Malignant Lesions

Tumours of the JawsTumours of the Jaws

Malignant TumorsMalignant Tumors

Tumor:Tumor:– Is a mass of cells, Is a mass of cells,

tissues or organs tissues or organs resembling those resembling those normally present normally present but arranged but arranged atypically and atypically and behave behave abnormally. abnormally.

Behavior is very Behavior is very essential and is of essential and is of great importance.great importance.


Classification:Classification:– HistogeneticHistogenetic::

Epithelial originEpithelial origin

connective tissue connective tissue originorigin

– HistologicalHistological: : Degree of Degree of differentiation. differentiation. – Well Well

– moderate moderate

– poorly differentiatedpoorly differentiated


– Clinical behavior: Clinical behavior: BenignBenign: :

– slowly growing and expanding causing pressure atrophy slowly growing and expanding causing pressure atrophy but remain within the capsule. but remain within the capsule.

– Very few mitosis could be seen. Very few mitosis could be seen.

Malignant:Malignant:– Invade surrounding tissues and locally invasive.Invade surrounding tissues and locally invasive.– Progressive growth and metastasize to distant organs, Progressive growth and metastasize to distant organs,

embolic spread due to lack of cell adhesion embolic spread due to lack of cell adhesion – Mitosis.Mitosis.

Intermediate:Intermediate:– Locally invasive, no metastasis. Basal cell carcinoma Locally invasive, no metastasis. Basal cell carcinoma

and Ameloblastomaand Ameloblastoma


Oral lesion are:Oral lesion are:– Carcinomas: Carcinomas:

Non‑secreting epithelialNon‑secreting epithelial– Squamous cellSquamous cell

90%90%

Secreting epithelialSecreting epithelial

– AdenocarcinomaAdenocarcinoma 5%5%

– Sarcomas:Sarcomas:LymphomasLymphomasOthersOthers


Early diagnosis is very essential Early diagnosis is very essential for managementfor management

Clinical diagnosis from the signs Clinical diagnosis from the signs and symptoms and symptoms

Referral for essential Referral for essential investigationinvestigation

Malignant TumorsMalignant TumorsCLINICAL DIAGNOSIS OF ORAL CANCERCLINICAL DIAGNOSIS OF ORAL CANCER

– Symptoms vary according to the site of the lesionSymptoms vary according to the site of the lesionpainless in the early stagespainless in the early stages

painful and tender when secondarily infected or involves painful and tender when secondarily infected or involves a sensory nervea sensory nerve

painless lump or ulcer on the lippainless lump or ulcer on the lip

Posteriorly no symptom until it reach a size of 2‑3 cm Posteriorly no symptom until it reach a size of 2‑3 cm swelling,swelling,

– pain and difficulty in deglutitionpain and difficulty in deglutition

absence of symptoms until the tumor metastasize to absence of symptoms until the tumor metastasize to regional lymph nodes regional lymph nodes

– hard lump on the neck hard lump on the neck


late symptoms: late symptoms: – pain due to secondary infection or nerve pain due to secondary infection or nerve

involvementinvolvement– excessive salivationexcessive salivation– difficulty in deglutition, speech difficulty in deglutition, speech – haemorrhagehaemorrhage

Within boneWithin bone::– painless swelling involving the buccal and lingual or painless swelling involving the buccal and lingual or

palatal sulci palatal sulci – teeth become loose and painful ‑acute alveolar teeth become loose and painful ‑acute alveolar

abscessabscess– edentulous pt. the denture does not fit edentulous pt. the denture does not fit – denture hyperplasiadenture hyperplasia– anaesthesia of the upper or lower lip and the cheek.anaesthesia of the upper or lower lip and the cheek.


Carcinoma of lip:Carcinoma of lip:age 50‑70 years. Male age 50‑70 years. Male lower class.lower class.

– Predisposition factor:Predisposition factor:dirty, jagged and stained dirty, jagged and stained teethteeth

irritation.irritation.

tobacco smoker tobacco smoker

leukoplakia.leukoplakia.

intense solar radiation ‑ intense solar radiation ‑ blistering cheilitis due to blistering cheilitis due to sunshine.sunshine.

Lower lip affected in Lower lip affected in 93%93%Upper lip affected in 5%Upper lip affected in 5%Angle of mouth affected Angle of mouth affected in 2%in 2%Metastases within a Metastases within a year ‑ submental, year ‑ submental, submandibular and submandibular and upper jugular. upper jugular.

D.D.:D.D.:– Molluscum pseudo Molluscum pseudo

carcinomatosurn lower lip.carcinomatosurn lower lip.Death due to infection and Death due to infection and bronchopneumonia.bronchopneumonia.


Carcinoma of Carcinoma of tonguetongueAnterior 2/3, affect males Anterior 2/3, affect males Posterior 1/3 equal in both sexes. Posterior 1/3 equal in both sexes. Age over 60 years. Age over 60 years.

– Predisposing factors:Predisposing factors:Female with cancer tongue suffer from Paterson‑Kelly Female with cancer tongue suffer from Paterson‑Kelly syndrome.syndrome.Bad oral hygieneBad oral hygieneHeavy alcoholic with element of Vit.B deficiency. Producing Heavy alcoholic with element of Vit.B deficiency. Producing precancerous mucosal atrophyprecancerous mucosal atrophySyphilitic and leukoplakia. 25% and 5%. Syphilitic and leukoplakia. 25% and 5%. Superficial glossitis, papilloma, fissures and non‑specific Superficial glossitis, papilloma, fissures and non‑specific ulcers.ulcers.


Site & Types:Site & Types:– 1. lateral edge of tongue 58%1. lateral edge of tongue 58%– 2. tip of tongue2. tip of tongue 2‑4% 2‑4%– 3. dorsum. of tongue 7‑15%3. dorsum. of tongue 7‑15%– 4. posterior 1/3 21‑33%4. posterior 1/3 21‑33%

1. ulcerative1. ulcerative2. fissured malignant2. fissured malignant3. papillary3. papillary4. flat nodules4. flat nodules5. scirrhous or atrophic type5. scirrhous or atrophic type


Clinically:Clinically:– Painless swelling Painless swelling – Painful infected ulcer, referred pain to the Painful infected ulcer, referred pain to the

ear.ear.– Excessive salivation, marked factor oris, Excessive salivation, marked factor oris,

haemorrhage haemorrhage – loss of mobility due to fixation to the floor loss of mobility due to fixation to the floor

of the mouth. of the mouth.


– Fixation occur at first on one side, when tongue is Fixation occur at first on one side, when tongue is protruded it deviate toward the affected sideprotruded it deviate toward the affected side

– indurations, fungation or ulceration which spread indurations, fungation or ulceration which spread to the floor of the mouth and alveolar process to the floor of the mouth and alveolar process and from post. 1/3 to the fauces, valleculae and and from post. 1/3 to the fauces, valleculae and epiglottis bilaterally.epiglottis bilaterally.

– Spread to regional lymph nodes.Spread to regional lymph nodes.– Death: Inhalation bronchopneumonia, Death: Inhalation bronchopneumonia,

haemorrhage, cachexia and starvation and haemorrhage, cachexia and starvation and asphyxia.asphyxia.


Carcinoma of the mouth:Carcinoma of the mouth:– Floor of the mouth. Floor of the mouth.

Typical malignant ulcer extend to alveolar process Typical malignant ulcer extend to alveolar process & tongue.& tongue.

– The cheek:The cheek:warty and proliferative.warty and proliferative.

– The alveolar process:The alveolar process:warty, nodules or proliferative.warty, nodules or proliferative.


– Palate:Palate:spread extensively before involving bone papillary spread extensively before involving bone papillary or ulcerative.or ulcerative.

– Soft palate and fauces: Soft palate and fauces: Poor prognosis. Poor prognosis. bilateral Lymph node bilateral Lymph node involvementinvolvement

Proliferative, fungating lesion spread to base of Proliferative, fungating lesion spread to base of tongue. tongue.

Pain, dysphagia and death due to erosion of Pain, dysphagia and death due to erosion of carotid arterycarotid artery


Malignant neoplasm of antrum:Malignant neoplasm of antrum:– Squamous cell carcinoma 93% of cases. Squamous cell carcinoma 93% of cases. – Infiltrate soft tissue, destroys bone, fungate Infiltrate soft tissue, destroys bone, fungate

either through cheek, mouth or pharynx. either through cheek, mouth or pharynx. – Spread to deep upper cervical lymph nodes.Spread to deep upper cervical lymph nodes.

AdenocarcinomaAdenocarcinoma

lympho‑epithelioma lympho‑epithelioma

sarcoma raresarcoma rare


Clinically:Clinically:– earliest symptom:earliest symptom:

unilateral sera‑sanguineous discharge or frank unilateral sera‑sanguineous discharge or frank epistaxsis in elderly. epistaxsis in elderly.

unilateral swelling of cheek, buccal sulcus or unilateral swelling of cheek, buccal sulcus or palate palate

dislodging denture, loose Painful and periostitic dislodging denture, loose Painful and periostitic teeth &alveolar abscessesteeth &alveolar abscesses

Denture hyperplasia or granuloma. Denture hyperplasia or granuloma.


Anaesthesia of cheek due to involvement of Anaesthesia of cheek due to involvement of infra orbital nerve. infra orbital nerve.

Anaesthesia and/or paraesthesia of the palate Anaesthesia and/or paraesthesia of the palate due to involvement of sphenopalatine due to involvement of sphenopalatine ganglionganglion


– Medial spreadMedial spread::occlusion of nasolacrimal duct (epiphora)occlusion of nasolacrimal duct (epiphora)

blocked nostril and blood‑stained discharge of pusblocked nostril and blood‑stained discharge of pus

– Superior spread:Superior spread:Eye is proptosed and with involvement of Ms & NsEye is proptosed and with involvement of Ms & Ns

strabismus, limitation of movement, diplopia strabismus, limitation of movement, diplopia

– Trismus due to involvement of medial pterygoid Trismus due to involvement of medial pterygoid muscle. muscle.

– Pain due to secondary infection.Pain due to secondary infection.

Documents

Malignant Lesions