Jaw and mouth cysts and lesions, jaw and facial fractures

What are jaw cysts and tumors?

Cleveland Clinic writes that a cyst is a sac filled with fluid or semi-fluid material, and a tumor is a solid mass made of abnormal cells that have built up. Both can arise in the jawbone, including the tissue that forms teeth, or in the soft tissue of the mouth. Most are benign, and the cancerous type is rare. Even so, some benign ones can damage the jaw or move teeth out of position.

The same source lists a few well-known examples: the radicular cyst at the tip of a tooth root (the most common jaw cyst, after a tooth injury or infection), the dentigerous cyst (around the crown of a tooth that has not come through, such as an impacted wisdom tooth), the odontogenic keratocyst, and tumors such as ameloblastoma, which grows slowly and is often in the lower jaw toward the back of the mouth. An impacted wisdom tooth can sometimes be associated with a cyst, and the impacted wisdom teeth page explains this.

Symptoms

Most cysts and tumors grow slowly without symptoms and are found by chance on a dental X-ray or other head and neck imaging. Cleveland Clinic says that larger ones may cause these signs:

• pain, tenderness or numbness in the jaw,
• swelling, which may or may not be painful,
• a change in the shape of the face,
• a new lump on the jawbone, hard or soft,
• a change in the bite,
• loose teeth.

Pain and swelling that worry you need an examination, whether or not it turns out to be a cyst.

Checks and tests

Cleveland Clinic says the doctor takes a history and examines you, then looks at the lesion with an X-ray, MRI or CT scan. A biopsy, which means taking fluid or a small piece of tissue, shows the type of lesion, whether it is benign or malignant, and how fast it is growing, and treatment decisions are based on it. A biopsy is usually done with numbing, and a pathologist examines the tissue under a microscope. To learn about the images, see the guide to jaw imaging.

Treatment and follow-up

The main treatment is surgery. Cleveland Clinic writes that the surgeon removes the lesion, and sometimes the affected tissue, such as a damaged tooth or part of the jaw, has to be removed too. For large lesions, reconstruction with bone from elsewhere in the body, dental implants, speech therapy and nutrition guidance may be needed. For the malignant type, depending on the tumor, radiotherapy or chemotherapy may also be considered.

Recurrence depends on the type of lesion. This source says radicular cysts, odontomas and dentigerous cysts usually do not come back, but central giant cell granuloma, myxoma and odontogenic keratocyst often do. Ameloblastoma can also come back, and the chance depends on the type of lesion and the surgical method. So some patients need follow-up for a while, with periodic X-rays. Regular dental check-ups matter too, because routine X-rays sometimes show a small lesion before it causes symptoms.

Questions the source suggests asking the surgeon: What type of lesion is it? Is it benign or malignant? Is surgery needed? How likely is it to come back? How should I look after myself while I heal?

A sore, patch or lump in the mouth

AAOMS points out that not every mouth lesion is cancer, but these signs should be seen early: a white patch, a red patch, or a mix of both; a sore that bleeds easily or does not heal; thickened tissue; a lump; a swollen lymph node in the neck; unexplained numbness; and a sore throat, hoarse voice or trouble swallowing or chewing that lasts. This association recommends checking your mouth and neck with a mirror and a light once a month.

The NHS gives a clear limit for mouth ulcers: more than three weeks. Simple ulcers usually heal in a week or two. A lasting ulcer, a white or red patch, a lump in the mouth, lip or neck, ongoing mouth pain, or trouble swallowing and speaking should be seen by a dentist or doctor. None of these is a diagnosis of cancer, but seeing someone early makes treatment easier.

Jaw and facial fractures

AAOMS writes that a fracture may involve the lower jaw, upper jaw, palate, cheekbone, eye socket, or several of these together, and is sometimes accompanied by soft-tissue cuts and tooth injury. A facial injury can affect vision, breathing, speaking, swallowing and chewing.

Possible signs of a fracture. The MSD medical manual (written for clinicians) lists these for the lower jaw: the bite does not fit together after a blow; local swelling and tenderness in the jaw; a step in the row of teeth; numbness of the lower lip or chin. A fracture of the jaw joint comes with pain in front of the ear, swelling and limited mouth opening. A fracture of the eye-socket floor may cause double vision, a sunken eye and numbness below the eye, and any injury to the eye socket needs an eye examination. After a severe blow, brain and neck spine injury may also be present.

Tests. X-rays and CT. A panoramic X-ray alone screens the lower jaw, and a thin-slice CT is the preferred method for facial fractures.

Treatment. According to AAOMS, the principle is the same as for a broken arm or leg: the pieces are put back in the right place (reduction) and held still until they heal. Methods range from a soft diet to wiring the upper and lower jaws together with wires and elastics, and open surgery with plates and screws. The MSD source writes that wiring the jaws shut may last up to 6 weeks, and combining it with plates and screws allows earlier movement. A fracture of the jaw joint often needs the jaws wired for only two to three weeks, followed by a soft diet. Midface fractures need surgery if they cause a bite problem, double vision or numbness, and it should ideally be done once the swelling has gone down and within about fourteen days of the injury.

Treatment often needs a hospital stay. The oral and maxillofacial surgeon works with other specialists, including an eye doctor and an ENT specialist, because facial injuries are often not isolated. Mouth hygiene matters while the jaws are wired, since plaque and infection become risks, and once the wires come off, mouth-opening exercises help function return. If your jaws are wired or held with elastics, ask the treatment team what to do if you vomit or cannot breathe easily.

Prevention. Mouthguards, masks and helmets in sport and high-risk activities.

When to act urgently

• After a blow to the face, if the injured person is unconscious, confused, dizzy or nauseous, or their neck hurts, call 115 right away and do not move them yourself.
• A severe or uncertain blow to the face, even without the signs above: go to the nearest emergency room.
• A blow to the face or head with double vision or reduced vision, severe headache, repeated vomiting, marked drowsiness, or clear fluid from the nose or ears is an emergency. Call 115.
• Difficulty breathing or swallowing, spreading swelling of the floor of the mouth or the neck, and heavy bleeding that does not stop with pressure are emergencies too.
• If you take a blood thinner and have hit your head, go to a hospital emergency room right then, or ask 115 for advice, even if you feel well.
• A permanent tooth knocked out by a blow needs urgent care. Hold the tooth by the crown and do not touch or scrape the root. If you can, put it back in place and bite gently on clean gauze. If you cannot, keep it in milk or saliva and go to a dentist right away. Do not put a baby tooth back, but take the child to a dentist right away.
• Jaw swelling and pain with fever or a bad taste in the mouth: be seen the same day.
• A mouth sore or patch that lasts more than three weeks: show it to a dentist or doctor that same week.

See the list of urgent signs too.

This page is for general information and does not replace an examination.