral contact radiographs of premolars and molars, which should attract the attention of the doctor. The destruction is clearly visible on orthopantomograms, lateral panoramic radiographs, extraoral oblique and intraoral contact images.

Depending on the extent of the tumor process, there is an intrasinusal phase and a phase when the tumor extends beyond its limits. The possibilities of radiological detection of the tumor in the intrasinusal phase are limited. It is practically impossible to assume the presence of a malignant process radiologically until the destruction of the bone walls of the sinus occurs.

Due to the disruption of the sinus outflow and the addition of a secondary inflammatory process, its darkening, as a rule, has a diffuse character. Cancer is often discovered accidentally after a morphological study of the material obtained during surgery for suspected sinusitis.

Tumor growth into the sinus bone walls is initially manifested by their thinning (the walls do not have the usual intensity), and then by their focal and complete destruction. Subsequently, the tumor extends beyond the sinus and is determined as a soft tissue shadow in the cavities adjacent to the sinus (the orbit, nasal cavity, ethmoid labyrinth, pterygopalatine and infratemporal fossae). Tumor growth into the soft tissues of the cheek is clearly determined on semi-axial and axial skull radiographs as a symptom of a soft tissue accompanying shadow located parallel to the inferoorbital margin. Periosteal reactions are absent.

Radiological symptoms of cancer of the mucous membrane of the maxillary sinus include its darkening, destruction of the bone walls, and the appearance of a soft tissue shadow.

Computed tomography and magnetic resonance imaging are of great importance in assessing the localization and spread of the tumor.

Cancer of the mucous membrane of the alveolar processes and hard palate. The jaws are affected secondarily due to the growth of cancerous tumors of the mucous membrane of the alveolar processes, hard palate and adjacent parts (oropharynx, floor of the mouth, tongue). The tumor is localized mainly along the edge of the alveolar process. When the tumor grows into the bone, the closing cortical plate disappears and marginal destruction of the alveolar process occurs. Later, the focus of destruction takes the shape of the letter "V" - the depth of the lesion prevails over the spread in the anteroposterior direction. The contours of the focus of destruction are unclear, "eaten away". As a result of the destruction of the bone tissue of the interdental septa and the closing cortical plates of the sockets, the teeth, deprived of a bone base, seem to hang in the air. Less often, as the tumor grows, only the buccal or lingual parts of the bone are destroyed. In the early stages, the radiograph shows a sort of blurred pattern of bone tissue, which is sometimes regarded as poor quality of the radiograph.

Tumor growth into the anterior nasal cavity is clearly visible on direct panoramic radiographs. When the maxillary sinus is involved in the pathological process in the area of premolars and molars, the image of the cortical plate of its bottom disappears at one or another extent. This symptom, which is also determined on intraoral contact radiographs, is more clearly visible on orthopantomograms and lateral panoramic radiographs. Cancer growth into the maxillary sinus is often accompanied by secondary inflammation, which is manifested in the form of its uniform darkening on the radiograph.

Cancer of the mucous membrane of the hard palate is rare. It is difficult to assess the condition of the bone tissue, especially in the initial stages of the tumor process. On the lateral radiograph of the maxillofacial region, due to the summation of the shadows of the unchanged sections of the hard palate, it is impossible to determine the initial destructive changes. With a more pronounced process, a decrease in the intensity of the shadow formed by the hard palate is noted.

Osteogenic sarcoma (osteosarcoma). The jaws are affected in 3-6% of all cases of osteogenic sarcomas of the skeleton. Of the patients, 75% are children, mainly boys, and young men aged 10 to 25 years. The lower jaw is most often affected. Osteogenic sarcoma develops inside the bone from bone-forming connective tissue.

Based on the radiological picture, a distinction is made between osteosclerotic (osteoplastic), osteolytic (osteoclastic) and mixed sarcomas.

At the initial stage, a single focus of bone tissue destruction of irregular shape with unclear contours is determined on the radiograph. Spreading and destroying the cortex, the tumor peels off and displaces the periosteum. To identify periosteal layers, the affected bone area should be brought out in the marginal position during radiography (radiographs in tangential projection). The periodontal spaces of the teeth located in the tumor growth zone are widened.

In the osteoplastic form of sarcoma with pronounced bone formation, randomly located, shapeless, merging and projecting foci of compaction onto each other are visible.

In the mixed variant, there are also foci of destruction and areas of compaction; in osteolytic sarcomas, only destruction of bone tissue occurs.

A characteristic type of periosteal deposits are the so-called spicules - thin needle-like growths running perpendicular to the bone surface, arising as a result of calcification of the adventitial layer of the periosteal vessels, perforating the cortical layer of the bone. Neurotrophic disorders accompanying tumor development cause osteoporosis of the bone sections adjacent to the neoplasm.

Chondrosarcoma. Chondrosarcoma most often develops in men aged 20-60 years (mainly in the 4th decade of life) in the anterior part of the upper jaw. The favorite localization on the lower jaw is the area of premolars and molars, the chin area, the coronoid and condylar processes.

Radiographically, the tumor is initially determined as a focus of destruction with lumpy, unclear contours. Later, starting from the peripheral sections, random calcification foci appear against its background. Resorption of the apices of the roots of the teeth is noted in the tumor area.

When the cortical layer grows, a periosteal reaction may occur in the form of spicules, the tumor spreads into the soft tissues, forming an extraosseous component.

Retinculosarcoma. Developing inside the body of the lower jaw or in the wall of the maxillary sinus from reticular connective tissue, the tumor subsequently grows into the sinus and perimaxillary soft tissues.

Radiologically, foci of bone tissue destruction are revealed, usually with unclear contours, in combination with areas of osteosclerosis. Foci of destruction without clear boundaries pass into the surrounding bone tissue, and their appearance is compared to tissue eaten by moths. The picture sometimes resembles a honeycomb: many foci of bone tissue destruction, mainly round in shape, merging with each other and forming larger foci. The periosteum reacts to tumor growth by forming spicules. Distinctive recognition with ameloblastoma and myxoma is possible only on the basis of the results of histological examination.

Significant difficulties arise in diagnosing Ewing's sarcoma, which develops primarily in children and adolescents. The initial signs of Ewing's sarcoma resemble the clinical manifestations of osteomyelitis. The diagnosis is established only after histological examination.