Cheek isoral cavityThe lateral walls of the vestibule that form part of the face.It has greater elasticity and ductility.The outside of the cheek is covered with skin, and the inside is the non keratinized oral mucosa.Directly facing the crown of the maxillary second molarParotid ductMucosal papilla formed by opening.The muscular layer of the cheek is mainly formed by the cheek muscles.There is a dense buccal pharyngeal fascia covering the cheek outside the buccal muscles.There are thick fat blocks outside the fascia and between the fascia and the mandibular branch, the front and the inside of the masseter muscle. They are filled here to make the cheeks look plump, especially developed in infancy, called buccal fat bodies.When infants suck milk, the buccal fat body can assist the buccal muscles in sucking.On the outside of the buccal fat body, there are skeletal muscles attached to the dermis, such as the platysma, zygomaticus and laughing muscles.
The cheeks are located on both sides of the face and are the side walls of the oral vestibule.It is mainly composed of skin, subcutaneous fat, facial superficial expression muscle, buccal fat body, buccal muscle and mucosa, among which the external maxillary artery, front vein, buccal branch of facial nerve and parotid duct pass through.There are a lot of mucus glands and mixed glands between mucosa and cheek muscles.
Clinical anatomy
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Buccal carcinoma
Malignant tumor of buccal mucosa.In China, the incidence rate is high, more men than women, mostly squamous cell carcinoma, a few adenocarcinoma, malignant mixed tumor and malignant melanoma.Leukoplakia is a common precancerous lesion or coexisting lesion.It usually occurs in the buccal mucosa near the posterior tooth area opposite to the occlusal line plane, and is ulcerative or exogenous.It grows slowly at the beginning, and then infiltrates into the buccinator muscle, which may break through the muscle layer and skin, or affect the upper and lower gums or jaw bones, or the palate and pharynx backwards.After the diagnosis of biopsy, comprehensive treatment based on surgery should be adopted;If the late stage has invaded the jaw bone with neck lymph metastasis, the combined radical operation of buccal, maxillofacial and neck can be performed;The tissue defect caused by the operation can be repaired at the same time, or the second stage plastic operation can be performed after the tumor is controlled.
Generally speaking, the primary cancer in the buccal mucosa is buccal cancer, more than 90% of which comes from the oral and buccal mucosa epithelium, and a few can come from the small salivary glands under the buccal mucosa.It is one of the most common cancers in oral cancer. The peak age of incidence is between 40 and 60 years old. Most of them are male, and the ratio of male to female is 1.72 ∶ 1.There is a trend of youth.Its pathogenic factor is mainly related to bad habits, and local stimulation is also a pathogenic factor.The pathological type is mainly squamous cell carcinoma.
clinical manifestation
1. Symptoms: Some patients become cancerous from precancerous lesions or precancerous status (leukoplakia, lichen planus).Early pathological changes are mostly manifested as rough mucosal surface, but most of them are ignored due to painlessness. The disease can pass through the buccal muscles and skin outward, causing buccal ulceration, and can cause difficulty in opening the mouth backward.
2. Signs Exogenous or ulcerative lesions of buccal mucosa, white spots or lichen planus around a few lesions, pay attention to whether there are restrictions on opening the mouth, and whether there is involvement of gums and mandibles.Carefully check the neck and submandibular lymph nodes for enlargement. If the lymph nodes are located in the back cheek, check the lymph nodes in the preauricular and parotid areas.
Supplementary Examination
1. B-ultrasonic examination to understand lymph node metastasis.
2. CT or MRI examination to understand the scope of the lesion, the depth of invasion and the relationship with surrounding tissues and organs, and to understand the lymph node metastasis.
3. Biopsy or cytological smear can make a definite diagnosis.
Diagnosis: diagnosis is generally not difficult, but what should be paid attention to clinically is how to determine whether precancerous lesions have malignant changes. Biopsy can assist in early diagnosis.
Treatment after admission
1. Surgical treatment: The resection scope of early cancer should be based on the buccal muscles, including the buccal muscles. For intermediate and advanced buccal cancer, whether the cervical lymph nodes are positive or not, the combined radical resection of buccal, jaw and neck should be performed. The defect after buccal resection can be repaired at the same time.
2. Chemotherapy: preoperative chemotherapy can be induced to improve the cure rate.
3. Radiotherapy: In patients with advanced stage, external irradiation can be performed before surgery, and then surgery can be performed.
