Maxillofacial cancers are tumors of the oral cavity, oropharynx, sinuses, salivary glands, and other parts of the maxillofacial region. These are generally aggressive tumors and need proper diagnosis with immediate, accurate evaluation and then management through a multidisciplinary approach for better results. The diagnosis and management of these cancers are discussed in detail as follows:
Diagnosis of Maxillofacial Cancers
Patient History and Clinical Examination
History Taking: This consists of detailed questioning on symptoms, including nonhealing ulcers, unexplained weight loss, persistent pain, bleeding, difficulty in chewing, swallowing, or speech, and lymphadenopathy. Among the important risk factors are smoking, alcohol use, betel quid chewing, and HPV infection.
Physical Examination: The oral structures, cervical lymph nodes, and abnormal masses or ulcers need to be inspected and palpated. Important signs include leukoplakia, erythroplakia, induration, and oral submucous fibrosis.
Imaging Studies
X-rays and Orthopantomograms (OPG): Useful for identifying bony involvement or structural abnormalities.
Computed Tomography (CT): Preferred for evaluating bone invasion and tumor staging.
Magnetic Resonance Imaging (MRI): Superior for soft tissue characterization and assessing perineural spread.
Positron Emission Tomography (PET): Helps in detecting metastases and determining tumor activity.
Biopsy
Incisional Biopsy: Gold standard for histopathological diagnosis. Small tissue samples are taken from suspicious lesions for microscopic analysis.
FNAC: Commonly used in evaluating palpable nodes or masses as a source of metastasis.
Excisional Biopsy: It can be used to obtain a cure for small size lesions where totally resected for cure.
Biomarker Investigations
Biomarkers, as such, constitute a critical value of p 16 expression regarding HPV-associated head and neck/oropharynx cancer.
Haematological Testing
Bloodwork such as count complete blood smear, liver enzyme studies, along with viral markers when performed will include evaluation of potential systemic spread.
Management involves a multidisciplinary approach with maxillofacial surgeons, oncologists, radiologists, and pathologists. The key aspects include:
Surgical Management
Primary Tumor Resection: Wide excision of the tumor with negative margins. The extent depends on the location and size of the cancer.
Neck Dissection: Done to address cervical lymph node metastasis. Options include selective, modified, or radical neck dissection.
Reconstruction: Free flaps are used for reconstruction (fibula, radial forearm, or anterolateral thigh flaps) for restoring function and aesthetics.
Radiation Therapy
It is done in the presence of advanced tumors or as an adjunct to surgery. The intensity-modulated radiation therapy and brachytherapy are most commonly used methods that minimize the damage to surrounding tissues.
Chemotherapy
In cases of locally advanced disease or metastatic disease, chemotherapy is often used with radiation. The commonly used agents are cisplatin, carboplatin, and 5-fluorouracil.
Targeted Therapy and Immunotherapy
Targeted Therapy: Cetuximab, an epidermal growth factor receptor (EGFR) inhibitor, is given for specific cases.
Immunotherapy: The immune checkpoint inhibitors, such as pembrolizumab, are promising agents, especially in recurrent or metastatic cancers.
Rehabilitation
Prosthetic Rehabilitation: Maxillofacial prostheses restore function, such as obturators for speech and swallowing.
Physical Therapy: Helps improve mobility, speech, and swallowing functions.
Psychosocial Support: The psychological and social impact of the disease is often significant and needs to be addressed.
Follow-Up and Surveillance
These require regular follow-ups for recurrence and secondary cancers, with periodic images and clinical and laboratory assessments.
Prevention and Public Health
Tobacco and alcohol cessation: counselling along with pharmacological intervention to diminish risk.
HPV vaccination : helps in a decrease in HPV-associated oropharyngeal cancer.
Programmes for Early Detection: Screenings in community-based settings focusing on high risk groups to target premalignant lesions and very early cancers.
There should be a logical approach to diagnosing and treating maxillofacial cancers. They are multifactorial diseases with a possibility of morbidity. Early diagnosis and timely management enhance survival rate and quality of life. Advances in molecular diagnostics, imaging, and the treatment modalities along with the preventive strategies improved patient outcomes more than ever before. Multidisciplinary teams remain the pillar of effective management.
Course Features
- Lecture 1
- Quiz 1
- Duration 60 minutes
- Skill level All levels
- Language English
- Students 195
- Certificate Yes
- Assessments Yes
Requirements
- BDS MDS
Features
- oral cancer, oral pathology, lesions in the mouth, biopsy, staging cancers
Target audiences
- all dental practitioners