Fig. 251.—Malignant Disease of Left Maxilla, which displaced the eyeball and caused double vision.
When the tumour grows from the periosteum of the posterior aspect of the bone, and extends into the spheno-maxillary or pterygo-maxillary fossa, the eyeball is usually protruded by the invasion of the orbit from behind, and a swelling appears in the temporal region. If the sinus is invaded, the tumour spreads in the various directions already indicated. Not infrequently a tumour, which appears to have its seat in the maxilla, is really a downward prolongation of a growth originating in the base of the skull, a point on which the X-rays may yield valuable information.
In all cases the tumour tends to infiltrate the surrounding tissues indiscriminately. There is severe pain referred to the distribution of the maxillary division of the trigeminal nerve. Hæmorrhage is liable to occur when exposed portions of the tumour ulcerate—for example in the nasal fossæ. Sarcoma is to be distinguished from the solid and cystic forms of odontoma, which also may distend the bone, bulging the hard palate and projecting on the face.
Treatment of Malignant Disease.—Without the help of radiation the results of operative treatment of malignant disease of the maxilla are far from encouraging. Probably the best line to follow is to embed several tubes of radium in different parts of the tumour for several days, and when the resulting shrinkage of the growth appears to have attained its limits, the maxilla should be excised. If on microscopic examination it is found to be a carcinoma, the glands on the same side of the neck should be removed at a second operation on lines similar to those in Butlin's operation in cancer of the tongue. The aid of the dentist is required to fit a denture which will at least restore the hard palate and alveolar margin. The operation of excising the upper jaw is not a dangerous one, especially if the risk of broncho-pneumonia is minimised by the intra-tracheal administration of ether. The final illness in cases of malignant disease of the upper jaw left to nature, or when it has recurred after operation, is a terrible one; the growth displaces and destroys the globe, blocks the nose and fungating on the face, causes hideous disfigurement.
Simple tumours are rare. Fibroma may originate in the periosteum or in the lining membrane of the maxillary sinus. It usually tends to assume the characters of sarcoma. Chondroma usually begins either on the nasal surface of the bone or in the maxillary sinus. Osteoma occurs in two forms: the exostosis, which may be composed of cancellated or of compact tissue, and the diffuse osteoma or leontiasis ossea (Volume I., p. 485). All intermediate forms are met with, and when confined to the maxilla, the resulting disfigurement may be improved or remedied by operation; the cheek is raised or reflected and the bone shaved away with a strong knife or osteotome.
Tumours of the Mandible.—The same varieties are met with as in the maxilla. The non-malignant forms—osteoma, chondroma, and fibroma—are rare.
A dentigerous cyst appears as a smooth, rounded, and painless swelling, usually in the region of the molar teeth. The bone gradually becomes expanded and crackles on pressure. The cyst is filled with a glairy mucoid fluid, and may contain one or more unerupted teeth ([Fig. 252]). The X-ray appearances are characteristic. The treatment consists in removing the anterior wall of the cyst, scraping the interior, and packing the cavity with iodoform or bismuth gauze.
