To benign tumors of the oral cavity and pharynx include fibroma, papilloma, angioma, neurinoma, mixed tumors. In the same section, some tumor-like formations are considered: hairy polyp, cyst, goiter of the root of the tongue.
Most often diagnosed with papilloma and fibroma on the foot. They are of small size, soft, are located on the soft palate and palatal arms and, as a rule, do not bother the sick a little. Diagnosis of the tumor by appearance and histological examination is not difficult. Treatment consists of the removal of individual papillomas followed by galvanic caustics of their base.
Sites of papillomatous degeneration of the mucous membrane give a deep cryo-action. Papillomatosis of significant areas of the mucous membrane often gives a relapse. Given the possibility of malignant degeneration of papillomas, they must be removed in a timely and radical way.
Angiofibroma of the nasal part of the pharynx
Among benign tumors of the nasal part of the pharynx, angiofibroma is most common. This tumor is only in boys aged 10-20 years, therefore called adolescent (juvenile). After a 25-year-old age, the tumor develops backward. Angiofibroma grows mainly from the body of the sphenoid bone and the sites of the posterior trellised cells.
This is the sphenoetmoidal type of tumor, characterized by a tendency to germination in the nasal cavity, maxillary sinus, trellis labyrinth, orbit, sphenoid sinus. Often, the tumor can leave the dome of the nose of the pharynx and the main part of the occipital bone - the basosphenoid type of fibroids. In this case, there is a tendency for the tumor to germinate into the cranial cavity. If the tumor originates from the area of the pterygoid fossa (pterygomaxillary type), its growth can occur in the retro-oxillary space and the nasal cavity.
Releasing the tissues encountered on the way of growth, outward, the fibroid causes a rough asymmetry of the face, a violation of the circulation of different parts of the brain, a shift in the eyeball. Unlike malignant tumors, the spread of angiofibroma to adjacent organs and tissues does not occur by infiltrative growth, but by compression (deformation of anatomical formations) and dystrophic changes. Such a tumor should be assessed as conditionally benign.
Angiofibroma of the nasal part of the pharynx is the formation of a rounded shape with a smooth or coarse-grained surface, a dense, sometimes almost cartilaginous consistency, bright red with a predominance of vascular elements over fibrous or pale pink in the case of an inverse relationship. Abundant vascularization of the tumor allows diagnosing angiofibroma based on histological studies.
In the early stages of development of angiofibroma of the nasal part of the pharynx, its clinical manifestations are not clearly expressed: moderate obstruction of nasal breathing, sore throat, catarrhal phenomena. With the growth of the tumor, breathing through one-half of the nose completely stops and hinders through the other, there is a closed nasal, changes naked, the face acquires an adenoid appearance.
In the case of tumor germination, a significant headache, dizziness, and vomiting occur in the underlying bone. Depending on the location and direction of tumor growth, there may be exophthalmos, decreased vision, diplopia, deafness, etc. The most common and severe symptom of angiofibroma of the nasal part of the pharynx is the periodically occurring severe spontaneous nasal bleeding that causes anemia.
The diagnosis of angiofibroma of the nasal part of the pharynx is usually not complicated and is based on endoscopic, radiographic, and in some cases angiographic research. The tumor fills the nasal part of the pharynx and can hang into its mouth part. During palpation, it bleeds very much.
Differential diagnosis is carried out with the choanal polyp, adenoids, papilloma, sarcoma, cancer, adenoma.
Treatment of angiofibroma of the nasal part of the pharynx is only surgical and as radical as possible. Surgical approaches: endoral, endonasal and transmaxillary. With intensive bleeding that occurs during surgery, a massive blood transfusion is usually required.
Hairy polyp refers to teratoid formations, it appears at the age of up to 1 year, comes mainly from the back surface of the soft palate or lateral wall of the pharynx, has a long stem, is internally covered with skin with delicate hairs. Histologically, hair follicular tissue is defined in the hairy polyp, which includes rudimentary remains and cartilaginous elements.
The hairy polyp is defined in the first days of life in connection with the violation of breathing and the difficulty of sucking. It has a long leg, often (especially during crying) is thrown into the mouth, making breathing even more difficult.
Treatment of hairy polyps is surgical. The polyp is grasped with forceps and removed to the oral cavity, its leg is bandaged and cut off. Bleeding is not observed, relapses do not occur.
Vascular tumors - angiomas - by origin are divided into hemangiomas and lymphangiomas. Their structure is almost the same, but the first contain the blood in the cavity, and the latter - lymph. Hemangiomas are capillary, cavernous, branched, have a cyanotic or dark violet color, a wide base, most often localized in the soft palate, palatine arches, lateral and posterior pharyngeal walls, can reach large sizes.
Lymphangiomas differ in light yellow color, large in size and are less common than hemangiomas. Angiomas of small size are asymptomatic, only occasionally nasal congestion and bleeding are possible. Large angiomas create the sensation of a foreign body in the nose of the pharynx, making it difficult for the nasal breathing. They can cause bleeding.
Angioma surgical treatment with electrocoagulation.
Cysts of the oral cavity
Cysts of the oral cavity do not refer to true tumors. They are localized mainly on the palatine tonsils, the root of the tongue, less often - on the soft palate. Cysts of tonsils, mostly retentional, contain a yellowish color of pyogenic mass, do not cause any sensations and are detected by chance. Sometimes patients complain of a feeling of irritation in the throat. Intramural cysts of the soft palate also show up in nothing and can reach large sizes, which is especially characteristic of teratoid tumors. Large cysts of the root of the tongue in early childhood can cause respiratory failure.
Diagnosis of cysts is not difficult, but in the case of localization at the root of the tongue, they should be differentiated from the ectopic thyroid gland. Surgical treatment - removal of the cyst along with the membrane. Intramural cysts of the soft palate should be removed completely submucosally with the application of sutures to the incision. Even the minimal left piece of the cyst wall leads to a relapse.
Throat neurinomas can be formed from peripheral branches of the cervical sympathetic and parasympathetic nerves, including the cranial ones. If the tumor affects the sympathetic nerves, then on the side of the lesion Horner's syndrome is often observed. In the case of involvement in the vagus nerve process, hemiparesis of the larynx sometimes appears. First, the tumor does not manifest itself in any way, but as it grows, it can cause a sensation of squeezing the pharynx, difficulty swallowing and breathing. The tumor is localized under the mucous membrane, never forms ulcers and does not bleed, it is dense, elastic, painless, grows slowly, does not metastasize.
Treatment of neurinoma of the pharynx is surgical: access is endoral, but sometimes an external approach is used (lateral or median pharyngotomy).
Goiter of the root of the tongue
The root of the tongue is a tumor-shaped formation with a wide base, covered with a mucosa with a dense network of dilated veins. It will give a sensation of a densely elastic consistency. The tumor is an additional thyroid gland, not associated with normal, or ectopic gland - the only body in the body of thyroid tissue. Complaints of patients depend on the size of the tumor and consist of the sensation of a foreign body, dysphagia, changes in the tone of the voice, respiratory disorders. Sometimes there is a discharge of blood from the mouth, which is associated with a trauma of the food coma of superficially placed veins.
Treatment of goiter at the initial stages of development is conservative: iodine preparations, radioactive iodine are prescribed. Surgical treatment is complete or partial (if this is the only concentration of thyroid tissue in the body) removal of the tumor.