X-ray signs of malignant tumors of the jaws

Depending on the histological features distinguish epithelial tumors - cancer and connective tissue - sarcomas (osteogenic, chondrosarcoma, reticulosarcoma, etc.). The defeat of the jaws occurs again as a result of the germination of the tumor, which developed from the epithelium of the mucous membrane of various parts of the oral cavity. Among tumors, cancer prevails, with a share of sarcoma of no more than 10%. Metastases in the jaws occur with adenocarcinomas of the dairy, thyroid and prostate gland, hyperneme.

Cancer of the mucous membrane of the maxillary sinus. From the mucous membrane of the maxillary sinus mainly squamous cell forms of cancer develop. Sometimes, intraoral contact radiographs of premolars and molars show destruction of the cortical plate of the alveolar bay, which should attract the attention of the doctor. Destruction is well defined on orthopantomograms, lateral panoramic radiographs, extraoral slanting and intraoral contact images.

Depending on the prevalence of the tumor process, the intra-anasal phase and phase are distinguished when the tumor extends beyond it. The possibilities of radiologic detection of a tumor in the intrasternal phase are limited. Almost until the destruction of the bone walls of the sinus occurs, it is radiologically impossible to assume the presence of a malignant process.

Due to the violation of outflow from the sinus and the attachment of the secondary inflammatory process, its darkening, as a rule, has a diffuse character. Often, the cancer is detected accidentally after a morphological examination of the material obtained during the surgery for the alleged sinusitis.

Germination of the tumor in the bone walls of the sinus is manifested first by their thinning (the walls do not have the usual intensity), and then their focal and complete destruction. Subsequently, the tumor extends beyond the sinus and is defined as a soft tissue shade in the cavities adjacent to the sinus (eye socket, nasal cavity, trellis labyrinth, pterygoid and peduncle pits). Germination of the tumor in the soft tissue of the cheek is well defined on the semi-axial and axial radiographs of the skull as a symptom of the soft-tissue accompanying shadow located parallel to the lower vertebral margin. There are no periodic reactions.

X-ray symptoms of cancer of the mucous membrane of the maxillary sinus are in its darkening, destruction of the bone walls, the appearance of a soft-tissue shadow.

Computer and magnetic resonance imaging is important in assessing tumor localization and prevalence.

Cancer of the mucous membrane of the alveolar processes and the hard palate. Jaws are affected again due to the germination of cancerous tumors of the mucous membrane of the alveolar processes, the hard palate and adjacent areas (oropharynx, bottom of the mouth, tongue). The tumor is localized mainly along the edge of the alveolar process. With the germination of the tumor into the bone, the terminal cortical plate disappears and a marginal destruction of the alveolar process occurs. In the future, the focus of destruction takes the form of the letter "V" - the depth of the lesion prevails over the spread in the anteroposterior direction. Contours of the source of destruction are indistinct, "eaten". As a result of the destruction of the bone tissue of the interdental partitions and the closing cortical plates of the holes, the teeth, devoid of the 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. At the first stages on the roentgenogram, a blurred pattern of bone tissue is defined, which is sometimes regarded as a poor quality of the radiograph.

Germination of the tumor in the anterior part of the nasal cavity is well defined on direct panoramic radiographs. When the maxillary sinus is involved in the pathological process in the region of premolars and molars, the image of the cortical plate of its bottom disappears on this or that extent. This symptom, which is also determined on intraoral contact radiographs, is more clearly visible on orthopantomograms and lateral panoramic radiographs. Germination of the cancer in the maxillary sinus is often accompanied by the attachment of secondary inflammation, which manifests itself in the form of its uniform dimming on the roentgenogram.

Cancer of the mucous membrane of the hard palate is rare. Assess the condition of bone tissue, especially in the early stages of the tumor process, is difficult. On the lateral radiograph of the maxillofacial region due to the summation of shadows of 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 sky is noted.

Osteogenic sarcoma (osteosarcoma). Jaws are affected in 3-6% of all cases of osteogenic sarcomas of the skeleton. Among the patients, 75% are children, mostly boys, and boys between the ages of 10 and 25. Most often the lower jaw is affected. Osteogenic sarcoma develops within the bone from the bone-forming connective tissue.

The x-ray picture distinguishes between osteosclerotic (osteoplastic), osteolytic (osteoclastic) and mixed sarcomas.

In the initial stage on the roentgenogram is determined a single focus of destruction of bone tissue of irregular shape with fuzzy contours. Spreading and destroying the cortical layer, the tumor exfoliates and displaces the periosteum. To identify periosteal stratifications, the affected area of the bone should be removed by radiography into the marginal position (radiographs in the tangential projection). Periodontal gaps of the teeth located in the tumor growth zone are widened.

In the osteoplastic form of sarcoma with pronounced bone formation, randomly located formless confluent and projecting foci of compaction are seen.

In the mixed version, foci of destruction and compaction sites also occur; In osteolytic sarcomas, only destruction of bone tissue occurs.

A characteristic type of periosteal stratification is the so-called spicules, thin needle-like growths that run perpendicular to the bone surface, resulting from the calcification of the adventitial layer of periosteum vessels perforating the cortical layer of the bone. Neurotrophic disorders accompanying the development of the tumor cause osteoporosis of the bone sections adjacent to the neoplasm.

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

Radiologically, the tumor is first identified as a lesion site with hummocky fuzzy contours. In the future, beginning with the peripheral departments, on its background there appear disorderly centers of calcification. Resorption of the tips of the roots of the teeth is noted in the area of the tumor.

With the emergence of the cortical layer, a periosteal reaction in the form of spicules may occur, the tumor spreads into soft tissues, forming an extraosteal component.

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

X-ray reveals foci of bone tissue destruction, usually with fuzzy contours, in combination with areas of osteosclerosis. Foci of destruction without clear boundaries pass into the surrounding bone tissue, and they are compared in appearance with a cloth eaten by a moth. The picture sometimes resembles bees' honeycombs: a number of foci of bone tissue destruction predominantly round, merging with each other and forming larger foci. The papilla responds to tumor growth with the formation of spicules. Distinctive recognition with ameloblastoma and myxoma is possible only on the basis of the results of histological examination.

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