Söderholm A L, Lindqvist C, Teppo L, Wolf J, Sane J
Dept. of Maxillofacial Surgery, Helsinki University Central Hospital, Finland.
J Craniomaxillofac Surg. 1988 Jul;16(5):224-9. doi: 10.1016/s1010-5182(88)80051-9.
Thirty-nine cases of mandibular sarcoma were reported to the Finnish Cancer Registry during the period 1953-1985. In 11 of these (nine osteosarcomas, one chondrosarcoma, one leiomyosarcoma), the pre- and postoperative radiographs were still available, and they were analyzed in order to evaluate the radicality of the primary surgical procedure in relation to recurrences during the follow-up. On the basis of several radiological details, the resection was considered inadequate in seven cases. One operation was probably inadequate because of rather scanty margins. In only three cases had an adequate primary resection with proper safety margins been performed. All of the seven patients with inadequate primary surgery had recurrence and five of them died of local disease or metastases, whereas only one of the three patients with adequate resection had recurrence in adjacent soft tissues. It is concluded, that radiological findings of mandibular sarcoma that often are missed include widening of the mandibular canal and disappearance of the lamina dura. Proper preoperative radiological examination resulting in more radical primary surgery would certainly decrease the recurrence and mortality rates in patients with mandibular sarcoma.
1953年至1985年期间，39例下颌骨肉瘤病例被报告给芬兰癌症登记处。其中11例（9例骨肉瘤、1例软骨肉瘤、1例平滑肌肉瘤）仍保存有术前和术后的X线片，对其进行分析以评估初次手术的彻底性与随访期间复发情况的关系。基于多项放射学细节，7例手术切除被认为不充分。1例手术可能因切缘相当窄而不充分。仅3例进行了具有适当安全切缘的充分初次切除。初次手术不充分的7例患者均出现复发，其中5例死于局部病变或转移，而初次切除充分的3例患者中仅1例在邻近软组织出现复发。得出的结论是，下颌骨肉瘤常常被漏诊的放射学表现包括下颌管增宽和硬骨板消失。进行适当的术前放射学检查从而实施更彻底的初次手术肯定会降低下颌骨肉瘤患者的复发率和死亡率。
