Osteosarcoma is a highly malignant tumor that commonly occurs in adolescents, with males being more affected than females. Approximately 5% of cases occur in the jawbones, with the mandible being more frequently involved than the maxilla. Injury and radiation exposure may be contributing factors. Osteosarcoma is composed of tumorous osteoblasts, tumorous osteoid tissue, and tumor bone. The more differentiated and tumor bone-rich type is called osteogenic osteosarcoma, which has a lower degree of malignancy. The less differentiated or embryonal type, with less tumor bone, is called osteolytic osteosarcoma, which has a higher degree of malignancy.

bubble_chart Auxiliary Examination

1. For cases with typical clinical manifestations and localized tumors, the examination items are mainly based on the examination scope "A".
2. For cases with atypical clinical manifestations, difficult differential diagnosis, large tumors closely related to surrounding important structures, or suspected metastasis, the examination items may include examination scopes "B" and "C".

1. The jaw area exhibits swelling and enlargement, with early onset of pain.
2. Rapid growth, destruction of the alveolar process and jaw, leading to loose and displaced teeth.
3. When invading soft tissues, facial deformities and prominent superficial skin veins appear.
4. X-ray examination shows increased bone density in osteoblastic osteosarcoma, with sunburst or onion-skin changes, while osteolytic osteosarcoma presents as moth-eaten osteolytic changes.
5. Pathological histological examination confirms the diagnosis.

bubble_chart Diagnosis

1. Early symptoms include intermittent numbness and pain, which quickly progress to persistent severe pain accompanied by referred pain.
2. The tumor grows rapidly, causing expansion and destruction of the alveolar process and jawbone, leading to loose and displaced teeth.
3. Once the tumor breaches the cortical bone and periosteum, facial deformities may appear, with dilated superficial veins and a dark red discoloration of the skin.
4. X-ray findings in osteoblastic osteosarcoma show increased bone density with sunburst or onion-skin patterns, while osteolytic osteosarcoma presents as moth-eaten bone destruction.

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bubble_chart Treatment Measures

Surgical treatment is the main approach, while radiotherapy and chemotherapy can serve as adjuvant therapies. Under no circumstances should the latter two be used as primary treatment measures.

For prophylactic anti-infection in general surgery, sulfonamides (such as compound formula co-trimoxazole) or drugs primarily effective against Gram-positive bacteria (such as erythromycin, penicillin, etc.) are selected. For cases involving a larger scope, simultaneous bone grafting, or complex repairs, combination drug therapy is generally adopted. The commonly used regimen includes: drugs effective against Gram-positive bacteria (such as penicillin) + drugs effective against Gram-negative bacteria (such as gentamicin) + drugs effective against anaerobic bacteria (such as metronidazole). For cases with severe pre- or post-operative infections, large surgical wounds, or complex compound formula repairs, effective antibiotics can be chosen based on clinical assessment and drug sensitivity testing.

bubble_chart Cure Criteria

1. Cure: After treatment, the original follicular tumor and metastatic sources have been completely removed or disappeared, and the wound has basically healed.
2. Improvement: After treatment, the tumor has shrunk and symptoms have alleviated.
3. No recovery: After treatment, the tumor shows no shrinkage and symptoms show no improvement.

bubble_chart Prevention

The primary treatment for this disease is surgery, while radiotherapy or chemotherapy may serve as auxiliary measures. However, the latter two should not be considered as main treatments to avoid delaying the optimal treatment window. Moreover, unverified folk remedies, whether applied externally or taken internally, must not be used, as they may stimulate tumor growth and cause treatment delays, ultimately leading to missed treatment opportunities. Additionally, local recurrence after treatment is relatively common for most fleshy tumors, often occurring 2 to 4 times clinically. In such cases, as long as the recurrence source does not invade unresectable structures like the central nervous system, an aggressive approach should still be adopted rather than palliative treatment, since repeat surgery can yield a prognosis similar to the initial procedure.