MALIGNANT NEOPLASMS OF THE MOUTH 105 



of the entire lip. In cases where a satisfactory diagnosis can- 

 not be made clinically a small portion can be removed for 

 microscopical examination. 



Treatment. — Surgical.— Complete excision early as pos- 

 sible. When the tumor is small and involving the lip, a 

 "V"-shaped incision should be made through the entire lip 

 removing all of the tissue affected. The wound should be 

 carefully sutured to bring the edges in direct apposition 

 when healing will readily take place. In more diffuse and 

 extensive growths complete excision is difficult but should 

 be attempted if at all possible. When the lymph glands are 

 involved treatment is usually unsatisfactory. After-treat- 

 ment consists in the use of antiseptic washes. 



Sarcomata. —This tumor most commonly affects the 

 maxillse, usually the superior maxilla, as it originates either 

 in the periosteum, the medulla, or the endosteum of the bone. 

 They are frequently quite large and often invade the nasal 

 passages, the orbits and the sinuses. Metastatic processes 

 are common in the adjacent lymph glands and occasionally 

 a generalized sarcomatosis is produced. 



Symptoms.— The growth first appears as a rather firm, 

 oval, reddish colored enlargement in close proximity to the 

 maxilla. Later the surface becomes irregular, lobulated and 

 covered with thickened mucous membrane. The tumor 

 usually has a broad base rather firmly attached, but may 

 in some cases be pedunculated. The growth is quite rapid, 

 beginning as one enlargement around which eventually 

 numerous secondary ones develop; later by confluence the 

 base becomes broad. The teeth are often hidden by the 

 growth or in some cases elevated from their position. 



Treatment.— The removal of the entire growth should be 

 done as early as possible. Under general anesthesia, dissect 

 out the tumor, using bone forceps, chisel or curette, being 

 careful to get out all the affected tissue. When the alveoli 

 are affected, extract the tooth and curette and cauterize the 

 cavities to destroy, as far as possible, all the sarcomatous 

 cells. When the lymph glands and the sinuses are involved 

 treatment is practically impossible. 



