Oral Diseases and Cancer

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Oral Diseases and Cancer
Dentigerous Cyst can arise from tooth related tissues and will often need to be removed early as they can grow to a large size which will render surgery difficulty and the jaws prone to fractures.
Other jaw cysts Jaw cysts can arise from a variety of tissues and require surgical removal. Diagnosis can be tricky as some of them may well be cystic degeneration of tumour such as ameloblastoma which will require a more aggressive surgical resection.
Apthous Ulcers in the mouth require a careful diagnostic process to elucidate the cause and institute appropriate management. It is important however, for the experience surgeon to determine if the ulcer is just a simple ulcer or a result of serious conditions such as oral cancer.
Ranula / Mucous cyst / Salivary Gland stones and infection and tumors : mucocoele or mucous cysts can be found on the oral mucosa commonly on the lower lip and some times underneath the tongue. Surgical removal of the cyst is often needed.
Salivary gland stones can be commonly found in the submandibular glands which sometimes require surgical removal of the entire gland from the neck. It can also manifest as a hard “pea” underneath the tongue.
It can be difficult to see in a plain x ray:
A special CBCT scan in our clinic can help us identify locations of the stone
Often it may be asymptomatic until the gland gets infected and enlarges.
The following patient had ignored his submandibular gland swelling for some time until it became acutely infected and it was one of the largest stone Dr Fan had removed.
The scar in the neck may not be obvious if the operation is carried out early.
Parotid Gland Surgery and salivary gland cancers

 

There can be tumors in the parotid gland which are usually benign but can be malignant. It is important for an assessment to be carried out carefully and surgery done early before they become too big. Lumps in the mouth can also be coming from cancer of the minor salivary glands.

Gum swellings: gingival lesions such as the pyogenic granuloma can be common but important to exclude oral cancer and hence all lesions should be examined by an oral and maxillofacial surgeon trained in the management of oral cancer.

Mucosal lesions: the fibroepithelial polyp can be easily diagnosed by an experienced surgeon though again it is important to exclude cancer. The FEPs could be caused by a virus called the Human Papilloma Virus which has some implications related to the development of oral cancer (see this link).

White / Red patches / Lichen planus : white or red patches or lines in the mouth or lip has to be carefully examined by an experienced surgeon as they can be precancerous lesions. White patches can be however be due to infections such as candidiasis or commonly known as thrush. A relative common condition called oral lichen planus may present as a white or red patch. It can be found on the lips and conditions that don’t heal should be biopsied.

It is usually not dangerous but some literature has associated it with cancerous changes. Careful management by an experienced surgeon is important. This patient had her left oral lichen planus treated by a surgeon for a few months which did not heal and had developed cancer.

Tongue Cancer and Jaw Oral Cancer : tongue swellings can have many causes. Tumors can be benign but one has to be careful that it did not grow to too large a size which can be a problem removing them without causing too much deformity.

However, it is very important to consult a specialist if there are any abnormal swellings, ulcers (that don’t heal), red or white patches etc which is not normally found in the tongue and mouth. Even a small crack can be dangerous as it could be a cancer developing in the tongue. Velscope examination can help to screen oral cancer from the usual ulcers and the following patient has tongue cancer even though it was a painless “crack” on the tongue.

It is also important not to ignore ulcers. The patient below applied “melon powder” from Yu Yang Seng for some time until someone asked him to see a doctor and was found to have developed cancer.

Oral cancer is a deadly disease with only 50% overall survival. It is however one of the most easily detectable cancers but the main problem is that most patients ignore them when they first appeared. The unfortunate consequence is that the cancer progressed on to become a late stage cancer and this has disastrous outcomes despite the best of medical and surgical treatment that we can offer today. Early stage disease can have almost 80-90% cure rates but once it becomes late stage, the cure rate drops down to 20-30% or less. Oral cavity cancers can progress from an early stage to late stage very rapidly as the cancer only need to invade a few mm (eg a cancerous ulcer on the tongue can extend to the deep muscles by growing only a few mm) to become classified as late stage.

The above patient presented in clinic with a red area which was not painful and she applied coconut oil to it for about 2 months before seeing Dr Fan. The velscope examination had clearly shown a dark area and on biopsy it was confirmed to be a cancerous lesion. She had to undergo surgery to remove part of her palate.

Oral Cancer Screening and Prevention

Mouth cancer or oral cancer if detected early has high cure rates of almost 90% 5 years survival but unfortunately most patients present to the doctor late. Studies in India had shown that oral cancer awareness will help to decrease mortality and improve survival as the disease is detected early.

Oral Self Examination

Doctors in India had shown that by teaching patients to examine their own mouth could help to detect early cancer lesions early and hence save lives. Dr Fan has modified the self examination steps for patients to help to look into their own mouths more systematically.

Modified Oral Self Examination Techniques by Dr Victor Fan:

Wash your hands and look in front of a mirror with good lighting. Do the following 10 steps in a systematic fashion from the lips, cheeks, tongue, floor and roof of mouth looking for any abnormalities. (see link)

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Dr Victor Fan
MB BCH; BAO (UK)
BDS (Singapore)
FDSRCS (England)
FRCS (England)
FRCS (Intercollegiate)  
FAMS
FICS

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