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1、口腔颌面部肿瘤总论-口腔颌面肿瘤总论 Still waters run deep.流静水深流静水深,人静心深人静心深 Where there is life,there is hope。有生命必有希望。有生命必有希望重点与难点重点与难点nn口腔颌面肿瘤的基本概念口腔颌面肿瘤的基本概念口腔颌面肿瘤的基本概念口腔颌面肿瘤的基本概念 nn良恶性肿瘤的鉴别诊断良恶性肿瘤的鉴别诊断良恶性肿瘤的鉴别诊断良恶性肿瘤的鉴别诊断口腔颌面肿瘤的基本概念口腔颌面肿瘤的基本概念n nn定义与命名定义与命名定义与命名定义与命名n nn头颈解剖分区头颈解剖分区头颈解剖分区头颈解剖分区n nn良性肿瘤及瘤样病变良性肿瘤及瘤
2、样病变良性肿瘤及瘤样病变良性肿瘤及瘤样病变n nn恶性肿瘤的病理分级恶性肿瘤的病理分级恶性肿瘤的病理分级恶性肿瘤的病理分级n nnUICCUICCUICCUICC临床分类分期临床分类分期临床分类分期临床分类分期临床流行病学特点临床流行病学特点n nn患病率、发病率及构成比患病率、发病率及构成比n nn口腔颌面肿瘤发病特点口腔颌面肿瘤发病特点 年轻化，女性发病上升，发病部位变化年轻化，女性发病上升，发病部位变化年轻化，女性发病上升，发病部位变化 病理复杂化病理复杂化病理复杂化 转移性口腔癌转移性口腔癌转移性口腔癌 隐匿性癌隐匿性癌隐匿性癌病因和发病条件病因和发病条件外外外外 因因因因物理因素物理
3、因素物理因素物理因素化学因素化学因素化学因素化学因素生物因素生物因素生物因素生物因素营养因素营养因素营养因素营养因素内内内内 因因因因 精神因素精神因素精神因素精神因素内分泌因素内分泌因素内分泌因素内分泌因素免疫因素免疫因素免疫因素免疫因素遗传因素遗传因素遗传因素遗传因素口腔颌面肿瘤的临床表现口腔颌面肿瘤的临床表现n nn良恶性肿瘤的良恶性肿瘤的生长特性生长特性n nn良恶性肿瘤的良恶性肿瘤的危害危害口腔颌面良恶性肿瘤的诊断口腔颌面良恶性肿瘤的诊断n nn采集病史采集病史采集病史采集病史n nn临床检查临床检查临床检查临床检查n nn影像学检查影像学检查影像学检查影像学检查n nn组织学检查组
4、织学检查组织学检查组织学检查小小 结结n nn口腔颌面肿瘤的命名原则口腔颌面肿瘤的命名原则n nn口腔颌面良恶性肿瘤的鉴别要点口腔颌面良恶性肿瘤的鉴别要点n nn影像学检查的地位及适应证影像学检查的地位及适应证n nn病理检查的方法及注意事项病理检查的方法及注意事项复习思考题复习思考题n nn简述口腔颌面肿瘤的命名原则、病理分级的简述口腔颌面肿瘤的命名原则、病理分级的意义以及意义以及TNMTNM分类分期分类分期n nn良恶性肿瘤的生长特征与诊断要点良恶性肿瘤的生长特征与诊断要点n nn试述活组织检查的主要方法和注意事项试述活组织检查的主要方法和注意事项n nn各种影像学诊断的地位及适应证各种影
5、像学诊断的地位及适应证参考书目参考书目n nn邱蔚六主编口腔颌面外科理论与实践邱蔚六主编口腔颌面外科理论与实践邱蔚六主编口腔颌面外科理论与实践199819981998年人民卫生出版社年人民卫生出版社年人民卫生出版社n nn李树玲主编头颈肿瘤外科学李树玲主编头颈肿瘤外科学李树玲主编头颈肿瘤外科学199319931993年天津科学技术出版社年天津科学技术出版社年天津科学技术出版社n nn吴奇光主编口腔组织病理学吴奇光主编口腔组织病理学吴奇光主编口腔组织病理学199419941994年人民卫生出版社年人民卫生出版社年人民卫生出版社n nnStephen T.Sonis,Principles and
6、Practice of Stephen T.Sonis,Principles and Practice of Stephen T.Sonis,Principles and Practice of oral medicine,oral medicine,oral medicine,1995,W.B.Saunders,Philadephia1995,W.B.Saunders,Philadephia1995,W.B.Saunders,Philadephia Squamous Cell Carcinoma(SCC)in OMFn nCancer is the second cause of death
7、Cancer is the second cause of deathn nOral cancer has high morbidity and high mortalityOral cancer has high morbidity and high mortalityn nEarly detection and treatment can minimize themEarly detection and treatment can minimize themn nMore than 90%of oral cancer are SCCMore than 90%of oral cancer a
8、re SCCn nOral cancer is 3%in all cancersOral cancer is 3%in all cancersClinical characteristicsn nVariety of clinical presentations ulcer,leukoplakia,ulcer,leukoplakia,exophytic formsexophytic formsn nLocation 38%-lower lip,22%-tongue,17%-mouth floor 38%-lower lip,22%-tongue,17%-mouth floor gingiva,
9、palate,tonsil,buccal mucosa,gingiva,palate,tonsil,buccal mucosa,n nBehavior SCC local invasion and regional metastasis SCC local invasion and regional metastasis Diagnosis of oral cancern nBiopsy,cellular smear,toluidine blue stainingBiopsy,cellular smear,toluidine blue stainingn nBiopsy offers the
10、most important information Biopsy offers the most important information leading to diagnosisleading to diagnosis aspiration(fine needle aspiration)aspiration(fine needle aspiration)resection(punch,frozen section)resection(punch,frozen section)Prognosis of oral cancern nnDepends on follow factorsDepe
11、nds on follow factors size,extent,location,nodal involvement size,extent,location,nodal involvementn nnResponse(effect)to cancer treatmentResponse(effect)to cancer treatment -5 years survival rate -5 years survival raten nnLower lip 84%(localized-87%,lymph-66%)Lower lip 84%(localized-87%,lymph-66%)n
12、 nnOverall 5 years survival rates of oral cancer Overall 5 years survival rates of oral cancer 54%,tongue is worsre54%,tongue is worsreStaging of oral cancerStage IStage IT1N0M0T1N0M0Stage IIStage IIT2N0M0T2N0M0Stage IIIStage IIIT3N0M0T3N0M0or any T with N1M0or any T with N1M0Stage IVStage IVAny T w
13、ith N2/N3Any T with N2/N3Or any T/N withM1Or any T/N withM1T12cm,2cm T24cm (AJCC,1995)5 years survival rate of oral cancer in USA(1983-1990)n nnOverall 5 year 52.5%Overall 5 year 52.5%Overall 5 year 52.5%n nnFemale Female Female 58%58%58%n nnMale Male Male 50%50%50%n nnWhites Whites Whites 55%55%55%
14、n nnBlacks Blacks Blacks 34%34%34%Black(M)28%,Black(F)47%Black(M)28%,Black(F)47%Black(M)28%,Black(F)47%Survival ratesn nnKochi,Japan (1994-2004),260 casesKochi,Japan (1994-2004),260 casesn nnTotal 5 yrs survival rate is Total 5 yrs survival rate is 73.6%73.6%T1,2 is 81.1%T1,2 is 81.1%T3 is 73.3%T3 is 73.3%T4 is 55.4%T4 is 55.4%n nnAverage 5 yrs survival in Japan is Average 5 yrs survival in Japan is 65-70%65-70%n nn64.7%in Shanghai(1999)64.7%in Shanghai(1999)DavosDavos