Jaw sarcomas
Introduction
- Sarcomas are rare tumors that represent 2% of cancers
- They are developed at the expense of connective tissue, giving rise to only slightly differentiated elements
- They mainly affect young people
- They are rapidly evolving and predominate in the mandible.
- Classification
- Hard sarcomas
- Osteosarcomas (osteogenic sarcomas)
- Chondrosarcomas
- Fibrosarcomas
- Soft sarcomas
- Reticulosarcoma
- Burkitt’s lymphoma
- Kahler’s disease
- Hodgkin’s lymphoma
- Lymphosarcomas
- Giant cell lymphoma
- Lymphoblastic lymphoma
- Lymphocytic lymphoma
- Radio-clinical study and diagnosis
- Location: the mandible+++, the maxilla and other facial bones
- Extension: neighboring cavities: CB, sinuses, nasal cavities
- They originate in the center of the face “central osteoma” or peripheral
“periosteal sarcoma”
- The cardinal signs are:
- Hard, indolent bony swelling (warning sign)
- Cutaneous hypoesthesia
- Early spontaneous and provoked pain
- Late tooth mobility and displacement
- Hard sarcomas
- Osteosarcomas of the jaws
- Age: before 30 years old+++
- Early DGC allows for early and adequate TRT
- Osteosarcoma of the mandible
- The most common osteosarcoma
- It affects children and adolescents
- Location: angle of the mandible+++
- Mandible Osteosarcoma Clinic
- Severe and early nighttime pain+++
- Rapidly evolving, painless, normal-appearing mandibular swelling
- Anesthesia or labiomental hypoesthesia (Vincent’s sign +)
- Absence of associated cervical adenopathies
- Tumor not movable relative to the bone
- Unexplained tooth mobility
- Possible gingival bleeding
- Biological explorations of osteosarcoma of the mandible
- VS ↑
- Alkaline phosphatases ↑
- Radiographic explorations of osteosarcoma of the mandible
- TDM
- Panoramic and retroalveolar X-rays
- Rx image of lysis and/or condensation
- Lysis image: Bone lysis image with blurred boundaries
- Condensation image: opaque Rx image with poorly defined blurred contours
- Retro-alveolar X-ray: movement of teeth in relation to the tumor
- Anatomopathological examination of osteosarcoma of the mandible
- Proliferation of bone tissue or osteoid tissue
- Production of cartilage and fibrous tissue
- Evaluation of extension of osteosarcoma of the mandible
- Local: clinical assessment and initial Rx
- Locoregional: Exceptional cervical ADPs
- General: liver ultrasound, lung x-ray and scintigraphy
- Evolution of osteosarcoma of the mandible
- Externalization in the CB
- Exaggeration of dental signs
- Metastases: pulmonary+++
- Recurrence after TRT +++
- Survival time after TRT: 5 years
- Chondrosarcomas
- Clinical
- It affects children during the growth period and young people before the age of 30.
- Relatively slow swelling, firm or hard in consistency, sometimes painful
- Location: maxilla+++, affecting growth areas
- Imaging
- Inhomogeneous image with areas of condensation and areas of lysis, associated with calcifications
- Rupture of the bone cortex and peripheral destruction
- Histology
- Giant cartilaginous form with numerous mitoses
- Evolution
- It is fast but slower than that of osteosarcoma
- Possible lung metastases
- Fibrosarcoma
- Clinical
- Jaw swelling and pain +++
- In the maxilla: exophthalmos and nasal obstruction
- In the mandible: labiomental paresthesia
- Imaging
- Frankly osteolytic appearance
- Poorly limited gap image
- Evolution
- She’s a little slow
- Late lung and bone metastases
- Frequent local recurrences
- Prognosis of maxillary fibrosarcoma is better than that of other bone fibrosarcomas
- Differential diagnosis
- In the mandible and maxilla
- Osteitis of dental or hematogenous origin
- Osteopathies
- Benign tumors of the jaws (myeloplaxous tumors)
- Essential facial pain
- Jaw carcinomas
-
- Mesostructure sarcomas
- Chronic maxillary sinusitis
- Common or specific osteitis
- Benign tumors of dental or non-dental origin
- Epitheliomas
- Sarcomas of the suprastructure
- Tumor of the eyeball
- Carcinomas
- Positive diagnosis
- Clinical arguments
- The young age of the patient
- Rapid evolution
- The clinical aspect of the lesion
- Accompanying signs: weight loss, anorexia and ADPs
- The Rx arguments:
- Poorly limited bone lysis
- The blurred contours of the image
- Rupture of the bone cortex
- Periosteal ossification and lamellar apposition
- Biological arguments:
- VS ↑
- Alkaline phosphatases ↑
- The anatomical-pathological arguments:
- Extemporaneous biopsy
- Soft sarcomas
- Lymphosarcomas or LNHG
They affect the lymphoid tissue (lymphocytes)
- Giant cell lymphoma
- Age: 40 to 60 years old
- Superficial, cervical then deep mediastinal ADPs, at an advanced stage they have clear limits
- Splenomegaly
- Puncture: lymphocytic hyperplasia
- Late stage: altered general condition; leukemia and death from cachexia
- Lymphoblastic sarcoma
- Age: 50 to 70 years old
- It affects all areas of the face
- Uncharacteristic telltale signs
- Localized or diffuse maxillary pain with sometimes hyperesthesia
- Dental signs: pain and mobility
- Unhealed socket in case of extraction with budding
- Swelling of the palatine vault
- Mucosal ulceration
- ADPs
- Radio: image of bone lysis with blurred contours
- Cortical rupture and soft tissue invasion
- Conservation of dental septa
- Osteolytic subperiosteal reaction in the form of an “onion bulb”
- DGC: clinical – Rx and biopsy
- Evolution: bone and pulmonary metastases
- Prognosis: bleak
- Reticulosarcomas : they affect the reticular tissue
- Clinical
- Age: young adult
- A fleshy mass develops in the bone
- Blowhole and destruction of the cortical bones
- Movement and mobility of teeth
- Facial pain and aches
- Rare ADPs
- Radio:
- A porous bone
- Poorly limited osteolysis causing the dental septa to disappear
- The apices appear to float above the tumor
- DGC diff: osteoperiostitis – carcinomas – aggressive periodontal diseases and benign osteolytic tumors
Ewing’s sarcoma (reticulosarcoma)
- Rare
- The boy+++ 10 – 15 years old
- Long bones
- Clinic:
- Swelling and pain
- Ulceration of the mucosa, covering the tumor
- Dental pain and mobility
- Paresthesia
- Fever
- Radio:
- Poorly defined late osteolysis areas
- Osteocondensing periosteal reaction “onion bulb”
- Invasion of soft tissues
- Biology: leukocytosis – anemia and increased ESR
- DGC diff: sarcomas and osteomyelitis
- Evolution: bone, pulmonary and gallbladder metastases
- Hodgkin lymphoma: It affects the reticulohistiocytic tissue
- Age: 20 to 30 years old
- Cervical ADPs with or without mediastinal ADPs
- Hepatosplenomegaly
- Mucosal erosion
- DGC diff: in case of cervical ADP (TBC)
- DGC+: Sternberg cells associated with plasma cells
- Improved prognosis after TRT
- Kahler’s disease (single or multiple plasmacytomas)
- It affects plasma cells
- Maxillary location is rare
- 1st : toothache
- Alteration of general condition
- Age: 40 to 60 years old
- Bone swelling and externalization in the CB
- Radio:
- Large geodes scattered with diffuse calcifications
- The geodes are surrounded by a peripheral R° of osteoclasts
- Significant decalcification and possibility of bone metastases
- Biopsy: plasma cells+++ and altered
- DGC: geodes at the skeleton level
- Evolution: rapid with deterioration of the general condition and death within 2 years
- Burkitt lymphoma (hematopoietic sarcoma)
- It affects boys aged 5 to 15
- The maxilla and the mandible
- Affected by the EB virus (MNI)
- Onset: dental signs and swelling of the para-alveolar region with mobility of a group of teeth
- Risk of post-extraction hemorrhage
- Telltale signs: spontaneous tooth loss and exophthalmos
- fused and osteolytic geodes (moth-eaten appearance)
- DGC diff: osteitis and aggressive periodontitis
- Evolution: CNS – PM fossa – GS – metastases
Conclusion
- Jaw sarcomas are rare
- Their DGC is based on Rx and biopsy in addition to clinical elements. elements related or not to the teeth.
- The role of the dentist would be the earliest possible screening given its direct accessibility to CB and with a view to early management in order to improve the chances of a vital prognosis.
Jaw sarcomas
Wisdom teeth can cause infections if not removed in time.
Dental crowns protect teeth weakened by cavities or fractures.
Inflamed gums can be a sign of gingivitis or periodontitis.
Clear aligners discreetly and comfortably correct teeth.
Modern dental fillings use biocompatible and aesthetic materials.
Interdental brushes remove food debris between teeth.
Adequate hydration helps maintain healthy saliva, which is essential for dental health.