49. MAXILLARY CARCINOMA

what is a carcinoma?

a cancer of epithelial cells

where does a primary intraosseous maxillary carcinoma originate?

from the epithelial embryonic residues of Malassez or an odontogenic cyst

explain the clinical features of primary intraosseous maxillary carcinomas

fast developing

pain in teeth near the tumour

teeth become mobile

swelling around maxilla

bone destruction can cause sinus involvement

after extraction exposed alveoli don’t heal but filled with soft tissue instead

diagnosis of primary intraosseous maxillary carcinomas

radiographic findings - destruction of bone and homogenous radiolucency with uneven borders

biopsy gives definite diagnosis

what is the differential diagnosis for primary intraosseous maxillary carcinomas?

osteoblastoclastoma

ameloblastoma

sarcoma

what is the treatment for primary intraosseous maxillary carcinomas?

partial or total resection

what is secondary carcinoma of the maxilla?

this is invasion from adjacent areas.

areas included are

- alveolar mucosa

- hard palate

- maxillary sinus

what are the clinical features of cancer of the alveolar mucosa?

fast growing

cause constant tooth pain and mobility spontaneous tooth loss

ulceration

bleeding upon irritation

alveolar mucosa carcinoma types

exophytic

endophytic

alveolar mucosa cancer diagnosis

medical history

clinical exam

biopsy

what are the differential diagnoses for cancer of the alveolar mucosa?

decubitus ulcer

tuberculous ulcer

ulcus durum

actinomycosis

what is the treatment for cancer of the alveolar mucosa for T1-T3 ?

T1,2,3- partial or total resection of the maxilla, and then post operative radiation 50-60Gy

percutaneous radiation therapy 70Gy

what is the treatment for cancer of the alveolar mucosa for T4 ?

T4- percutaneous radiation 40Gy, total radical resection of maxilla, post op radiation 60Gy

explain the presentation of cancer of the hard palate

dense, pale area on palate

around 2-3cm diameter

fast growing

centre of lesion softens and becomes ulcerated

what Is the treatment for cancer of the hard palate for t1-t3 pts?

T1,2,3- partial or total resection of the maxilla, and then post operative radiation 50-60Gy

what Is the treatment for cancer of the hard palate for t4 pts?

T4- percutaneous radiation 40Gy, total radical resection of maxilla, post op radiation 60Gy

explain the presentation of cancer of maxillary sinus

slowly developing

without many symptoms

purulent mucous from one nostril harder to breathe from this nostril

epistaxis

night time tooth pain

facial asymmetry

explain the presentation of SCC of the maxillary sinus

dull pain in the maxillary teeth when laying down

swelling/lump with no pain

serous/purulent exudate from the nose

pain in the eyelids

Explain the Ohngren classification?

maxillary sinus divided into 4 parts

line starts from interior angle of eye and ends at a angle of mandible seprating intp superior-posterior region and inferior-anterior region with lines mesial and lateral

superior-posterior mesial symptoms includes

nasals signs

• bloody exudate sometime purulent with dreadful smell

• reduced breathing capacity one nostril

eye signs

• tears

• hypoaesthesia

superior-posterior lateral symptoms includes

stubborn pain in teeth and jaws

lasting headache

exopthalmos

inferior-anterior lateral symptoms includes

facial asymmetry

tendency to infiltate ramus mandible and tmj - decrease mouth opening

inferior-anterior mesial symptoms includes

destuction of alveolar bone hard palate or anterior sinus

facial asymmetry

how is diagnosis of SCC of maxillary sinus made?

history

clinical examination

biopsy

CT- destruction of alveolar process, hard palate, frontal wall of sinus, shadow in sinus, infiltration towards the nasal cavity

what is the differential diagnosis of SCC of maxillary sinus?

chronic sinusitis

osteoma

fibroma

odontogenic cyst

what are the treatment options for SCC of maxillary sinus?

1- complex therapy

- surgery and radiation

2- when cases are too advanced, palliative care

- bleomycin

- methotrexate

when do metastatic cancers of the maxilla occur?

they are very rare, but they can come from the lungs, kidney, liver, thyroid

for men- can also come from prostate

for women- can also come from the female sex organs

explain the clinical features of metastatic cancers of the maxilla

sometimes asymptomatic

sometimes with mild pain, trismus, TMJ pain, hypoesthesia and tooth mobility

extraction sockets full of granulation tissue

what are the differential diagnoses for metastatic cancers of the maxilla?

primary intraosseous carcinoma

malignant ameloblastoma

malignant tumour of salivary gland

jaw sarcoma

Treatment of mestatic carcinoma of maxilla

systemic treatment of primary tumor

radiation and chemotherapy