Facial Tumors

Read the following information about reconstructive surgical treatment for facial tumors and jaw tumors offered by Denver oral and maxillofacial surgeon, Randolph C. Robinson, MD, DDS, FAACS:

Tumors of the face and jaws are rare but can be very disfiguring and serious. Tumor means ‘swelling,’ and the term refers to an enlarged and abnormal mass. Its cells are growing or proliferating, independent of neighboring tissues.

Tumors may be benign or malignant. Benign means ‘mild,’ usually not recurrent or progressive, and non-malignant. Whereas, malignant means ‘bad kind, tending to injure or harm.’

The presence of such tissue is called a neoplasm, or a new and abnormal formation of tissue. Tumors, or neoplasms, have no useful function, but grow at the expense of the healthy host organism. The longer a tumor exists, the greater the likelihood it will worsen someone’s overall health, threatening nearby structures and organs.

If you have questions about surgical treatment for facial tumors or jaw tumors, contact Robinson Cosmetic Surgery today to schedule an appointment.

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Types of Tumors of the Face and Jaw

Benign Tumors

Benign tumors usually grow slowly in their size and rarely spread to other areas on the body, unlike malignant tumors. Benign tumors, however, can cause pressure on surrounding structures and be disfiguring. They are usually discovered by x-rays before they are even large enough to be noticed. Most benign tumors of the maxillofacial area should be excised, or fully-removed, along with some margins, or surrounding normal tissue, since some may have tendency to recur in the original area.

Cancer means ‘crab,’ a malignant neoplasm marked by uncontrolled cell growth. It often includes invasion of healthy tissues throughout the body. Cancer is a serious medical condition. It is the second most deadly disease in the United States. It is second only to cardiovascular (or heart) disease. The most common cancers in the U.S., in order of greatest prevalence, are: lung, breast, colon, prostate, and skin.

People 65 years or older at highest risk. If cancer is not caught and treated early, it can grow and demand more of the body’s metabolic output. That’s why it’s important to evaluate suspicious tumors as soon as possible.

Malignant Tumors

Malignant tumors also require removal of some of the surrounding tissue, called margins. These margins of normal tissue help prevent recurrence in the original area and spreading to other areas of the body such as the brain, lung, lymph nodes, bones, and liver.

Most Common Forms of Head and Neck Cancers

The most common form of cancer in the head and neck region is squamous cell carcinoma. Oral cancer and throat cancer accounts for 3-5% of all cancers. Its emergence has a high association with smoking and alcohol use.

Most oral and throat cancers present as non-healing ulcers. Some, however, in the early stage, before they ulcerate, may appear as red or white areas on the tongue, cheeks, palate (roof of the mouth), back of the throat, or floor of the mouth. Many oral cancers are discovered by dentists and dental hygienists during routine examinations.

A biopsy is a small tissue sample that is taken and sent to the pathologist to examine under a microscope. A biopsy is required to determine the actual tissue diagnosis.

Throat cancers and cancers of the vocal cords, called laryngeal cancer, may cause hoarseness or a sore throat. The lesion usually cannot be seen, except by a special scope that is inserted through the mouth or the nose while the patient is under anesthesia.

Because oral cancer tends to spread to the lymph nodes of the neck, a careful neck examination is important to feel for any areas of swelling. The lymph nodes are normally difficult to feel and are small, pea-size ‘glands’ that help filter and participate in the immune system. Metastasis, or spreading of the cancer cells to the nodes, bloodstream, or cerebrospinal fluid, indicates more aggressive treatment may be necessary.

You can learn more about types of head and neck cancers here: Cancer.net/cancer-types/head-and-neck-cancer

Excision of the Lesion, Dissection, Staging, and Differentiation

Treatment for oral and throat cancer requires excision of the lesion with at least a one-centimeter margin of normal tissue. Dissection, or surgical separation and delineation of tissues for study, of the neck lymph nodes is important and performed at the same time to reach a ‘staging’ of the cancer. This staging determines whether the patient receives additional treatment with radiation to clear the area of any microscopic tumor cells.

The tumor cells are also characterized by their ‘differentiation.’ This finding means the more a cancer cell appears like normal tissue, then the less it tends to be aggressive. Conversely, the more different and chaotic the cell formation is compared to normal cells, the more aggressive the cancer tends to be.

Surgery Planning and Reconstruction

Careful planning is important to coordinate the reconstruction between the different surgeons who may be involved in the surgery and subsequent reconstruction. Routine oral cancer examinations are an important part of the regular dental exam, usually once or twice a year. Note: Any lesion that does not heal within two to three weeks should be biopsied to make sure it is not a cancer.

Other Types of Malignant Facial Tumors

These facial tumors include:

• Osteosarcoma and Ewing sarcoma: both bone tumors are more common in younger patients,
• Chondrosarcomas: cartilage tumors
• Osteochrondrosarcoma: bone/cartilage type tumors,
• Fibrosarcomas: connective tissue tumors,
• Liposarcomas: fat cell tumors,
• Melanoma: pigmented skin cell tumors, and …other metastatic tumors such as from: breast cancer, lung cancer, multiple myelomas (originating from the bone marrow), and lymphomas.

Benign Tumors of the Maxillofacial Area

These tumors include the benign versions of the various general tissue-type tumors such as:

• Fibromas: from connective tissue ossifying fibromas from bone-fibrous tissue,
• Chondromas: from cartilage, osteochondromas from bone-cartilaginous tissue,
• Lipomas: from fat cells, giant cell tumors likely arise from connective tissue of the bone marrow, with “multi-nucleated” giant cells
• Neurofibromas: from the connective tissue, especially Schwann cells of a nerve, and
• Myxomas: from mucous connective tissue, pure or mixed tumors.

Odontogenic (Tooth Tissue) Benign Tumors

There are special benign tumors that occur in the jaws that are from the tissues that are dedicated to tooth formation. Therefore, the tumors of the jaws which have developed from tooth tissues are named, based on these various tissue types.

Overall, they are called odontogenic tumors. The word odontogenic is derived from Greek (οδοντος ‘tooth’ and γινομαι ‘to be born,’ respectively). For example, enamel-forming cells called ameloblasts, and the hard tissue covering tooth roots is called cementum, and is formed by cementoblasts. Odontogenic tumors of these tissues are, therefore, called ameloblastomas or cementoblastomas, respectively.

The main odontogenic tumors are:

Ameloblastoma – various types include:

• Desmoplastic: forming adhesions or fibrous bands
• Follicular: associated with secretory sacs
• Acanthomatous: usually benign tumor of the skin
• Plexiform: resembling a web or network

Cementoma/Cementoblastoma: from cementum, predominantly found in African Amercian women older than 40.

Calcifying Epithelial Odontogenic Tumor (CEOT) or Pindborg Tumor: Arising mostly from the epithelial element of the enamel, found within the bone and in the posterior mandible of adults, ages 20-60, usually associated with an impacted tooth that remains, slowly enlarging, painless, can cause proptosis (downward displacement of the eyeball), epistaxis (nosebleed), and nasal airway obstruction, recurrence rate 10-15%,

Odontogenic Myxoma: soft, gray tumors composed of mucous connective tissue,

Odontogenic Fibroma: irregular, slow-growing, firm, fibrous encapsulated connective tissue tumor,

Odontoma: tumor originating from dental tissue, can be simple or complex involving enamel, dentin, and/or odontogenic tissue.

General Comments About Odontogenic Tumors

Radiographic, CT, and MRI imaging, as well as obtaining a biopsy, are necessary to diagnose these various tumors. The location and tissue type determine the recommended treatment. Most of these tumors occur in younger patients.

Some tumors, like the common odontoma, can be treated like an impacted tooth extraction. Odontomas make up approximately 50% of odontogenic tumors.

Other tumors, like the rare CEOT, should be treated with more extensive excision with 1-cm margins. But due to few reported cases in the world the best treatment remains uncertain.

The ameloblastoma is one of the more common tumors of the jaws (20% of all jaw tumors) that require surgical excision, with a 1-centimeter margin beyond the tumor to ensure better that it will not recur. If left untreated, the ameloblastoma can become very large and disfiguring. The conservative treatment of curettage most likely means the tumor will come back. It is best to remove the tumor completely the first time, if possible.

How to Get More Information About Facial or Jaw Tumor Surgery

Contact the office of Randolph C. Robinson, MD, DDS, FAACS to schedule an appointment to discuss your options for surgery to remove a facial or jaw tumor. A physician’s order may be required. Talk to your insurance carrier for coverage details.