Sarin Vanita, Singh Karanvir, Kakkar Vikas, Singh Gursimranjitt
Department of Otorhinolaryngology, Shri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, India.
Department of Surgery, Shri Guru Ram Das Institute of Medical Sciences and Research , Amritsar, India.
Iran J Otorhinolaryngol. 2021 Nov;33(119):389-394. doi: 10.22038/IJORL.2021.47251.2553.
Chondrosarcomas (CS) are malignant mesenchymal tumours with cartilaginous differentiation that rarely affects the maxillofacial region. It accounts for approximately 10-20% of malignant bone tumours. The CS is rare in occurrence with aggressive course with high malignant potential, and poor prognosis.
Here we report a rare case of a 37year old female presenting tumoral mass in the lower jaw, for the past 3 years, which was gradually progressive in nature with an area of skin ulceration. The CT revealed a well- defined lesion with soft tissue component measuring 15x12x10 cm in size infiltrating both right and left masseter. Biopsy confirmed the diagnosis of grade IIICS. Considering the size and aggressive nature of the lesion, surgical resection was done. The reconstruction of the mandible was done with vascularised fibula pedicle flap to achieve acceptable cosmesis. The patient was discharged uneventfully. Though few cases of high grade CS have been reported in literature but CS of this enormous size has not been reported yet.
In this case report we documented the management of a relatively rare but challenging reconstructive maxillofacial surgery. Since in this case the CS was enormous in size and aggressive surgery was required, the cosmetic and functional outcomes were challenging. In our case report we have found that a vascularised fibula pedicle flap gives a good functional and cosmetic outcome and can be used for reconstruction of complete mandible.
软骨肉瘤(CS)是一种具有软骨分化的恶性间充质肿瘤,很少累及颌面部区域。它约占恶性骨肿瘤的10%-20%。软骨肉瘤发病率低,病程侵袭性强,恶性潜能高,预后差。
在此,我们报告一例罕见病例,一名37岁女性下颌出现肿瘤性肿块,持续3年,呈逐渐进展性,伴有皮肤溃疡区域。CT显示一个边界清晰的病变,软组织成分大小为15×12×10厘米,侵犯双侧咬肌。活检确诊为IIICS级。考虑到病变的大小和侵袭性,进行了手术切除。采用带血管蒂腓骨瓣对下颌骨进行重建,以达到可接受的美容效果。患者顺利出院。尽管文献中报道过少数高级别软骨肉瘤病例,但如此巨大尺寸的软骨肉瘤尚未见报道。
在本病例报告中,我们记录了一例相对罕见但具有挑战性的颌面部重建手术的治疗过程。由于本病例中软骨肉瘤尺寸巨大且需要进行侵袭性手术,美容和功能效果具有挑战性。在我们的病例报告中,我们发现带血管蒂腓骨瓣可带来良好的功能和美容效果,可用于全下颌骨重建。