Tumors in the oral cavity

Tumors in the oral cavity

TUMORS IN THE ORAI, (‘AVITY” BY DR. JOFIS W. SEY.ROI,I),DESVE(:I~!(lor,o. A LL tumors have certain common characteristics; for instance, indepen...

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TUMORS

IN THE

ORAI,

(‘AVITY”

BY DR. JOFIS W. SEY.ROI,I),DESVE(:I~!(lor,o.

A

LL tumors have certain common characteristics; for instance, independence of growth, vitality, function, cause, manner of growth and recurrcnre. Their growth is unlimited and uncont,rolled except by passive resistance tri the invaded tissues. Tumor cells appear to possess more vitality than nortnal cells and wiil grow and multiply while normal cells are atrophying. As to function: tumor cells are phpsiolo,oically usclcss; in fact, the>- itI+<‘ dangerous to their host. The cause of tumor formation is not gencrall~~ known. Irritations have received much attention as a cause, but fail to satisfy scientific requirements entirely. The growth is entirely by mult~iplication of its own eelIs and expresses itself in one of two ways, either by expansion or by infilt,ration. It is a well-known fact that tumor operations are occasionally followed I>>+ recurrences of the growth, which arc due to one or more cells of the growth having been left. Tumors may be benign or malignant, and the diagnosis is as follows: A benign tumor is one consisting for the most part, normal in type, resembling more or less completely the tissue of the part from which it grows. Its growth is generally slow, it is usually circumscribed and enca,psulated; it does not recur after thorough removal or reproduce itself in distant parts. The following benign or innocent tumors arc of interest to the dental profession : Fibroma, ehondroma, osteoma, multilocular Cystic tumors, and follicular odontoma. Fibroma is a tumor composed of connective tissue cells and whit,e fibers arranged in wavy bundles. It is round or lobulated in form and generall) enclosed in a, distinct capsule. On section and viewed obliquely it looks like watered silk. It is found on the gum tissues at the neck of t,he tooth, probably arising more often from the peridental membrane. The diagnosis is made mostly on their slow growth and distinctly nodular outline! also on their consistency, which is less hard than bone or cartilage. Chondroma is a tumor composed of hyaline eartilagc and, according to Bland-Sut,ton, grows from preexisting cartilage, oecuring in relation to the maxillae, they may arise from the cartilagenous sept,um of the nose. They are encapsulat,ed and nonmalignant, and cause distress only by their size and relations. They occur most commonly in children and young persons and are they a,rr to be distinguished usually a relatively large size. Pathologically Lmdand,

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John W. Xeylbold from the more rapidly growing, infiltrating chondrosarcomata, which grow to a large size. They should be excised with the cartilage from which they grow. Osteoma : These tumors are composed of bone, surrounded by a layer or cap of cartilage, therefore ossifying chondromata. They occur on any part of the bones of the face, but probably more commonly on the maxilla than the mandible. They may be of compact or cancellous bone and may be pedunculated or attached by a broad base. They grow very slowly but may attain a large size. As they grow, the soft, t,issnes covering t,hem may ulcerate, leaving the bone exposed. They are painless, but pain may be caused by pressure. When pedunculated they may become detached and be thrown off spontaneously. They are nonmalignant,. They should be removed together with a very small area of the bone to which they are attached. Multilocular cyst,ic tumors (epithelial odontoma) are composed of a number of small cysts lined with cubical cpithelium and embedded in a fibrous stroma. They contain a viscid fluid. The jaw becomes expanded and shows no tendency to affect the glands or to dissiminate. They occur more often in the mandible and in young persons. Follicular odontoma (dentigerous cyst) is a cystic formation which occurs in connection with a misplaced or nonerupted tooth. The expanded dental sac represents the cystic wall. It contains a viscid fluid and the crown of the nonerupted tooth, the root of which is usually fixed to the cyst wall, though sometimes the tooth is loose. With rare exceptions, follicular odontoma forms onl! in connection with permanent teeth. The tumor grows slowly. Owing to the expansion of surrounding bone, “egg shell crackling” may in the course of time be felt on pressure. Malignant tumor consists of a perverted type of tissue, i.e., differing from any normal tissue. It generally exhibits extreme activity of growth, increasing in size until the fatal end. It tends to invade the surrounding tissues irregularly, so that there is no sharp division between it and t,hem, encapsulation being exceptional. It, tends to reproduce itself in distant parts. There are t,wo chief kinds of malignant tumors: (1) The sarcoma, which grows from connect,ive tissue; (2) the cardnomata which grow from epithelial tissue. Broadly, there are two clinical types of carcinoma of the jaws: the soft, medullary type which is found in the antrum and oral surfaces of the maxilla; and the hard ulcerating type, which usually appears on the mandible. The medullary type is usually very soft and is first noticed as a small papule which bleeds easily. As it extends it may take on a cauliflower appearance. It rapidly extends on the surface and into the antrum but does not ulcerate easily. The hard ulcerating type usual to the mandible grows more slowly and in the early stages is painless. The induration and ulceration invade the neighboring surfaces much more rapidly than the deep tissues. In tumors arising in the antrum or nasal cavity, pain is an early and almost constant symptom. This may be localized in the form of a toothache or be diffused over the distribution of the fifth cranial nerve. As the tumor enlarges, there are symptoms of obstruction of the nasal fossae and the nasal duct. The cheek becomes prominent, and when the external bony wall is perforated, the

Tumors

of the Oral Cavity

tumor may be felt in the soft tissues of the cheek. The skin may becom? discolored but rarely ulcerat.es. The tumor may fungate into the mouth. DIBPERENTIAL

DIAGNOSIS

Sarcoma Occurs at any age but most commonly early in life. May be encapsulated and circumscribed. (Jrows more rapidly. Lymph&es as a rule not involved. Netastases through blood vessels. Iless apt to form metastases. Does not tend to ulcerate.

BETWEES

:

Carcinoma Occurs late in life. Not encapsulated. Grows less rapidly, Adjacent lymphatics involved. Metastases through lymphaties. More apt to form metastases. Tends to ulcerate.

In conclusion I wish t,o point out that the prognosis for sarcoma and carcinoma of the mouth is not good. As a general rule, the operation becomes more serious t,he farther back in the mouth the growth occurs. 911 patients having abnormal growths in or about the jaws, should be warned that such growths are dangerous, and should be removed immediately to prevent malignancy. If the growth is malignant, the earlier the operation: the better the prognosis.