Benign tumors and tumor-like formations of facial bones. Other jaw diseases

Benign tumors jaws

Benign tumors of the jaw bones develop from various tissues and cells that form bone. All benign tumors of the jaw bones can be divided into odontogenic, osteogenic and non-osteogenic.

Odontogenic tumors and tumor-like formations

Odontogenic tumors are a group of benign formations, the occurrence of which is associated with the development of the dental system. I. I. Ermolaev considers odontogenic tumors as formations resulting from the directed differentiation of the primary epithelium immersed in the jaw oral cavity and mesenchyme towards the construction of structures similar to dental tissues and the tooth as a whole, at different stages of its development, or representing derivatives of these tissues. Changes in the original tissues during development should explain the diversity of cellular forms of odontogenic formations.

Odontogenic tumors and tumor-like formations include adamantinomas, odontogenic fibromas, cementomas, and ontomomas.

Adamantinoma (ameloblastoma)

Adamantinoma refers to benign epithelial tumors, resembling the enamel organ of the tooth in its histological structure. The name of the tumor comes from the Greek word “adamantos” - enamel, diamond. Other names for this tumor have not become widespread in our country. Adamantinoma is most often observed at the age of 20-40 years, but there have been cases of tumor development in newborns and the elderly. Adamantinoma is somewhat more common in women. The tumor occurs predominantly in the thickness of the jaw bones, and the lower jaw is affected 6-7 times more often than the upper jaw. The favorite place of primary localization of adamantinoma is the angle and branch lower jaw. Much less often, the tumor develops in the anterior part of the body of the lower jaw.

IN histological structure adamantinomas distinguish a stroma consisting of connective tissue, and parenchyma - epithelial cells that penetrate the stroma and form cells. Along the periphery of these cells there are tall cylindrical cells, and closer to the center there are stellate cells. The described histological picture corresponds to the structure of the developing enamel organ of the tooth. In the development of adamantinoma, two forms are distinguished - dense (adamantinoma solidum) and cystic (adamantinoma cysticum) (Fig. 148).

In cystic adamantinoma, the connective tissue stroma is presented less prominently than in massive one. The solid form in the form of a massive formation is less common than the cystic one and is an earlier stage of the process. In the cystic form, there is a sharp thinning jaw bone. Cyst cavities are completed yellow liquid without or with very few cholesterol crystals.

The origin of adamantine is a lot of controversial and unclear. Some authors believe that the occurrence of adamantine is associated with a violation of the development of the tooth germ, others suggest its development from the epithelial elements of the oral mucosa, and still others from odontogenic epithelial remains (islets of Malasse). It is believed that adamantinoma arises from the epithelial lining of follicular cysts.

Clinic. Adamantinoma appears gradually, develops slowly and painlessly. Initial manifestations tumors usually go undetected and can be discovered accidentally during an X-ray examination. The duration of the asymptomatic period of adamantinoma depends on the location of the tumor, associated complications and character tumor growth. The jawbone affected by the tumor gradually thickens, and a noticeable deformation of the face appears. The surface of the thickened jaw is in most cases smooth, but it can also be uneven. The skin over the tumor remains unchanged and mobile for a long time. With significant thinning of the cortical plate of the jaw, the compliance of the bone wall is determined. If the tumor is located in the area of ​​the angle and ramus of the lower jaw, then signs of bone thinning are much more difficult to detect. From the side of the oral cavity, thickening and deformation are determined alveolar process. Often fistulas with serous-purulent discharge can be found in the oral cavity. When palpating the alveolar process, along with its swelling, fenestrated bone defects are determined. The teeth located in the area of ​​the tumor are displaced, slightly mobile and painless upon percussion. The percussion sound is noticeably shortened due to damage to the periapical tissues. Adamantinoma can fester after the removal of teeth located in the tumor area, or as a result of infection from the gum pockets. It is often during the period of suppuration that patients first turn to the doctor, unaware of the existence of a tumor. Symptoms associated with displacement and compression of neighboring organs and tissues refer to late manifestations diseases and are expressed in dysfunction of chewing, swallowing and speech. With a significant tumor size, the jaw walls become thinner, spontaneous fractures of the lower jaw are possible, as well as profuse bleeding. Regional lymph nodes enlarge during adamantinoma suppuration.

Diagnosis of adamantine in some cases causes certain difficulties, especially in the early stages of tumor development. The correct diagnosis is established after the analysis of anamnestic and clinical data, as well as X-ray and histological examination.

The X-ray picture of the jaws with adamantinomas is quite characteristic. With a solid form, one large cavity is found, and with cystic adamantinoma, a picture of multiple small cystic cavities is found. Often one large cavity is divided by bony septa into several smaller cavities. As the tumor grows, the bony septa either completely disappear or remain in the form of spikes and ridges protruding into the cyst cavity, forming characteristic small bays. Sometimes the x-ray picture with adamantinoma is similar to the picture of a follicular cyst. In these cases, the true nature of the tumor is established only after histological examination. At the border of the tumor and unchanged bone, you can see a zone of sclerosis in the form of a narrow whitish strip. Yu. A. Zorin identifies four main radiological forms of adamantinoma: single-chamber, multi-chamber, cellular and tooth-containing.

Despite the benign nature of adamantinoma, cases of its malignancy are known (about 4%).

Treatment with adamantine is surgical and consists of removing the tumor with areas of clinically healthy bone tissue. The extent of surgical intervention depends on the extent of the tumor. In most cases, patients consult a doctor at a stage of the disease when resection of a significant part, half or all of the lower jaw with disarticulation is required. These radical interventions are usually combined with primary bone grafting. The patient's own rib or lyophilized allogeneic grafts from the mandibular bone are used as a bone graft.

With a slight spread of the tumor in the lower jaw, P. V. Naumov offers a gentle method that combines the radical removal of the tumor while maintaining the continuity of the mandibular bone (Fig. 149, a, b).

With this method, surgical access to the tumor is carried out through an incision in the submandibular region. The fibers of the masticatory muscle are cut off along the entire length of the lower jaw and the outer surface of the jaw branch is exposed. Using Luer bone pliers and a chisel, the outer bone wall is removed, and then the inner bone wall of the jaw is removed. The edges of the bone defect are carefully processed with pliers and a chisel (at least 1 cm from the tumor border). In some cases, depending on the degree of bone damage by adamantinoma, only a thin bone strip of the posterior part of the jaw branch remains, which will subsequently serve as the basis for bone formation. The coronoid process can be preserved if the tumor does not reach its base and the edge of the mandibular notch. After removing the tumor and treating the bone in this way, the masticatory muscle is placed into the resulting flaw in the bone of the lower jaw and fixed with several sutures to the bone base of the lower jaw. The wound is sutured tightly in layers. Considering the possibility of a fracture of the lower jaw, a Vankevich splint is made before the operation for subsequent fastening of the fragments. This technique creates the most favorable conditions for subsequent prosthetics. Curettage of adamantinoma is now completely abandoned. After curettage, tumor relapses occur in 90% of cases. Radiation methods Treatments for adamantinoma have not become widespread. After radiation therapy, tumor relapses develop within 5 years in more than half of the patients, and after 10 years in all the rest.

Odontogenic fibroma

Odontogenic fibroma is extremely rare and is a type of intraosseous fibroma of the jaws.

The origin of odontogenic fibromas is associated with impaired development of the tooth germ, as evidenced by the histological structure of the tumor. Microscopic examination of the tumor reveals cell-poor fibrous tissue, among which are located strands or islands of dental epithelial cells. Some areas of the tumor may have more loose structure and contain significant amount cells. Sometimes mucous degeneration of tumor areas is observed.

Odontogenic fibroma develops slowly, painlessly and leads to thickening of a certain area of ​​the jaw. The teeth located in the area of ​​the tumor are displaced, their roots are resorbed. Upon palpation of the jaw, a rounded bulge of dense elastic consistency is determined. The tumor is easily separated from the surrounding bone tissue. On section, the tumor is grayish-white.

Clinical and radiological signs odontogenic fibromas are uncharacteristic, therefore accurate diagnosis is possible only after histological examination of the tumor.

Treatment of odontogenic fibromas is reduced to enucleation of the tumor along with the capsule.

Cementoma

Cementoma is a benign connective tissue tumor built from tissue similar to tooth cement. The histological structure of cement can vary: in some cases, characteristic growths of coarse fibrous tissue similar to dental cement are found, in others - cellular fibrous tissue with areas of calcification.

Cementoma often develops in the lower jaw, mainly in young women. It is extremely rare to have multiple lesions of the jaw bones. A tumor develops around the roots of one tooth or a group of them. There are cases of cementum occurring far from the roots of the teeth. The tumor is limited to the capsule.

Cementoma develops slowly and in clinical picture no characteristic signs. As the tumor grows, the jaw becomes deformed, and pain in the teeth often appears when eating or palpating the tumor. An inflammatory process may develop around the tumor. The infection penetrates either through the tooth canal or through the mucous membrane of the oral cavity, destroyed as a result of the “eruption” of cementoma.

The radiograph reveals an oval or irregular shape a uniform dense shadow around or at some distance from the roots of the teeth.

According to the clinical picture, cementomas resemble osteoblastoclastoma, osteoma, osteoid osteoma and other benign tumors.

Treatment of cementoma is surgical and boils down to desquamation of the tumor along with the capsule. Teeth fused with cementoma must be removed.

Odontoma

The emergence and development of odontoma is associated with the development of the dental system. There are two types of odontomas, differing from each other in the degree of differentiation of dental tissues - soft and hard. Soft odontoma is a true tumor and consists of low-differentiated dental tissues found in developing tooth germs, while hard odontoma consists of petrified, highly differentiated dental structures.

Soft odontoma (ameloblastic fibroma). This tumor is extremely rare. The histological structure of the tumor is characterized by epithelial growths (as in adamantinoma), between which are located connective tissue elements of the stroma, reminiscent of the structure of the papilla of the tooth germ. Soft odontoma is a formation of dense elastic consistency; on the section it has a light-colored grey colour with separate lighter areas.

Clinic. With soft odontoma, there are symptoms of other benign tumors located in the jaw bones. The tumor grows slowly, gradually causing a “swelling” of the jawbone, as with adamantinoma. Unlike adamantinomas, soft odontoma is mainly observed in young people during the formation period. permanent teeth. Soft odontoma grows expansively, but sometimes has pronounced infiltrative growth and relapses after non-radical operations. There have been cases of transformation of soft odontoma into sarcoma.

The X-ray picture is similar to that of adamantinoma. In some cases, the tumor may contain permanent teeth or their beginnings. A violation of the cortical layer of the jaw is often observed.

Treatment of soft odontoma is exclusively surgical. In case of a benign course (expansive growth, highly differentiated structure of the tumor), we can limit ourselves to enucleating the tumor within healthy tissues. In case of infiltrative growth and other signs of a malignant course, extended surgical intervention is indicated - resection of a significant area of ​​the jaw.

Hard odontoma. This tumor-like formation consists of hard tissues of the tooth, pulp, periodontium and is distinguished by a wide variety of structure. Hard odontoma is characterized by a disorderly arrangement of tooth tissues, where the enamel can be located inside the dentin and the pulp outside. The tumor is hard, round or irregular in shape, covered by a capsule of coarse fibrous tissue, which may include dental tissue.

There are three types of hard odontomas: simple, complex and cystic. A simple odontoma consists of the tissues of one tooth germ and differs from a normal tooth by a violation of the ratio of enamel, dentin and cement. A simple odontoma can be complete, consisting of all dental tissues, and incomplete, containing some tissues. Incomplete odontoma occurs as a result of disruption of the development of only part of the tooth germ - the crown or root. If an incomplete simple odontoma develops in the crown area, then the roots have a normal shape. With the development of odontoma in the root area, the crown regular form. A simple odontoma can be fused with adjacent teeth or displace them, causing retention of the corresponding teeth.

Simple odontomas include the so-called periodontomas - lumpy hard formations tightly fused to the neck or to the root of the tooth. Such formations associated with enamel are called enamel drops.

Complex odontomas include the tissues of several teeth and sometimes even formed teeth.

Hard odontomas in most cases are asymptomatic and are discovered accidentally during an X-ray examination due to dental disease or due to the “eruption” of a tumor. In the latter case, the mucous membrane of the alveolar process ulcerates under the pressure of the odontoma, and a hard bone-like formation appears on the surface, which is mistaken for an impacted tooth. The addition of infection subsequently leads to inflammation in the surrounding soft tissues and bone. The formation of external fistulas with minor purulent discharge is possible.

Hard odontoma, having reached a certain size, usually stops growing, which is sometimes mistaken for a developmental defect. This is proven by the almost permanent absence of one or more teeth in the area of ​​the tumor. The acceleration of the growth of hard odontoma during teething also confirms this point of view. On a radiograph, an odontoma produces a round or irregularly shaped shadow of the same intensity as the tooth tissue (Fig. 150).

A capsule is visible around the tumor in the form narrow strip made of tissue that is highly permeable to x-rays, followed by a strip of bone sclerosis.

Treatment of hard odontoma is surgical and comes down to desquamation of the tumor along with the capsule. In case of large odontomas and significant destruction of the jaw bone, a partial one is performed. jaw resection with primary bone grafting.

Small odontomas that are asymptomatic and do not cause any complications do not need to be operated on.

Odontogenic tumors- tumors, the formation of which is associated with a malformation of the tissues from which the tooth is formed, or with the presence of a tooth in the jaw. This group of neoplasms is organ-specific.

Classification (I.I. Ermolaev, 1964).

I. Odontogenic formations of epithelial nature.

1. Adamantinomas (ameloblastomas).

2. Odontogenic cysts of inflammatory origin: root, tooth-containing, paradental.

3. Odontogenic cysts, which are a malformation of the dental epithelium: primary, follicular, eruption.

4. Odontogenic cancers.

II. Odontogenic formations of connective tissue nature: odontogenic fibroma, cementoma, odontogenic sarcoma.

III. Odontogenic formations of epithelial and connective tissue (mixed) nature:

• Soft odontomas.

Hard calcified odontomas

ADAMANTINOMA (AMELOBLASTOMA)

Adamantinoma- a tumor from cells that are precursors to enamel in the embryonic period.

Adamantinoma occurs mainly in patients aged 21 to 40 years, but can occur in newborns and the elderly. It mainly affects women.

It is most often localized on the lower jaw in the area of ​​the angle and its branches, less often - on the body of the jaw; most often develops in the region of the lower wisdom teeth.

Clinic. Patients complain of facial asymmetry that they (or others) suddenly noticed.

Adamantinoma symptoms:

1. Aching dull pain in the jaws and teeth, which in the past led the patient (more than once) to the idea of ​​​​the need to remove intact teeth.

2. Periodically observed phenomena of periostitis or phlegmonous inflammation on the affected side.

3. Fistulas on the oral mucosa with purulent discharge.

4. Wounds that do not heal for a long time after tooth extraction, from which a cloudy liquid is released.

5. With tumors that have reached large sizes, patients complain of difficulty chewing, speaking and even breathing.

Objectively: in the early stages, a spindle-shaped swelling of the body of the jaw is noted; in this case, the tumor appears smooth or slightly uneven - lumpy, dense (bone) consistency. The skin over the tumor is not changed in color, it is folded; sometimes a little pale. Later, signs of a cystic neoplasm appear: areas of parchment crunch, fluctuation; the skin over the tumor becomes thinner, turns pale, and visible vasculature, it is difficult to fold. Over time, the skin becomes thinner and can even reach the point of ulceration over the most pronounced bony protrusions. Regional lymph nodes are not enlarged provided that the contents of the cystic cavities have not yet suppurated and bone inflammation has not joined the tumor process. The teeth in the area of ​​the tumor are usually quite stable, but they can also be somewhat loose (in the presence of a chronic inflammatory background). The mucous membrane of the gums is of normal color or cyanotic.

Radiographic findings are varied. The most important radiological feature of adamantine is the varying degrees of transparency of the cavities.

The histological structure of adamantine is characterized by the absence of clear boundaries of the tumor, the presence of processes and protrusions infiltrating the surrounding tissue. This determines the need for radical removal of the tumor, deviating from its radiographically determined outlines.

Adamantine treatment must be radical to avoid relapses, which increase the threat of malignancy.

Methods of surgical treatment:

I. Economical resection according to P.V. Naumov (1965). Used for small affected areas.

Operation stages:

tissue incisions from the skin of the face and oral cavity, providing a wide overview of the surgical field;

removal of the tumor in one block or in parts under eye control;

processing the edges of a bone defect in the jaw with pliers and a chisel, capturing healthy tissue at least 1 cm in all directions from the boundaries of the visible location of the tumor;

filling the jaw bone defect with the masticatory muscle on the feeding pedicle;

layered sutures on the edges surgical wound.

II. Resection or disarticulation of the jaw with simultaneous autoosteoplasty is indicated for extensive damage to the jaw bone. If adamantinoma has grown into the peri-maxillary tissue, subperiosteal resection is unacceptable. The adjacent affected tissue must also be removed. The defect is replaced by a section of the rib or scallop ilium.

III. Replantation osteoplasty. After removing the tumor area of ​​the bone, it is boiled and then modeled according to the size of the defect.

ODONTOMA

Odontoma- odontogenic tumor of mixed nature, consisting of tooth tissue. The formation of odontomas is based on disturbances in the processes of tooth formation. They occur during the formation of permanent teeth. In childhood, they are most often localized in the area of ​​the canines and premolars. There are soft and hard odontoma. However, recently many authors believe that there is no soft odontoma, but there is a special, specific form of ameloblastoma.

Odontoma hard(calcified). There are 3 main groups of hard odontoma: simple, complex and compound. A simple odontoma is formed from the tissue of the 1st tooth. Complex odontoma occurs from several teeth. In this case, dental tissues are presented separately. A compound odontoma consists of a conglomerate of small vestigial teeth or tooth-like formations. Simple odontomas can be complete (consist of the entire tooth germ) or incomplete (consist of part of the tooth germ).

The diagnosis is most often made during the eruption of permanent teeth. There is a violation of the eruption of permanent teeth, thickening of the alveolar process and the body of the jaw, and displacement of existing teeth. It is localized mainly in the area of ​​incisors, canines and premolars of the upper jaw. The tumor grows slowly and painlessly. Hard odontoma is often diagnosed as a result of infection. In these cases, there are signs of acute or chronic inflammation (swelling, hyperemia, fistulas), which simulates osteomyelitis of the jaw, difficult tooth eruption.

X-ray picture. In case of complex odontoma, multiple tooth-like formations with clear contours in the form of a “mulberry” are determined. A rarefaction strip (tumor envelope) is visible along the periphery of the tumor. Odontoma displaces adjacent tooth buds. With a simple odontoma, the X-ray image shows the shadow of a separate malformed tooth or tooth-like formation (underdeveloped, deformed tooth), the ratio of enamel and dentin, which is chaotic. The X-ray density of the tumor corresponds to the density of the tooth tissue.

Treatment solid odontoma surgical. The operation consists of complete removal tumor and its membranes. The tumor bed is scraped to prevent recurrence. Often, “cutting out”, “gouging out” of the tumor from the bone tissue is required. If possible, the rudiments of adjacent teeth and impacted formed permanent teeth should be preserved. Access can be both extraoral and intraoral.

Completely calcified, mature formations that have completed the biological development cycle and do not cause inflammatory diseases or functional disorders cannot be removed.

Soft odontoma (ameloblastic fibroma) clinically in its course resembles ameloblastoma. However, it is observed more often during the formation of teeth. As the tumor grows, the bone swells, and then the cortical plate of the jaw is destroyed, and the tumor grows into soft fabrics. Bulging tumor tissue It has dark color. The tumor is elastic, bleeds and may ulcerate. The teeth are mobile and misaligned. Histologically, epithelial growths and soft fibrous connective tissue in the form of cords are determined. In the tumor, an incompletely formed permanent tooth is sometimes located. The course of the tumor is usually benign, but in some cases signs of infiltrative growth are revealed (growth into soft tissue, ulceration).

The X-ray picture of the tumor resembles ameloblastoma: thinning of the cortex, several cyst-like areas of clearing. Bone cavities may contain teeth and tooth buds. The boundaries of the tumor are clear.

Treatment soft odontoma surgical - resection of the jaw within healthy tissue to prevent its recurrence. Curettage of the tumor to healthy bone can lead to recurrence and even malignancy.

The most interesting is ameloblastoma (adamantinoma). This is a benign odontogenic epithelial tumor, located predominantly in the lower jaw (approximately 80%). In approximately 70% it is localized in the molar area, angle and ramus, in 20% in the premolar area and in 10% in the chin area. Ameloblastoma has a structure similar to the tissue from which the enamel of the tooth germ develops. Microscopically, many types of ameloblastoma are distinguished: follicular, plexiform, acanthomatous, basal cell, granular and others. The tumor is rare, with equal frequency in men and women aged 20-40 years. Observations of ameloblastoma in newborns and elderly people are described; there are cases when it was localized in the tibia and other bones.

Ameloblastoma most often occurs in the form of a cystic form (polycystoma) and does not have a pronounced capsule. A group of cysts, uniting, forms large cavities that communicate with each other and are filled with yellow liquid or colloidal masses. The tumor is gray in color and soft. The bone around the ameloblastoma is significantly thinned. As it develops, it spreads very deeply. Strands are identified microscopically epithelial cells(cubic and cylindrical structure) in the connective tissue stroma or plexus of stellate cells, surrounded by cylindrical or polygonal cells. Cysts are visible in the areas where stellate cells are located. Another form of ameloblastoma is solid, which is five times less common than polycystic. Such a massive neoplasm has a pronounced capsule and macroscopically differs from polycystoma in the absence of cysts. B. I. Migunov (1963) noted that the cystic form usually forms gradually from solid ameloblastoma.

A benign course of ameloblastoma is not always observed; sometimes all the signs of a malignant tumor appear. Ameloblastoma has an exceptionally high tendency to recur, sometimes many years after extensive resection of the lower jaw. In reports dating back to the 40-50s, it was noted that relapses after radical operations were observed in almost 1/3 of patients. In modern articles, authors report 5-35% relapse rates. Cases of malignant transformation of adamantinoma are described. I. I. Ermolaev (1965) reports that the frequency of possible true malignant transformation ranges from 1.5 to 4%.

Clinical course ameloblastoma of the lower jaw is manifested by a gradual thickening of the area of ​​the bone where it arose, and the appearance of facial deformation (see Fig. 145, A). Ameloblastoma is characterized by a slow and painless course. The thickening appears first in a small area and is often localized in the area of ​​the angle of the lower jaw. Over time, facial deformity increases, movement disorders develop in mandibular joint, swallowing, pain appears. With large adamantinomas, there may be bleeding from a mucosal ulcer over the tumor, respiratory failure, and pathological fractures of the lower jaw. Clinically, the transformation of ameloblastoma into cancer is characterized by the acceleration of tumor growth and the phenomena of germination of the neoplasm in the surrounding tissues. Metastasis is rare and occurs lymphogenously.

Recognizing ameloblastoma is often very difficult. X-ray and cytological examination. On radiographs of the lower jaw, according to the location of the neoplasm, a single or multicystic delimited shadow with bends, swelling and thinning of the bone is usually visible (see Fig. 145, b). Bay-shaped bends can be large or small. Sometimes the bone crossbars are preserved. There is no reaction from the periosteum. Ameloblastoma should usually be differentiated from single-chamber cysts of the lower jaw, which, when palpated, often give a symptom of parchment crunching, and radiologically the shadow is located in the peri-radicular area. In unclear cases, a biopsy is performed, however, this does not always bring clarity. As an example, let us give one of our observations.

Patient E., 17 years old, was admitted to the Sverdlovsk hospital in 1966 with complaints of an increasing tumor on the left half of the face. I first noticed a tumor in front of my left ear six months ago. Diagnosed at the hospital malignant tumor mandible and remote gamma therapy (2043 rad, or 20.4 Gy) was performed. There was no effect from radiation treatment and the patient was referred to us. Upon examination and palpation, a rather large painless tumor was identified, belonging to the lower jaw (Fig. 141). The mouth opens freely. X-ray examination did not allow us to make a definitive statement about the nature of the neoplasm; ameloblastoma or a malignant tumor was assumed, so it was decided to perform a biopsy, but it was performed twice histological examination did not specify the diagnosis - sarcoma of the lower jaw was suspected. Catheterization of the external carotid artery and regional infusion of sarcolysin were performed without effect. Resection of the left half of the lower jaw and simultaneous bone grafting with a lyophilized graft were performed. The postoperative period proceeded smoothly. Microscopic examination- fibrous dysplasia. Discharged home. After 13 years, he is healthy, opens his mouth well, and maintains correct facial features.

Treatment of ameloblastoma is exclusively surgical. The curettage and scooping out of the tumor used in past years turned out to be non-radical; in almost all cases relapses occurred. The size and location of the adamantinoma determines the volume of resection of the mandible (without or with a violation of its continuity, resection of half or complete disarticulation of the mandible). In this regard, we agree with the opinion of A.L. Kozyreva (1959) that for ameloblastoma of the lower jaw, mainly four types of operations can be used, but sometimes it is necessary to perform resection of the chin of the lower jaw. They are shown schematically in Fig. 142. In order to obtain good functional and cosmetic results after surgical interventions, direct splinting should be performed followed by bone grafting or prosthetics. Thanks to radical and correct treatment, relapses have become rare. Rational prosthetics and osteoplastic surgery usually lead to good functional results.

Other types of benign tumors that developed from odontogenic tissues and the bone of the lower jaw are rare (Fig. 143). The histological structure of neoplasms arising from bone is the same as when localized in tubular and flat bones. The principles of treatment differ little from those just described for ameloblastoma.

Odontoma - a benign tumor, rarely observed in the lower jaw, consists of the tissues of one or several teeth and is located inside the bone (Fig. 144). Odontoma translated from Greek language means "tumor consisting of teeth." In the dental tissue from which the tooth must grow, various degrees of disruption of tooth formation occur. These processes are more often observed in the area of ​​premolars and molars.

In the International histological classification Several types of odontomas are given. The clinic distinguishes mainly soft and hard odontoma. In soft odontoma, epithelial growths of various shapes and soft fibrous connective tissue resembling cords are histologically determined. The clinical course of soft odontoma resembles ameloblastoma, but is observed mainly in young people (younger than 20 years old), during the period of tooth formation. As the tumor grows, the bone gradually swells, then the cortical plate of the jaw is destroyed and the tumor penetrates into the soft tissue. The bulging tumor tissue has a soft elastic consistency, is dark in color, bleeds when touched, and can ulcerate.

Hard calcified odontoma is also observed in at a young age, equally common in both sexes, is usually localized in the area of ​​the angle or ramus of the lower jaw. The histological structure of the tumor is very complex and is due to the presence of different pulp tissues, hard elements of the tooth and periodontium, which are in varying degrees of maturity and calcification. Depending on the structural features, hard odontomas are divided into simple, complex and cystic. A simple odontoma develops from the tissues of one tooth germ and differs from a tooth in the chaotic arrangement and ratio of enamel, dentin and cement. A complex odontoma is formed by a conglomerate of teeth and other tissues. Cystic odontoma is presented follicular cyst, in the cavity of which tooth-like formations are determined.

Hard odontoma refers to a very rare benign tumor - dentinoma, consisting mainly of dentin and immature connective tissue. It can only be verified by histological examination.

The surface of a hard odontoma is usually covered with a coarse fibrous capsule. The tumor is characterized by slow expansive growth and gradually calcifies. The clinic is determined by the location, size, structure of the odontoma and the severity of inflammatory changes in the surrounding tissues. A dense, painless tumor with an uneven surface appears in the jaw area. As the odontoma grows, it destroys the bone tissue of the jaw and perforates the mucous membrane covering it. Infection of the mucous membrane leads to the development of chronic inflammation in soft tissues and bone. A decubital ulcer with a bottom consisting of dental tissue may form. As a result of chronic inflammation with periodic exacerbations in the oral cavity or submandibular region, fistulas with purulent discharge are formed. The acute inflammatory process around the odontoma is combined with the phenomena of secondary regional lymphadenitis.

Treatment of odontoma is surgical: the tumor is carefully removed along with the capsule, and its bed is scraped out. The resulting cavity is gradually filled with bone substance. Non-radical surgical intervention causes recurrence of odontoma. Completely calcified odontomas cannot be removed in the absence of signs of chronic inflammation and functional disorders.

In the lower jaw there are often giant cell tumors (osteoblastoclastoma), which are central (intraosseous) and peripheral (giant cell epulis). Their nature has not been precisely established. Some authors consider them to be a tumor, others - a regeneration-restorative process or a manifestation of localized fibrous osteodystrophy. In the International Histological Classification they are classified as non-tumor bone lesions.

Central giant cell tumors are observed more often in women, developing predominantly in the horizontal branch of the lower jaw, often on the left; 60% of patients are between the ages of 10 and 30 years. X-ray determined destructive changes bones with a coarse-mesh pattern. There are cellular, cystic and lytic forms of giant cell tumors, characterized by rapid growth and the nature of bone destruction. The most rapid growth is observed in the lytic form. Treatment for intraosseous giant cell tumor should be surgically taking into account the size and shape of the neoplasm. In case of cellular and cystic forms, the tumor should be removed and the bone surfaces adjacent to it should be scraped out. For larger lesions, bone resection is sometimes indicated. The most effective operation for the lytic form is resection of the affected areas of the bone. For contraindications to surgical treatment, A. A. Kyandsky (1952) recommended prescribing radiation therapy, with the help of which a cure is supposedly sometimes achieved. We have never observed such an effect.

Giant cell epulis (supragingival) is observed mainly at the age of 30-40 years, more often in women. The development of epulis is often preceded by prolonged irritation from sharp edges of teeth, crowns and dentures. The top of the epulis is covered with a mucous membrane. Its consistency is dense or soft. Sometimes the tumor reaches large sizes. Based on the histological structure, fibrous, angiomatous and giant cell epulis should be distinguished. The tumor is located on the gum and is a painless, round, brown formation, often with areas of ulceration. Giant cell epulis often bleeds. Their pace of development is different. Cases of transformation of epulis into sarcoma have not been described; infiltrating growth is not observed. Due to the fact that epulis develops from the periodontium or surrounding bone (the wall of the alveolus or alveolar process), treatment should consist of resection of the alveolar process along with one or two teeth. An iodoform swab is inserted into the resulting defect, strengthened with a plate or dental wire splint. Electrocoagulation with a spherical tip of a diathermy apparatus can be successfully used. In this case, during electrocoagulation it is necessary to cool the tissues surrounding the epulis with cold physiological solution.

Questions of plastic surgery of the lower jaw. During the surgical treatment of benign neoplasms of the lower jaw, it is often necessary to perform its resection or halving, as a result of which a bone defect is formed and new problem: what and how to replenish it. Many methods have been proposed for this purpose. Only a specialist who knows the basic techniques of plastic surgery can begin treatment of a patient with a tumor of the lower jaw. In the general treatment plan for such a patient, the indications and contraindications for a particular method of mandibular plastic surgery and the technique for its implementation must be carefully considered. This is especially important to emphasize, since we do not yet have a reliable and generally accepted method for bone grafting of the lower jaw.

Mandibular plasty methods are divided into autotransplantation and allotransplantation.

Most surgeons believe that mandibular defects are best replaced with one's own bone taken from the rib or iliac crest. We are of the same opinion, but we continue to explore other methods. This operation lasts longer and with it complications are possible due to intervention on the rib or ilium - these are negative points. When the replacement of a defect with an autologous bone, for one reason or another, has to be carried out long after the resection of the lower jaw, it is usually not possible to obtain good anatomical, functional, and cosmetic results.

Almost all surgeons believe that after resection of the lower jaw for a benign tumor, the resulting defect should be restored immediately. This was well shown in the sixties in the doctoral dissertations of P. V. Naumov (1966) and N. A. Plotnikov (1968), although for the first time primary bone grafting of the lower jaw were produced in our country by N. I. Butikova in 1951 and P. V. Naumov in 1952, abroad - N. Marino et al. (1949); J. J. Conley, G. T. Pack (1949).

The success of primary autoplasty of the lower jaw depends on many factors. The main ones are: taking and forming a bone graft, resection of the lower jaw within healthy tissues, preparation of the bed and replacement of a bone defect with a prepared bone graft, immobilization of the lower jaw and correct post-operative care. When removing a benign tumor, resection of the lower jaw should be done without excision of surrounding tissues, preferably subperiosteally, excising the periosteum only when it is involved in the process. If a communication has formed between the oral cavity and a bone wound, you should immediately separate them by suturing the mucous membrane and treat the bone wound with antibiotics. The bone graft is carefully fixed with bone sutures and covered with soft tissue. Intraoral splints are quite sufficient to immobilize the lower jaw.

IN postoperative period Thorough oral hygiene and timely removal of fixing devices should be carried out. If a bone graft site is exposed on the side of the oral cavity, the latter should be covered with a tampon and the wound should be maintained until granulation tissue forms. If the wound is suppurated, there is no need to rush to remove the graft; it is necessary to strengthen anti-inflammatory treatment. Only after 5 weeks can light chewing movements be allowed; This should not be done earlier, especially since intraoral splints should not be removed, since at this time blood vessels have not strengthened, the bone graft is fragile. Judging about the regeneration and formation of bone calluses, as well as removing fixing devices, should be done under the control of an x-ray examination. The shortest period of fixation of the lower jaw is 2.5-3 months.

Simultaneous resection of the jaw and replacement of the defect with a bone autograft in a weakened patient significantly increases the risk of surgery, so the proposal of N.A. Plotnikov (1967, 1979) to use a lyophilized mandibular graft from a corpse interested many surgeons. Currently, this method has received the approval of many clinicians. For many years (since 1966) at the All-Russian Scientific Center of the Academy of Medical Sciences, we have been performing operations together with N.A. Plotnikov, and in order to popularize the method, a special film “Bone alloplasty of the lower jaw” has been prepared. Donors of the lower jaw are the corpses of people who died as a result of trauma. The graft taken from the corpse is placed in an antiseptic solution. Then the jaw is cleaned of soft tissues and subjected to lyophilization in a special laboratory. As a result, bone tissue loses the properties of immunotissue incompatibility. To perform osteoplastic surgery, you need to have several grafts in order to select the appropriate one according to the parameters of the part to be removed or the entire jaw. In most cases, surgical wounds heal well, graft rejection is rare, the function of the lower jaw is preserved in full, and the cosmetic result is satisfactory (Fig. 145, a, b, c; 146).

Of interest is the proposal of Yu. I. Vernadsky and the methodological letter written by him and his co-authors (1967) on the method of subperiosteal resection with simultaneous replantation of the affected part of the jaw. The resected part of the lower jaw is boiled in an isotonic sodium chloride solution for 30 minutes. After boiling, thorough scraping of the bone and modeling of the bone replant, it is placed in its original place and secured with a polyamide thread. Then intermaxillary fixation is carried out for 2.5-3 months. The authors pay attention to the features of preparation for surgery, surgical technique, postoperative treatment and care, as well as possible complications and their prevention. Yu. I. Vernadsky et al. note good immediate and long-term results surgical treatment of patients with ameloblastoma, osteoblastoclastoma and fibrous dysplasia.

At our suggestion, M. G. Kiryanova (1972, 1975, 1977) at the clinic surgical dentistry Omsk medical institute conducted experimental studies of boiled autoreplant for the purpose of replacing postoperative defects of the lower jaw. In 22 dogs, resections of the lower jaw of varying lengths were performed with disruption of the continuity of the lower jaw arch. In 19 cases, primary healing of the surgical wound occurred. Histological studies of the junction of the replant with the edge of the jaw defect were carried out within a period of 7 days to 1 year. It has been established that the boiled replant, transplanted into its own periosteal bed, does not resolve and is not rejected. Moreover, a connection is established with the tissues of the maternal bed and these complex processes interactions promote reparative regeneration in the replant. It should be considered as the basis on which the newly formed osteogenic tissue. Gradually, the boiled autoreplant is absorbed and in its place, newly formed bone tissue is formed by the osteogenic elements of the receptive bed. On average, within 5-6 weeks, an osteogenic adhesion of the edges of the replant with the resected part of the lower jaw is formed; by the 6th month, ossification ends.

In clinics in Omsk and Moscow, we operated on 30 patients aged from 11 to 61 years for benign tumors of the lower jaw. Subperiosteal resections of the jaw were performed with disruption of the continuity of the jaw bone. The resulting bone defects ranging in size from 5 to 23 cm were immediately replaced with boiled and cleaned autoreplant. In 23 patients, a favorable result was achieved: the jaw defect was replaced, see Fig. 146, correct facial contours and function of the temporomandibular joint were restored. In 7 patients, complications were observed, the causes of which were impaired fixation and suppuration in the wound. In one case, resorption of the autoreplant occurred during primary healing wounds. Clinical and radiological observations lasted up to 7 years. We came to the conclusion that the boiled autoreplant of the lower jaw, transplanted into its own periosteal bed, can also be used as an osteoplastic material.

Many techniques have been described and proposed using various xenoplastic materials, including metal, plastic, etc. Works in this direction continue to be published, and various substitutes for osteoplastic material are proposed. For example, K. E. Salyer et al. (1977) suggest using acrylic for plastic surgery of the lower jaw. IN last years majority plastic surgeons are very skeptical about these kinds of reports and consider autotransplantation (for example, split rib) to be the method of choice.

Jaw tumor is complex disease, requiring integrated approach to treatment with the involvement of specialists in several fields of medicine. If a neoplasm is detected, it is necessary to consult not only a dentist, but also a surgeon (possibly a neurosurgeon), and also (if necessary) an otolaryngologist and an ophthalmologist.

The number and specialization of specialists involved depends on the course of the disease. Osteoma of the mandible is benign in nature, consists of bone tissue and is characterized by a slow growth rate.

Disease

As mentioned earlier, this is a benign tumor consisting of mature bone tissue. The process of its appearance is similar to the process of growth of ordinary bones. Osteoma is classified as a non-odontogenic neoplasm of the jaws.

Osteoma of the mandible can develop inside the bone tissue or manifest itself as superficial (exophytic) growth. This neoplasm can spread to the sinuses of the upper jaw and orbit (if localized in the upper jaw). Osteoma of the mandible can cause facial asymmetry and limitation of jaw mobility (up to complete).

Compact osteoma of the lower jaw in the area of ​​teeth 44 and 45

Types of osteomas of the lower jaw

Osteomas in general and the lower jaw in particular are divided into several great friend from other species. Among these neoplasms there are:

• tubular osteoma - it usually has a spherical correct form; Moreover, the structure of such a neoplasm is a continuation of the structure of the jaw itself;
• compact osteoma – the neoplasm has a wide base or a wide stalk;
• intraosseous osteoma - its boundaries have clear outlines, while standing out well against the background of healthy jaw tissue.

Causes of jaw tumors

At the moment, there is no clear answer to the question of the reasons for the appearance of jaw tumors.

Experts continue to study this issue to this day. At the moment, there is evidence linking the formation of tumors with a single or chronic injury(for example, with a bruise of the jaw, cases of damage to the mucous membrane oral cavity, with teeth destroyed by caries, with tartar, uneven edges of fillings, insufficiently fitted dentures and crowns and other similar cases).

A connection has also been identified with inflammatory processes occurring over a long period of time (for example, chronic periodontitis, maxillary osteomyelitis, sinusitis, actinomycosis and so on). Experts do not rule out the possibility of jaw neoplasms appearing against the background of foreign bodies in the maxillary sinus: pieces of filling material, dental roots, and other things.

Having previously determined the exact location using x-rays, in most cases the osteoma is excised through surgery. Usually this surgery must be combined with plastic surgery.

Plastic surgery methods can be of several types: alloplasty, autotransplantation, homo- or heterotransplantation. The tissue removed during the operation must be filled with something ( best solution– these are the patient’s own tissues).

Important! In the absence of timely therapeutic interventions, the fistula becomes chronic.

Exostoses

This type of neoplasm refers to jaw anomalies. Bone growths appear on them. Normally, such a lump on the gum under the teeth does not hurt. Sometimes over time it is able to increase its size, which leads to a feeling of discomfort. The biggest inconvenience occurs when using removable dentures. They constantly put pressure on the growth and injure it.

Exostoses appear when:

• traumatic injuries of the jaws;
• hereditary predisposition;
• congenital anomalies;
• after traumatic tooth extraction.

Need to know! Exostoses are detected during external examination. An x-ray can serve as additional confirmation.

Epulis

Epulis refers to growths of gum tissue. They have a red or pink tint. Most often they are found on the lower jaw.

When is it likely to appear:

• mechanical impact from the overhanging edge of the filling;
• exposure to tartar;
• malocclusion;
• low-quality dentures.

The symptoms of epulis are very similar to gingivitis. Therefore, during the appointment, the doctor conducts a differential diagnosis and tries to exclude inflammatory phenomena gums

X-rays are also taken, as there are changes in the bone tissue at the site of the lesion. A histological examination of the epulis will be informative.

Periodontitis

Periodontitis looks like a dense formation above the gum.

The reasons will be:

• poor-quality root canal treatment;
• spread of inflammation from the dental pulp to the periapical tissues.

A cyst forms at the apex of the root, in which pus accumulates. It gradually grows and destroys surrounding tissues, gradually coming to the surface.

Need to know! The lump itself doesn't hurt. The tooth causes discomfort. There is discomfort when biting.

Hematomas

Hematomas form after traumatic tooth extraction. A red or dark red swelling appears on the gum, having a watery consistency.

Important! This neoplasm does not pose a great danger. But you should see a doctor to rule out infection of the hematoma.

Pathologies when the lump hurts:

• periostitis;
• gingivitis;
• periodontitis.

Periostitis

If a tooth hurts and there is a lump on the gum, then it is necessary to consider more serious diseases. The most common is periostitis.

Important! Due to an actively working immune system and the imperfection of all tissues, periostitis manifests itself most clearly in children.

In this case, inflammatory changes spread to bone tissue. The patient's general condition is disturbed and the body temperature rises. In the area of ​​the neoplasm, the tissues are swollen and painful when touched. Regional lymph nodes are enlarged in size.

Gingivitis

Gingivitis is an inflammatory disease of the gums. When it worsens, they swell. Externally, the inflammation looks like balls of small diameter, dark red in color. The formations themselves are painful. The patient cannot eat or brush his teeth normally.

Important! If not treated promptly, gingivitis progresses to periodontitis.

Periodontitis

This disease of periodontal tissue is manifested by the formation of pathological pockets and tooth mobility. During the exacerbation of periodontitis, white balls appear. They are an accumulation of pus, which is the result of the activity of microorganisms in periodontal pockets.

The patient may suffer general state and low-grade fever appears. The neoplasm itself is painful. Eating will be difficult, as will personal oral hygiene.

Important! Exacerbation is facilitated by hypothermia, colds, and violation of doctor’s recommendations during treatment of periodontitis.

How to treat?

Treatment will depend on the nature of the neoplasm, its cause and clinical features:

1. Fistulas. Its elimination consists of measures aimed at the main cause of the disease. You can make a soda-salt solution with your own hands, which will temporarily alleviate the condition. They rinse with it until the fistula disappears completely.
2. Exostoses. Most often there is no need to treat them. Only when using removable dentures may surgical correction of the tumor be required.
3. Epulis. Epulis is removed completely, including the underlying bone tissue. It also affects the underlying cause of the disease. Tartar is removed, the bite is corrected, and dentures are replaced. If teeth were affected, the surgeon removes them too.
4. Periodontitis. In case of periodontitis, the doctor performs root canal treatment. The methodology will be slightly different. Antibacterial drugs are injected into the canal itself; solutions for washing the lumen will also be different. In particularly severe cases, systemic antibiotic therapy is prescribed. Permanent filling is carried out only after the inflammation has completely subsided.
5. Hematoma. Usually the hematoma resolves on its own after some time. Important! Antibiotics are prescribed for preventive purposes, since a hematoma is a favorable place for the development of microorganisms.
6. Periostitis. With periostitis, the doctor opens the formation and creates an outflow for pus. The operation itself can be seen in the video in this article. Then the cavity is washed with antiseptics, and the wound is drained. The tooth that caused it is removed.
7. Gingivitis. Treatment for gingivitis begins with professional hygiene oral cavity. The doctor removes all dental plaque. Home rinses and medicinal ointments are prescribed. Instructions for their use are given by the dentist.
8. Periodontitis. For periodontitis, treatment consists of cleaning all pathological pockets by a periodontist. All altered tissues are scraped out, and the defects are washed with antiseptics. But such therapy is possible only after the inflammation subsides. If abscesses have formed, they are opened and the patient is prescribed antibiotics. Need to know! Severely mobile teeth are removed.

Any growths on the gums should not be missed. If neoplasms appear, you should immediately go to the doctor to rule out more serious illnesses. The cost of inattention can be very high.

Tumors of the jaws are cancer jawbone, coming from the structure of the tooth or bone tissue. The development of neoplasms is accompanied by pain, changes in the shape of the jaw bone, and agnosia of facial symmetry. There is mobility and a change in the position of the teeth. Patients are diagnosed with a malfunction of the temporomandibular joint and swallowing reflex. The progression of the disease is accompanied by penetration of the tumor into the nasal cavity or upper jaw. Depending on the nature of the disease, tumors can be malignant, but more often benign.

Causes of jaw tumors

Tumor diseases tend to change their nature of origin, which is why it is not possible to name a single cause for the occurrence of a tumor in the jaw. Modern medicine continues to study various circumstances that provoke a tumor process in the jaw. The only reason for the appearance of a tumor, as all experts believe, is a jaw injury. In all other respects, opinions differ to a greater or lesser extent. The nature of the injury can be either protracted ( internal trauma mucous membrane of the oral cavity) and single (bruise of the jaw). Also common cause diseases are foreign bodies (material for filling a tooth or its root) and processes inflammatory in nature, developing over a long period of time.

Promotes the formation of tumors bad habits in the form of smoking and poor oral hygiene. There is a high probability of a jaw tumor appearing during chemotherapy and radiotherapy treatment.

Tumors of the jaws can manifest themselves as a distant focus of cancer pathology.

Classification of jaw tumors

Tumors of the jaws are of the following types:

1. Odontogenic - organ-nonspecific formations associated with the tissues that form the tooth.
2. Nonodontogenic - organ-specific formations associated with bone.

In addition to this classification, tumors can be benign or malignant, occurring in epithelial (epithelial) or mesenchymal (mesenchymal) tissues. Combined neoplasms - epithelial-mesenchial - may occur.

The main representatives of benign organ-specific tumors are:

• ameloblastoma;
• odontoma;
• odontogenic fibroma;
• cementoma.

The main representatives of benign organ-nonspecific tumors are:

• osteoma;
• osteoid osteoma;
• osteoblastoclastoma;
• hemangioma.

Malignant organ-specific neoplasms include cancer and sarcoma.

Symptoms of jaw tumors

Based on the classification of jaw tumors, experts identify various symptoms of tumors.

Benign odontogenic tumors

Ameloblastoma. Its characteristic feature is a pronounced change in the shape of the face associated with a violation of symmetry proportions as a result of the development of a tumor located in the lower jaw. The violation of symmetry can be mild or pronounced. The degree of distortion of the face shape is influenced by the size and position of the tumor. For example, the localization of a tumor along the body and ramus of the lower jaw is characterized by a change in the shape of the lower lateral part of the face. The color of the skin does not change, and it can be easily moved in the area of ​​the tumor.

Inflammatory processes accompanying the tumor can give similar symptoms with phlegmon or mandibular osteomyelitis. During palpation, the body of the tumor is felt, which makes it possible to assess the degree of distortion of the shape of the face. The lymph nodes located directly next to the tumor do not change in size, and the deformed area is clearly defined. The formation has a thick filling and a wavy surface. Examination of the oral cavity reveals thickening of the alveolar ridge, soft tissue may be swollen, and teeth tend to shift or move.

Odontoma. Often this type of tumor is diagnosed in adolescence. The tumor has similar symptoms to other tumors localized in the jaw bones. The course of the disease is quite slow and ambiguous. During development, there is a gradual swelling of the jaw bones, which leads to delayed or absent teeth eruption. Large tumor sizes can change the shape of the jaw or contribute to the formation of a fistula. Despite the fact that the course of the disease passes practically without symptoms, it may be disrupted upper layer jaws, and the tumor itself may contain teeth or their rudiments. When diagnosing, it is necessary to differentiate the tumor from adamantinoma. Odontoma can be simple, complex, soft or mixed.

Odontogenic fibroma. The nature of the development of this neoplasm is very slow; the tumor is mainly diagnosed in young children. A striking symptom tumor development is a violation of teething; during the period of tumor growth, pain syndrome is not observed. Odontogenic fibroma can be located equally on both jaws and is rarely accompanied by inflammatory process. It differs from similar neoplasms in its composition, which includes remnants of the epithelium that forms the teeth.

Cementoma. Distinctive feature tumor is the presence of tissue similar to cement. The tumor grows quite slowly and is manifested by a change in the shape of the jaw. The tumor is clear and round, has pronounced boundaries, most often affects the upper jaw and is almost always connected to the root of the tooth.

Benign non-odontogenic tumors

Osteoma. This tumor is not often diagnosed, and men are more susceptible to developing osteoma than women. It occurs mainly during adolescence. Tumor development proceeds without pain syndrome, quite slowly and is localized in the nasal cavity, orbit or sinuses of the upper jaw. Tumor growth can occur both inside the jaw bones and on the surface. The mandibular location of the tumor is characterized by pain and a violation of the symmetry of the face, as well as the motor abilities of the jaw in this area. The maxillary localization of the tumor leads to failure of nasal breathing, doubling of the image perceived by the eyes, and bulging of the eyes.

Osteoid osteoma. The main symptom of the development of this tumor is the presence of pain, which intensifies with the progression of the tumor. It is noted that people with osteoid osteoma especially feel increased pain at night. Establishing a correct diagnosis is made difficult by the nature of the pain syndrome, which tends to spread, resulting in the activation of other diseases. In diagnosing a tumor, the action of medications (analgesics) that suppress the occurrence of pain helps. The affected areas appear swollen, and the motor function of the joints is impaired. The difficulty of making a diagnosis is due to the small size of the tumor and the absence of special symptoms.

Osteoblastoclastoma. The tumor is a single separate formation. It is extremely rare to see a double appearance of a tumor on adjacent bones. Mostly young people under the age of 20 are susceptible to developing the disease. The most pronounced symptoms are increased pain in the jaw, impaired facial symmetry and tooth mobility. The manifestation of the main symptoms depends on the location of the tumor. The peri-tumor tissues become pronounced, and fistulas begin to appear. Quite often, patients notice an increase in average body temperature, the cortical layer becomes thin, which can cause a fracture of the lower jaw.

Hemangioma. How independent disease is relatively rare; a combination of hemangioma of the soft facial tissues or oral cavity with a jaw hemangioma is often diagnosed. The disease is characterized by a color change in the mucous membrane to bright red or blue-purple shades. This symptom is the main one at the time of diagnosis. However, diagnosis may be difficult in situations where the soft tissues of the oral cavity are not involved in the inflammatory and tumor process. Increased bleeding of the gums and root canals is considered to be a symptom of isolated hemangioma.

Malignant tumors of the jaws

Malignant jaw tumors are not observed in patients as often as benign ones. Oncological lesion accompanied by painful sensations that have the ability to self-propagate. Teeth become loose and prone to rapid loss. Some tumors, due to their morphological manifestations, can cause fractures of the jaw bones. With the progression of a malignant tumor, erosion of bone tissue is observed, while the growth of the parotid and submandibular glands is noticeable, and the masticatory muscles increase. The source of the disease penetrates the cervical mandibular lymph nodes.

Some tumors affecting the upper jaw extend into the eye socket or nasal cavity. As a result, complications of the disease may occur in the form of bleeding from the nose, a suppurating one-sided runny nose, difficulty with nasal breathing, pain in the head, increased production of tears, bulging eyes and double vision.

Malignant tumors affecting the lower jaw quite quickly penetrate the soft tissues of the mouth and cheeks, begin to bleed, resulting in disruption and difficulty in closing the jaws.

Malignant tumors originating from bone tissue are characterized by rapid progression and penetration into soft tissues, which leads to disruption of facial symmetry, increased pain and the rapid appearance of foci of disease in the lungs and other organs.

Diagnosis of jaw tumors

The nature of the formation of tumors, both malignant and benign, is sluggish, which significantly complicates the diagnosis of the disease in initial stages. In this regard, turning to specialists and making a diagnosis occurs more recently late stages neoplasm development. The reason for this is not only the specificity of the disease with a characteristic asymptomatic course, but also the careless attitude of people towards their health, neglect of regular preventive examinations, a lowered level of awareness of the seriousness of the disease associated with the development of cancer in them.

It is possible to determine a possible tumor of the jaw through high-quality collection of information provided by the patient about his condition, complaints about any ailments. A thorough examination of the oral cavity is also carried out and skin faces to detect tumors. In the diagnosis of neoplasms, one of the main roles is played by palpation examination, which makes it possible to determine the size and location of the neoplasm. It is also necessary to take x-rays and computed tomography paranasal sinuses nose A radionuclide test that records infrared radiation human body.

Increased size lymph nodes located near the neck and in the lower jaw area indicates the need for a biopsy. If there is any doubt about determining the nature of the tumor, you should consult with an otolaryngologist and perform rhinoscopy and pharyngoscopy. If there is insufficient information, you should contact an ophthalmologist for qualified advice.

Treatment of jaw tumors

Basically, all benign formations are subject to treatment surgically, during which the tumor is removed with excision of the jaw bone to healthy areas. This treatment eliminates recurrent disease. If teeth are involved in the tumor process, then most likely they will have to be removed. In some cases, gentle removal using curettage is used.

Malignant tumors are treated complex method, including surgical treatment and gamma therapy, in particularly difficult situations a course of chemotherapy may be prescribed.

The postoperative period involves orthopedic restoration and wearing special splints.

Prognosis of jaw tumors

In situations where the tumor is benign and has undergone timely surgical intervention, the prognosis for recovery is favorable. Otherwise, there is a risk of relapse of the disease.

Malignant tumors, as a rule, do not have a favorable prognosis. Five-year survival rate for sarcoma and jaw cancer after combination treatment is less than 20%.