Oral Pre cancer and Cancer Management

Biopsy is the procedure done to acquire a sample of tissue that is to be subjected to histopathological examination in order to arrive at a diagnosis of a condition. In simpler terms, it is a diagnostic procedure that helps us to identify the disease and its stage; thus helping the Oral and Maxillofacial Surgeon in delivering prompt and appropriate treatment to the patient.

Red and white lesions, as the name suggests, are either red or white coloured lesions that affect the oral tissues. Changes in the cells of the oral mucous membrane may occur due to inflammation, reactive conditions, erosion, etc. These red and white lesions comprise a whole spectrum of disorders such as Erythroplakia (red patches), Leukoplakia (white patches), Lichen planus (immune disorder) etc. Some of these lesions have a tendency to progress into malignancy (cancer). Hence most red and white lesions fall in the category of pre-malignant lesions or conditions.

Management of these lesions begins with correct diagnosis, usually by means of biopsy. Removal of the initiating factors is of utmost importance. Treatment includes excision (removal) of the lesion followed by histopathologic examination of the specimen. Regular follow ups are a must to assess the healing and to ensure that there is no recurrence.

Oral submucous fibrosis (OSMF) is a chronic, complex, premalignant condition of the oral cavity, characterized by an inflammatory reaction and progressive fibrosis of the submucosal tissues. As the disease progresses, the jaws become rigid to the point that the person is unable to open the mouth; severe cases may transform into oral cancer.

The condition is associated with areca nut or betel quid chewing, a habit similar to tobacco chewing, that is practiced predominantly in India. In the initial phase of the disease, the mucosa feels leathery with palpable fibrotic bands. In the advanced stage the oral mucosa loses its resiliency and becomes blanched and stiff. The uvula may become bud like. The patient has reduced mouth opening and burning sensation in the mouth.

First step of treatment is to stop the habit. Depending on the stage of the disease, treatment may be conservative or surgical. Early stages can be managed conservatively, using a combination Antioxidant therapy and/or intra-lesional Steroid + Local Anesthetic injections and Oral physiotherapy. Surgical treatment includes Excision of the fibrotic bands and bilateral removal of the coronoid process of mandible with or without the placement of inter-positional grafts. Long term oral physiotherapy is a must to ensure success of treatment.

Orofacial cancers are cancers that affect the oral and/or facial tissues. They may involve the tongue, lips, floor of mouth, jaws, salivary glands, cheeks, hard and soft palate, etc. Oral cancer appears as a growth or sore in mouth that does not go away. It can be life threatening if not diagnosed and treated early.

Maxillofacial fractures implies fracture of one or more facial and/or jaw bones. These are often a result of trauma due to accidents or acts of violence. These injuries not only cause fractures of the bone, but also cause significant disfigurement of the overlying soft tissues.

Treatment of maxillofacial fractures involves anatomic reduction and fixation of the fractured bones, to restore their function. The overlying soft tissues are to be debrided (cleaned) and sutured (stitched) back to their original positions. Scars formed as a result of the injury can be corrected by secondary surgery.