Benign and Malignant Tumours in Oral and Maxillofacial Surgical Treatment

Tumours involving the oral cavity and maxillofacial region represent a significant clinical concern in both dental and medical practice. The role of oral and maxillofacial surgery (OMS) in managing these conditions is essential, as the anatomical complexity of the head and neck demands precise diagnosis and surgical expertise.

Both benign and malignant tumours can affect the soft tissues, bones, and glands of the oral and maxillofacial region. While benign tumours are generally slow-growing and non-invasive, malignant tumours pose serious health risks due to their potential to invade surrounding tissues and metastasize. Early recognition and appropriate surgical intervention are critical to improving patient outcomes and quality of life.

Benign Tumours

Benign tumours of the oral and maxillofacial region are non-cancerous neoplasms that arise from various tissues, including bone, soft tissue, salivary glands, and odontogenic structures. They typically exhibit a slow and localized pattern of growth and lack the ability to invade adjacent tissues aggressively or metastasize to distant organs. Despite their non-invasive nature, benign tumours in this anatomically complex region can still have significant clinical impact.

Due to the tight anatomical relationships of the oral cavity, jaws, and facial structures, even benign tumours can cause functional disturbances such as altered mastication, speech difficulties, or airway compromise. Additionally, they may lead to dental displacement, occlusal changes, and facial asymmetry as they expand within the confined spaces of the maxillofacial skeleton or soft tissue compartments.

From an aesthetic standpoint, benign tumours can distort facial contours and compromise facial harmony, which may affect a patient’s self-image and psychological well-being. Furthermore, their proximity to critical structures such as nerves, blood vessels, and muscles of mastication requires careful clinical evaluation and management to preserve function and prevent secondary complications.

Types of Benign Tumours

• Benign odontogenic tumours: These tumours are non-cancerous neoplasms that originate from the tooth-forming tissues of the jaws, and can affect the surrounding bone, teeth, and soft tissues.

• Benign non-odontogenic bone tumours: Also arise from the bone or supporting structures of the jaws, however, they are not derived from tooth-forming tissues.

• Benign soft tissue tumours: These are non-cancerous growths arising from connective tissue, muscle, fat, blood vessels, or nerve tissue within the mouth, face, and jaw areas, often affecting function and facial aesthetics depending on their size and location. Included are:

• • Fibroma
  • Lipoma
  • Hemangioma
  • Neurofibroma

• Benign salivary gland tumours: Non-cancerous neoplasms that develop within the major or minor salivary glands, often presenting as slow-growing masses that can affect glandular function, facial symmetry, and oral health. Included are:

• • Pleomorphic adenoma
  • Warthin’s tumour

Malignant Tumours

Malignant tumours of the oral and maxillofacial region are cancerous growths characterized by their ability to invade surrounding tissues and spread (metastasize) to regional lymph nodes and distant organs. These neoplasms typically exhibit rapid and uncontrolled cellular proliferation, coupled with a propensity to infiltrate vital anatomical structures within the head and neck.

The oral and maxillofacial region presents unique challenges in the context of malignancy due to its dense concentration of critical structures, including the tongue, floor of the mouth, jawbones, salivary glands, cranial nerves, and airway components. Malignant tumours in this area can profoundly impact essential functions such as chewing, swallowing, speech, and respiration. As these tumours expand and infiltrate local tissues, they may disrupt the integrity of the oral mucosa, skeletal framework, and soft tissue planes, resulting in significant morbidity.

From an aesthetic perspective, malignant tumours can lead to facial disfigurement, either through direct tissue destruction or as a consequence of necessary surgical resection and reconstruction. The psychosocial effects of these visible changes are substantial and often require comprehensive rehabilitation to support the patient’s quality of life.

Given their aggressive nature, malignant tumours of the oral and maxillofacial region demand a multidisciplinary treatment approach that prioritizes oncologic control while striving to preserve or restore both function and appearance. Early intervention and precise surgical management are critical to optimizing patient outcomes and minimizing the long-term impact of the disease.

Types of Malignant Tumours

• Malignant odontogenic tumours: These are rare, cancerous neoplasms arising from tooth-forming tissues, characterized by their potential to invade surrounding bone and soft tissue and, in some cases, metastasize to distant sites.

• Oral squamous cell carcinoma (OSCC): The most common malignant tumour of the mouth, affecting the lips, tongue, floor of the mouth, and gums.

• Salivary gland cancers: Salivary gland cancers are malignant tumours that arise from the major or minor salivary glands in the oral and maxillofacial region, with the potential to invade surrounding tissues and spread to regional lymph nodes or distant organs. Included are:

• • Mucoepidermoid carcinoma
  • Adenoid cystic carcinoma
  • Acinic cell carcinoma

• Sarcomas: These are rare malignant tumours that arise from connective tissues such as bone, cartilage, muscle, or blood vessels, often exhibiting aggressive local invasion and a risk of metastasis. Included are:

• • Osteosarcoma (bone)
  • Chondrosarcoma
  • Rhabdomyosarcoma

• Lymphomas: Lymphomas in the oral and maxillofacial region are malignant tumours originating from lymphoid tissues, which can present as masses in the soft tissues, jawbones, or lymph nodes, with the potential for both local and systemic spread.

• Metastatic tumours: These are malignant growths that originate from primary cancers elsewhere in the body and spread secondarily to the jawbones, oral soft tissues, or regional lymph nodes.

Causes and Risk Factors of Oral and Maxillofacial Tumours

Several factors contribute to the development of benign and malignant tumours in the oral and maxillofacial region:

Benign Tumours

• Genetic mutations in tooth-forming tissues (odontogenic tumours)
• Developmental anomalies of bone or soft tissue
• Chronic irritation or trauma
• Hormonal influences (less common)

Malignant Tumours

• Tobacco use (smoking, smokeless tobacco)
• Alcohol consumption
• Human papillomavirus (HPV) infection
• Poor oral hygiene
• Chronic irritation (ill-fitting dentures, sharp teeth)
• Exposure to radiation
• Genetic predisposition
• Immunosuppression

Combined exposure to tobacco and alcohol significantly increases the risk of oral cancer.

Symptoms of Oral and Maxillofacial Tumours

The symptoms of oral and maxillofacial tumours vary depending on the tumour type, size, and location:

Common symptoms of benign tumours:

• Slow-growing lump or swelling
• Painless mass in jaw, gums, or cheeks
• Facial asymmetry
• Displacement of teeth
• Difficulty with chewing or speech (large tumours)

Common symptoms of malignant tumours:

• Persistent ulcer or sore that does not heal
• Pain or burning sensation in the mouth
• Lump or thickening in oral tissues
• Difficulty swallowing or speaking
• Loose teeth without periodontal cause
• Numbness in the lower lip or chin
• Unexplained weight loss
• Enlarged cervical lymph nodes

Early symptoms of malignant tumours can be subtle, which is why regular oral examinations are crucial for early detection.

Pre-Treatment Diagnosis of Oral and Maxillofacial Tumours

Accurate diagnosis of oral and maxillofacial tumours involves a combination of clinical examination and diagnostic tools:

• Detailed patient history and risk factor assessment
• Clinical examination of oral cavity, face, and neck
• Imaging studies:
  • Panoramic X-rays
  • Cone-beam computed tomography (CBCT)
  • CT scans
  • MRI
  • PET scans (for staging malignant tumours)

• Biopsy:
  • Incisional or excisional biopsy for histopathological diagnosis
  • Fine needle aspiration cytology (FNAC) for salivary gland lesions

• Molecular testing may be used in certain cases (HPV testing, genetic markers).

A multidisciplinary approach involving oral and maxillofacial surgeons, pathologists, radiologists, and oncologists ensures an accurate and comprehensive diagnosis.

Treatments and Procedures for Both Types of Tumours

The treatment of benign and malignant tumours in the oral and maxillofacial region requires a carefully tailored approach, with the goal of achieving complete tumour control while preserving function, aesthetics, and the patient’s quality of life.

Treatment of Benign Tumours

• Surgical excision is the primary treatment for most benign tumours with the goal of complete removal while preserving function and aesthetics.

• Some tumours require curettage or en bloc resection (especially odontogenic tumours like ameloblastoma).

• Reconstructive surgery may be necessary for large tumours involving bone or soft tissues.

• Regular follow-up is essential due to the risk of recurrence with certain benign tumuors.

Treatment of Malignant Tumours

• Wide surgical excision with clear margins is the cornerstone of treatment.

• Lymph node dissection is often performed for oral squamous cell carcinoma.

• Reconstruction with free flaps, bone grafts, or prosthetic devices restores form and function after extensive resections.

• Adjuvant therapies: These are additional treatments administered after primary surgical intervention to reduce the risk of cancer recurrence and improve overall treatment outcomes.

• Radiation therapy
• Chemotherapy
• Targeted therapies (in selected cancers)

• Neoadjuvant therapy: Therapy given before primary surgical intervention to shrink the tumour, improve surgical outcomes, and reduce the risk of metastasis to certain oral and maxillofacial cancers depending on the type and stage of the tumour.

• Multidisciplinary care is critical to optimize survival and quality of life.

Rehabilitation

Rehabilitation after treatment applies to both malignant and benign oral and maxillofacial tumours, although the goals and extent of rehabilitation may differ depending on the tumour type, location, and treatment performed.

In both cases, rehabilitation may involve:

• Prosthodontic rehabilitation (dental prostheses, obturators)
• Speech and swallowing therapy
• Physical therapy for facial mobility
• Nutritional counseling
• Psychosocial support