What Is the Buccal Mucosa?

Carcinoma of the buccal mucosa is a cancerous lesion that originates in the buccal mucosa. Early clinical manifestations generally have no significant pain. When cancer invades deep tissues such as muscles or co-infection, there is obvious pain, with varying degrees of opening restriction, until the teeth are closed tightly. Toothache or tooth loosening, secondary bleeding, etc. may occur. It has the characteristics of invasive growth and high local recurrence rate.

Basic Information

Visiting department

Department of Stomatology, Oncology

Common locations

Buccal mucosa

Common causes

Associated with poor mechanical stimulation

Common symptoms

Pain, restricted opening, closed teeth, toothache, loose teeth, secondary bleeding

Buccal Mucosal Cancer Classification

According to the TNM classification of the International Anti-Cancer Union UICC staging, the anatomical limit of the buccal mucosa is as follows: the anterior boundary is the medial line of the medial lip, the posterior boundary is the anterior pteromandibular ligament, and the upper and lower boundaries are the gingival buccal groove. More than 90% of the disease is squamous cell carcinoma, and 5% to 10% is glandular epithelial cancer.

Causes of Buccal Cancer

Occurred in the mucosa between the upper and lower buccal furrows, before the pterygognathic ligament (including the corner of the mouth and the inside of the lips), and most of them are related to poor mechanical stimulation. The incidence of oral cancer ranks second. It is mainly moderately differentiated squamous cell carcinoma, and a few are adenocarcinoma and malignant mixed tumor.

Clinical manifestations of buccal mucosa cancer

Buccal mucosal cancer is mostly ulcerative, with basal and peripheral infiltration. There are no obvious symptoms at an early stage, and mild or moderate pain may occur when the lesion continues to develop or secondary infection. When the cheek muscles and masticatory muscles are violated, mouth opening may be restricted and progressively aggravated. Advanced cancer can penetrate the skin of the cheek to form a sinus; invade the upper and lower gums and jaw bones, causing toothache, tooth loosening, and jaw bone damage; backwards can spread to the soft palate, the pharyngeal wall, and the mandibular ligament. The rate of cervical lymphatic metastasis is higher in buccal mucosal cancer, which is reported in the literature between 30% and 50%. Submandibular lymph nodes are most commonly affected, followed by deep cervical lymph nodes.

Cheek Mucosal Cancer Examination

1. Pathological examination confirmed the diagnosis.

2. X-ray and CT examination can understand the invasion and jaw condition.

Buccal Mucosal Cancer Diagnosis

1. Buccal mucosa erosion, ulcers or lumps, which may be accompanied by white spots or lichen planus.

2. Chronic irritation factors exist in the corresponding parts of erosion and ulcer, such as the margins of the posterior teeth, residual crowns, residual roots, and bad restorations.

3. The tumor can infiltrate deep, involving buccal muscles, skin, and jaw bones, often with restricted mouth openings.

4. Cancers such as erosive lichen planus and leukoplakia need biopsy to confirm diagnosis.

5. Lymph node metastasis pathway, cheek cancer, submandibular lymph node, parotid gland lymph node, deep cervical lymph node.

Buccal Mucosal Cancer Treatment

For surgery-based comprehensive treatment, simple superficial buccal mucosal cancer can be considered only radiation therapy.

If the diameter of the pathogen is less than 1cm and the surface is superficial, local enlarged resection can be performed. The remaining wound can be closed by suture or free skin graft. Lesions with a diameter greater than 1 cm and those with invasion depth reaching the muscular layer can be repaired with buccal fat pads, frontal flaps, temporal muscle flaps, temporal fascia flaps, neck flaps, thoracic triangle flaps, and forearm flaps. If it invades the jaw, it is necessary to design the scope of jaw resection according to the principle of tumor surgery according to the size of tumor invasion.

Patients with cervical lymphadenopathy should undergo therapeutic neck dissection. In clinical examination, no enlarged lymph nodes were found, but if the thickness of the tumor is more than 3.0 mm or the primary tumor is T ₂ or more, selective neck dissection should be performed in principle. In the middle and advanced cases, chemotherapy or radiation therapy should be supplemented before and after surgery.