Tumors of The Mandible
Cancers/Tumors of the Jaw Bones (mandible and maxilla)
The upper and lower jaws (maxilla and mandible) are important for many reasons. They provide for the support of the overlying face and attachment for the palate and tongue so are important in speech, swallowing and appearance. Benign and malignant tumors of the mandible and maxilla destroy the lining tissue (mucosa), the bone and the deep muscle tissue attached to the jaws, and no matter what the treatment is we cannot undo that. But most patients can still be very functional. Benign tumors are usually excised with surgery. Some rare tumors may occasionally be observed and followed closely in certain select patients. For cancers, the most common is squamous cell carcinoma. As for all squamous cell carcinomas, radiation and surgery are the treatment modalities that have the potential to cure them. Chemotherapy may help radiation work better in advanced cancers or in non-surgical candidates. Squamous cell carcinoma of the jaw bones is potentially curable in many cases if it has not spread outside the head and neck region. We perform imaging (PET scan, CT, MRI) to determine if it has.
Generally, cancers involving the mandible and/or maxilla are treated by initial surgery and then radiation with or without chemotherapy is given afterward in more advanced cases. Mandible cancers often become known earlier manifesting as a nonhealing tooth socket, a sore or an ulcer. Maxillary cancers may be advanced as often diagnosed late due to silent initial growth inside the silent maxillary sinus cavity. Radiation therapy, if required, is generally given daily as on outpatient five days a week for 6-8 weeks (exact amount determined by radiation oncology). Chemotherapy if given is done intermittently again on an outpatient basis. Surgery focuses on two things equally: removing the cancer and reconstruction. Most of the time we can remove these tumors through the mouth and avoid external scars. Occasionally, there is a need to make incisions around the chin or around the nose. Once the cancer is removed, we examine the defect.
For maxillary reconstruction, we will often use an obturator (special denture like device made by a prosthodontist) or a transplant of bone bearing tissue from another part of the body (a transplant where tissue with its blood supply is brought into the head and neck to provide healthy tissue with a blood supply). The site of the tissue transplanted depends on the volume needed and could be from the lower leg (fibula), forearm (skin and radius bone or skin alone), or scapula bone and skin. Often it is necessary to remove some lymph nodes from the neck or parotid region (neck dissection and parotidectomy respectively) due to the risk of spread to these areas.
Immunotherapy has had an increasing but not perfectly well-defined role as an adjunctive treatment. Most patients are able, once healed, to eat by mouth and speak. In addition, not all but many patients are able to get dental implants placed into the transplanted tissue to allow for the patients to get teeth back (removed often with the jaw bone).