Tumour surgery

In principle, head and throat tumours must be differentiated into benign and malignant tumours. Being diagnosed with a "tumour", which is Latin for selling, never means a life-threatening disease. In principle, the malignancy of a tumour can be derived from three characteristics: From damaging, unrestricted growth; from the metastasis as well as the formation of secondary growths in other places on the body and from the degeneration of the cells. As tumour cells always bear little resemblance to the organ’s healthy cells they must be removed, even the benign ones. The tumour’s growth pressure can also cause damage to the adjacent tissue and it will sometimes cause malignant degeneration as well.

The range of treatments that we provide fully covers the treatment of all benign and malignant tumours in the oral and maxillofacial area, including reconstruction procedures. Reconstruction has become a major part of the range of treatments that we provide due to the exposed positions of the tumours.

Here is a brief summary of our treatment concept for certain types of tumour:

Skin tumours

Basalioma (also called: Basal-cell carcinoma)
Basalioma is the most frequent type of malignant tumour that grows on the facial skin and it affects approx. 50 out of every 100,000 people. The incidence rate of this disease increases with age. These tumours normally occur, with rare exceptions (i.e. Gorlin-Goltz syndrome), in the facial skin areas that are exposed to strong sunlight, which includes the external part of the ears, eyelids, nose, lips and the forehead. They are ascribed to chronic light damage, which is not the result of being sunburnt once or twice, but from a long-life outdoors. Sailors, builders, farmers and sallow and/or red-haired people with sensitive skin are particularly prone to basalioma.

As making a “good” and “malignant” differentiation is too simple (just as it is in real life), there are also “localised” crossover cases, which are slightly malignant. These so-called basaliomas have the “degeneration” and “damaging growth”, characteristics, but not the metastases characteristic.

The therapy of choice is surgical removal and neoplasm. The defect is normally corrected using local skin flaps. This type of surgery is usually carried out on an outpatients basis under a local anaesthetic.

These tumours can cause considerable tissue damage if left untreated, which might well result in a severe aesthetic affect in the facial area and it is not unusual if certain functions are lost as well. Our concern here in particular is to realise an optimum aesthetic recovery in addition to the restoration of the function(s). In rare cases it might also be necessary to use microsurgery to reconstruct by means of a skin transplant with anastomosed vessels if the defect is widespread. Maxillofacial reconstruction procedures might have to be used in special situations, e.g. tumour related eye or nose loss.

A relevant diagnostics examination will be made in each case before the individual customised therapy is introduced and this will be carried out in close co-operation with other specialisations such as dermatology and ophthalmologists (if eyelids are involved).

Patients, who have already had a basalioma should have regular medical check-ups, as a basalioma can start growing in other places. 

Malignant melanoma (also called: black skin cancer)
This appearance of this type of tumour is similar to a basalioma. It is also caused by frequent exposure to ultra-violet light (UV). However, it is very malignant and comes from other cells, the melanocytes. As these are responsible for skin pigmentation (tanning), a malignant melanoma will normally have a deep brown to blue-black appearance. A malignant melanoma must be detected as early as possible and radical removal is called for, as it is one of the most aggressive types of tumour. Chemotherapy might also be needed, depending on the acuteness and the age of the patient, and this is normally carried out at a specialist clinic. However, the site of the melanoma will usually heal well if the melanoma is detected and completely removed in time. 

Naevus (also called: birthmarks)
The closest relation to a melanoma and basalioma is the naevus, which is also known colloquially as a “birthmark”. A birthmark is completely harmless, but it should always be checked if it starts to change its appearance, just in case it is changing into a melanoma. In such cases or if a birthmark looks similar to a basalioma, it should be removed in a minor surgical procedure and the tissue should be sent to a pathologist to confirm the diagnosis.

Salivary gland tumours

This type of tumour is predominantly benign and occurs mainly in the parotid gland, which is found in the area inbetween the ear, cheek and mandibular angle. This type of tumour must also be removed, as it will degenerate or damage the adjacent tissue if it continues to grow. A lot of expertise is required in order to be able to remove this type of tumour, as the facial nerve passes through the parotid gland and it must be protected during the operation, whenever possible, in order to prevent facial paralysis. This means that all the mimic muscles on one side of the face will cease to function. If these muscles cease to function then you will not be able to close the affected eye and this in turn will result in the cornea drying up and ulcers. At the same time the saliva continually dribbling out of the corner of the mouth, which has become slack and started to droop, will cause inflammations. The affected patients will suffer from this obvious disfigurement, which cannot be concealed.

We carry out this type of surgery very often, so that the danger of permanent facial paralysis is minimised. Transplanting bodily nerves and muscles under microsurgery, which are connected to the healthy side and still receive their motion impulse from there, mostly results in both a satisfactory functional reconstruction as well as an aesthetic recovery of the facial symmetry.

Oral cavity tumours

Squamous cell carcinoma:
Malignant tumours do not push out adjacent structures such as nerves and blood vessels, as compared to benign tumours. They start to ingress into the adjacent structures instead without any regard for anatomical boundaries and damage these structures as they continue to grow. They can also set metastases through the blood or lymph streams later on.

The most frequent malignant tumours in the oral cavity, the jaw and the face come out on the coating on the surface of the oral cavity, the mucous membrane or the outer skin. They are called squamous cell carcinomas. Squamous cell carcinomas in the oral cavity occur in 7.9 % of the world’s men and 3.9 % of the world’s women, making them the fourth and eighth most common tumour manifestations. An increase in this ailment has been monitored over the last decades and it appears that men contract this ailment 3 times more frequently than women.

Many studies have proven that there is a relationship between the occurrence of squamous cell carcinomas and heavy smoking or excessive alcohol consumption. The mutually reinforcing effects of simultaneous alcohol and tobacco consumption should also be taken into consideration. The frequency of this ailment in these patients is increased by more than 10 times, which clearly results in the manifestation of this type of tumour much earlier on. Even chronic inflammation of the mucous membrane in the oral cavity, which, for example, is the result of inadequate oral hygiene or the recurrence of mucous membrane injuries that can be caused by sharp edges of teeth and fillings, are possible causes of the emergence of this type of malignant tumour.

In principle, any oral cavity ulcer that has not healed within 14 days after being treated locally should be looked upon as suspicious and the patient needs to be examined by a specialist.

If you strongly suspect the presence of a mucous membrane carcinoma, then advanced diagnostics are required, which include a magnetic resonance tomography or computer tomography of the head and throat regions, an ultra-sonic examination of the cervical lymph nodes and abdominal organs as well as an thoracic x-ray. A tissue sample will also have to be taken so that the histologic cell structures can be examined.

We carry out the treatment of malignant ailments in the oral cavity and the salivary glands in accordance with the guidelines issued by DÖSAK (German, Austrian & Swiss working group for studying tumours in the jaw and facial areas) as well as the DGMKG (German Association of oral and maxillofacial surgeons) and it depends on the type of tumour, the localisation, the size of the tumour, the infestation of the lymph nodes and the other organs (metastases) as well as the patient’s general state of health.

The first choice regarding oral cavity carcinoma therapy is surgical treatment. Radiation is the second choice. However, a multi-modal therapy concept is frequently needed. High demands are placed on the surgical treatment of tumours in the jaw and facial areas due to the exposed location with regard to retaining the functions and the aesthetics are of far more importance here than in other bodily regions. The functional and aesthetic rehabilitation of the patients is therefore of great importance to us in addition to the safe surgical removal of the tumour.

Our orthodontic repertoire also includes dental implantology in order to realise the rehabilitation of chewing functions in addition to the different tissue replacement microsurgery procedures and the local plastic surgery reconstructions. Special care must be taken with pre-irradiated jaws.

The use of reconstructive microsurgery, in which our oral and maxillofacial surgeon, Barbara Iwan specialises, makes it possible to operate even on huge tumour defects. We make the time to give our patients with malignant tumours extensive advice and support, as the tumours are all different and no person is the same as anyone else. We direct official channels to all of our colleagues in other specialisations that will be involved in the therapy involved with this ailment, so that the overall treatment will still be “from a single source”.

We place great importance on the care of our patients and we always produce an integrated treatment concept, which also includes the supervision of logopaedic and nutritional medicine. Regular follow-up examinations and this means four to six during the first year, also help to ensure the success of the healing process. These examinations will not be so frequent from the second year onwards, but you will still be examined in order to detect any possible recurrence of the ailment or metastases promptly and introduce the relevant procedures. We will still be in charge of the co-operation with the other participating specialist departments during the post-operative care.