Modarressi Ghavami S A, Lombardi T, Becker M, Richter M
Service de Chirurgie Maxillo-faciale et de Chirurgie Buccale, Département de Chirurgie, Hôpital Cantonal Universitaire, Genève, Suisse.
Rev Stomatol Chir Maxillofac. 2006 Nov;107(5):380-5. doi: 10.1016/s0035-1768(06)77069-3.
Osteosarcoma, the second most frequent primary malignant bone tumor, is usually found in long bones: femur, tibia or humerus with only 6 to 7% of cases occurring in the jaws. Patients with osteosarcoma of the mandible usually complain of a swelling, which can be painful or not, accompanied by paresthesia of one of the trigeminal nerve branches in about 20% of cases.
We report a case of chondroblastic osteosarcoma of the mandible affecting a 33-year-old woman with 14 years follow-up illustrating the difficulties of a rapid diagnosis.
The prognosis of osteosarcoma of the mandible relies on its histological grade and the amount of time elapsing from diagnosis to treatment onset. The treatment of choice is radical surgery providing a 5-year survival rate up to 80%. The definitive surgical treatment is usually performed only after several interventions because operative-room pathology cannot be obtained due to the necessity of decalcification. In order to avoid multiple resections, an interim bridging with a reconstructive plate with a condylar head can be proposed before definitive graft reconstruction. The prognosis of osteosarcoma of the mandible is better than that of long bones. Chemotherapy or radiotherapy, which are very efficient for osteosarcoma in general, do not change the prognosis of osteosarcoma of the mandible.
骨肉瘤是第二常见的原发性恶性骨肿瘤,通常发生于长骨:股骨、胫骨或肱骨,仅6%至7%的病例发生于颌骨。下颌骨肉瘤患者通常主诉肿胀,可能伴有疼痛,约20%的病例伴有三叉神经分支之一的感觉异常。
我们报告一例下颌骨软骨母细胞性骨肉瘤病例,患者为一名33岁女性,随访14年,说明了快速诊断的困难。
下颌骨肉瘤的预后取决于其组织学分级以及从诊断到开始治疗所经过的时间。首选治疗方法是根治性手术,5年生存率可达80%。由于需要脱钙而无法获得手术室病理结果,通常仅在多次干预后才进行确定性手术治疗。为避免多次切除,在确定性移植重建之前,可以先使用带有髁突头的重建板进行临时桥接。下颌骨肉瘤的预后优于长骨骨肉瘤。一般来说,对骨肉瘤非常有效的化疗或放疗并不能改变下颌骨肉瘤的预后。