Noguchi Tadahide, Sugiura Yasushi, Okada Naruo, Tsuchiya Yoshiyuki, Hyasaka Jun-Ichi, Sasaguri Ken-Ichi, Sarukawa Shunji, Fujita Akifumi, Amano Yusuke, Mori Yoshiyuki
Department of Dentistry, Oral and Maxillofacial Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan.
Department of Plastic Surgery, Saitama Medical University, International Medical Center, Yamane 1397-1, Hidaka-city, Saitama, 350-1298, Japan.
J Med Case Rep. 2019 Mar 12;13(1):58. doi: 10.1186/s13256-019-1975-1.
Osteosarcomas of the head and neck region are rare entities that comprise < 10% of all osteosarcomas. Multimodality treatment of patients with osteosarcoma is well-established for osteosarcoma in long bones, and the benefits of chemotherapy in long bones are clearly known. However, there is no consensus regarding the effects of chemotherapy in cases of head and neck osteosarcoma. The prognostic factor for head and neck osteosarcoma is complete tumor resection with negative margin, which is a radical surgery. However, a clear margin may be difficult to achieve in the head and neck region.
We present a case of a 69-year-old Japanese woman who developed osteosarcoma of the condyle within the masticator space and infratemporal fossa, which was treated with radical surgery using a modified preauricular and transmandibular approach. Although we recommended adjuvant treatment after surgery, the patient refused this treatment. There was no evidence of local recurrence or distant metastasis through 30 months of follow-up.
Our modified preauricular and transmandibular approach allowed access to the masticator space and infratemporal fossa, thereby increasing complete resection of the tumor and resulting in minimal functional and cosmetic deficits.
头颈部骨肉瘤是罕见的实体肿瘤，占所有骨肉瘤的比例不到10%。骨肉瘤患者的多模式治疗在长骨骨肉瘤中已得到充分确立，化疗在长骨骨肉瘤中的益处也已明确知晓。然而，对于头颈部骨肉瘤病例中化疗的效果尚无共识。头颈部骨肉瘤的预后因素是肿瘤切缘阴性的完整切除，这是一种根治性手术。然而，在头颈部区域可能难以实现切缘阴性。
我们报告一例69岁日本女性患者，其咀嚼肌间隙和颞下窝内髁突发生骨肉瘤，采用改良耳前和经下颌入路进行根治性手术治疗。尽管我们建议术后进行辅助治疗，但患者拒绝了该治疗。经过30个月的随访，没有局部复发或远处转移的证据。
我们改良的耳前和经下颌入路能够进入咀嚼肌间隙和颞下窝，从而增加肿瘤的完整切除，并使功能和美容缺陷最小化。
