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Oral & Maxillofacial Surgery

Oral and maxillofacial surgery is surgery to treat many diseases, injuries and defects in the head, neck, face, jaws and the hard and soft tissues of the oral (mouth) and maxillofacial (jaws and face) region.

What is Oral/facial Cancer?

Oral cancer is a subtype of head and neck cancer is any cancerous tissue growth located in the oral cavity. It may arise as a primary lesion originating in any of the oral tissues, by metastasis from a distant site of origin, or by extension from a neighboring anatomic structure, such as the nasal cavity or the Oral cancers may originate in any of the tissues of the mouth, and may be of varied histologic types: teratoma, adenocarcinoma derived from a major or minor salivary gland, lymphoma from tonsillar or other lymphoid tissue, or melanoma from the pigment-producing cells of the oral mucosa. There are several types of oral cancers, but around 90% are squamous cell carcinomas, originating in the tissues that line the mouth and lips. Oral or mouth cancer commonly involves the tongue, the floor of the mouth, cheek lining, gingiva (gums), lips, or palate (roof of the mouth).

Rehabilitation after oral cancer:

Rehabilitation may vary from person to person depending on the type of oral cancer treatment, and the location and extent of the cancer. Rehabilitation may include:

• Dietary counseling - Many patients recovering from oral cancer surgery have difficulty eating, so it is often recommended that they eat small meals consisting of soft, moist foods.
• Surgery - Some patients may benefit from reconstructive or plastic surgery to restore the bones or tissues of the mouth, returning a more normal appearance.
• Prosthesis - If reconstructive or plastic surgery is not an option, patients may benefit from dental or facial-part prosthesis to restore a more normal appearance. Special training may be needed to learn to use a prosthetic device.
• Speech therapy - If a patient experiences difficulty in speaking following oral cancer treatment, speech therapy may help the patient relearn the process

For patients treated for oral cancer major concerns may include their ability to masticate, speak and swallow and if these issues are not addressed this may lead to psychological difficulties. The loss of teeth is a determinant of patient health-related quality of life, with a reduced self-perceived oral health status in association with greater numbers of missing teeth. There is, therefore, a patient need and demand for dental rehabilitation which aims to restore orofacial form and function and general well being. Dental rehabilitation begins at time of diagnosis and a multidisciplinary approach is critical for best treatment outcomes. Implant-based dental rehabilitation is also an effective treatment modality but should be used judiciously. The beneficial effects of dental rehabilitation may be veiled by the side effects of cancer and concurrent comorbidities.

Signs and symptoms

Skin lesion, lump, or ulcers that do not resolve in 14 days located:

• On the tongue, lip, or other mouth areas
• Usually small
• Most often pale colored, be dark or discolored
• Early sign may be a white patch (leukoplakia) or a red patch (erythroplakia) on the soft tissues of the mouth
• Usually painless initially
• May develop a burning sensation or pain when the tumor is advanced
• Behind the wisdom tooth
Additional symptoms that may be associated with this disease:
• Tongue problems
• Swallowing difficulty
• Mouth sores
• Pain and paraesthesia are late symptoms.

In many Asian cultures chewing betel, paan and Areca is known to be a strong risk factor for developing oral cancer. In India where such practices are common, oral cancer represents up to 40% of all cancers, compared to just 4% in the UK.

Some oral cancers begin as leukoplakia a white patch (lesion), red patches, (erythroplakia) or non healing sores that have existed for more than 14 days. In the US oral cancer accounts for about 8 percent of all malignant growths. Men are affected twice as often as women, particularly men older than 40/60. In Indian subcontinent Oral submucous fibrosis is very common. This condition is characterized by limited opening of mouth and burning sensation on eating of spicy food. This is a progressive lesion in which the opening of the mouth becomes progressively limited, and later on even normal eating becomes difficult. It occurs almost exclusively in India and Indian communities living abroad.