Benign tumors and tumor-like formations of the bones of the face. Other diseases of the jaws

Benign tumors of the jaw bones develop from various tissues and cells that form the 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 called 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 that are the result of directed differentiation of the primary epithelium sunk into the jaw oral cavity and mesenchyme in the direction of building 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 in the process of development should explain the diversity of cellular forms of odontogenic formations.

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

Adamantinoma (ameloblastoma)

Adamantinoma refers to benign epithelial tumors, resembling the histological structure of the enamel organ of the tooth. The name of the tumor comes from the Greek word "adamantos" - enamel, diamond. Other names of this tumor in our country have not received distribution. Adamantinoma is more often observed at the age of 20-40 years, however, there have been cases of tumor development in newborns and in the elderly. Adamantinoma is slightly more common in women. The tumor occurs mainly in the thickness of the jaw bones, and the lower jaw is affected 6-7 times more often than the upper. Favorite place of primary localization of adamantinoma - corner and branch mandible. Much less often, the tumor develops in the anterior part of the body of the lower jaw.

IN histological structure adamantinomas distinguish stroma, consisting of connective tissue, and parenchyma - epithelial cells that penetrate the stroma and form cells. Along the periphery of these cells are high cylindrical cells, and closer to the center - 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 less prominent than in massive. 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 jawbone. Cyst cavities are made 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 others from odontogenic epithelial remnants (Islands 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 unnoticed and may be found incidentally on x-rays. The duration of the asymptomatic period of adamantinoma depends on the location of the tumor, related complications and character tumor growth. The jaw bone affected by the tumor gradually thickens, a noticeable deformation of the face appears. The surface of the thickened jaw is in most cases smooth, but may be uneven. The skin over the tumor remains unchanged and mobile for a long time. With a 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 branch of the lower jaw, then signs of bone thinning are much more difficult to detect. From the oral cavity are determined, thickening and deformation alveolar process. Quite often in an oral cavity it is possible to find fistulas with serous and purulent discharge. On palpation of 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 on percussion. Percussion sound is noticeably shortened due to damage to the near-apex tissues. Adamantinoma can suppurate after the removal of teeth located in the tumor zone, or as a result of infection from the gum pockets. It is often during the period of suppuration that patients first go to the doctor, unaware of the existence of a tumor. Symptoms associated with displacement and compression of neighboring organs and tissues are related to late manifestations diseases and are expressed in violation of the function 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 increase with suppuration of adamantinoma.

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. On the border of the tumor and unchanged bone, one 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 comes down to the removal of the tumor with areas of clinically healthy bone tissue. The amount of surgical intervention depends on the extent of the tumor. In most cases, patients go to the doctor at a stage of the disease when resection of a significant part, half or the entire lower jaw with exarticulation is required. These radical interventions are usually combined with primary bone grafting. As a bone graft, the patient's own rib or lyophilized allogeneic grafts from the mandibular bone are used.

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

With this method, operative access to the tumor is carried out through an incision in the submandibular region. Throughout the length of the lower jaw, the fibers of the masticatory muscle are cut off and the outer surface of the jaw branch is exposed. Luer bone cutters and a chisel remove the outer bone wall, and then remove the inner bone wall of the jaw. The edges of the bone defect are carefully treated with wire cutters and a chisel (at least 1 cm from the border of the tumor). 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 subsequently will serve as the basis for bone formation. The coronoid process can be saved if the tumor does not reach its base and the edge of the notch of the mandible. After removal of the tumor and treatment of the bone in this way, the masticatory muscle is placed in the resulting defect 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. Given the possibility of a fracture of the lower jaw, a Vankevich splint is made before the operation for subsequent fixation of the fragments. This technique creates the most favorable conditions for subsequent prosthetics. Curettage of adamantinoma is now completely abandoned. After curettage, tumor recurrences occur in 90% of cases. Beam methods treatment for adamantinoma has not gained distribution. After radiation therapy, tumor relapses develop in more than half of the patients within 5 years, and in all the rest after 10 years.

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 a fibrous tissue poor in cells, among which strands or islets of cells of the dentition epithelium are located. Individual areas of the tumor may have more loose structure and contain significant amount cells. Mucous degeneration of tumor sites is sometimes 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. On palpation of the jaw, a rounded swelling of a densely elastic consistency is determined. The tumor is easily separated from the surrounding bone tissue. On section, the tumor is greyish-white.

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

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

Cementoma

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

Cementoma often develops on the lower jaw, mainly in young women. It is extremely rare for multiple lesions of the jaw bones. The tumor develops around the roots of one tooth or a group of them. Cases of occurrence of cement away from the roots of the teeth are observed. The tumor is limited to the capsule.

Cementoma develops slowly and in clinical picture no characteristic features. With the growth of the tumor, the jaw is deformed, often there are pains in the teeth when eating or during palpation of the tumor. An inflammatory process may develop around the tumor. The infection penetrates either through the canal of the tooth, or through the mucous membrane of the oral cavity, destroyed as a result of "eruption" of the cementoma.

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.

The treatment of cementoma is surgical and comes down to exfoliation of the tumor along with the capsule. Teeth soldered with cementoma are subject to removal.

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, consists of poorly differentiated dental tissues found in developing tooth germs, and 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 there are connective tissue elements of the stroma, resembling the structure of the papilla of the tooth germ. Soft odontoma is the formation of a densely elastic consistency, on the cut it has a light color. 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 the jawbone to 'swell', as in adamantinoma. Unlike adamantinoma, soft odontoma is mainly observed in young people during the formation of permanent teeth. Soft odontoma grows expansively, but sometimes it has a 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 be permanent teeth or their beginnings. Often there is a violation of the cortical layer of the jaw.

Treatment of soft odontoma is exclusively surgical. In a benign course (expansive growth, highly differentiated structure of the tumor), it is possible to limit the excision of the tumor within healthy tissues. With infiltrative growth and other signs of a malignant course, extended surgical intervention is indicated - resection of a significant part of the jaw.

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

There are three types of solid 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 cementum. A simple odontoma can be complete, consisting of all tooth tissues, and incomplete, containing some tissues. Incomplete odontoma occurs as a result of impaired development of only part of the tooth germ - crown or root. If an incomplete simple odontoma develops in the region of the crown, then the roots have a normal shape. With the development of odontoma in the root area, the crown regular shape. A simple odontoma can be soldered to adjacent teeth or displace them, causing retention of the corresponding teeth.

Simple odontomas include the so-called periodontoma - bumpy hard formations, tightly soldered to the neck or to the root of the tooth. Similar formations associated with enamel are called enamel drops.

Complex odontomas include tissues from several teeth, and sometimes formed teeth.

Solid odontomas in most cases are asymptomatic and are discovered incidentally during X-ray examination due to dental disease or in connection with the "eruption" of the 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. Accession of infection further leads to inflammation in the surrounding soft tissues and bones. Perhaps the formation of external fistulas with a slight purulent discharge.

A solid odontoma, having reached a certain size, as a rule, stops growing, which is sometimes mistaken for a developmental defect. This proves the almost constant absence of one or more teeth in the area of the tumor. The accelerated growth of hard odontoma during dentition also supports this view. On the radiograph, the odontoma gives a round or irregular shadow of the same intensity as the tooth tissue (Fig. 150).

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

The treatment of hard odontoma is surgical and comes down to exfoliation of the tumor together with the capsule. With large odontomas and significant destruction of the jawbone, a partial one is produced. jaw resection with primary bone grafting.

Small odontomas that are asymptomatic and do not cause any complications may not 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 belongs to organ-specific.

Classification (I.I. Ermolaev, 1964).

I. Odontogenic formations of an epithelial nature.

1. Adamantinomas (ameloblastomas).

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

3. Odontogenic cysts, which are a malformation of the tooth-forming 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 - precursors of enamel in the embryonic period.

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

It is localized more often on the lower jaw in the area of \u200b\u200bthe angle and its branches, less often - the body of the jaw; most often develops in the region of the lower wisdom teeth.

Clinic. Patients come with complaints of suddenly noticed by them (or others) asymmetry of the face.

Symptoms of adamantinoma:

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

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

3. Fistulas on the oral mucosa with purulent discharge.

4. Wounds that do not heal for a long time after the extraction of teeth, from which a turbid liquid is released.

5. With tumors that have reached a large size, patients complain of difficulty in the function of chewing, speech, and even breathing.

Objectively: in the early stages, a spindle-shaped swelling of the body of the jaw is noted; while the tumor appears smooth or slightly uneven - bumpy, 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: foci of parchment crunch, fluctuation; the skin over the tumor becomes thinner, turns pale, visible vasculature, it is difficult to fold. Over time, the skin becomes thinner and can even reach ulceration over the places of the most pronounced bony protrusions. Regional lymph nodes are not enlarged, provided that the contents of the cystic cavities have not yet festered and inflammation of the bone has not joined the tumor process. The teeth in the area of the tumor are usually quite stable, but may be somewhat loosened (in the presence of a chronic inflammatory background). The gingival mucosa is of normal color or cyanotic.

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

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

Adamantine treatment should be radical in order to avoid relapses, which increase the risk of malignancy.

Methods of surgical treatment:

I. Economical resection according to P.V. Naumov (1965). It is used for small areas of damage.

Operation steps:

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

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

processing the edges of the bone defect of the jaw with nippers and a chisel with the capture of healthy tissues not less than 1 cm in all directions from the boundaries of the visible location of the tumor;

filling the defect of the jawbone with the masticatory muscle on the feeding leg;

layered suturing at the edges operating wound.

II. Resection or disarticulation of the jaw with one-stage autoosteoplasty is indicated for extensive damage to the jawbone. If adamantinoma has grown into the perimaxillary tissues, subperiosteal resection is unacceptable. It is necessary to remove the adjacent affected tissue. The defect is replaced by a section of the rib or scallop ilium.

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

ODONTOMA

Odontoma- an odontogenic tumor of a mixed nature, consisting of tooth tissues. At the heart of the formation of odontomas are violations of the processes of tooth formation. They occur during the formation of permanent teeth. In childhood, they are most often localized in the area of canines and premolars. Allocate soft and hard odontoma. Recently, however, 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 solid odontoma: simple, complex and compound. A simple odontoma is formed from the tissue of the 1st tooth. A complex odontoma arises from several teeth. In this case, dental tissues are presented separately. Composite odontoma consists of a conglomeration of small rudimentary teeth or tooth-like formations. Simple odontomas can be complete (consist of the entire tooth germ) and incomplete (consist of part of the germ).

The diagnosis is established most often 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, displacement of existing teeth. It is localized mainly in the area of incisors, canines and premolars of the upper jaw. The tumor grows slowly, painlessly. Hard odontoma is often diagnosed as a result of its infection. In these cases, there are signs of acute or chronic inflammation (edema, hyperemia, fistulas), which mimics osteomyelitis of the jaw, difficult teething.

X-ray picture. With a complex odontoma, multiple tooth-like formations with clear contours in the form of a “mulberry” are determined. On the periphery of the tumor, a strip of rarefaction (tumor envelope) is visible. The odontoma displaces adjacent tooth buds. With a simple odontoma, the shadow of a separate viciously developed tooth or tooth-like formation (underdeveloped, deformed tooth), the ratio of enamel and dentin, in which is chaotic, is determined on the radiograph. The radiological density of the tumor corresponds to the density of the tissues of the tooth.

Treatment solid odontoma surgical. The operation is complete removal tumors and their 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.

Fully calcified, mature formations that have completed the biological cycle of development and do not cause inflammatory diseases and functional disorders are not subject to removal.

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 collapses, and the tumor grows into soft tissues. bulging tumor tissue It has dark color. The tumor is elastic, bleeds and may ulcerate. The teeth are mobile and displaced. Histologically, epithelial growths and soft fibrous connective tissue in the form of strands 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 (germination into soft tissues, ulceration) are revealed.

The x-ray picture of the tumor resembles ameloblastoma: thinning of the cortical substance, several cyst-like areas of enlightenment. Bone cavities may contain teeth and rudiments of teeth. The boundaries of the tumor are clear.

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

Of greatest interest is ameloblastoma (adamantinoma). This is a benign odontogenic epithelial tumor, located mainly in the lower jaw (approximately 80%). Approximately 70% of it is localized in the region of the molars, angle and branch, in 20% - in the region of premolars and in 10% - in the chin region. 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 the same frequency in men and women aged 20-40 years. Observations of ameloblastoma in newborns and the elderly are described; there are cases when it was localized in the tibia and other bones.

Ameloblastoma is more common 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 a yellow liquid or colloidal masses. The tumor is gray and soft. The bone around the ameloblastoma is significantly thinned. As it develops, it spreads very deeply. Strands are microscopically determined 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 of stellate cells. Another form of ameloblastoma, solid, 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. BI Migunov (1963) noted that the cystic form is usually formed gradually from a solid ameloblastoma.

The 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 mandibular resection. In reports relating 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% relapses. Cases of malignant transformation of adamantinoma are described. I. I. Ermolaev (1965) reports that the frequency of a possible true malignant transformation is 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 a deformity of the face (see Fig. 145, A). Ameloblastoma is characterized by a slow and painless course. The thickening appears first in a small area and is more often localized in the region 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.

Recognition of ameloblastoma is often associated with great difficulties. Very useful X-ray and cytological research. 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 and small. Sometimes bone bars are preserved. There is no reaction of the periosteum. Ameloblastoma should usually be differentiated from single-chamber cysts of the lower jaw, which, when palpated, often give a symptom of a parchment crunch, and radiographically, the shadow is located in the periradicular region. In unclear cases, a biopsy is performed, however, it does not always bring clarity. Let's take one of our observations as an example.

Patient E., aged 17, was admitted to the Sverdlovsk hospital in 1966 with complaints of an increasing swelling of the left side of the face. For the first time I noticed a tumor in front of the left auricle six months ago. Diagnosed in the hospital malignant tumor mandible and carried out remote gamma therapy (2043 rad, or 20.4 Gy). The effect of radiation treatment was not observed and the patient was referred to us. During examination and palpation, a rather large painless tumor was found, related to the lower jaw (Fig. 141). The mouth opens freely. X-ray examination did not allow us to speak definitely about the nature of the neoplasm, ameloblastoma or a malignant tumor was assumed, therefore it was decided to perform a biopsy, however, twice histological examination did not specify the diagnosis - sarcoma of the mandible was suspected. Produced catheterization of the external carotid artery and regional infusion of sarcolysin without effect. Resection of the left half of the lower jaw and one-stage 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, the correct facial features are preserved.

The treatment of ameloblastoma is exclusively surgical. The curettage and scooping out of the tumor used in past years turned out to be non-radical; almost all cases relapsed. The volume of resection of the lower jaw depends on the size and localization of the adamantinoma (without violating its continuity or with violation, resection of half or complete exarticulation of the lower jaw). In this regard, we agree with the opinion of A.L. Kozyreva (1959) that four types of operations can be used for ameloblastoma of the lower jaw, but sometimes it is necessary to resect 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 have developed from odontogenic tissues and the lower jaw bone itself are rare (Fig. 143). The histological structure of neoplasms arising from the 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 more teeth and is located inside the bone (Fig. 144). Odontoma translated from Greek means "a tumor consisting of teeth". In the dental tissue, from which the tooth should grow, there are varying degrees of damage to the formation of the tooth. These processes are more often noted in the region of premolars and molars.

In the International histological classification There are several types of odontomas. The clinic distinguishes mainly soft and hard odontoma. In a soft odontoma, epithelial growths of various shapes and soft fibrous connective tissue resembling strands are histologically determined. The clinical course of soft odontoma resembles ameloblastoma, but it is observed mainly in young people (under 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 neoplasm is introduced into the soft tissues. The protruding tissue of the tumor has a soft elastic consistency, has a dark color, bleeds when touched, and can ulcerate.

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

Hard odontoma is 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 localization, size, structure of the odontoma and the severity of inflammatory changes in the surrounding tissues. A dense, painless swelling with an uneven surface appears in the jaw area. Increasing, the odontoma 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 may form with a bottom consisting of dental tissues. As a result of chronic inflammation with periodic exacerbations, fistulas with purulent discharge are formed in the oral cavity or submandibular region. An acute inflammatory process around the odontoma is combined with the phenomena of secondary regional lymphadenitis.

Surgical treatment with odontoma: 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 is the cause of recurrence of odontoma. Completely calcified odontomas are not subject to removal in the absence of signs of chronic inflammation and functional disorders.

Often seen in the lower jaw giant cell tumors (osteoclastoma), which are central (intraosseous) and peripheral (giant cell epulis). Their nature has not been precisely established. Some authors consider them a tumor, others - a regenerative 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, develop mainly in the horizontal branch of the lower jaw, more often on the left, 60% of patients are between the ages of 10 and 30 years. Radiologically determined destructive changes bones with large-mesh pattern. There are cellular, cystic and lytic forms of giant cell tumors, which differ in the rate of growth and the nature of bone destruction. The fastest growth is observed in the lytic form. Treatment of intraosseous giant cell tumor should be surgically taking into account the size and shape of the neoplasm. With cellular and cystic forms, the tumor should be removed and the bone surfaces adjacent to it should be scraped. For large lesions, bone resection is sometimes indicated. The most effective operation for the lytic form is resection of the affected areas of the bone. With contraindications to surgical treatment, A. A. Kyandsky (1952) recommended prescribing radiation therapy, with the help of which, supposedly, a cure is sometimes achieved. We have never seen such an effect.

Giant cell epulis (grip) is observed mainly at the age of 30-40 years, more often in women. The development of epulis is often preceded by prolonged irritation by the sharp edges of teeth, crowns and prostheses. From above, the epulis is covered with a mucous membrane. Its consistency is dense or soft. Sometimes the tumor reaches a large size. According to the histological structure, fibrous, angiomatous and giant cell epulis should be distinguished. The tumor is located on the gum and is a painless rounded brown formation, often with areas of ulceration. Quite often, giant cell epulis bleed. Their rate of development is different. Cases of transformation of epulis into sarcoma are not described, infiltrating growth is not observed. Due to the fact that the epulis develops from the periodontium or the surrounding bone (wall of the alveolus or alveolar process), treatment should consist in resection of the alveolar process along with one or two teeth. An iodoform tampon is introduced into the formed defect, reinforced with a plate or a dental wire splint. With success, electrocoagulation with a spherical tip of a diathermy apparatus can be used. In this case, during electrocoagulation, it is necessary to cool the tissues surrounding the epulis with cold saline.

Issues of plastic surgery of the lower jaw. In the surgical treatment of benign neoplasms of the lower jaw, it is often necessary to resect it or half-cut it, as a result of which a bone defect is formed and new problem: what and how to fill it. For this purpose, many methods have been proposed. Only a specialist who knows the basic techniques of plastic surgery can start treating a patient with a tumor of the lower jaw. In the general plan for the treatment of such a patient, indications and contraindications for one or another method of lower jaw plasty, as well as the technique for its implementation, should be carefully thought out. 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 grafts 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 postoperative care. When removing a benign tumor, resection of the lower jaw should be done without excising the 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 the bone wound, they should immediately be separated by suturing the mucous membrane and treating the bone wound with antibiotics. The bone graft is carefully fixed with bone sutures and covered with soft tissues. For immobilization of the lower jaw, intraoral splints are quite sufficient.

IN postoperative period a thorough toilet of the oral cavity and the timely removal of fixing devices should be carried out. If a section of the bone graft is exposed from the side of the oral cavity, the latter should be covered with a swab and the wound should be treated in this way until granulation tissue is formed. When the wound suppurates, there is no need to hurry with the removal of the graft, it is necessary to strengthen the 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 not strengthened, the bone graft is fragile. To judge the regeneration and formation of calluses, as well as to remove the fixing devices should be under the control of 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 increase the risk of surgery, so the proposal of N. A. Plotnikov (1967, 1979) to use a lyophilized lower jaw graft from a corpse interested many surgeons. Currently, this method has received the approval of many clinicians. For many years (since 1966), we have been performing operations at the VONC AMS together with N. A. Plotnikov, and in order to popularize the method, a special film “Bone alloplasty of the lower jaw” was 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. For the production of osteoplastic surgery, you need to have several grafts in order to select the appropriate one according to the parameters of the removed part or the whole jaw. In most cases, surgical wounds heal well, graft rejection is rare, the function of the lower jaw is preserved in full, the cosmetic result is satisfactory (Fig. 145, a, b, c; 146).

Of interest is the proposal of Yu. I. Vernadsky and the methodical 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, careful scraping of the bone and modeling of the bone replant, it is put in its original place and fixed with a polyamide thread. Then intermaxillary fixation is carried out for 2.5-3 months. The authors pay attention to the peculiarities of preparation for surgery, surgical technique, postoperative treatment and care, as well as to 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. Kiryanov (1972, 1975, 1977) in the clinic surgical dentistry Omsk medical institute conducted experimental studies of the digested autoreplant in order to replace postoperative defects in the lower jaw. In 22 dogs, mandibular resections of various lengths were performed with discontinuity of the mandibular arch. In 19 cases, primary healing of the surgical wound occurred. Histological studies of the junctions of the replant with the edge of the jaw defect were carried out in terms of 7 days to 1 year. It has been established that the digested replant, transplanted into its own periosteal bed, does not dissolve and is not rejected. Moreover, a connection is established with the tissues of the mother's 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 digested autoreplant is absorbed and in its place, the newly formed bone tissue is formed by the osteogenic elements of the perceiving 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, and ossification ends by the 6th month.

In the clinics of Omsk and Moscow, we operated on 30 patients aged 11 to 61 years for benign tumors of the lower jaw. Were made subperiosteal resection of the jaw with a violation of the continuity of the jawbone. The resulting bone defects ranging in size from 5 to 23 cm were immediately replaced by boiled and cleaned autoreplant. A favorable result was achieved in 23 patients: the jaw defect was replaced, see fig. 146, the correct contours of the face and the function of the temporomandibular joint were restored. In 7 patients, complications were observed, the causes of which were a violation of fixation, 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 mandibular plasty. IN last years majority plastic surgeons are very skeptical of this kind of reports and consider autotransplantation (for example, a split rib) as the method of choice.

The 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 with a dentist, but also with a surgeon (possibly a neurosurgeon), and also (if necessary) with an otolaryngologist and ophthalmologist.

The number and specialization of involved specialists depends on the course of the disease. The mandibular osteoma is benign in nature, consists of bone tissue and is characterized by slow growth rates.

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 as superficial (exophytic) growth. This neoplasm can spread to the sinuses of the upper jaw, and the orbits (in case of localization in the region of the upper jaw). Osteoma of the lower jaw can cause facial asymmetry and limited jaw mobility (up to complete).

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

Types of mandibular osteomas

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

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

Causes of jaw tumors

To date, there is no unequivocal answer to the question of the causes of the appearance of neoplasms of the jaws.

Experts continue to study this issue to this day. At the moment, there is evidence of an association between the formation of tumors and a single received or chronic injury(eg, with bruised jaw, cases of mucosal injury oral cavity, with teeth destroyed by a carious process, with tartar, uneven edges of fillings, insufficiently fitted dentures and crowns, and other similar cases).

Also, a connection with inflammatory processes occurring for a long time (for example, chronic periodontitis, jaw osteomyelitis, sinusitis, actinomycosis, and so on). Experts do not exclude the possibility of the appearance of neoplasms of the jaw against the background of foreign bodies of the sinus of the upper jaw: pieces of material for filling, dental roots and other things.

Having previously determined the exact location using X-ray, in most cases, the osteoma is excised with the help of an operation. Usually this surgery must be combined with plastic surgery.

Methods of plastic surgery can be of several types: alloplasty, autotransplantation, homo- or heterotransplantation. The tissues removed during the operation must be filled with something ( best solution 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 anomalies of the jaws. Bone growths appear on them. Normally, such a bump 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 the growth of gum tissue. They are red or pink in color. Most often they are found on the lower jaw.

When is it possible to appear:

mechanical impact of the overhanging edge of the filling;

impact of tartar;

malocclusion;

poor quality dentures.

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

An x-ray is also performed, since changes in the bone tissue are present at the site of the focus. Histological examination of the epulis will be informative.

Periodontitis

Periodontitis looks like a dense formation above the gum.

The reason will be:

poor-quality root canal treatment;

spread of inflammation from the dental pulp to the periapical tissues.

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

Need to know! The bump itself doesn't hurt. Unpleasant sensations delivers a tooth. There is discomfort when biting.

Hematomas

Hematomas are formed after traumatic extraction of teeth. A swelling of a red or dark red color appears on the gum, which has a watery consistency.

Important! This neoplasm does not pose a great danger. But it is worth consulting a doctor to exclude infection of the hematoma.

Pathologies when the lump will hurt:

periostitis;

gingivitis;

periodontitis.

Periostitis

If a tooth hurts and there is a lump on the gum, then more serious diseases should be considered. The most common is periostitis.

Important! Due to the actively working immunity and the imperfection of all tissues, periostitis is most pronounced in children.

In this case, inflammatory changes extend to the bone tissue. The patient's general condition is disturbed, body temperature rises. In the area of the neoplasm, the tissues are edematous and hurt when touched. Regional lymph nodes are enlarged.

Gingivitis

Gingivitis is an inflammatory disease of the gums. With its exacerbation, they swell. Outwardly, inflammation looks like balls of small diameter, having a dark red color. The formations themselves are painful. The patient cannot eat normally and brush his teeth.

Important! In the absence of timely treatment, gingivitis turns into periodontitis.

Periodontitis

This disease of periodontal tissues is manifested by the formation of pathological pockets and tooth mobility. In the stage of exacerbation of periodontitis, white balls appear. They are a collection of pus, which is the result of the activity of microorganisms in periodontal pockets.

The patient may suffer general state and subfebrile temperature appear. The neoplasm itself is painful. Eating will be difficult, as well as individual oral hygiene.

Important! Exacerbation contributes to hypothermia, colds, violation of the doctor's recommendations during the treatment of periodontitis.

How to be treated?

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

Fistulas. Its elimination consists in measures aimed at the main cause of the disease. With your own hands, you can make a soda-salt solution, which will temporarily alleviate the condition. They are rinsed until the fistula completely disappears.

Exostoses. Most often there is no need to treat them. Only when prosthetics with removable dentures may surgical correction of the neoplasm be required.

Epulis. Epulis is removed completely, including the underlying bone tissue. It also affects the underlying cause of the disease. Tartars are removed, the bite is corrected, and dentures are replaced. If the teeth were affected, the surgeon removes them as well.

Periodontitis. With 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 especially severe cases, systemic antibiotic therapy is prescribed. Permanent filling is carried out only after the inflammation has completely subsided.

Hematoma. Usually the hematoma resolves itself after some time. Important! For prophylactic purposes, antibiotics are prescribed, since the hematoma is a favorable place for the development of microorganisms.

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.

Gingivitis. Treatment for gingivitis begins with professional hygiene oral cavity. The doctor removes all dental deposits. Rinsing and therapeutic ointments are prescribed for home. Instructions for their use are given by the dentist.

Periodontitis. With periodontitis, treatment consists in cleaning all pathological pockets by a periodontist. All altered tissues are scraped out, and 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! Strongly mobile teeth are removed.

None of the formations on the gums should be missed. When neoplasms appear, you should immediately go to the doctor to exclude more serious illness. The cost of carelessness can be very high.

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

Causes of tumors of the jaws

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

Contribute to the development of neoplasms addictions in the form of smoking and poor oral hygiene. There is a high probability of the appearance of a jaw tumor in the process of chemotherapy and radiotherapy.

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

Classification of jaw tumors

Tumors of the jaws are of the following types:

Odontogenic - organ-nonspecific formations associated with the tissues that form the tooth.
Non-odontogenic - organ-specific formations associated with the bone.

In addition to this classification, tumors can be benign or malignant, occurring in the tissues of the epithelium (epithelial) or mesenchyme (mesenchial). There may be combined neoplasms - epithelial-mesenchial.

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.

Organ-specific malignancies include cancer and sarcoma.

Symptoms of jaw tumors

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

Benign odontogenic tumors

Ameloblastoma. Its characteristic feature is a pronounced change in the shape of the face, associated with a violation of the proportions of symmetry as a result of the development of a tumor located in the lower jaw. Symmetry breaking can be subtle or pronounced. The degree of distortion of the shape of the face is affected by the size and position of the tumor. For example, localization of a neoplasm along the body and branches 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, in the area of the tumor it can be easily moved.

Inflammatory processes accompanying the tumor can give similar symptoms with phlegmon or mandibular osteomyelitis. During palpation, the body of the tumor is palpated, which makes it possible to assess the degree of distortion of the shape of the face. Lymph nodes located directly near the tumor do not change their size, the deformed area is clearly expressed. The formation has a dense filling and a wavy surface. Examination of the oral cavity shows thickening of the alveolar process, soft tissues may have swelling, and teeth tend to move or move.

Odontoma. This type of tumor is often diagnosed in adolescence. The neoplasm has similar symptoms to other tumors localized in the jaw bones. The course of the disease is quite slow, ambiguous. In the process of development, a gradual swelling of the jaw bones is observed, which leads to delayed eruption of teeth or its absence. The large size of the tumor 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 with virtually no symptoms, it may be disturbed 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 is simple, complex, soft and mixed.

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

Cementoma. hallmark tumor is the presence of a cement-like tissue. The neoplasm grows rather slowly, and is manifested by a change in the shape of the jaw. The tumor - clear and rounded - has pronounced boundaries, most often affects the upper jaw and is almost always connected to the root of the tooth.

Benign nonodontogenic tumors

Osteoma. This tumor is not often diagnosed, and men are more prone to developing osteoma than women. It occurs mainly during adolescence. Tumor development proceeds without pain syndrome, rather slowly and is localized in the nasal cavity, eye socket or sinuses of the upper jaw. Tumor growth can take place both inside the jaw bones and on the surface. The mandibular location of the neoplasm 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 a failure of nasal breathing, a bifurcation 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 increases 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 hampered by the nature of the pain syndrome, which tends to spread, as a result of which other diseases are activated. In diagnosing a tumor, the action of medications (analgesics) that prevent the occurrence of pain helps. The affected areas look swollen, the motor function of the joints is disturbed. The complexity of establishing the diagnosis is due to the small size of the tumor and the absence of specific symptoms.

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

Hemangioma. How independent disease is relatively rare, the combination of hemangioma of the soft facial tissues or oral cavity with the jaw hemangioma is often diagnosed. The disease is characterized by a color change in the mucous membrane to bright red or blue-purple hues. It is this symptom that is the main one at the time of diagnosis. However, diagnosis can be difficult in situations where the soft tissues of the oral cavity are not involved in the inflammatory and tumor process. As a symptom of an isolated hemangioma, it is customary to consider increased bleeding of the gums and root canals.

Malignant tumors of the jaws

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

Some tumors that affect the maxilla invade the eye socket or nasal cavity. As a result, there may be a complication of the disease in the form of nosebleeds, a festering unilateral runny nose, difficulties with nasal breathing, headaches, increased tear secretion, bulging eyes and a split image.

Tumors of a malignant nature that affect the lower jaw quickly penetrate into the soft tissues of the oral cavity and cheeks, begin to bleed, as a result of which there is a violation 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 a violation of facial symmetry, increased pain and the early appearance of foci of the disease in the lungs and other organs.

Diagnosis of tumors of the jaws

The nature of the formation of tumors, both malignant and benign, is sluggish, which greatly complicates the diagnosis of the disease on initial stages. In this regard, it takes more than later 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 to their health, the neglect of regular preventive examinations, a lower level of awareness of the severity of the disease associated with the development of cancer in them.

It is possible to determine a possible tumor of the jaw due to the qualitative collection of information provided by the patient about his condition, complaints of any ailments. A thorough examination of the oral cavity is also carried out and skin faces for tumors. In the diagnosis of neoplasms, one of the main roles is played by palpation examination, which allows determining the size and location of the neoplasm. X-rays should also be taken and computed tomography paranasal sinuses nose. A radionuclide test can help in making a diagnosis. infrared radiation human body.

Increased size lymph nodes located near the neck and in the lower jaw, indicates the need for a biopsy. If there is any doubt in determining the nature of the tumor, it is necessary to consult 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 formations of a benign type are subject to treatment. surgically, during which the tumor is removed with excision of the jaw bone to healthy areas. This treatment eliminates recurrence. If teeth are involved in the tumor process, then most likely they will have to be removed. In some cases, sparing 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 recovery 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 recurrence of the disease.

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