Cancer of the upper jaw

Most often, maxillary cancer originates from the mucous membrane of the maxillary sinus. As a rule, it is squamous cell carcinoma, but various forms of adenocarcinoma, cystadenoid carcinoma, and mucoepidermoid cancer of the maxilla can also occur. Less often, the source of the tumor is the mucous membrane of the hard palate, alveolar processes. It is also possible for the tumor to grow from the nasal cavity and paranasal sinuses.

As a rule, in the early stages, maxillary cancer is asymptomatic, therefore, stages I-II of the disease are diagnosed accidentally during antrostomy. With a small tumor, initial stages of the tumor process are characterized by nasal congestion and serous-purulent discharge from the nasal passage. Such symptoms can be present in patients for several months, then facial asymmetry occurs due to swelling, more often in the infraorbital region, discharge from the corresponding nasal passage increases, a feeling of heaviness appears, and then pain.

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Symptoms

Symptoms of maxillary cancer largely depend on the localization of the tumor in a particular section. To determine the localization of the tumor and the direction of growth, the Ongren scheme is used, with the help of which the upper jaw is divided into segments. One inclined plane is directed from the inner edge of the orbit to the angle of the lower jaw and divides the maxillary sinus into the lower anterior and upper posterior sections. The sagittal plane, which runs perpendicular to the pupillary line, divides each section into internal and external. Thus, four segments are formed: lower anterior internal and external, upper posterior internal and external. Localization of the tumor mainly in a particular segment of the jaw determines, on the one hand, the characteristic clinical picture, on the other hand, the clinical course and prognosis.

In tumors localized in the lower anterior internal segment of the maxillary sinus, in addition to nasal discharge, the most characteristic features are mobility of premolars and canine, as well as the phenomenon of paresthesia. After tooth extraction, tumor tissue growths appear in the socket. Deformation of the corresponding part of the face is often noted.

When the lower anterior internal segment is affected, the tubercle is involved in the process, mobility of the large molars is noted, and contracture of the jaws appears early, arising as a result of infiltration of the masticatory muscles.

In cancer of the upper jaw of the superoposterior outer segment, the ethmoid labyrinth is usually affected, it should be differentiated from primary cancer of the cells of the ethmoid labyrinth. The most common symptom in widespread cancer of this localization with damage to the orbit is narrowing of the palpebral fissure with displacement of the eyeball, sometimes exophthalmos.

From the superoposterior outer segment, maxillary cancer grows into the orbit, as well as the zygomatic bone, pterygopalatine and infratemporal fossa. Spread of the tumor to these areas can cause contracture and neurological symptoms. The most unfavorable prognosis is with damage to the superoposterior outer segment, which is often due to the spread of the process to the reticular plate with tumor growth into the anterior cranial fossa. The most favorable localization in terms of prognosis is the lower anterior internal segment.

Diagnostics

Radiologically, cancer of the upper jaw in the maxillary sinus at an early stage is noted by darkening without damage to the integrity of the bone, which is also typical for the picture of chronic sinusitis. When the bone walls are involved in the process, bone destruction is observed, up to complete disappearance. An important prognostic factor is the involvement of the posterior wall of the maxillary sinus in the process. In order to identify its lesion, it is necessary to conduct CT of the upper jaw, which allows for more accurate detection of the lesion. Regional metastases in cancer of the upper jaw occur rarely and are localized mainly in the upper deep jugular lymph nodes.

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Treatment

Cancer of the upper jaw is treated in a combined manner, the therapy is carried out in two stages. At the first stage, preoperative radiation therapy is indicated at a dose of 50-60 Gy, and at the second - electroresection. The volume of resection depends on the prevalence of the tumor process and can vary from removal of the alveolar process to removal of part or the entire jaw together with the cells of the ethmoid labyrinth by exenteration of the orbit. In case of regional metastases, fascial-case excision of the neck tissue or the Krail operation or an operation on deep lymph nodes is performed.