CLINICAL MANIFESTATIONS OF ORAL CAVITY TUMORS
- INTRODUCTION :
Oral cancer is a malignant tumor that occurs in the oral cavity.
Are tumors with a male predominance (90% of cases concern men).
In 90% of cases, these cancers are linked to alcohol and tobacco poisoning.
Treatment is based on surgery, chemotherapy, radiotherapy.
It is most often located on the tongue, soft palate, floor of the mouth, gums, tonsils, inner surfaces of the cheeks and lips.
- PRECANCEROUS LESIONS:
Precancerous lesions precede the cancerous lesion in approximately 10% of cases.
- White mucous lesions:
- Leukoplakia, or leukokeratosis:
Leukoplakia (Fig. 1) is characterized by a whitish, soft area that does not come off when scratched and corresponds histologically to an accumulation of keratin (hyperkeratosis) on the surface. The more inhomogeneous these leukoplakias appear, the more suspicious they are.
Figure .1: Leucokeratosis.
CLINICAL MANIFESTATIONS OF ORAL CAVITY TUMORS
- Oral lichen
Which can evolve into chronicity or even healing, such as erosive lichen (fig. 2) or atrophic lichen which evolves in flare-ups. The occurrence of an erythematous, irregular plaque, dotted with grayish, adherent, fine and tight punctuations is very suggestive of cancer.
Figure .2: Erosive oral lichen planus of the cheek
- Chronic candidiasis
Chronic candidiasis (fig. 3), particularly in its hyperplastic or even pseudo-tumoral forms, should be monitored.
Figure .3 Tongue mycosis
CLINICAL MANIFESTATIONS OF ORAL CAVITY TUMORS
- Oral papillomatosis florida
Sometimes called malignant villous keratosis, florid oral papillomatosis (fig. 4) presents as tufts of fine, more or less elongated villi, white or pink in color. This tumor is extensive and very recurrent. Its diagnosis often requires three or four successive and very deep samples. Progression to verrucous carcinoma is almost inevitable.
Figure .4: Florid oral papillomatosis
- Red mucous membrane lesions, or erythroplasia of Queyrat
Red mucous lesions, or erythroplasia of Queyrat
(fig. 5), are less frequent but more worrying than white lesions. They are often extensive red plaques, remaining superficial, with a velvety appearance and irregular edges. The epithelium is estatrophic and covers a telangiectatic vascular network. The precancerous intraepithelial lesion corresponds to severe dysplasia or carcinoma in situ. In 50% of cases, this intraepithelial lesion is already associated with an infiltrating squamous cell carcinoma.
Figure 5: Erythroplasia of Queyrat
CLINICAL MANIFESTATIONS OF ORAL CAVITY TUMORS
III – CIRCUMSTANCES OF DISCOVERY:
Sometimes the discovery of the lesion is fortuitous, made by the patient himself, or more often by his dentist or doctor during an examination of the oral cavity.
At first, the warning signs are subtle and discreet: simple discomfort with the impression of food sticking, irritation on a prosthesis or an aggressive decayed tooth, persistent “mucosal inflammation”, gingival bleeding, loose tooth.
The persistence of the sign, its unilaterality and its location always in the same place should attract attention. Later, pain on swallowing appears, often accompanied by reflex otalgia, fetid breath due to an infection with frequently associated anaerobic germs, dysphagia, dysarthria, progressive and inexorable limitation of mouth opening or tongue protraction, occurrence of stomatorrhagia, all manifestations suggesting malignancy. The general condition is generally preserved as long as feeding remains possible.
The oral cavity is examined using effective lighting (frontal mirror on transformer), the patient having removed his dentures with, if necessary, local anesthesia to combat gag reflexes. It focuses on the entire oral mucosa carefully unfolded and explored in its smallest corners. The tumor can present in different aspects:
- Ulceration:
The ulceration (fig. 6) does not heal, is sensitive, or even, in the case of superinfection, painful and is then accompanied by fetid breath. It is of variable shape and its more or less irregular, raised, sometimes everted edges have an external slope covered with healthy or inflammatory mucosa. The internal slope discreetly budding, with a raspberry appearance and sometimes covered with a greenish-gray coating, extends into the raw, sanious base of the ulceration.
This ulceration bleeds easily on contact and, above all, rests on an indurated base appreciated by palpation. This induration extends beyond the visible limits of the tumor which are more or less clear depending on the degree of infiltration of the tumor into the underlying planes.
This induration has an almost pathognomonic value of cancer.
The ulceration is sometimes barely visible, hidden in an anatomical groove (fissural forms) (fig. 7).
Deep induration is a major diagnostic guideline, as well as pain and reduced or even loss of mobility of the muscle elements infiltrated by the cancer.
Figure .6: Ulceration
Figure .7: Fissure shape
CLINICAL MANIFESTATIONS OF ORAL CAVITY TUMORS
- Budding tumor
Devoid of covering mucosa, friable, more or less exuberant, hemorrhagic , its implantation base is more extensive than the tumor it supports and, here too, indurated (fig 8).
Figure. 8: Budding tumor
- Mixed aspect
Mixed ulcerative-budding forms result from the combination of the two previous forms (fig. 9).
Figure. 9: Mixed ulcerative-budding appearance
CLINICAL MANIFESTATIONS OF ORAL CAVITY TUMORS
4-Interstitial nodule
Covered for a long time by healthy mucosa, the nodule (fig. 10), by its hardness and its infiltrating character, should sound the alarm. These forms generally correspond to a glandular origin . By increasing in volume, these tumors end up ulcerating the mucosal plane.
Figure. 10: Nodular shape
Dental crowns are used to restore the shape and function of a damaged tooth.
Bruxism, or teeth grinding, can cause premature wear and often requires wearing a retainer at night.
Dental abscesses are painful infections that require prompt treatment to avoid complications. Gum grafting is a surgical procedure that can treat gum recession. Dentists use composite materials for fillings because they match the natural color of the teeth.
A diet high in sugar increases the risk of developing tooth decay.
Pediatric dental care is essential to establish good hygiene habits from an early age.