Oral cancer is a rather collective concept, which includes malignant neoplasms of epithelial origin, growing on the lips, mucous membrane of the cheeks, palate, gums, floor of the mouth, tongue. Each type of tumor has its own distinctive features and features of the course, but all of them, with belated diagnosis, present serious threat to the life of the patient.
The overall incidence of neoplasms of the oral cavity does not exceed 3%, but their number is constantly growing. Only in Russia the number of cases during the year is approaching 30 thousand, and the countries of Southeast Asia have overcome the 50 thousandth milestone in the number of new cases of oral cancer annually. In many ways, the risk of a tumor is associated with lifestyle, habits, hygiene, nutrition, and exposure to environmental adverse factors.
Among patients with cancer of the oral cavity, men predominate, the number of which is 4-5 times more than women. Patients are more often elderly people over the age of 50, but occasionally the disease is recorded even in children.
The danger of this form of cancer is due to the fact that the tissues are well supplied with blood, endowed with a large number of lymphatic vessels, which means that the spread of the tumor will go quite intensively (). It is also impossible to write off the proximity of the location of the brain, respiratory tract, large vascular and nerve trunks, the involvement of which often leads to tragic consequences.
The favorite localization of tumors of the oral cavity is the tongue, which is affected in more than half of the cases. Neoplasms of the tongue are quite dangerous, neoplasia can quickly increase in size and actively metastasize, therefore, it requires early diagnosis and treatment. , which describes the varieties, course of the disease and ways to deal with it.
In most cases, the tumor is detected by the patient himself, and the symptoms of trouble can appear quite early, but only especially vigilant and responsible patients immediately go to the doctor, while others give the cancer a chance to reach severe stages, when the diagnosis is not difficult, but the treatment is already ineffective. Meanwhile, a malignant tumor of the oral cavity detected in time responds quite well to treatment, and the patient is measured for more than one year of life after successful therapy. You need to know and remember this, at least periodically examining the oral cavity for any changes, caring for the oral mucosa and visiting the dentist in a timely manner.
Why does cancer appear?
The causes of oral cancer are:
- Smoking and use of smokeless tobacco blends.
- Alcohol consumption.
- Excessive exposure to the sun and outdoors.
- Occupational hazards.
- radioactive radiation.
- Eating hot food.
- Viral infection.
Among all the risk factors for oral cancer, the main place is given to smoking and tobacco use in another form, and 90% of patients indicate their addiction to tobacco products. Smokers risk more than 6 times more than non-smokers, while it does not matter if the carrier of a bad habit is fond of a pipe, cigars or regular cigarettes, but the localization of the tumor may differ. With a long stay of the tube in the mouth, it develops, with the use of chewing tobacco - cancer of the gums, cheeks, lips. It also does not matter the type of cigarettes, their nicotine content or the level of filtration of inhaled smoke.
Various types of chewing or snuff tobacco, tobacco blends, nasvay, snuff increase the likelihood of getting cancer of the lips, cheeks, gums by 50 times. Such a predominance compared to conventional smoking is due to the fact that harmful substances directly contact the mucous membrane for a long time, having a pronounced damaging effect and leading to chronic inflammatory processes.
Some patients who have successfully undergone cancer treatment never give up bad habits, and a third of them subsequently develop a tumor of another localization (tongue, palate, etc.).
It is worth recalling that passive smoking also harms the health of others and can contribute to the appearance of a tumor in non-smokers.
Alcohol, passing through the oral cavity, has a carcinogenic effect on the mucous membrane, which increases many times when combined with smoking. Up to 80% of patients note the use of a significant amount of alcohol-containing substances. Care should also be taken when using mouthwashes containing alcohol, which can also be a risk factor for cancer.
Prolonged exposure to sunlight most often associated with professional activities and occurs in about a third of patients. Other occupational factors that cause oral cancer are contact with paints and varnishes, dust, soot, and work at high temperatures.
Nutrition Features associated with the constant use of too hot food, spicy and with an abundance of seasonings that injure and irritate the mucous membrane of the oral cavity. A lack of vitamin A in foods causes atrophic changes in the epithelium, disruption of its regeneration, and the appearance of precancerous processes with a high risk of malignancy.
Some viruses able to multiply and live in stratified squamous epithelium, can have a carcinogenic effect. So, carriers of papillomavirus infection are more at risk, so they should pay more attention to the condition of the oral cavity. Of course, if they know about the presence of such a problem.
Constant irritation the surface of the gums, cheeks, tongue with sharp edges or fragments of teeth, ill-fitting fillings or crowns also pose a risk of cancer to a certain extent, so visiting the dentist and caring for your teeth should be a must for those who do not want to get cancer of the oral mucosa.
Among the causes of cancer that we cannot change are age and gender.. In older people, the likelihood of oncopathology is generally higher, and men are more prone to bad habits, so tumors affect them more often. An unfavorable family history, when close relatives suffered from oral neoplasms, should also be considered as a risk factor.
Precancerous changes and types of oral cancer
Precancerous changes in the oral mucosa are leukoplakia, erythroplakia, and epithelial diplasia.
Leukoplakia is suspected in the event of the appearance of a white painless spot in one or another part of the oral cavity, and it is characterized by the appearance of keratinization, similar to that which normally occurs in the skin.
erythroplakia looks like red foci with an abundance of blood vessels. After microscopic examination, about half of erythroplakias turn out to be a malignant tumor, so this condition requires prompt diagnosis and treatment.
Dysplasia is actually a precancer, when cells acquire some features of malignancy, their maturation and structure are disturbed. The next stage in the development of the dysplastic process will be directly a malignant tumor.
precancerous changes (from left to right): leukoplakia, erythroplakia, dysplasia
Since most of the oral cavity is lined with stratified squamous epithelium, it is quite logical to expect the development of squamous cell carcinoma of one degree or another of differentiation here. From the small salivary glands of the tongue, cheeks, pharynx, glandular tumors - adenocarcinomas - can grow.
In appearance, the tumor most often represents a long-term non-healing ulcerative defect with a pronounced and fairly rapid penetration into the surrounding tissues. With a nodular form, the neoplasm looks like a seal that grows even faster than an ulcer. The papillary type of cancer is characterized by the appearance of papillary outgrowths that can hang down into the oral cavity when located on the palate, uvula, and pharynx. This form is not characterized by active ingrowth into the surrounding tissues, and therefore the treatment is quite effective.
Signs and symptoms of oral cancer
In the initial stage of the development of the disease, not every patient considers it necessary to consult a doctor, attributing its manifestations to dental problems, chronic tonsillitis or laryngitis. Meanwhile, the presence of ulcers, cracks, nodular changes is very typical for the early stages of tumor development, and the absence of pain should not be reassuring.
Pain joins the advanced stage of neoplasia growth, which is initially limited to the growth zone of cancer cells, and over time becomes widespread - it spreads to the ear, temporal region, and head.
In advanced cases, the tumor grows into neighboring organs and tissues, destroys them, and actively metastasizes. Since the oral cavity is inhabited by various kinds of microorganisms, and many of them constantly get there from the external environment, early accession of a secondary infection with the formation of foci of a purulent and even putrefactive nature is characteristic of cancer of this localization, which further aggravates the patient's condition, increases intoxication, pain syndrome. .
In order to prevent severe forms of oral cancer, you need to carefully monitor the condition of its cavity, teeth, and early signs that indirectly indicate the possibility of growth of the malignant process should always be a reason to consult a doctor. Such signs include:
- The presence of long-term non-healing ulcers, swelling in one or another part of the oral cavity.
- The appearance of white or red spots on the mucous membrane, often asymptomatic.
- Prolonged pain in the mouth.
- Violation of chewing, swallowing, speech function, feeling of the presence of a foreign body.
The presence of the described signs that do not disappear in 2 or more weeks, especially with unexplained weight loss, decreased performance, and rapid fatigue, should be a cause for serious concern.
Of course, these changes do not always indicate the presence of cancer, so you should not give in to excessive panic, but only a doctor can distinguish a precancerous or inflammatory process from the early stages of carcinoma, and postponing a visit to him or, God forbid, self-medication, is fraught with adverse developments.
typical sites to check for oral cancer
The symptoms of oral cancer are largely similar with its different localization, but there are also features in the defeat of one or another department. The very first signs of a tumor, regardless of the place of its formation, are reduced to the appearance of a site of ulceration, compaction or swelling without a pronounced pain syndrome, and over time they join:
- Pain is periodic or constant soreness at the site of growth of neoplasia, and if it damages the nerves - numbness, decreased sensitivity. A little later - pain in the ear, head, temple area.
- Bleeding without a clearly established cause.
- Difficulty in chewing, swallowing, speech formation, limited mobility of the jaws, tongue.
One of the most unfavorable localizations is cancer of the floor of the mouth. This area has a rather complex structure with an abundance of muscles, blood and lymph vessels, contains salivary glands, so the neoplasm grows early and quickly in these tissues and actively metastasizes. At first, the patient feels the presence of a foreign formation, and subsequently profuse salivation, pain, impaired mobility of the tongue, and difficulty in swallowing join. With ulceration of the tumor, bleeding is possible, metastases affect the submandibular, cervical lymph nodes.
Cheek cancer usually appears in the area of the corner of the mouth, along the line of closing of the teeth, that is, where injuries, contact with damaged teeth or poorly installed crowns are more likely. The ulcerative form predominates here, and the symptoms are reduced to pain when chewing, swallowing food and talking. With a significant size of the cancerous ulcer, it becomes problematic for the patient to open his mouth. Histological examination of tumor tissue most often finds squamous cell carcinoma.
sky cancer It is considered a rather rare form of the disease and it is mainly represented by glandular tumors (adenocarcinomas) of the hard palate due to the sick number of small salivary glands located in this area, while the soft palate is more often affected by squamous cell carcinoma.
Glandular tumors of the hard palate for quite a long time they can remain limited to the salivary glands, manifesting themselves as an encapsulated infiltrate without severe pain. As the size of the neoplasm increases, it ulcerates, the pain intensifies, and the infection joins with the development of the inflammatory process. Further, the tumor is introduced into the surrounding tissues and bone structures that form the basis of the hard palate. Squamous cell carcinoma is much less common but ulcerates early and can therefore be detected early.
soft palate cancer in most cases, it is represented by a squamous variant, which is less aggressive than adenocarcinoma, therefore it is better treatable. With the growth of such a tumor, patients experience discomfort when swallowing, talking, speech becomes slurred, pain and a sensation of a foreign body appear.
gum cancer is rare and is mainly found on the surface of the mucous membrane of the lower jaw. The most likely cause of its development is dental problems, and the characteristic histological type is squamous cell carcinoma.
gum cancer
Diagnosis and treatment of oral cancer
For the detection of oral cancer, examination by the patient of the mucous membrane is important. A careful examination can detect a tumor at an early stage of development. Since not all parts of the oral cavity are available for examination at home, it is recommended to visit a dentist at least once every six months, who will conduct a more thorough examination using special tools and mirrors.
In addition to a visual assessment of the condition of the oral cavity, the doctor will feel the regional lymph nodes, which may have metastases.
The possibilities of instrumental and laboratory methods are limited for oral cancer, but ultrasound techniques can be used for soft tissue lesions, radiography to clarify the nature of tumor ingrowth into bone tissue, CT or MRI with additional contrast.
The most accurate information is provided by a histological examination of neoplasm fragments, which can be obtained using a conventional cytobrush or removed with a needle or scalpel with preliminary anesthesia.
Oral cancer treatment is more effective the earlier the tumor is detected. All the main methods of combating cancer are used - surgery,.
Surgery remains the main one and involves the removal of tumor tissues. Given the localization of neoplasia, most patients require subsequent plastic surgery, so a gentle approach to tumor removal is important. So, for lip cancer, the so-called micrographic removal of the tumor can be used, when tissues are excised in layers with histological control of each area. So it is possible to achieve the removal of only the affected area without capturing the "extra" amount of lip tissue.
Often, neoplasms of the oral cavity require excision of the bone sections of the jaws, which creates additional difficulties in the rehabilitation and subsequent reconstruction of parts of the facial skull.
Removal of lymph nodes is an integral stage of surgical treatment when a tumor spreads in them, but it is fraught with damage to the nerves, of which there are quite a lot in this area. Side effects of lymph node dissection can be numbness of the skin of the ear, face, impaired mobility of masticatory and facial muscles, etc.
Radiation therapy can be prescribed both independently for early forms of cancer, and in addition to surgery. In some cases, brachytherapy is indicated - the introduction of radioactive elements directly into the tumor. Against the background of irradiation, tissue damage is possible not only in the oral cavity, but also in the thyroid gland with a decrease in hormone levels, so patients often need to consult an endocrinologist and prescribe hormonal drugs.
As you know, many diseases are easier to prevent than to treat, therefore preventive measures should be known to everyone:
- Smoking and tobacco use is the main risk factor, it is better not to start or give up this habit, even if the smoking experience is quite long.
- You should not abuse alcohol-containing products, and if you still want to drink an alcoholic drink sometimes, then it is better to limit yourself to a small amount.
- Sun exposure should be limited, especially in the middle of the day when radiation activity is highest.
- A healthy and nutritious diet with enough vitamins and minerals significantly reduces the risk of developing oral tumors.
The prognosis after oral cancer treatment depends on the stage at which the tumor was detected and the form of growth of the neoplasia. So, almost all patients with stage 0 have a chance to live 5 years or more, while in stages III-IV this figure is 20-50%. The ulcerative form of cancer is more malignant, metastasizes faster and more often leads to an unfavorable outcome. Tumor recurrences are also not uncommon, especially with gentle treatment methods, so constant monitoring and supervision by an oncologist is a prerequisite after tumor therapy.
Video: cancer of the oral mucosa - lecture
The author selectively answers adequate questions from readers within his competence and only within the limits of the OncoLib.ru resource. Face-to-face consultations and assistance in organizing treatment are not currently provided.
Excision of mucous membranes occupies a significant place in the plastic correction of the face. This is a complex of surgical interventions that allow you to significantly adjust facial features. The operation consists in removing part of the fatty and mucous tissues, followed by tightening and correcting the shape of the cheek. Depending on individual characteristics. The operation can be performed both externally and in the oral cavity, which guarantees the absence of scars and other postoperative formations on the patient's face.
We are also happy to advise you on new technology SLIM cheeks - this is an improved author's technique for removing Bish's lumps with excision of the mucosa , in which the rehabilitation process is reduced due to a new method of excision of the mucosa. This technique was developed by the leading plastic surgeons of the Center for Laser Medicine "Correct", the main contribution to which was made by the candidate of medical sciences
Indications for surgery
- A large accumulation of adipose tissue, forming a lump of Bish.
- Sagging or age-related sagging of the cheeks (complex surgery with a lift is recommended).
- Deep or uneven nasolabial folds.
- Plastic surgery on the face.
- Rounded or irregular face shape.
- Other indications for reducing the volume of the cheekbones and cheeks.
Operation steps
The operation is carried out in several stages. Initially, the plastic surgeon examines the patient, outlines an approximate work plan and discusses the course of the surgical intervention with the patient. Depending on the plan proposed by the specialist, a decision is made on what part of the tissues will be removed, whether a facelift will be performed, whether other work will be carried out, for example, the removal of Bish's lumps or the author's operation "French cheeks". This is the preparatory stage.
The main stage is the operation stage. Depending on the characteristics of the patient, it includes certain components.
- The operation is performed under general or local anesthesia. 1-2 minutes after anesthesia in the patient's oral cavity, an incision of 1.5 - 2.5 cm is made on the outer or inner side of the cheek. Then the connective and muscle tissues are moved apart to provide free access to Bish's lumps. Then the fat body is pulled outward, detachment and partial or complete removal of adipose tissue occurs. The first stitches are applied.
- During the operation, a part of the mucous tissue is excised in order to give the patient's face the planned shape. Correction and partial lifting is carried out.
- At the end of the operation, postoperative sutures are applied to the dissected mucosa.
Stage of rehabilitation
Depending on the complexity of the work performed, the time for the patient's rehabilitation and the period of postoperative support are set. Usually, the healing of the mucous membrane takes place in a period of 2-3 days; discomfort and pain can persist for 4-7 days; complete recovery of the patient occurs by the end of 2 weeks.
Contraindications
- Blood cancer and other blood diseases.
- Systemic diseases.
- Viral and infectious diseases.
- Inflammatory processes in the area of operation.
- Diabetes.
- Chronic diseases.
- Mental illness.
- Age up to 25 years.
results
The first results become visible by the end of 2 weeks. By week 3, postoperative symptoms almost completely subside, and the patient already looks noticeably better. However, some swelling may persist for more than a month. After the rehabilitation period, the oval of the face becomes a given shape, and the cheeks become slightly retracted.
The provision of plastic surgery services is carried out in the scope of consultative and diagnostic measures, referral for surgical treatment in a hospital, postoperative monitoring and rehabilitation.
Swelling of the cheek from the mucous membrane is a sign of an inflammatory process in the oral cavity. Inflammation of the cheek from the inside not only affects the appearance of the face, breaking its symmetry, but can also cause a number of serious complications.
If swelling of the cheek is detected, even if the teeth and gums do not show signs of illness, you should immediately seek dental advice.
Causes of cheek swelling can vary. Inflammation can be the result of many different factors. However, a number of the most common causes of swelling can be identified:
- Dental. As a rule, the cause of inflammation of the cheek lies in the disease of the gums or teeth. There are a number of possible situations:
- inflammation can be caused infection in the root of an already sealed tooth, when the nerve has already been removed, but the root canals have not been completely cleaned;
- removal of a tooth during a complex surgical operation, it can cause, which, in turn, can lead to swelling and redness of the buccal mucosa;
- gum disease, type, can also cause inflammation of the cheek, and such a disease cannot be left unattended, since subsequently it can develop into periodontitis or periodontitis, depriving the patient of teeth;
- wisdom tooth eruption often associated with a number of unpleasant consequences, one of which can be inflammation and swelling of the cheek, if the tooth.
At the first sign of swollen cheeks, you should consult a doctor.
- Infectious diseases. With the exception of purely dental infections, there are many other infectious diseases that cause inflammation of the cheek from the inside. For example, parotitis affects the parotid salivary glands, which causes severe swelling in the neck and cheeks. In adulthood, such a disease is difficult to tolerate and its treatment should take place under the strict control of an infectious disease specialist. Another infection that can cause inflammation of the cheek can be considered lymphadenitis, which affects the lymph nodes closest to the oral cavity.
- Allergic reaction. In case of individual intolerance to certain products, as well as insect bites, an acute anaphylactic reaction may occur, causing swelling and redness of the neck, lymph nodes and salivary glands.
- Injuries. Swelling of the cheek may well be the result of a bruise of the soft tissues and disappears within a day. If the injury did not damage the jaw joints, bone tissue and teeth, the worst consequence would be only a bruise and a hematoma passing over time.
- Tumor. The rarest, but at the same time the most dangerous causative agent of inflammation and swelling of the cheek will be. It develops relatively slowly and at first it is not easy to identify a tumor, and its symptoms can be mistaken for manifestations of other diseases.
First aid
Depending on the causes of edema, first aid methods also differ. So, in case of injury, unless it has caused damage to the facial bones, you should alternate dry and cold compresses, and also cover the bruised area with an anti-inflammatory gel.
Swelling of the cheek, both on the left side and on the right, in this case will be only a minor cosmetic defect for a while.
Inflammation of the cheek should not be ignored
If the cause is dental, you should visit the dentist immediately, and in anticipation of the visit, you can use pharmacy anti-inflammatory drugs and to relieve inflammation of the cheek inside.
As for the allergic reaction, antihistamines will come to the rescue here.
If the swelling of the cheek has come due to an insect bite, compresses from anti-inflammatory drugs can also be used.
Nevertheless, you should still visit a doctor and avoid active self-medication. Removing the primary symptoms does not mean eliminating the problem, and only a specialist can prescribe an effective and correct treatment.
Do not apply hot compresses to the site of inflammation., since they are able to initiate a purulent process. Also, it is better to refrain from taking antibiotics before a doctor's diagnosis.
Eruption of wisdom teeth may be one of the causes of cheek swelling.
Treatment
In case of detection of continuing swelling of the cheek, visit the dentist first. Especially if the patient has previously suffered from diseases of the oral cavity. In the absence of a dental reason, you may be referred to a number of other doctors, from an otolaryngologist to an oncologist.
The very first procedure, most likely, will be an x-ray of the problem area. According to the picture, the doctor will be able to determine the diagnosis and prescribe the appropriate treatment. Self-medication without consulting a specialist can have an extremely negative impact and lead to an aggravation of your problem. It is important to remember that any inflammation in the oral cavity is a good reason to seek qualified medical help.
2088 0
In this group, studies were conducted in 12 (11.3%) patients with locally advanced malignant processes of the buccal mucosa.
Of the 12 operated patients, operations were performed only on the primary focus in 6, in the rest - combined operations with simultaneous removal of neck tissue.
Of the features of surgical interventions, it should be noted the need for a wide electrical excision of the tumor with a deviation from its edge by 5 cm and the inclusion of skin and buccal mucosa tissues to be removed in the block.
After such operations, through cheek defects of various shapes and sizes are formed.
For defects up to 4 cm in diameter, plastic surgery was performed with local tissues. Closure of large defects was performed using the Filatov stalk, as well as skin flaps on the supply leg, formed on the lateral surface of the neck. An example of a successful combined operation for locally advanced cancer of the buccal mucosa is the following clinical observation.
Clinical example
Patient G., 52 years old, was in the department of head and neck tumors of the Research Institute of Oncology from 16.01 to 18.03.1975 due to cancer of the mucous membrane of the right cheek with metastases in the lymph nodes of the neck on the right, stage IIIb, T4N1M0. He has been ill since April 1974, when, after an injury, an ulcer appeared on the mucous membrane of the right cheek, which rapidly increased in size. For five months he was treated independently with ointments, but without effect. When the tumor had grown into the skin of the cheek, he turned to the oncological dispensary at the place of residence and was sent to the Research Institute.Upon admission to the department of the patient on the mucous membrane of the right cheek, starting from the 4th tooth to the corner of the mouth, there was a large tumor ulcer, growing into all layers and skin up to 8 cm in diameter. Enlarged lymph nodes, dense, displaced, up to 1.5 cm in diameter, were determined on the right neck. Histologically No. 112206-14 - keratinizing squamous cell carcinoma. The result of a cytological examination of enlarged lymph nodes No. 60425 - the picture is suspicious for cancer.
In terms of the combined method of treatment, from October 21 to November 15, 1974, a course of preoperative remote gamma therapy was performed on the area of the primary focus and the area of regional metastasis at a dose of 47.4 Gy with a slight decrease in the tumor.
At the 2nd stage of treatment on January 28, 1975, a wide electrical excision of the tumor on the right cheek was performed with marginal resection of the alveolar process of the lower jaw, fascial-case excision of the shen tissue on the right. Tracheostomy.
Operation description. After appropriate treatment of the skin of the right half of the face and neck, a T-shaped incision was made in the skin of the neck. The skin flaps were separated to the sides. The sternocleidomastoid muscle was separated from the case. Then - the allocation of fiber with enlarged lymph nodes of the lateral triangle of the neck along the neurovascular bundle, accessory zone, submandibular and mental triangles, along with the submandibular salivary gland.
Accessory nerve traced and preserved throughout. The tissue of the neck on the right with enlarged lymph nodes is removed. Hemostasis. The wound was treated with antibiotics and tightly sutured in layers. An active rubber drainage was introduced into the supraclavicular region. Then - an operation on the primary focus.
Stepping back from the edge of the tumor by 5 cm, a wide electrical excision of the tissues of the right cheek was performed with a marginal resection of the alveolar edge of the lower jaw at the level of 8-4 teeth. As a result, a through defect was formed up to 5 cm in diameter. The mucous membrane was restored with local tissues, and the skin defect was restored with a flap on a pedicle from the lateral surface of the ooze on the right.
Silk sutures were placed on the skin and mucous membrane. Superimposed tracheostomy with the introduction of a tracheotomy tube No. 6. Aseptic dressing.
Histological examination No. 11420-1-21 - keratinizing squamous cell carcinoma of the mucous membrane with germination of all layers to the skin. In the lymph nodes, metastases of cancer of the same structure. The postoperative course is smooth. Healing by first intention. Currently without signs of recurrence and metastases (Fig. 25).
Rice. 25. Patient G. 11 years after combined surgery for locally advanced cancer of the mucous membrane of the right cheek
Postoperative period
In the early postoperative period, two patients died (one from arrosive bleeding from the carotid artery, the other from pulmonary embolism). As observations have shown, patients die in the first year after surgery. Thus, three patients died within 6 to 14 months after the operation from the progression of the malignant process with spread to the pterygomandibular fossa at the base of the skull.Therefore, the spread of the process in this area, grade III trismus should be considered a contraindication to performing extended operations for advanced cheek cancer. Of the 6 combined operations, the lymph nodes of the neck were removed for prophylactic purposes in three patients.
Metastases were not found in any of the cases. Of the 12 patients, 6 lived for periods of 1 to 11 years, 2-5 years or more, which is 40% of the observed patients, so extended and combined operations for locally advanced cancer of the buccal mucosa should be considered justified.
The effectiveness of surgical treatment of cancer patients is usually judged by 5-year survival after surgery. Let us first consider the life expectancy of patients, depending on the volume and location of the surgical intervention (Table 19).
Table 19. Life expectancy of patients with cancer of the oral mucosa, depending on the localization of the process
The worst results were obtained with the localization of the malignant process in the region of the alveolar process of the lower jaw and the floor of the mouth. The greatest lethality from the progression of the disease occurs in the first year after surgery.
Thus, out of 41 patients who died from the progression of the disease, 29 died in the first year after extended operations. The main percentage was made up of people with cancer of the root of the tongue and the mucous membrane of the floor of the mouth (19 patients) (Fig. 26).
Rice. 26. Survival of patients with locally advanced cancer of the oral mucosa, depending on the localization of the process: 1 - tongue; 2 - mucous membrane of the bottom of the mouth; 3 - alveolar process of the lower jaw; 4 - cheek
However, despite the extensive scope of surgical intervention, the overall life expectancy of patients on average was quite encouraging. These results coincide with the literature data (Gremilov V.A., 1966; Paches A.I., 1971; Lyubaev V.L., 1971; Falileev G.V., Krugovoi B.A., 1979).
The study of the features of extended and combined operations in 106 patients with locally advanced cancer of the oral mucosa allows us to clarify the indications for their use, improve their performance, develop a number of our own methods and approaches, as well as plastic surgery to restore tissue defects. So, in case of cancer of the tongue (47 patients), it is always necessary to include the corresponding half of the lower jaw with exarticulation in the block of tissues to be removed.
This allows the operation to be carried out ablastically and radically. We have proposed and implemented a new approach for surgical removal of advanced cancer of the root of the tongue through lateral pharyngotomy with temporary resection of a segment of the horizontal branch of the lower jaw.
This access allows a good view of the root of the tongue, contributes to a more radical operation, and skin and subsequent bone grafting accelerate the rehabilitation of this severe category of patients.
The use of a deltopectoral flap for primary plasty and formation of the floor of the mouth in 7 out of 28 patients operated on for advanced cancer of the mucous membrane of the floor of the mouth allows one-stage closure of extensive tissue defects and greatly facilitates rehabilitation.
The study of the results of extended operations in 19 patients with locally advanced cancer of the mucous membrane of the alveolar process of the mandible suggests the expediency of performing a through resection of the mandible with exarticulation, since the surgical intervention takes place in more ablastic conditions.
In the hospital, 14 patients died from various causes, which is 13.2% of all operated patients. This is due to the severe general condition of patients before surgery and the extended scope of surgical interventions.
An analysis of the causes of relapses in 30 patients (27.7%) made it possible to determine contraindications for performing extended and combined operations for locally advanced cancer of the oral mucosa. These are: the spread of the tumor to 2/3 of the tongue or its total lesion, to the side wall of the pharynx to the base of the skull, intimate attachment or germination of metastatic nodes in the wall of the common carotid artery.
Features of metastasis
The study of the features of metastasis in 47 patients (44.3%) made it possible to determine the tactics in relation to regional metastases. So, if regional metastases are clinically determined before surgery, it is necessary to perform a combined operation, i.e., simultaneous removal of the primary focus and regional metastasis zones.In the absence of clinical metastases on the neck, the operation can be performed in two stages: first, an extended operation on the primary focus, and then, 3-4 weeks after its cure, perform a fascial-case excision of the neck tissue.
The exception is cancer of the root of the tongue and the body of the tongue, where it is necessary in all cases to perform a one-stage operation on the primary focus and areas of regional metastasis. The main factor determining the prognosis after radical surgery is the stage of the disease.
The differences in long-term results according to the stages of the disease can be judged from the data in Table. 20. Thus, the lowest of them were noted in relapses of oral mucosal cancer after radiation therapy, confirming the aggressiveness of X-ray resistant forms of oral mucosal cancer.
Table 20. Life expectancy of patients with cancer of the oral mucosa, depending on the prevalence of the tumor process
Analysis of long-term results showed that 16 patients lived for 5 years or more. This allows us to talk about the justification for performing extended and combined operations for locally advanced mucosal cancer.
"White line" cheeks- a common white wavy line protruding above the level of the buccal mucosa at the level of the bite plane, it is due to a pronounced tendency of the epithelium to keratinize. The "white line" of the cheek has a width of 1-2 mm, stretches in a horizontal direction from the second molar to the area where the canine is located, does not separate from the mucous membrane when rubbed with a spatula, and is usually located on both sides. Often associated with scalloped tongue and seen in bruxism and in patients who have a habit of clenching their teeth or sticking their tongue to their teeth, creating negative pressure in the mouth; does not cause any pain. Does not require treatment.
Leukedem.
leukedem- change in the buccal mucosa in the form of an opalescent area of milky white or gray color. Usually observed in individuals with dark skin, represents a variant of the normal structure of the mucous membrane, less common in people with fair skin. The incidence of leukedema increases with age, reaching 50% in African American children and 92% in adults. Localization of leukedema on the mucous membrane of the lip, soft palate and floor of the mouth is less common.
leukedem usually has bilateral localization. A close examination of the oral cavity reveals white lines and folds. With prolonged existence, these folds can find one on top of the other. Changes in leukedema depend on the degree of pigmentation of the mucous membrane, the quality of oral care and the intensity of smoking. The boundaries of the altered area of the mucous membrane are uneven and blurred. A characteristic sign of leukedema is a pronounced decrease or disappearance of the whiteness of the affected area when the mucous membrane is stretched. When rubbing with a spatula, the changed mucous membrane is not removed. The cause of leukedema has not been established, however, it has been noted that it is more pronounced in smokers, and when quitting smoking, it tends to reverse development. Histological examination of the biopsy material shows a thickening of the epithelium, a pronounced swelling of the cells of the spinous layer without signs of inflammation. Leukedema does not pose any danger. Does not require treatment.
Biting or chewing on the buccal mucosa.
Cheek biting- a bad habit, more common in mentally unbalanced individuals. Chronic traumatization of the mucous membrane leads to a hyperplastic reaction with the formation of irregularly shaped white plaques, sometimes lines or stripes. With continued trauma, there is an increase in plaque, the appearance of erythema and ulceration.
Chewing of the buccal mucosa observed at any age, regardless of race and gender of patients. Persons with this bad habit usually chew the mucous membrane of the anterior part of the cheek, less often the lips. The diagnosis is based on the clinical picture and history. Despite the fact that the injured mucosa is usually not prone to malignant transformation, patients should be warned about the changes to which it undergoes. In the differential diagnosis, patchy leukoplakia and candidiasis should be included, given the similarity of mucosal changes caused by chewing with these diseases. Histological examination reveals areas of both normal and wrinkled epithelium with signs of parakeratosis and mild subepithelial inflammation.
