When it comes to oral and maxillofacial tumors, many people do not know enough about them, but they do not know that a small ulcer in the mouth may have a big danger. You may not think that an untreated oral ulcer may be an oral cancer. So how to identify oral and maxillofacial tumors? Professor Sun told us that the diagnosis and treatment concept of oral and maxillofacial tumors has undergone a “radical” change. There are many types of oral and maxillofacial tumors, and there are benign and malignant types. Benign tumors: there are many types. Those occurring in soft tissues include salivary gland mixed tumor, gingival tumor, hemangioma, lymphadenoma, neurofibroma, fibroma and so on. Those occurring in bone tissues include giant cell tumor of bone, osteoma, etc. There are also benign tumors in the oral and maxillofacial region that are related to dental tissues and are of dental origin, such as odontoma and enamel-forming cell tumor. Generally speaking, benign tumors are not life-threatening, but when the tumor grows to a particularly large size, it will affect the patient’s oral functions such as swallowing, chewing, speaking and breathing, and even risk asphyxiation. When the tumor reaches a certain size, it can also break down, bleed, or even become malignant. Certain specific tumors that are prone to bleeding, such as vascular malformations, can also cause hemorrhage and death. Malignant tumors: Oral and maxillofacial malignant tumors are mainly carcinomas of epithelial origin, most of which are squamous cell carcinomas of squamous epithelial origin, followed by carcinomas of glandular epithelial origin, as well as basal cell carcinomas, undifferentiated carcinomas and lymphoepithelial carcinomas. According to their sites of occurrence, they can be divided into gum cancer, lip cancer, cheek cancer, tongue cancer, floor of mouth cancer, palate cancer, maxillary sinus cancer and so on. In addition to cancers of epithelial origin, there are also malignant tumors of mesenchymal tissue origin, such as osteosarcoma, chondrosarcoma, fibrosarcoma, etc. Malignant tumors, especially squamous cell carcinoma, will undergo regional cervical lymphatic metastasis in early stage and distal metastasis, such as metastasis to lung, brain and bone, in late stage, thus endangering life and being particularly harmful. Thus, oral and maxillofacial tumors should not be taken lightly. Many patients do not think that the ulcers in their mouths can be fatal. Professor Sun reminded us that malignant tumors of the oral and maxillofacial region, especially epithelial malignant tumors, are most often manifested as “persistent oral ulcers”. Therefore, after regular treatment, if the ulcer lasts for one month or more and does not heal, you must go to a regular dental hospital or a regular general hospital for oral and maxillofacial surgery, and ask a specialist to determine what the nature of the ulcer is. In addition to ulcer, some patients with oral and maxillofacial tumors may have unexplained severe pain in the mouth, numbness or pain in the tongue, limited tongue movement, loose and displaced teeth, inability to chew, and numbness in the lower lip. With these manifestations, early medical consultation is also necessary. Diagnosis and treatment of oral and maxillofacial tumors Among Professor Sun’s patients, there is no shortage of cases that are referred to him due to various reasons of misdiagnosis and delayed treatment. Some of these patients were delayed because they did not seek regular medical institutions or were seen by non-specialist doctors in the early stage. For malignant tumors, “time is life” and early diagnosis and treatment is crucial. Moreover, improper or untreated dental diseases may cause oral tumors in the long run; benign tumors may also turn into malignant tumors if they are not treated or treated inappropriately. For this reason, Professor Sun repeatedly emphasized that the diagnosis and treatment of various dental diseases must be done in qualified dental clinics, professional specialty hospitals, and specialty clinics of general hospitals. For the diagnosis of oral and maxillofacial tumors, Prof. Sun said that in addition to the physical examination of patients by professional physicians, some imaging examinations are also needed, such as dental films, oral panoramic films, 3D dental CT, MRI, and even PET-CT to exclude the distant metastasis of malignant tumors when the information of the above examinations is not enough to judge whether it is suitable for surgical operation. The purpose of the examination is, on the one hand, to clarify the presence of tumor, and on the other hand, to determine where the tumor is located, how large the extent is, and whether cervical lymphatic metastasis or even distant metastasis has occurred. This has an important reference role in the selection and determination of the subsequent treatment plan. As to how to establish the treatment plan, Prof. Sun advised that it should be considered comprehensively, depending on the nature of the tumor, the extent of infiltration, whether the lymph nodes in the neck have metastasized and so on. For example, in the treatment of tongue cancer, the surgical plan should be established according to the size of the primary focus, the mode of metastasis and the extent of infiltration. Firstly, the primary lesion will be removed surgically; secondly, the treatment of cervical lymph nodes will be done. If the metastasis rate of cervical lymph nodes is expected to be high, preventive cervical lymphatic dissection should be done, and if cervical lymph node metastasis has already appeared, radical cervical lymphatic dissection should be done; thirdly, the local defect after surgical excision should be repaired, and if half of the tongue tissue or more is cut off, skin flaps should be taken from distant places to repair it, so as to restore the shape and function of the patient’s tongue. In addition, Professor Sun reminded that whether it is benign or malignant tumor, it is necessary to follow up regularly after surgery. For benign tumors, it is basically the same as normal people, and there is usually no recurrence, but patients are required to follow up for at least 2 years, and for critical tumors (between benign and malignant) follow up should be more diligent. After surgery, malignant tumors should be prevented from regional and distant metastasis and local recurrence, therefore, corresponding radiotherapy and chemotherapy should be done. In terms of diet, patients are also required to be able to eat a light diet and not to eat spicy and irritating food to avoid severe irritation to the mouth. When it comes to the treatment of oral and maxillofacial tumors, Prof. Sun informed that in fact, in China, the surgical skills have long been in line with international ones, and even some surgeries are better than foreign counterparts. However, after studying in France and having in-depth contact with foreign doctors, he deeply felt that the treatment philosophy of foreign doctors is much higher than that in China. Before studying in France, he thought that “the bigger the tumor is, the better it is; if the tumor is not cut cleanly, the tumor will come back easily and the patient’s survival time will be short.” However, many unfortunate cases show that it is not true that the larger the tumor is cut, the longer the survival time can be. Even though the survival time is prolonged, the patients seem to be “living” rather than “living” because they cannot reintegrate into society. After staying in France, a new world opened up in front of Prof. Sun. Although the surgical skills were not very different from those in China, the treatment philosophy of foreign doctors was very different. Take “cervical lymphatic dissection” as an example, in China, it was considered necessary to perform radical cervical cervical lymphatic dissection regardless of whether the cervical lymph nodes had metastases or not, and some important structures such as sternocleidomastoid muscle, collateral nerve and internal jugular vein had to be removed, so many patients became “chicken neck” after surgery in the past. Therefore, in the past, many patients became “chicken neck” after surgery, and the head and face were cleared together with the drainage, so the patient’s head and face would become edematous after surgery, “a huge head on a thin neck”, which is a terrible thing to think about. But foreign doctors told Prof. Sun that for patients who have not yet developed cervical lymph node metastases, a “functional cervical lymphatic dissection” is sufficient, and there is no significant difference in treatment results and patient prognosis. However, many functions of the patient can be preserved, which is more conducive to postoperative recovery and significantly improves the quality of life. In addition, whether the jawbone of benign tumor can be preserved or not, a large number of doctors in China once thought that regardless of benign or malignant tumor, the jawbone should be removed and then a fibula should be taken from the patient’s lower leg to repair the jawbone, but Prof. Sun said that this is in fact “Although many doctors are now familiar with this surgery and can do it beautifully, the fibula is not the jaw bone after all, and it is difficult to fully restore the jaw bone to its original form and function. In addition, the bone amputation on the lower leg will not only leave a long scar on the lower limb, but also affect the motor function of the patient’s lower limb, so that women can no longer dance and men can no longer carry weight and engage in strenuous sports for a long time, especially for young patients. In contrast, foreign doctors believe that for benign tumors of the jaw bone, if the jaw bone can be preserved, it is not necessary to remove it before repairing it, as long as it can be done through simple preservation surgery. For example, in the case of benign lesions such as odontogenic keratotic cysts, domestic doctors used to think that the jawbone should be cut out and then repaired, but foreign doctors have long believed that this lesion does not require bone amputation at an early stage, and that some preservation scraping surgery is sufficient, and that the incision is not visible from the patient’s face after surgery, because they feel that it is quite important to maintain the best years of the patient’s life. Although these types of cysts can recur, removing them by the time they recur does not delay the patient’s condition. Professor Sun said that after returning to China with such a philosophy, he did encounter many cases of odontogenic keratotic cysts in China. There was a young female patient who suffered from this disease since she was a teenager, and at that time Professor Sun gave her a preservation scraping operation, and more than ten years have passed since then, during which a small recurrence was treated in time, and the patient experienced a wonderful relationship afterwards and got married and had children. If the jaws had been moved, I am afraid it would be a different story now. The experience of studying abroad made Professor Sun feel deeply, and after returning to China, he spoke the new ideas he had absorbed to his peers as well, and the change in philosophy made him unique in his field. With the efforts of a group of returnee scholars represented by Prof. Sun, the diagnosis and treatment situation of oral and maxillofacial tumors in China has been greatly changed over the years, both the level and philosophy of diagnosis and treatment are very close to those of foreign developed countries, and in some fields, they are even in the leading position internationally. While treating patients, we also pay more attention to their prognosis and quality of life. The change of concept has changed the situation of over-treatment in the past and opened up a brand new world, which is of great benefit to patients. “Philosophy should be higher than technology, and only under the guidance of correct guidelines can the best efficacy be achieved in the diagnosis and treatment of oral and maxillofacial tumors.” This idea has been deeply rooted in Professor Sun’s heart. With such a thought, I believe he will continue to take steps forward to heal his patients and enable more families to live happily ever after.